Introduction
Chapter 15 of the Sushruta Samhita Sutrasthana, titled Dosha-Dhatu-Mala-Kshaya-Vriddhi-Vijnaniya Adhyaya, establishes the foundational principles of physiological homeostasis, pathogenesis, and clinical diagnosis in Ayurveda. This critical treatise provides an exhaustive analysis of the quantitative and qualitative variations—specifically depletion (Kshaya) and proliferation (Vriddhi)—of the three fundamental bio-elements: Doshas (humors), Dhatus (structural tissues), and Malas (metabolic excreta). Acharya Sushruta systematically delineates the specific clinical manifestations, systemic symptoms, and pathological consequences that arise when any of these core biological constituents deviate from their optimal equilibrium. By elucidating how humoral imbalances trigger tissue degradation or excess, the chapter bridges fundamental physiological theory with bedside diagnostics. It underscores the Ayurvedic paradigm that health is maintained through dynamic equilibrium, while disease originates from quantitative or functional fluctuations within the body matrix. This authentic description serves as an indispensable diagnostic manual for clinicians, offering precise frameworks to identify early signs of tissue deficit or accumulation before overt pathology manifests.
अथातो दोषधातुमलक्षयवृद्धिविज्ञानीयमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
Now, the chapter titled “Dosha-Dhatu-Mala-Kshaya-Vriddhi-Vijnaniya Adhyaya” (The Treatise on Understanding the Depletion and Proliferation of Humors, Tissues, and Metabolic Excreta) shall now be expounded as explained by Lord Dhanvantari.
Sharira Mula: The Fundamental Basis Of The Human Body
दोषधातुमलमूलं हि शरीरं, तस्मादेतेषां लक्षणमुच्यमानमुपधारय ||३||
The physical body finds its fundamental roots in the Doshas (humors), Dhatus (tissues), and Malas (metabolic excreta). Therefore, listen attentively as the specific characteristics and manifestations of their depletion and proliferation are now being explained.
Commentary
- Doshas (Vata, Pitta, Kapha): The primary humors or regulatory forces that govern all physiological mechanisms, movement, and metabolic processes.
- Dhatus (The Seven Tissues): The vital structural elements that sustain, nourish, and build the physical body. These progress sequentially from Rasa ( Extracellular Fluid / Plasma Matrix) and Rakta(Formed Elements of Blood / Hematopoietic Tissue ) to Mamsa (Muscular Tissue / Myofascial Mass ) ,Meda (Adipose Tissue / Lipid Matrix ) , Asthi (Osseous Tissue / Skeletal Framework ) , Majja (Intraosseous Core ), and finally Shukra (Reproductive & Germinal Tissue).
- Malas (Metabolic Excretions): The bodily waste products—specifically Purisha (feces), Mutra (urine), and Sweda (perspiration)—whose effective elimination is essential for preventing toxicity and maintaining optimal health.
Physiological Roles And Functions Of The Doshas
Vata
तत्र प्रस्पन्दनोद्वहनपूरणविवेकधारणलक्षणो वायुः पञ्चधा प्रविभक्तः शरीरं धारयति ||४||
Vayu (the vital air/bio-humor), characterized by its functions of pulsation (Praspandana), movement and transportation (Udvahana), filling (Purana), discrimination or metabolism (Viveka), and retention or holding (Dharana), is divided into five distinct sub-types and continuously sustains and supports the physical body.
Pitta
रागपक्त्योजस्तेजोमेधोष्मकृत् पित्तं पञ्चधा प्रविभक्तमग्निकर्मणाऽनुग्रहं करोति ||५ ||
Pitta (the bio-humor responsible for transformation), characterized by its distinct functions of imparting coloration (Raga), digestion and metabolism (Pachana), maintaining vitality and immunity (Ojas), producing bodily luster and radiance (Tejas), fostering intellect and comprehension (Medha), and generating internal heat (Ushma), is divided into five specialized subtypes and actively supports and sustains physiological functions through its inherent thermal and metabolic actions (Agnikarma).
Kapha
सन्धिसंश्लेषणस्नेहनरोपणपूरणबलस्थैर्यकृच्छ्लेष्मा पञ्चधा प्रविभक्त उदककर्मणाऽनुग्रहं करोति ||६||
Shleshma (Kapha—the bio-humor responsible for cohesion and structural integrity), characterized by its functions of binding joint articulations (Sandhisanshleshana), providing lubrication (Snehana), facilitating healing and tissue regeneration (Ropana), filling anatomical spaces (Purana), and bestowing physical strength (Bala) and structural stability (Sthairya), is divided into five distinct sub-types and continuously sustains physiological well-being through its watery, fluid-like actions (Udakakarma).
Dhatus: The Seven Biological Tissues
रसस्तुष्टिं प्रीणनं रक्तपुष्टिं च करोति, रक्त्ं वर्णप्रसादं मांसपुष्टिं गीवयति च, मांसं शरीरपुष्टिं मेदसश्च, मेदः स्नेहस्वेदौ दृढत्वं पुष्टिमस्थनां च, अस्थीनि, देहधारणं मज्ज्ञः पुष्टिं च, मज्जा स्नेहं बलंशुक्रपुष्टिं पूरणमस्थ्नां च करोतिः शुक्रं धैर्यं च्यवनं प्रीतिं देहबलं हर्षं बीजार्थंच ||७||
Rasa ( Extracellular Fluid / Plasma Matrix) imparts contentment and nourishment while fostering the development of Rakta (Formed Elements of Blood / Hematopoietic Tissue ) . Rakta enhances complexion and skin clarity, sustains life, and nourishes Mamsa (Muscular Tissue / Myofascial Mass ) . Mamsa provides physical bulk and structural stability to the body while nurturing Medas (Adipose Tissue / Lipid Matrix ). Medas generates unctuousness and sweat, imparts firmness to the anatomy, and nourishes Asthi (Osseous Tissue / Skeletal Framework ) . Asthi provides structural framework and support to the body while developing Majja (Intraosseous Core ). Majja promotes unctuousness, physical strength, fills the internal osseous cavities, and nourishes Shukra (Reproductive & Germinal Tissue). Shukra induces courage and mental fortitude, facilitates ejaculation, fosters attachment and pleasure, bestows bodily vigor and sexual gratification, and serves as the fundamental seed for reproduction.
