Chapter 6 – Agnimandya, Ajirna, Visuchika, Alasaka and Vilambika Nidanam

The sixth chapter of Madhava Nidana deals with Agnimandya, Ajirna, Visuchika, Alasaka and Vilambika i.e., Dyspesia, Indigestion and Allied Diseases.

Varieties of Digestive fire –

मन्दस्तीक्ष्णो अथ विषमः समश्चेति चतुर्विधः |
कफ – पित्तानिलाधिक्यात्तात्सात्म्या ज्जठरो अनलः || १ ||
mandastīkṣṇo atha viṣamaḥ samaśceti caturvidhaḥ |
kapha – pittānilādhikyāttātsātmyā jjaṭharo analaḥ || 1 ||

The Jatharagni (gastric fire, digestive activity) is of four varieties:

• Manda
• Tikshna
• Vishama and
• Sama

The first three are due to the predominance of vata, pitta and kapha respectively and the fourth due to the normalcy of all the three. 1

विषमो वातजान् रोगान् तीक्ष्णः पित्तनिमित्तजान् |
करोत्याग्निस्तथा मन्दो विकारान् कफ सम्भवान् || २ ||

viṣamo vātajān rogān tīkṣṇaḥ pittanimittajān |
karotyāgnistathā mando vikārān kapha sambhavān || 2 ||

Vishamaagni gives rise to vata diseases, tikshnagni leads to pitta diseases, while the mandaagni generates diseases related to kapha. 2

समा समाग्नेरशिता मात्रा सम्यग्विपच्यते |
स्वल्पा अपि नैव मन्दाग्नेर्विषमाग्नेस्तु देहिनः || ३ ||
कदाचित् पच्यते संयक्कदाचिन्न विपच्यते |
मात्रा अतिमत्रा अप्यशिता सुखं यस्य विपच्यते |
तीक्ष्णाग्निरिति तं विध्यात् समाग्निः श्रेष्ठ उच्यते || ४ ||

samā samāgneraśitā mātrā samyagvipacyate |
svalpā api naiva mandāgnerviṣamāgnestu dehinaḥ || 3 ||
kadācit pacyate saṃyakkadācinna vipacyate |
mātrā atimatrā apyaśitā sukhaṃ yasya vipacyate |
tīkṣṇāgniriti taṃ vidhyāt samāgniḥ śreṣṭha ucyate || 4 ||

• The samagni is the fire that digests the normal amount of food without causing any difficulty;
• Mandagni is the status that reflects a capability to digest only small quantities of food.
• The vishamaagni on the other hand digests the food sometimes properly and sometimes improperly while
• Tikshnagni is that level of digestive fire which digests the usual or excess amount of food without difficulty and within a very short time.

Out of these four, only samagni is considered ideal for health. 3-4

Varieties of Indigestion –

आमं विदग्धं विष्टब्धं कफ – पित्तानिलैस्त्रिभिः |
अजीर्णं केचिदिच्छन्ति चतुर्थं रसशेषतः || ५ ||
āmaṃ vidagdhaṃ viṣṭabdhaṃ kapha – pittānilaistribhiḥ |
ajīrṇaṃ kecidicchanti caturthaṃ rasaśeṣataḥ || 5 ||

There are three varieties of Ajirna (indigestion):

• Aama
• Vidagdha and
• Vistabdha

They are generated by Kapha, Pitta and vata doshas respectively. There is also a fourth type of indigestion that is called Rasashesha. It relates to aahara rasa and its symptom is indigestion of nutrient portion of the eatables. 5

अजीर्णं पञ्चमं केचिन्निर्दोषं दिनपाकि च |
वदन्ति षष्टं चाजीर्णं प्राकृतं प्रतिवासरम् || ६ ||
ajīrṇaṃ pañcamaṃ kecinnirdoṣaṃ dinapāki ca |
vadanti ṣaṣṭaṃ cājīrṇaṃ prākrtaṃ prativāsaram || 6 ||

