MECHANISM OF PRODUCTION OF AMA - A PERSPECTIVE:

Physiology:

A normal homeostatic function involves input from the food, processing by the action of Agni at the levels of Amasaya, Mahabhoota and Dhatus, transformation of the raw materials in to the vital elements (Sara) consistent with tissue compatibility and waste products (Kitta or Malas) warranting expulsion. This process affects the nourishment of Dhatus, development and maintenance of Vyadhikshamatva (the capacity of the body to resist the disease onslaught) initiated by Kshut (appetite), Trit (thirst) and Malavisarjana (excretion).

 

          Hence, the total body homeostasis is the augmented effect of non-defective functioning of the multiple organizations called Srotases. Each Srotas has a feeding point, a target point, a controlling center (Srotomula) and a pathway (Srotas) and its function is appropriate transformation of the input raw material in to a finished product with elimination of the waste product, effected by the transformative principle Agni.

Pathology:

The Vikara or Dhatu Vaishamya is hence a defective transformation, giving rise to a morbid finished product. The cause for which may exist in the raw material provided, the Srotomula, the Srotas or in the target tissue, in the backdrop of impaired Vyadhikshamatva, effected by vitiated Agni and inflicted by Doshas.

          The resulting incompletely transformed product or Ama exhibits certain characteristic features, it is neither suitable for absorption nor is the body capable of excreting it. It is toxic and hence hinders the normal functions of the Srotases. The severity of morbidity is directly proportional to its accumulation.

 

LEVELS OF EXISTENCE OF AMA:

          As mentioned above, the Ama exists at three levels in the body.

A)   Ama at Jatharagni level: Amashaya is the substratum of Jatharagni, when the vitiated Agni acts upon the Ahara, it fails to completely transform Ahara into nourishing moieties. The resulting Ahara Rasa is a mixture of formed and unformed elements called Ama, which is thrown out of the Amashaya through the Urdhwamarga by the Chardi (vomiting) and through the Adhomarga (diarrhoea), or it may get displaced into the Grahani to remain stagnant. Due to prolonged stagnation, it may assume the properties of Visha. Further, Ama may associate with the Doshas, Dhatus and Malas after getting absorbed from Amashaya and manifest symptoms related with each of them.

          Dietetic indiscretions and emotional stresses may between them impair the functioning of the neurohumoral mechanisms responsible for ensuring proper secretion of the digestive juices, the disturbances of the pH in the gastro-intestinal environment and more often sluggish and sometime hyper-motility of the stomach and intestine, thus leading to Shuktata or Shuktapaka where food will be Avipakva, Asamyukta, Bahupicchila and Durgandha, due to fermentation and putrefaction of the carbohydrate, fat and protein components. Thus causes the toxic state - Visharupatvam.

 

This pathogenesis may cause the following metabolic disturbances

·       Toxic states:

1.    Intermediate toxic byproducts of metabolism

2.    Superadded microbial action

·       Malnutritional states

 

Intermediate toxic by products of metabolism: It is clear from the texts that Sama Ahara Rasa induces the production of various deranged metabolites like,

      i.         Sama Dosha: In Avasthapaka, there will be Udeerana of the Doshas i.e. Madhura Avasthapaka – Kapha (Amashaya),

Amla Avasthapaka – Pitta (Pittashaya)

Katu Avasthapaka – Vata (Pakvashaya)

But, due to Apakva Ahara produced by Mandagni, there will be Udeerana of Dushita Dosha called as Samadosha. Further in Nishthapaka, due to affliction of Rasa and Rakta Dhatu, there will be further increase of vitiated Kapha and Pitta in the form of Mala thus contributing to Sama Dosha.

 

ii.   Bhutagni and Dhatvagni Mandya: Jatharagnimandya will lead to Bhutagni and Dhatvagni Mandya also. Jatharagni is the Poshaka to the different Agni of the body, but Bhutagni and Dhatvagni can even get vitiated independently i.e. irrespective of Jatharagnimandya. Apakva Ahara from Avasthapaka when gets treated by Manda Bhutagni and Dhatvagni further causes Vikrita or Dushita Nishthapaka.

a)    Sama Dhatu: With affliction of both Avastha and Nishthapaka, the Dhatu Poshaka Rasa produced is Vikruta. Thus, with production of Sama Rasa Dhatu, succeeding Dhatu will also get vitiated producing Dhatu Pradoshaja Vikara. Sama Dhatu Utpatti is due to Bhutagni and Dhatvagni Mandya but it can even be independent of Jatharagni status.¹⁴

b)    Sama Mala: The word Mala includes 2 entities.

·       Mala of Ahara Rasa i.e. Pureesha, Mutra and Sweda and also the other Dhatugata Malas.

·       Dushita Dosha and Dhatu are also called Mala

 

Superadded microbial action: Toxins in the intestines in the present days are greatly attributed to the action of different microbes, thus leading to different manifestations like:

·       Infective gastro-enteritis

·       Toxic gastro-enteritis

·       Botulism

 

Intestinal flora in the human body exists in the state of symbiosis; these can be very well compared with Sahaja Krimi. Chakrapanidatta¹⁵ explains them as the one which exists within the body without causing diseases. Intestinal flora breaks the complex molecule which are not broken by the body, metabolises them into simple molecules by 2 kinds of actions. They are Fermentation and Putrefaction.

 

Putrefaction is similar to fermentation but it specifically refers to conversion of protein substances to smaller molecules with the liberation of various gases viz. Indol, Skatole, Phenol, Hydrogen sulphate and Ammonia that are characteristically pungent in odour. Fermentation is related to the Carbohydrate and fat metabolism by the microbes. Microbe’s metabolism releases few of the waste products vital for the body like Vit. B groups.

 

Among these microbes, there are some in borderline populations which under circumstances become parasitic. There are other groups of virulent organisms which invade body through food and drinks, producing abnormalities in the body. e.g.: Salmonella, Staphylococcus, B. botulinus, B. typhosus and coma bacillus of Koch. Hence, the normal food metabolism also includes the metabolism by Intestinal flora (Sahaja Krimi).

 

The following are circumstances which make the body susceptible to the infection.

·       Irradiation, metabolic abnormalities, emotional stress, overstrain, intense treatment with anti-microbial agents

·       Tissue produces an anti-microbial substance called Properdin. It has been shown that a low concentration of this substance in an area coincides with the highest susceptibility to the invasion of the tissue even by otherwise friendly intestinal flora causing bacteremia.

·       Experiments carried out at the Rockfeller institute and other research centers in U.S.A. have shown that susceptibility to microbial disease can be caused by manipulation of metabolism. e.g.: with such simple measures as temporary deprivation of food or feeding an unbalanced diet rich in Citrate. The resistance was again seen to have been restored back to normal within 2-3 days by the correction of nutritional errors.

·       But in case of epidemics and pandemics the microbes strike human irrespective of body strength, constitution and other predisposing factors. Interestingly, this phenomenon is observed when a microbe is newly introduced in a susceptible population which serves as a virgin soil.

          Ama is the immediate cause of most human affliction, exposure to disease causing microbes results in the disease only in those people where internal conditions are ripe for colonization. Louis Pasteur and Claude Bernard argued for years over the primacy of infective agents versus internal conditions, and it was only on his deathbed that Pasteur finally admitted that Bernard was right and that the milieu interior is more important than exposure to a pathogen. This is especially true of diseases in which no pathogen can be detected.⁶

 

Hence, different microbial infection occur in the body when it is made susceptible by predisposing factors like metabolic abnormalities, emotional stress, overstrain and other Agnimandyakara and Amotpattikara Nidana.