The Malas: Excretory Products And Their Physiological Roles
पुरिषमुपस्तम्भं वाय्वग्रिधारणं च, बस्तिपुरणविक्लेदकृन्मूत्रम्, स्वेदः क्लेदत्वक्सौकुमार्यकृत् ||८||
Purisha (feces) provides structural support (Upastambha) to the abdominal cavity and maintains the functional balance of Vayu and Agni (digestive fire). Mutra (urine) fills the urinary bladder (Basti), facilitates the excretion of liquid waste, and maintains moisture balance (Vikleda) within the physiological systems. Sveda (sweat) regulates cutaneous hydration (Kleda) and preserves the softness and supple texture of the skin (Twak Saukumarya).
Physiology Of Artava (Female Reproductive Tissue)
रक्तलक्षणमार्तवं गर्भकृच्च, गर्भो गर्भलक्षणं स्तन्यं स्तनयोरापीनत्वजननं जीवनं चोति॥९ ॥
Artava (menstrual blood/female reproductive element) possesses characteristics identical to Rakta (blood tissue) and serves the primary function of enabling conception (Garbhakrit). Garbha (the fetus) manifests the distinct attributes of fetal growth and development within the womb. Stanya (maternal breast milk) induces full engorgement and enlargement of the breasts while providing essential sustenance and life-preserving nourishment (Jivana) to the offspring.
तत्र विधिवत् परिरक्षणं कुर्वीत ||१०||
Therefore, one should administer proper and systematic protection (Parirakshanam) [of these Doshas, Dhatus, and Malas] according to the prescribed rules and methods (Vidhi).
Dosha Kshaya: Clinical Manifestations Of Humoral Depletion
अत ऊर्ध्वमेषां क्षीणलक्षणं वक्ष्यामः |
तत्र, वातक्षये मन्दचेष्टताऽल्पवाक्त्वमप्रहर्षो मूढसञ्ज्ञता च, पित्तक्षये मन्दोष्माग्निता निष्प्रभता च, श्लेष्मक्षये रूक्षताऽन्तर्दाह आमाशयेतरश्लेष्माशयशून्यता सन्धिशैथिल्यं (तृष्णा दौर्बल्यं प्रजागरणं) च ||११ ||
- The clinical manifestations resulting from the depletion (Kshaya) of these vital entities shall be described.
- When Vata undergoes depletion, it manifests as diminished physical activity and sluggishness (Manda-Cheshtata), sparse or reduced speech (Alpa-Vaktva), a lack of cheerfulness or enthusiasm (Apraharsha), and impaired sensory perception or clouding of consciousness (Mudha-Sanjnata).
- In the event of Pitta depletion, the clinical presentation includes a reduction in body temperature (Mando-Ushmata), impaired digestive fire and metabolic capacity (Mandagnita), and a distinct loss of skin luster and radiance (Nishprabhata).
- When Shleshma (Kapha) suffers depletion, it gives rise to systemic dryness (Rukshata), an internal burning sensation (Antardaha), a feeling of emptiness within the stomach and other functional seats of Kapha (Amashayetara-Shleshmashaya-Shunyata), laxity or instability in the joint articulations (Sandhi-Shaithilya), alongside persistent thirst (Trishna), generalized debility (Daurbalya), and sleeplessness or insomnia (Prajagarana).
तत्र स्वयोनिवर्धनान्येव प्रतीकारः ||१२ ||
In those conditions [of humoral or tissue depletion], the remedial treatment (Pratikara) consists precisely of administering substances and therapies that share the same origin (Sva-yoni-vardhanani) to promote their restoration and growth.
Dhatu Kshaya: Clinical Signs And Symptoms Of Tissue Depletion
रसक्षये हृत्पीडाकम्पशून्यतास्तृष्णा च, शोणितक्षये त्वक्पारुष्यमम्लशीतप्रार्थना सिराशैथिल्यं च, मांसक्षये स्फिग्गण्डौष्ठोपस्थोरुवक्षःकक्षापिण्डिकोदरग्रीवाशुष्कता रौक्ष्यतोदौ गात्राणां सदनं धमनीशैथिल्यं च, मेदःक्षये प्लीहाभिवृद्धिः सन्धिशून्यता रौक्ष्यं मेदुरमांसप्रार्थना च, अस्थिक्षयेऽस्थिशूलं दन्तनखभङ्गो रौक्ष्यं च, मज्जक्षयेऽल्पशुक्रता पर्वभेदोऽस्थिनिस्तोदोऽस्थिशून्यता च, शुक्रक्षये मेढ्रवृषणवेदनाऽशक्तिर्मैथुने चिराद्वा प्रसेकः प्रसेके चाल्परक्तशुक्रदर्शनम् ||१३ ||
In the event of the quantitative depletion (Kshaya) of the seven primary structural tissues (Dhatus), the body manifests distinct clinical signatures:
- When Rasa ( Extracellular Fluid / Plasma Matrix) becomes depleted, it causes precordial distress or cardiac pain (Hrid-Pida), tremors (Kampa), a subjective sensation of emptiness or void in the cardiac region (Shunyata), and unquenchable thirst (Trishna).
- The depletion of Rakta (Formed Elements of Blood / Hematopoietic Tissue) results in severe cutaneous roughness (Twak-Parushya), a pronounced craving for sour and cooling substances (Amla-Shita-Prarthana), and laxity or collapse of the blood vessels (Sira-Shaithilya).
- When Mamsa (Muscular Tissue / Myofascial Mass) undergoes atrophy, it leads to emaciation and dryness (Shushkata) of the buttocks, cheeks, lips, external genitalia, thighs, chest, axillae, calf muscles, abdomen, and neck, accompanied by bodily roughness (Rauxya), pricking sensations (Toda), generalized malaise or fatigue (Gatranam Sadanam), and loss of arterial tone (Dhamani-Shaithilya).
- The diminution of Medas (Adipose Tissue / Lipid Matrix) manifests as splenomegaly (Plihabhivriddhi), a sensation of hollow emptiness in the joint articulations (Sandhi-Shunyata), systemic dryness (Rauxya), and an intense craving for fatty meats and rich foods (Medura-Mamsa-Prarthana).
