The Pittam is aggravated by anger, grief, fear, fatigue, fasting, acid transformation (reaction) of the assimilated food, or deficient gastric digestion, unnatural sexual indulgence, partaking of a food consisting of pungent, acid or saline, keen, heat making or light substances, as well as of those whose digestion is followed by a reactionary acidity. It is aggravated by the use of sesamum oil, or of sesamum paste. Kulattha, Sarshapa, Atashi, the pot-herbs known as Haritaka, fish, the flesh of a Godha or a goat or mutton may lead to its aggravation, if taken injudiciously.
Similarly, the use of curd, whey, Kurchika, (inspissated milk), Sauviraka, different kinds of wine, Amla-phala (sour fruits), or Katvara (curd mixed with oil) and excessive exposure to the sun, may be followed by the same consequences.
In addition to all these, the Pittam is spontaneously and abnormally aggravated in summer, in autumn, at noon, at mid-night and during the process of digestion, as well as by the partaking of hot or warm substances.
The deranged Kapham is aggravated by sleep in the day time, or by the following of lazy or sedentary habits. The partaking of food, composed of substances which are heavy, slimy, sweet, acid or saline in their taste, or of one consisting of substances which increase the mucous secretions from the fissures of the body may be likewise set down as aggravating factors. The use of food grains, which are called the Hayanaka, the Yavaka, the Naishadha, the Itcata, the Masha, the Mahamasha, the Godhuma, the Tilam, or of rice cakes may lead to its aggravation. Curd, milk, the Krishara, the Payasha (sweetened rice porridge), the various preparations of cane-sugar are things which produce the same result. The flesh of beasts and birds that are aquatic in their habits or live in swampy lands, as well as lard, have the same effect, if used as food. The use of bulbs and lotus stems or of Kasheruka, Shringataka, Madhura-phala, Valli-phala as well as eating before digestion or the partaking of food consisting of both wholesome and unwholesome substances may aggravate this bodily humour.
The Kapham is naturally and spontaneously aggravated in the morning and evening, in Hemanta, and specially in Spring, and just after a meal. Likewise, it is aggravated by the use of cold food or drink, etc.
[Owing to a natural similarity between blood and the Pittam, and through a natural affinity between their attributes], causes, which tend to aggravate the deranged Pittam, tend to aggravate or agitate the blood as well. Moreover, frequent meals or repeated use of food, into the composition of which cool, liquid and heavy substances largely enter, are followed by a disturbed or aggravated condition of the blood. Sleep in the day time, anger, exposure to the glare of the sun or fire, over-fatiguing labour, an external blow, ingestion of indigestible or incompatible substances, and eating before the full digestion of a previous meal, may as well be set down as causes which tend to aggravate blood.
As the bodily humours are never aggravated independently of the blood, their aggravation goes together with a disturbed or agitated condition of the blood. The aggravated condition of the humours gives rise to pain and moves the wind (Vayu) in the bowels; it further occasions acid eructations, thirst, burning sensations, aversion to food, vomiting and nausea. Any of these symptoms should be regarded as the second occasion which calls for medical aid.