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| EDITORIAL |
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| Year : 2012 | Volume
: 32
| Issue : 2 | Page : 67-68 |
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Critical review and validation of the concept of Āma
P Ram Manohar
Director and CSO, AVP Research Foundation, Ramanathapuram P.O., Coimbatore, Tamil Nadu, India
| Date of Web Publication | 20-Sep-2013 |
Correspondence Address:
P Ram Manohar
Director and CSO, AVP Research Foundation, Ramanathapuram P.O., Coimbatore, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0257-7941.118524
How to cite this article:
Manohar P R. Critical review and validation of the concept of Āma. Ancient Sci Life 2012;32:67-8 |
Āma is a key concept in the Ayurvedic understanding of physiology, pathology and therapeutics. Rather than being a single entity or substance, Āma denotes the abnormal or impaired process of digestion and metabolism that leads to build up of toxic by-products, which cannot be neutralized or eliminated by the body.
Āma is often loosely translated as undigested food resulting from a process that is entirely gastrointestinal. A careful study of the texts, however, indicates that the production of Āma is a systemic process that extends to metabolic and other physiological processes in the body.[1]
In the tradition of Āyurveda, Āma has been defined from three viewpoints. On a closer examination, it can be understood that these three viewpoints represent Āma in its totality. The three positions on Āma are summarized below.[2]
- Āma is the by-product of impaired digestion
- Āma is the accumulation of unexpelled wastes in the body
- Āma is the first expression of aberrations in the physiological processes of the body.
Āma also represents the transition from physiology to pathology. Therefore, it is the precursor of inflammatory, degenerative and infective processes that eventually manifest as full-fledged diseases.
That Āma may also include infective processes is implied in certain descriptions in the classical texts of Āyurveda. For example, in the Aṣṭāṇga Hṛdaya,. it is mentioned that Āma is formed by a process of fermentation akin to that which renders the Kodrava (Paspalum scrobiculatum L.) grain toxic.[1]
This does not mean that Āma has no gastrointestinal connection. The same text primarily defines Āma as the improperly digested essence of food that is located in the āmāśaya or stomach. In fact, uncooked food is itself known as Āma, which is why the Sanskrit word for stomach means the receptacle of Āma or āmāśaya.
A fundamental principle in Āyurveda is that by tackling Āma at an early stage, progression of diseases can be arrested or prevented.
Āma progressively undergoes various transformations in the process of developing into full-fledged diseases. The stages can be visualized as follows:
- The formative phase: This is the phase in which Āma forms and accumulates in the body. In this stage, clinical symptoms hardly manifest themselves. All indigestion does not lead to Āma, but it does only when Kapha is involved. Only when Kapha is involved, indigestion leads to Āma. In the case of other doṣas, indigestion leads to different outcomes. When Vāta is involved, indigestion is known as Viṣṭabdha and results in drying up and degeneration. When Pitta is involved, indigestion is known as Vidagdha and leads to inflammation[3]
- The interactive phase: In this phase, Āma interacts with the three doṣas and becomes more complex and active. Āma interacting with Vāta creates a condition known as Sāma Vāta. Āma interacting with Pitta and Kapha creates conditions known as Sāma Pitta and Sāma Kapha respectively. Similarly, Āma can also interact with the Dhātus[1]
- The phase of disease manifestation: In this phase, degenerative, inflammatory or infective disease manifests. This is technically known as the sāma stage of the disease, which is an acute condition
- The phase of complications: This is the phase of development of Āmaviṣa.[4] It is a stage of crisis that can even lead to death
- The phase of resolution: This is the stage in which the active interactions between Āma and doṣas and dhātus have resolved and the body may recover with mild, moderate, severe or no damage. The disease may also persist in a chronic phase. This is known as nirāma stage of the disease.[5]
The concept in Āyurveda is that if treated in early stages, it is possible to interfere with the degenerative, inflammatory and other progressive pathologies for early prevention of disease.
There are also specific interventions in more active stages of the progression of Āma.
Depending upon the severity, quantity as well as type of Āma, a three pronged approach has been advised to tackle Āmadoṣa.
- Laṇghana
- Laṇghana Pācana and
- Śodhana.[6]
Out of these, Laṇghana involves restriction of nutritional intake even to the extent of complete fasting to rest the digestive and metabolic apparatuses of the body.
Laṇghana Pācana involves prescribing active medications also, which will neutralize and transform the Āma by digesting and metabolizing it so that it is rendered inactive. Specific medicines are to be used depending upon the type of Āma.
Śodhana is a purification process, which removes the Āmadoṣa from the body altogether.
When used in the appropriate context, these three measures can help to neutralize, inactivate and eliminate Āma from the system.
Many studies could be visualized for experimental validation of the concept of Āma. One approach would be to identify biochemical pathways and processes that underlie degenerative and inflammatory pathologies in the body. This should be with a specific focus on identifying the traditional and non-traditional metabolic risk factors and to identify specific biomarkers as indicators of disease presence, severity or activity, prognosis and therapeutic efficacy. For example, low levels of adiponectin as a risk factor for diabetes, cardiovascular disease and other inflammatory diseases. Another example is the prediction of metabolic syndrome by leptin and C-reactive protein (CRP). Another approach would be to explore the possible correlations between microorganisms and their role in the production of Āma. This will explore the human microbiome with specific reference to the role of microbes in the gut and their role in digestion. Studies should also attempt to correlate the Ayurvedic classification of the alimentary tract with the variations in gut flora.
Āma can also be studied from a clinical point of view. Clinical studies can be designed for early detection of metabolic syndrome. Biomarkers such as adinopectin, endothelial dysfunction, like leptin, High Sensitivity C-Reactive Protein (hsCRP,) homocysteine etc., can be used to detect high risk groups and Ayurvedic interventions including internal medications and purification therapies such as emesis, purgation and especially medicated enema can be evaluated in patients to explore their preventive and curative effects. Clinical studies to assess the variations in gut flora depending upon constitution of individuals and how Ayurvedic interventions help to normalize the gut flora and prevent the formation of Āma is another possibility.
Validation of the concept of Āma would be a significant step in the process of improving our understanding of how Ayurvedic physicians diagnose, classify and stage the progress of disease as well as how specific therapeutic decisions are made in clinical practice.
| References | |  |
| 1. | Harisastri PV, editor. Ashtanga Hridayam. Varanasi: Chaukhambha Orientalia; 2007. p. 216. 
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| 2. | Yadavji TA, editor. Madhava Nidana. Varanasi: Chaukhambha Orientalia; 1986. p. 186.
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| 3. | Sharma S, editor. Ashtanga Sangraha. Varanasi: Chaukhambha Orientalia; 2012. p. 114.
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| 4. | Sharma S, editor. Ashtanga Sangraha. Varanasi: Chaukhambha Orientalia; 2012. p. 110.
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| 5. | Yadavji TA, editor. Caraka Samhita. Varanasi: Chaukhambha Surabharati Prakashan; 2008. p. 408.
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| 6. | Sharma S, editor. Ashanga Sangraha. Varanasi: Chaukhambha Orientalia; 2012. p. 113.
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