- When Asthi (Osseous Tissue / Skeletal Framework) is depleted, it precipitates bone pain (Asthi-Shula), cracking or brittleness of teeth and nails (Danta-Nakha-Bhanga), and marked dryness (Rauxya).
- The deficiency of Majja (Intraosseous Core ) presents as a reduction in seminal fluid (Alpa-Shukrata), pain in the interphalangeal and intervertebral joints (Parva-Bheda), continuous deep osseous pain (Asthi-Nistoda), and an internal sense of emptiness within the bones (Asthi-Shunyata).
- Finally, the depletion of Shukra (Reproductive & Germinal Tissue) gives rise to acute pain in the penis and testicles (Medhra-Vrishana-Vedana), sexual dysfunction or inability to perform intercourse (Ashakti-Maithune), delayed ejaculation (Chirad-Vā Praseka), or the ejection of semen mixed with small traces of blood (Praseke Chalpa-Rakta-Shukra-Darshanam).
तत्रापि स्वयोनिवर्धनद्रव्योपयोगः (प्रतीकारः) ||१४||
In those conditions [of tissue depletion / Dhatu Kshaya] as well, the proper remedial measure (Pratikara) consists of the therapeutic administration of substances (Dravya-upayoga) that share the same origin (Sva-yoni-vardhana) to promote their restoration and growth.
Mala Kshaya: Clinical Signs And Symptoms Of Excretory Depletion
पुरीषक्षये हृदयपार्श्वपीडा सशब्दस्य च वायोरूर्ध्वगमनं कुक्षौ सञ्चरणं च, मूत्रक्षये बस्तितोदोऽल्पमूत्रता च; अत्रापि स्वयोनिवर्धनद्रव्योपयोगः |
स्वेदक्षये स्तब्धरोमकूपता त्वक्शोषः स्पर्शवैगुण्यं स्वेदनाशश्च; तत्राभ्यङ्गः स्वेदोपयोगश्च ||१५||
- Purisha Kshaya (Fecal Depletion): Characterized by pain in the cardiac region and flanks (Hridaya-parshva-peeda), upward movement of flatus accompanied by gurgling sounds (Sa-shabdasya cha vayor-urdhvagamanam), and erratic movement/gaseous rumbling in the abdomen (Kukshau sancharanam).
- Mutra Kshaya (Urinary Depletion): Characterized by pricking/stabbing pain in the bladder region (Basti-todo) and oliguria/diminished urine volume (Alpa-mutrata).
- Therapeutic Principle: In these conditions as well, the remedial measure is the administration of substances that promote restoration through homologous origin (Sva-yoni-vardhana-dravya-upayoga).
- Sweda Kshaya (Sweat/Perspiration Depletion): Characterized by constriction or rigidity of the hair follicles (Stabdha-romakupata), dryness of the skin (Twak-shosha), impairment or loss of tactile sensation (Sparsha-vaigunyam), and absence of perspiration (Sweda-nasha).
- Therapeutic Principle: The management consists of therapeutic oil application (Abhyanga) and the administration of sudation/fomentation therapies (Sweda-upayoga).
Upadhatu Kshaya: Clinical Signs And Symptoms Of Secondary Tissue Depletion
आर्तवक्षये यथोचितकालादर्शनमल्पता वा योनिवेदना च; तत्र संशोधनमाग्नेयानां च द्रव्याणां विधिवदुपयोगः |स्तन्यक्षये स्तनयोर्म्लानता स्तन्यासम्भवोऽल्पता वा; तत्र श्लेष्मवर्धनद्रव्योपयोगः |गर्भक्षये गर्भास्पन्दनमनुन्नतकुक्षिता च; तत्र प्राप्तबस्तिकालायाः क्षीरबस्तिप्रयोगो मेद्यान्नोपयोगश्चेति ||१६||
The quantitative depletion (Kshaya) of the secondary tissue products (Upadhatus), specific physiological deficits manifest:
- When Artava (menstrual flow / female reproductive fluid) becomes depleted, it clinically presents as delayed or irregular menses (Yathochita-Kala-Adarshanam), hypomenorrhea or scanty menstrual discharge (Alpata), and local vaginal discomfort or pelvic pain (Yoni-Vedana). Therapeutic intervention requires systemic bio-purification (Samshodhana) alongside the methodical administration of fiery, heat-generating substances (Agneya Dravya) in accordance with prescribed protocols.
- The depletion of Stanya (maternal breast milk) leads to flaccidity or loss of fullness in the breasts (Stanayor-Mlanata), complete agalactia (Stanya-Asambhava), or markedly deficient lactation (Alpata). Treatment involves the targeted use of dietary and therapeutic agents that augment the Shleshma (Kapha) humor (Shleshma-Vardhana-Dravya), as breast milk is derived from the watery matrix of the body.
- In the event of Garbha-Kshaya (fetal growth retardation or deficient fetal weight gain), the condition is identified by an absence of perceptible fetal movements (Garbha-Aspandana) and an abnormally un-distended or flat maternal abdomen (Anunnata-Kukshita). The indicated management for a pregnant woman who has reached the appropriate gestational stage includes the administration of nutrient-rich milk-based enemas (Kshira-Basti) and a wholesome diet rich in unctuous, fat-promoting, and tissue-building food items (Medya-Anna).
Manifestations Of Dosha Aggravation And Proliferation
अत ऊर्ध्वमतिवृद्धानां दोषधातुमलानां लक्षणं वक्ष्यामः | वृद्धिः पुनरेषां स्वयोनिवर्धनात्युपसेवनाद्भवति ||१७||
The clinical signs and manifestations resulting from the excessive proliferation (Vriddhi) of the Doshas (humors), Dhatus (tissues), and Malas (metabolic excreta) shall be expounded. This abnormal increase or hyper-accumulation occurs primarily due to the excessive consumption or over-indulgence in dietary substances, activities, and environmental factors that possess attributes identical to the inherent qualities (Sva-Yoni) of these respective biological elements.