Some others name a fifth type of indigestion. It is called dinapaaki ajirna. In this condition, the eatables are digested the next day without causing any problem. There are still other individuals who count a sixth sort of indigestion. It is called the prativasara ajirna that is found every day normally immediately after taking eatables.6

Etiology/ causative factors of Ajirna (Indigestion) –

अत्यंबुपानाद्विषमाशनाच्च संधारणात स्वप्न विपर्ययाच्च |
काले अपि सात्म्यं लघु चापि भुक्तमन्नं न पाकं बजते नरस्य || ७ ||
ईर्ष्या – भय – क्रोधपरिप्लुतेन लुब्धेन रुग्दैन्य निपीडितेन |
प्रद्वेषयुक्तेन च सेव्यमानमन्नं न सम्यक्परिपाकमेति || ८ ||

atyaṃbupānādviṣamāśanācca saṃdhāraṇāta svapna viparyayācca |
kāle api sātmyaṃ laghu cāpi bhuktamannaṃ na pākaṃ bajate narasya||7||
īrṣyā – bhaya – krodhapariplutena lubdhena rugdainya nipīḍitena |
pradveṣayuktena ca sevyamānamannaṃ na samyakparipākameti || 8||

The factors that generate indigestion of food are –

• Drinking large amount of water,
• taking food in large or small quantity;
• taking meals at unusual times,
• frequent suppression of natural urges of the body,
• loss of sleep at nights or sleeping during day hours.

Food taken does not go proper digestion if the person concerned is afflicted by jealousy, fear, anger, greed, disease, wretchedness, and enmity. 7-8

मात्रया अप्यभ्यवहृतं पथ्यं चान्नं न जीर्यति |
चिन्ता- शोक – भय – क्रोध – दुःखशय्या – प्रजागरैः || ९ ||

mātrayā apyabhyavahrtaṃ pathyaṃ cānnaṃ na jīryati |
cintā- śoka – bhaya – krodha – duḥkhaśayyā – prajāgaraiḥ || 9 ||

Meals even if suitable and taken in proper measure do not get digested properly if the person suffers from anxiety, sadness, fear, anger and has undergone uncomfortable sleep and has remained awake for a long period. 9

Symptomatology of Ajirna –

तत्रामे गुरुतोत्क्लेदः शोथो गण्डाक्षि कूटगः |
उद्गारश्च यथाभुक्तम विदग्धः प्रवर्तते || १० ||

tatrāme gurutotkledaḥ śotho gaṇḍākṣi kūṭagaḥ |
udgāraśca yathābhuktama vidagdhaḥ pravartate || 10 ||

The features of Amajirna include

• heaviness of the abdomen and/ or of the whole body,
• Nausea,
• swelling of cheeks and eyes,
• belching occurring soon after meals. 10

Vidagdhajirna — 

विदग्धे भ्रम तृण मूर्च्छा पित्ताच्च विविधा रुजः |
उद्गारश्च सधूमाम्लः स्वेदो दाहश्च जायते || ११ ||

vidagdhe bhrama trṇa mūrcchā pittācca vividhā rujaḥ |
udgāraśca sadhūmāmlaḥ svedo dāhaśca jāyate || 11 ||

The symptoms of Vidagdhaajirna include –

• Giddiness
• Thirst
• Fainting
• Sour and warm belching
• Perspiration
• Burning sensation inside
• And other symptoms of the provoked pitta. 11

Vistabdhaajirna — 

विष्टब्धे शूलमाध्मानं विविधा वातवेदनाः |
मल वाताप्रवृत्तिश्च स्तम्भो मोहो अङ्गपीडनम् || १२ ||
रसशेषे अन्नविद्वेषो हृदयाशुद्धि – गौरवे |

viṣṭabdhe śūlamādhmānaṃ vividhā vātavedanāḥ |
mala vātāpravrttiśca stambho moho aṅgapīḍanam || 12 ||
rasaśeṣe annavidveṣo hrdayāśuddhi – gaurave |

The Vistabdhaajirna manifests with

• pain in the abdomen,
• Tympanitis
• Non movement of flatus
• Delusion
• And other features of Vata.