तत्र, वातवृद्धौ वाक्पारुष्यं कार्श्यं कार्ष्ण्यं गात्रस्फुरणमुष्णकामि(म)ता निद्रानाशोऽल्पबलत्वं गाढवर्चस्त्वं च; पित्तवृद्धौ पीतावभासता सन्तापः शीतकामित्वमल्पनिद्रता मूर्च्छा बलहानिरिन्द्रियदौर्बल्यं पीतविण्मूत्रनेत्रत्वं च; श्लेष्मवृद्धौ शौक्ल्यं शैत्यं स्थैर्यं गौरवमवसादस्तन्द्रा निद्रा सन्धिविश्लेषश्च ||१८||
The clinical manifestations arising from the pathological proliferation (Vriddhi) of the three Doshas present as follows:
- When Vata undergoes hyper-accumulation, it clinically manifests as harshness or roughness of speech (Vak-Parushya), progressive emaciation (Karshya), hyper-pigmentation or dark discoloration of the skin (Karshnya), localized muscular twitching or tremors (Gatra-Sphurana), an intense craving for warmth (Ushna-Kamita), insomnia (Nidra-Nasha), loss of physical strength (Alpa-Balatva), and severe constipation with hard, dry stools (Gadha-Varchastva).
- In the event of Pitta proliferation, the clinical features include a distinct yellowish hue of the skin (Pita-Avabhasata), an elevated sense of internal heat or burning sensations (Santapa), a marked desire for cooling measures (Shita-Kamitvam), reduced sleep (Alpa-Nidrata), transient loss of consciousness or syncope (Murchha), decline in physical stamina (Bala-Hani), sensory organ debility (Indriya-Daurbalya), and yellow discoloration of the feces, urine, and sclera (Pita-Vit-Mutra-Netratva).
- When Shleshma (Kapha) becomes excessively increased, it leads to pallor or whitish discoloration of the body (Shauklya), a pervasive sensation of coldness (Shaitya), physical immobility or excessive firmness (Sthairya), bodily heaviness (Gaurava), mental depression or asthenia (Avasada), drowsiness (Tandra), excessive sleepiness (Nidra), and looseness or instability within the joint articulations (Sandhi-Vishlesha).
Dhatu-Vriddhi Lakshana: Features Of Tissue Proliferation
रसोऽतिवृद्धो हृदयोत्क्लेदं प्रसेकं चापादयति; रक्तं रक्ताङ्गाक्षितां सिरापूर्णत्वं च; मांसं स्फिग्गण्डौष्ठोपस्थोरुबाहुजङ्घासु वृद्धिं गुरुगात्रतां च; मेदःस्निग्धाङ्गतामुदरपार्श्ववृद्धिं कासश्वासादीन् दौर्गन्ध्यं च; अस्थ्यध्यस्थीन्यधिदन्तांश्च; मज्जा सर्वाङ्गनेत्रगौरवं च; शुक्रं शुक्राश्मरीमतिप्रादुर्भावं च ||१९||
The pathological proliferation (Vriddhi) of the seven primary structural tissues (Dhatus), distinct clinical signs of hyper-accumulation manifest throughout the body:
When Rasa ( Extracellular Fluid / Plasma Matrix) undergoes excessive proliferation, it induces a subjective sensation of nausea or cardiac discomfort (Hridaya-Utkleda) accompanied by hypersalivation (Praseka).The hyper-accumulation of Rakta (Formed Elements of Blood / Hematopoietic Tissue ) leads to reddish discoloration of the skin and body parts, redness of the sclera (Raktanga-Akshita), and engorgement or fullness of the blood vessels (Sira-Purnatva).When Mamsa (Muscular Tissue / Myofascial Mass ) undergoes abnormal hypertrophy, it causes pathological enlargement and bulk in the buttocks, cheeks, lips, external genitalia, thighs, arms, and calves (Sphik-Ganda-Oshtha-Upastha-Uru-Bahu-Janghasu Vriddhi), along with generalized bodily heaviness (Guru-Gatrata).The excess of Medas (Adipose Tissue / Lipid Matrix ) manifests as unctuousness or greasy texture of the limbs (Snigdhangata), localized swelling and fatty deposition around the abdomen and flanks (Udara-Parshva-Vriddhi), respiratory distress such as cough (Kasa) and dyspnea (Shwasa), and offensive body odor (Daurgandhya).When Asthi (Osseous Tissue / Skeletal Framework ) hyper-proliferates, it causes the formation of extra bone outgrowths or exostoses (Adhyasthini) and supernumerary or extra teeth (Adhidantan).The excess of Majja (Intraosseous Core ) produces a pervasive sense of heaviness throughout the entire body and eyes (Sarvanga-Netra-Gauravam).Finally, the pathological proliferation of Shukra (Reproductive & Germinal Tissue) results in the formation of seminal calculi (Shukrashmari) and excessive, hyper-active seminal discharge (Ati-Pradurbhavam).
Clinical Manifestations Of Excreta Proliferation (Mala-Vriddhi)
पुरीषमाटोपं कुक्षौ शूलं च; मूत्रं मूत्रवृद्धिं मुहुर्मुहुः प्रवृत्तिं बस्तितोदमाध्मानं च; स्वेदस्त्वचो दौर्गन्ध्यं कण्डूं च ||२०||
The pathological proliferation (Vriddhi) of the three primary metabolic excreta (Malas), distinct clinical manifestations present within the body:
When Purisha (feces) undergoes excessive accumulation, it induces abdominal flatulence with audible intestinal gurgling (Atopa) alongside colicky pain in the abdominal cavity (Kukshau Shula).The hyper-accumulation of Mutra (urine) leads to an absolute increase in urinary volume (Mutra-Vriddhi), abnormally frequent micturition (Muhurmuhur-Pravritti), pricking or sharp discomfort in the urinary bladder (Basti-Toda), and lower abdominal distension (Adhmana).When Sveda (sweat) undergoes excessive secretion, it results in foul body odor emanating from the skin (Twacho-Daurgandhya) and persistent cutaneous pruritus or itching (Kandu).
Upadhatu-Vriddhi Lakshana: Pathophysiological Indices Of Excessive Secondary Tissue Accumulation
आर्तवमङ्गमर्दमतिप्रवृत्तिं दौर्गन्ध्यं च; स्तन्यं स्तनयोरापीनत्वं मुहुर्मुहुः प्रवृत्तिं तोदं च; गर्भो जठराभिवृद्धिं स्वेदं च ||२१||
The pathological proliferation (Vriddhi) of the secondary tissue products (Upadhatus), specific manifestations of structural and functional excess present as follows:
When Artava (menstrual flow / female reproductive fluid) undergoes excessive proliferation, it clinically manifests as generalized body aches and muscular soreness (Angamarda), menorrhagia or hypermenorrhea characterized by excessive bleeding (Atipravritti), and foul odor of the vaginal discharge (Daurgandhya).The hyper-accumulation of Stanya (maternal breast milk) leads to engorgement and marked distension of the breasts (Stanayor-Apinatva), spontaneous or overly frequent galactorrhea (Muhurmuhur-Pravritti), and sharp, pricking pain within the mammary glands (Toda).When Garbha (fetal tissue / gestational mass) undergoes excessive development or proliferation, it results in abnormal or exaggerated enlargement of the maternal abdomen (Jathara-Abhivriddhi) accompanied by excessive maternal sweating (Sveda).
तेषां यथास्वं संशोधनं क्षपणं च क्षयादविरुद्धैः क्रियाविशेषैः प्रकुर्वीत ||२२||
- For Proliferation (Vriddhi): Employ targeted bio-purification (Samshodhana) or reducing therapies (Kshapana) to eliminate excessive Doshas, Dhatus, or Malas.
- For Depletion (Kshaya): Administer element-building, non-conflicting restorative therapies (Aviruddha Kriya) to replenish the deficient substrates.
Etiological Factors Responsible For Tissue Depletion
पूर्वः पूर्वोऽतिवृद्धत्वाद्वर्धयेद्धि परं परम् |
तस्मादतिप्रवृद्धानां धातूनां ह्रासनं हितम् ||२३||
An over-expansion of a predecessor tissue (Purva Dhatu) inevitably triggers hyper-accumulation in the subsequent tissue down the metabolic chain. Therefore, immediate reducing and pacifying measures (Hrasana) targeting the excess tissue are essential to arrest this pathological overload.
Characteristics And Clinical Features Of Ojas
बललक्षणं बलक्षयलक्षणं चात ऊर्ध्वमुपदेक्ष्यामः |
तत्र रसादीनां शुक्रान्तानां धातूनां यत् परं तेजस्तत् खल्वोजस्तदेव बलमित्युच्यते, स्वशास्त्रसिद्धान्तात् ||२४||
Ojas is the ultimate, refined metabolic essence (Param Tejah) produced from all seven tissues (Dhatus), from Rasa through Shukra. By classical medical doctrine (Sva-Shastra-Siddhanta), this supreme essence is directly synonymous with Bala (vital strength and immunity).
तत्र बलेन स्थिरोपचितमांसता सर्वचेष्टास्वप्रतिघातः स्वरवर्णप्रसादो बाह्यानामाभ्यन्तराणां च करणानामात्मकार्यप्रतिपत्तिर्भवति ||२५||
Optimal vital strength (Bala) manifests as firm, well-developed musculature (Sthira-Upachita-Mamsata), unhindered physical capacity across all activities (Apratighata), radiant voice and complexion (Svara-Varna-Prasada), and the precise, flawless execution of functions by all internal and external faculties.
भवन्ति चात्र –
ओजः सोमात्मकं स्निग्धं शुक्लं शीतं स्थिरं सरम् |
विविक्तं मृदु मृत्स्नं च प्राणायतनमुत्तमम् ||२६||
देहः सावयवस्तेन व्याप्तो भवति देहिनः |
तदभावाच्च शीर्यन्ते शरीराणि शरीरिणाम् ||२७||
Ojas is intrinsically watery and lunar in nature (Somatmakam), possessing unctuous (Snigdha), translucent or white (Shukla), cooling (Shita), stable (Sthira), fluid (Sara), clear (Vivikta), soft (Mridu), and smooth or viscous (Mritsnam) properties. It serves as the supreme, paramount seat of life force (Uttamam Pranayatanam) within the living entity.
This vital essence pervades the entire physical body and all its constituent limbs and organs (Dehah Sa-Avayavah Vyapto Bhavati). In the absence or utter destruction of Ojas, the physical bodies of living beings inevitably undergo rapid decay, disintegration, and death (Tad-Abhavach Cha Shiryante Sharirani Sharirinam).
Etiology And Clinical Manifestations Of Ojo-Kshaya
अभिघातात्क्षयात्कोपाच्छोकाद्ध्यानाच्छ्रमात्क्षुधः |
ओजः सङ्क्षीयते ह्येभ्यो धातुग्रहणनिःसृतम् |
तेजः समीरितं तस्माद्विस्रंसयति देहिनः ||२८||
The vital essence (Ojas) undergoes marked depletion (Samkshiyate) due to physical trauma or injury (Abhighata), progressive tissue wasting (Kshaya), excessive anger (Kopa), intense grief (Shoka), persistent psychological worry or overthinking (Dhyana), physical overexertion (Shrama), and prolonged hunger or severe starvation (Kshudha). Under the influence of these debilitating physical and psychological stressors, Ojas—which is continuously derived from and permeates all the constituent tissues (Dhatu-Grahana-Nisritam)—is dislodged from its primary sites. The displaced metabolic essence (Tejas), driven out of its normal equilibrium by aggravated Vata (Samiritam), causes systemic instability, looseness, and functional impairment across the entire bodily matrix (Visramsayati Dehinah).
Pathological Triad Of Ojas Impairment (Ojo-Vyapat)
तस्य विस्रंसो व्यापत् क्षय इति (त्रयो दोषाः;) लिङ्गानि भवन्ति सन्धिविश्लेषो गात्राणां सदनं दोषच्यवनं क्रियासन्निरोधश्च विस्रंसे, स्तब्धगुरुगात्रता वातशोफो वर्णभेदो ग्लानिस्तन्द्रा निद्रा च व्यापन्ने, मूर्च्छा मांसक्षयो मोहः प्रलापो मरणमिति च क्षये ||२९||
Ojas exhibits three distinct pathological states: Displacement (Visramsa), Qualitative Perversion (Vyapat), and Quantitative Depletion (Kshaya). Displacement (Visramsa) manifests as joint laxity (Sandhi-Vishlesha), physical prostration (Gatranam Sadanam), dislodgement of Doshas, and functional impairment (Kriya-Sannirodha). Perversion (Vyapat) presents with bodily stiffness and heaviness (Stabdha-Guru-Gatrata), Vata-type edema (Vata-Shopha), altered complexion (Varna-Bheda), malaise (Glani), drowsiness (Tandra), and excessive sleep (Nidra). Severe depletion (Kshaya) leads to syncope (Murchha), muscle atrophy (Mamsa-Kshaya), mental confusion (Moha), delirium (Pralapa), and ultimately death (Marana).