In case of Rasaajirna –

• Aversion to food,
• Bad belching
• Heaviness of abdomen.

Complications of Indigestion –

मूर्च्छा प्रलापो वमथुः प्रसेकः सदनं भ्रमः |
उपद्रवा भवन्त्येते मरणं चाप्यजीर्णतः || १३ ||

mūrcchā pralāpo vamathuḥ prasekaḥ sadanaṃ bhramaḥ |
upadravā bhavantyete maraṇaṃ cāpyajīrṇataḥ || 13 ||

Problems due to Ajirna –

• Fainting
• Delirium
• Vomiting
• Excessive salivation
• Debility
• Giddiness
• And even death. 13

Over eating leads of indigestion –

अनात्मवन्तः पशुवद् भुञ्जते ये अप्रमाणतः |
रोगानीकस्य ते मूलमजीर्णं प्राप्नुवन्ति हि || १४ ||

anātmavantaḥ paśuvad bhuñjate ye apramāṇataḥ |
rogānīkasya te mūlamajīrṇaṃ prāpnuvanti hi || 14 ||

Persons who acts like cattle and takes large quantities of food recklessly will develop the disease ajirna which inturn could produce several others ailments. 14

अजीर्णमामं विष्टब्धं विदग्धं च यदीरितम् |
विसूच्यलसकौ तस्माद् भवेच्चापि विलम्बिका || १५ ||

ajīrṇamāmaṃ viṣṭabdhaṃ vidagdhaṃ ca yadīritam |
visūcyalasakau tasmād bhaveccāpi vilambikā || 15 ||

Amajirna, Vidagdha, and Vishtabdha are the three types of indigestion which produce diseases named Visuchika, Alasaka and Vilambika respectively.

Visuchi (Gastro enteritis?) –

सूचीभिरिव गात्राणि तुदन् सन्तिष्टते अनिलः |
यस्याजीर्णेन सा वैध्यैर्विसूचीति निगध्यते || १६ ||
न तां परिमिताहारा लभन्ते विदितागमाः |
मूढास्तामजितात्मनो लभन्ते अशनलोलुपाः || १७ ||

sūcībhiriva gātrāṇi tudan santiṣṭate anilaḥ |
yasyājīrṇena sā vaidhyairvisūcīti nigadhyate || 16 ||
na tāṃ parimitāhārā labhante viditāgamāḥ |
mūḍhāstāmajitātmano labhante aśanalolupāḥ || 17 ||

The condition produced by indigestion in which vata produces a pricking pain in the entire body has been identified as Visuchi. Those who take food in limited amount would not be afflicted by this disease. This ailment disturbs only those ignorant who consume uncontrolled amount of food. 16-17

Symptomatology of Visuchi –

मूर्च्छाः अतिसारो वमथुः पिपासा शूलं भ्रमोद्वेष्टन – जृम्भ – दाहाः |
वैवर्ण्य – कम्पौ हृदये रुजश्च भवन्ति तस्यां शिरसश्च भेदः || १८ ||

mūrcchāḥ atisāro vamathuḥ pipāsā śūlaṃ bhramodveṣṭana – jrmbha – dāhāḥ |
vaivarṇya – kampau hrdaye rujaśca bhavanti tasyāṃ śirasaśca bhedaḥ || 18 ||

Physicians diagnose the disease as visuchika when the patient suffers from a pricking pain as though he is being pierced by needles. This is due to ajirna manifesting in persons who due to craving for eatables eat recklessly without any limitation.

The features of the disease are –

• Fainting
• Diarrhoea
• Vomiting
• Excessive thirst
• Colic Pain
• Giddiness
• Cramps
• Yawning
• Burning sensation
• And also discolouration of the body
• Tremors
• Pericardial pain
• Headache.