भवन्ति चात्र –
त्रयो दोषा बलस्योक्ता व्यापद्विस्रंसनक्षयाः |
विश्लेषसादौ गात्राणां दोषविस्रंसनं श्रमः |अप्राचुर्यं क्रियाणां च बलविस्रंसलक्षणम् ||३०||
Bala (vital strength) undergoes three pathological states: Qualitative Perversion (Vyapat), Displacement (Visramsa), and Depletion (Kshaya). Displacement (Bala-Visramsa) specifically presents as joint laxity (Vishlesha), physical prostration (Gatra-Sada), dislodgement of Doshas from their physiological seats (Dosha-Visramsana), unprovoked fatigue (Shrama), and a severe reduction in functional or motor capacity (Aprachuryam Kriyanam).
गुरुत्वं स्तब्धताऽङ्गेषु ग्लानिर्वर्णस्य भेदनम् |
तन्द्रा निद्रा वातशोफो बलव्यापदि लक्षणम् ||३१||
मूर्च्छा मांसक्षयो मोहः प्रलापोऽज्ञानमेव च |
पूर्वोक्तानि च लिङ्गानि मरणं च बलक्षये ||३२||
Qualitative perversion (Bala-Vyapat) presents with bodily heaviness (Gurutva), stiffness (Stabdhata), malaise (Glani), skin discoloration (Varna-Bheda), drowsiness (Tandra), excessive sleep (Nidra), and Vata-type edema (Vata-Shopha). Severe quantitative depletion (Bala-Kshaya) manifests through syncope (Murchha), muscle wasting (Mamsa-Kshaya), mental confusion (Moha), delirium (Pralapa), loss of cognitive awareness (Ajnanam), the presence of all preceding pathological features (Purvoktani Lingani), and ultimate death (Marana).
तत्र विस्रंसे व्यापन्ने च क्रियाविशेषैरविरुद्धैर्बलमाप्याययेत्; इतरं तु मूढसञ्ज्ञं वर्जयेत् ||३३||
In cases of displacement (Visramsa) and qualitative perversion (Vyapat), vital strength (Bala) should be restored using specific, non-antagonistic therapeutic interventions (Aviruddha Kriya-Vishesha). Conversely, when dealing with severe depletion (Kshaya) accompanied by loss of consciousness or comatose states (Mudha-Sanjna), the patient is considered incurable and should be refused treatment (Varjayet).
दोषधातुमलक्षीणो बलक्षीणोऽपि वा नरः |
स्वयोनिवर्धनं यत्तदन्नपानं प्रकाङ्क्षति ||३४||
यद्यदाहारजातं तु क्षीणः प्रार्थयते नरः |
तस्य तस्य स लाभे तु तं तं क्षयमपोहति ||३५||
यस्य धातुक्षयाद्वायुः सञ्ज्ञां कर्म च नाशयेत् |
प्रक्षीणं च बलं यस्य नासौ शक्यश्चिकित्सितुम् ||३६||
When an individual suffers from the depletion of Doshas, Dhatus, Malas, or overall vital strength (Bala), the body naturally craves specific foods and drinks (Annapana) that possess similar properties to replenish those missing elements (Sva-Yoni-Vardhanam). Fulfilling these specific dietary cravings allows the depleted person to directly counteract and eliminate the corresponding tissue deficiency (Kshayam Apohati). However, if tissue wasting (Dhatu-Kshaya) causes aggravated Vata to destroy sensory awareness, consciousness, and motor function (Sanjnam Karma Cha Nashayet) alongside total depletion of vital strength (Praksheena Bala), the patient is considered beyond medical intervention and incurable (Na Asau Shakya Chikitsitum).
Pathophysiology Of Sthaulya (Obesity) And Karshya (Emaciation)
रसनिमित्तमेव स्थौल्यं कार्श्यं च |
तत्र श्लेष्मलाहारसेविनोऽध्यशनशीलस्याव्यायामिनो दिवास्वप्नरतस्य चाम एवान्नरसो मधुरतरश्च शरीरमनुक्रामन्नतिस्नेहान्मेदो जनयति, तदतिस्थौल्यमापादयति; तमतिस्थूलं क्षुद्रश्वासपिपासाक्षुत्स्वप्नस्वेदगात्रदौर्गन्ध्यक्रथनगात्रसादगद्गदत्वानि क्षिप्रमेवाविशन्ति, सौकुमार्यान्मेदसः सर्वक्रियास्वसमर्थः, कफमेदोनिरुद्धमार्गत्वाच्चाल्पव्यवायो भवति, आवृतमार्गत्वादेव शेषा धातवो नाप्यायन्तेऽत्यर्थमतोऽल्पप्राणो भवति, प्रमेहपिडकाज्वरभगन्दरविद्रधिवातविकाराणामन्यतमं प्राप्य पञ्चत्वमुपयाति, सर्व एव चास्य रोगा बलवन्तो भवन्त्यावृतमार्गत्वात् स्रोतसाम्; अतस्तस्योत्पत्तिहेतुं परिहरेत् ||३७||
Both corpulence (Sthaulya) and emaciation (Karshya) originate directly from the metabolic quality of nutrient fluid (Rasa). Indulging in Kapha-provoking diets, overeating before previous meals are digested (Adhyashana), sedentary habits, and daytime sleeping cause the metabolic nutrient stream (Ama-Anna-Rasa) to become excessively sweet and unctuous. Circulating throughout the body, this overly rich fluid excessively nourishes adipose tissue (Meda), inducing severe obesity (Atisthaulya).