Alasaka (Lethargy of food) –

कुक्षिरानह्यते अत्यर्थं प्रताम्येत् परिकूजति |
निरुद्धो मारुतः एव कुक्षावुपरि धावति || १९ ||
वात – वर्चोनिरोधश्च यस्यात्यर्थं भवेदपि |
तस्यालसकमाचष्टे तृष्णोद्गारौ च यस्य तु || २० ||

kukṣirānahyate atyarthaṃ pratāmyet parikūjati |
niruddho mārutaḥ eva kukṣāvupari dhāvati || 19 ||
vāta – varconirodhaśca yasyātyarthaṃ bhavedapi |
tasyālasakamācaṣṭe trṣṇodgārau ca yasya tu || 20 ||

The disease alasaka has been identified with such symptoms as severe distension of the abdomen and delusion. The patient of this disease cries helplessly; his flatus moves upwards as it is blocked downwards. Moreover, there is non expulsion of flatus and faeces. There is thirst and belching as well. 19 -20

Vilambika –

दुष्टं तु भुक्तं कफ – मारुताभ्यां प्रवर्तते नोर्ध्वमधश्च यस्य |
विलम्बिकां तां बृशदुश्चिकित्स्यामाचक्षते शास्त्रविदः पुराणाः || २१ ||

duṣṭaṃ tu bhuktaṃ kapha – mārutābhyāṃ pravartate nordhvamadhaśca yasya |
vilambikāṃ tāṃ brśaduścikitsyāmācakṣate śāstravidaḥ purāṇāḥ || 21||

The ingested food, when vitiated by kapha and vata, does not move upwards or downwards. Such symptoms have been identified as Vilambika that is very tough to manage according to the learned ones. 21

Role of Ama (unripe or undigested stuff) in causing diseases —

यत्रस्थमामं विरुजेत्तमेव देशं विशेषेण विकारजातैः |
दोषेण येनावततं शरीरं तल्लक्ष्णैराम समुद्भवैश्च || २२ ||

yatrasthamāmaṃ virujettameva deśaṃ viśeṣeṇa vikārajātaiḥ |
doṣeṇa yenāvatataṃ śarīraṃ tallakṣṇairāma samudbhavaiśca ||22||

The place where Aama gets lodged produces not only pain but also becomes the site for occurrence of several diseases. This situation develops because of the action of the doshas that travel across the body associated with Aama.

Incurability of Visuchi and Alasaka –

यः श्यावदन्तौष्टनखो अल्पसंज्ञो वम्यर्दितो अभ्यन्तरयातनेत्रः |
क्षामस्वरः सर्वविमुक्त संधिर्यायान्नरः सो अपुनरागमाय || २३ ||

yaḥ śyāvadantauṣṭanakho alpasaṃjño vamyardito abhyantarayātanetraḥ |
kṣāmasvaraḥ sarvavimukta saṃdhiryāyānnaraḥ so apunarāgamāya || 23 ||

The patient of Ajirna who has developed a blackish discolouration of teeth, lips and nails; who has lost consciousness; who is having severe vomiting; sockets of whose eyes have sunk, who is uttering in a feeble voice and who suffers from looseness of all the joints may soon reach a fatal stage. 23

Signs of relief from indigestion, complication of Visuchi and significance of tackling indigestion and symptomatology of common indigestion –

उद्गारशुद्धिरुत्साहो वेगोत्सर्गो यथोचितः |
लघुता क्षुत्पिपासा च जीर्णाहारस्य लक्षणम् || २४ ||

udgāraśuddhirutsāho vegotsargo yathocitaḥ |
laghutā kṣutpipāsā ca jīrṇāhārasya lakṣaṇam || 24 ||

The features reflecting proper digestion of food –

• Pure belching without bad smell or taste
• Enthusiasm
• Elimination of faeces
• Passing of proper flatus and urine,
• Lightness of body
• Appearance of hunger and desire for water. 24

इति श्री विजयरक्षितकृतायां मधुकोश व्याख्यायामग्निमान्द्याजीर्ण विसूचिकालसकविलम्बिका निदानं समाप्तम् || ६ ||

iti śrī vijayarakṣitakrtāyāṃ madhukośa vyākhyāyāmagnimāndyājīrṇa visūcikālasakavilambikā nidānaṃ samāptam ||6||

Thus concludes the chapter on ajirna and the like.