The morbidly obese individual rapidly develops dyspnea on exertion (Kshudra-Shvasa), excessive thirst and hunger (Pipasa-Kshut), hypersomnia (Swapna), excessive sweating and offensive body odor (Sveda-Gatra-Daurgandhya), snorting/obstructive breathing (Krathana), bodily lethargy (Gatra-Sada), and slurred speech (Gadgadatva). Due to the softness of soft tissue (Meda) and occlusion of bodily channels (Srotas) by Kapha and fat, functional capacity and sexual potency (Alpa-Vyavaya) decline. Because obstructed channels prevent nourishment from reaching the remaining tissues (Dhatus), vitality (Prana) is compromised. Consequently, such individuals risk lethal complications—including obstinate urinary disorders/diabetes (Prameha-Pidaka), fever (Jvara), fistula-in-ano (Bhagandara), abscesses (Vidradhi), and neurological disorders (Vata-Vikara)—which manifest severely due to systemic channel obstruction. Prevention requires strict avoidance of the primary etiological factors (Utpatti-Hetu).
उत्पन्ने तु शिलाजतुगुग्गुलुगोमूत्रत्रिफलालोहरजोरसाञ्जनमधुयवमुद्गकोरदूषकश्यामाकोद्दालकादीनां विरूक्षणच्छेदनीयानां च द्रव्याणां विधिवदुपयोगो व्यायामो लेखनबस्त्युपयोगश्चेति ||३८||
Once obesity (Sthaulya) has manifested, management requires the systematic administration of drying (Viruksana) and tissue-scraping or fat-reducing (Chedaniya) substances. Recommended remedies include Shilajit, Guggulu (Commiphora mukul), cow’s urine (Gomutra), Triphala, purified iron calx (Lauha Bhasma), Rasanjana, raw honey (Madhu), barley (Yava), green gram (Mudga), and light, coarse grains such as Koradusha (Kodo Millet) , Shyamaka (Barnyard Millet) , and Uddalaka (Wild Paspalum) . Therapeutic protocols also mandate regular physical exercise (Vyayama) and the administration of scrapative, lipid-clearing enemas (Lekhana Basti).
Karshya: Clinical Manifestations And Management Of Tissue Wasting
तत्र पुनर्वातलाहारसेविनोऽतिव्यायामव्यवायाध्ययनभयशोकध्यानरात्रिजागरणपिपासाक्षु त्कषायाल्पाशनप्रभृतिभिरुपशोषितो रसधातुः शरीरमननुक्रामन्नल्पत्वान्न प्रीणाति, तस्मादतिकार्श्यं भवति; सोऽतिकृशः क्षुत्पिपासाशीतोष्णवातवर्षभारादानेष्वसहिष्णुर्वातरोगप्रायोऽल्पप्राणश्च क्रियासु भवति, श्वासकासशोषप्लीहोदराग्निसादगुल्मरक्तपित्तानामन्यतममासाद्य मरणमुपयाति, सर्व एव चास्य रोगा बलवन्तो भवन्त्यल्पप्राणत्वात्; अतस्तस्योत्पत्तिहेतुं परिहरेत् ||३९||
Emaciation (Karshya) arises when the nutrient fluid (Rasa Dhatu) becomes desiccated due to Vata-provoking diets, excessive physical exertion, sexual overindulgence, intense study, fear, grief, anxiety, nocturnal wakefulness (Ratri-Jagarana), suppressed thirst or hunger, and astringent or inadequate food intake. The depleted Rasa fails to circulate adequately or nourish the body, inducing severe emaciation (Atikarshya).
An excessively emaciated individual becomes intolerant to hunger, thirst, thermal extremes (cold and heat), wind, rain, and heavy lifting (Bhara-Adana), while becoming susceptible to Vata disorders and diminished vitality (Alpa-Prana). Consequently, such individuals face lethal complications—including dyspnea (Shvasa), cough (Kasa), tissue consumption/wasting (Shosha), splenomegaly (Plihodara), impaired digestion (Agnisada), abdominal tumors (Gulma), and bleeding disorders (Raktapitta)—which manifest with heightened severity due to compromised physical endurance. Prevention requires avoiding these primary etiological factors (Utpatti-Hetu).
उत्पन्ने तु पयस्याश्वगन्धाविदारिगन्धाशतावरीबलातिबलानागबलानां मधुराणामन्यासां चौषधीनामुपयोगः, क्षीरदधिघृतमांसशालिषष्टिकयवगोधूमानां च, दिवास्वप्नब्रह्मचर्याव्यायामबृंहणबस्त्युपयोगश्चेति ||४०||
When severe emaciation (Karshya) has manifested, management focuses on restorative and anabolic protocols (Brimhana). The primary intervention includes administering processed milk or decoctions formulated with sweet, nourishing medicine (Madhura Aushadhi) such as Ashwagandha (Withania somnifera), Vidarigandha (Desmodium gangeticum), Shatavari (Asparagus racemosus), Bala (Sida cordifolia), Atibala (Abutilon indicum), and Nagabala (Sida veronicifolia). The dietary regimen incorporates regular consumption of milk (Kshira), curd (Dadhi), clarified butter (Ghrita), meat soup (Mamsa), Shali rice, Shashtika rice, barley (Yava), and wheat (Godhuma). Lifestyle measures involve daytime rest (Diva-Swapna), practice of celibacy or sexual abstinence (Brahmacharya), avoidance of physical exertion (Avyayama), and the systematic administration of nourishing, tissue-building enemas (Brimhana Basti).
Pathophysiology Of Madhya-Sharira (Moderate Physique And Nutritional Homeostasis)
यः पुनरुभयसाधारणान्यासेवेत तस्यान्नरसः शरीरमनुक्रामन् समान् धातूनुपचिनोति, समधातुत्वान्मध्यशरीरो भवति सर्वक्रियासु समर्थः क्षुत्पिपासाशीतोष्णवातवर्षातपसहो बलवांश्च, स सततमनुपालयितव्य इति ||४१||
An individual who consistently adheres to a balanced regimen—incorporating both nourishing (Brimhana) and lightening (Lekhana) dietary habits and lifestyle practices—enables the circulating nutrient fluid (Rasa) to uniformly nourish all tissue elements (Dhatus). This state of tissue equilibrium yields a moderate physique (Madhya-Sharira), characterized by optimal functional capacity across all activities, robust physical strength (Balavan), and excellent physiological resilience against hunger, thirst, thermal extremes (cold and heat), wind, rain, and direct sunlight. Because this balanced state represents ideal health and metabolic harmony, it should be continuously maintained through mindful diet and lifestyle (Satatam Anupalayitavya).
भवन्ति चात्र –
अत्यन्तगर्हितावेतौ सदा स्थूलकृशौ नरौ |
श्रेष्ठो मध्यशरीरस्तु कृशः स्थूलात्तु पूजितः ||४२ ||
Both the excessively obese (Sthula) and the severely emaciated (Krusha) individuals are universally condemned and deemed unhealthy (Antyanta-Garhitau), as neither state represents physiological balance. Between the two extremes, the moderate physique (Madhya-Sharira) is considered the highest standard of health and vitality. However, if a comparison must be drawn between the two pathological states, the emaciated individual (Krusha) is regarded as superior to or more manageable than the extremely obese individual (Sthula).
दोषः प्रकुपितो धातून् क्षपयत्यात्मतेजसा |
इद्धः स्वतेजसा वह्निरुखागतमिवोदकम् ||४३||
When a Dosha becomes severely aggravated (Prakupita), it consumes and depletes the bodily tissues (Dhatus) through its intrinsic metabolic heat (Atma-Tejasa). This pathological process is directly analogous to water contained in a cooking vessel (Ukha) being evaporated and dried up by an intensely blazing fire (Iddhah Vahni) fueled by its own radiant heat (Sva-Tejasa).
Quantitative Physiology Of Doshas And Dhatus (Dosha-Dhatu-Pramana)
वैलक्षण्याच्छरीराणामस्थायित्वात्तथैव च |
दोषधातुमलानां तु परिमाणं न विद्यते ||४४||
Due to the inherent individuality and constitutional uniqueness of human bodies (Vailakshanyat Shariranam), as well as the continuous, dynamic fluctuations occurring within biological systems (Asthayitvat), an absolute or fixed quantitative measure (Parimana) cannot be universally assigned to the Doshas, Dhatus, and Malas.
Equilibrium Of Doshas And Tissues: The State Of Health
एषां समत्वं यच्चापि भिषग्भिरवधार्यते |
न तत् स्वास्थ्यादृते शक्यं वक्तुमन्येन हेतुना ||४५||
The physiological state of balance (Samatvam) among the Doshas, Dhatus, and Malas—as recognized and evaluated by competent physicians (Bhisagbhih Avadharyate)—cannot be demonstrated or established through any criterion other than the objective state of ideal health (Svasthya). In clinical practice, systemic equilibrium is confirmed strictly through the presence of well-being and normative bodily function.
Clinical Inference Of Dosha, Dhatu, And Mala Alterations
दोषादीनां त्वसमतामनुमानेन लक्षयेत् |
अप्रसन्नेन्द्रियं वीक्ष्य पुरुषं कुशलो भिषक् ||४६||
A skilled physician (Kushalo Bhishak) should clinically infer (Lakshayet) the imbalance or disequilibrium (Asamatam) of the Doshas and other biological elements through careful observation and logical deduction (Anumanena), specifically by recognizing dullness, impairment, or distress in the patient’s sensory and motor faculties (Aprasannendriyam).
(स्वस्थस्य रक्षणं कुर्यादस्वस्थस्य तु बुद्धिमान्) |
क्षपयेद्बृंहयेच्चापि दोषधातुमलान् भिषक् |
तावद्यावदरोगः स्यादेतत्साम्यस्य लक्षणम् ||४७||
A wise physician (Buddhiman Bhishak) must protect and preserve the health of the healthy (Svasthasya Rakshanam) while curing the ailments of the diseased. To restore health, the practitioner should employ therapeutic depleting methods (Kshapayet) for aggravated elements and nourishing methods (Brimhayet) for depleted ones, continuously adjusting the Doshas, Dhatus, and Malas until complete freedom from disease (Aroga) is achieved. This state of systemic harmony and disease-free functioning serves as the definitive benchmark of biological equilibrium (Samya).
Svastha-Purusha: The Classical Paradigm Of Complete Health
समदोषः समाग्निश्च समधातुमलक्रियः |
प्रसन्नात्मेन्द्रियमनाः स्वस्थ इत्यभिधीयते ||४८||
An individual is formally defined as healthy (Svastha) when their biological humors (Doshas), digestive and metabolic fire (Agni), tissue elements (Dhatus), excretory functions (Mala-kriya), and the physiological capacities of all bodily systems are in a state of absolute equilibrium, accompanied by clarity, tranquility, and cheerfulness of the soul (Atma), senses (Indriya), and mind (Manas).
इति सुश्रुतसंहितायां सूत्रस्थाने दोषधातुमलक्षयवृद्धिविज्ञानीयो नाम पञ्चदशोऽध्यायः ||१५||
Thus concludes the fifteenth chapter, entitled “Doshadhatumalaksayavriddhivijnaniya” (The Knowledge of Depletion and Increase of Doshas, Dhatus, and Excretory Products), in the Sutrasthana section of the Sushruta Samhita.
Conclusion
Chapter 15 of Sushruta Samhita, Sutrasthana (Dosha-Dhatu-Mala-Kshaya-Vriddhi Vijnaniya) culminates in a profound shift from pathological taxonomy to holistic clinical integration. While the chapter initially establishes the structural baseline and volumetric dynamics of Doshas, Dhatus, and Malas, its functional climax moves beyond mere metrics. Ultimately, the chapter redefines the role of the physician (Bhishak) not merely as an avenger of disease, but as a guardian of homeostasis. Through the foundational definition of the Svastha-Purusha (Shloka 48), Sushruta synthesizes physical metabolic stability (Samadosha, Samagni, Samadhatu-Mala-Kriya) with psycho-spiritual tranquility (Prasannatmendriyamanah). By articulating the dual therapeutic mandates—preserving wellness in the healthy (Svasthasya Rakshanam) and rectifying structural imbalances through judicious Kshapana (depletion) and Brimhana (nourishment)—Chapter 15 anchors the entire clinical strategy of the Sushruta Samhita in the conscious maintenance of systemic equilibrium.