- 1 Foreword
- 2 India, The Source
- 3 The Triumvirate
- 4 The Origin of inquiry into Pathogenetics
- 5 Inquiry must be Adequate and Scientific
- 6 What is Science?
- 7 The Totality of Knowledge
- 8 The Need for Analysis
- 9 Specific Biological Terms
- 10 The Characteristics of the Golden Age
- 11 From Metaphysics to Science
- 12 Biocatalysis
- 13 The Story Of Life
- 14 Creative Evolution
- 15 Vital or Motivating Organization
- 16 The Triumvirate of Organizations
- 17 Matrix or Material organization
- 17.1 Beginning of Evolution
- 17.2 Evolution Mythologically
- 17.3 Stream of Life
- 17.4 Modern Anatomy and Physiology Perspective
- 17.5 Complexity and Inter-dependability of Human Organs
- 17.6 Results of Complexity in Human Structure
- 17.7 Practical Therapeutics
- 17.8 Significance of Water in Sustenance
- 17.9 Significance of Temperature in Sustenance
- 17.10 Role of Psycho Somatic Organization
- 17.11 As per Other Philosophers
- 17.12 Significance of Vāta
- 17.13 Functions of Vāta
- 17.14 Abnormalities of Vāta
- 17.15 Evolution of Science of Physiology
- 18 The Three States of Life functioning in Men
- 19 The Study of Environment
- 20 V The Study of Constitution
- 21 Prakriti or Constitution in Ayurveda
- 22 V Method of Nomenclature
- 23 VII The Nature and Functions of the Body Triymvirate
- 24 Physiological Pitta
- 25 Physiological Kapha
- 26 Pathological Vata
- 27 Pathological Kapha
- 28 Clinical Manifestations and their Interpretation in Physical Qualities
- 29 Imbalance Condition
- 30 Vitiation Condition
- 31 VIII Imbalance Condition Due to Increase or Decrease
- 32 IX Vitiation process
- 33 Vitiation Process or Pathogenesis
- 34 References
Tridoṣvijnānam is the 'Science of the Triumvirate of Pathogenesis' or it can also be referred as the 'Triumvirate of the Constitutional Pathology'. It is necessary to understand the background of the origin and growth of the disease to understand the whole process to the degree of its impact and duration. This stands even more legitimate when it comes to the perception related to the working and maintenance of the life currents of the psychosomatic constitution of a man. It is more appropriate especially in the concept which bespeaks the 'Tridoṣa' in the country. The Hippocratic constitutional theory or humoral theory from the West has always remained the central doctrine of health and disease for centuries.
The meaning and the interpretation of the terminology, being degenerated and distorted during the long period of two thousand years, received a temporary setback during the dominance of the analytical age of the local study of individual organs, tissues and cells. But the recent evolution of microbiology, the progress of knowledge of nutrition and metabolism, the theory of integrative functioning of endocrine glands, the vegetative nervous system and the studies of allergy and immunity has revived the clinical interests in the study of constitutional concepts of not only the human body but also the personality as a whole.
Arturo Castighom, a renowned medical historian, describes this modern revival of the ancient constitutional concept as neo-Hippocratism. He says that such principles indicate that the orientation of Modern Medicine is turning towards a neo-Hippocratism. It is like the return of some of the classical principles of medical thoughts in the present medicine era. Present day pharmacy has turned towards a dynamic, synthetic and consolidated direction after a period in which a morphological, analytical and localized tendency dominated. It is a return to the classical concepts of the ancient sages for focusing the well-being of the individual as well as improvement of the race.
This study seeks the cause of the disease, its prevention and cure, both in the humans as well as the environment surrounding it. The study of the nature and the cause of disease is progressing more and more along the lines of an integrated physical, chemical, bacteriological, experimental and above all clinical methods, in which the study of economic and social conditions are also important. It is significant that the best type of clinician is learning and teaching how best to utilize the laboratory to its best as well as focus more efficiently on the study and treatment of the patient. The careful physician is convinced that no test, however important and decisive, can take the place of a synthetic clinical opinion and the personal judgement of an intelligent and experienced clinician for the condition of the patient as well as the community.
At this juncture of the revival of the constitutional concept all over the world, it will be certainly interesting and instructive to study the Tridoṣa doctrine. The Tridoṣa concept of Ayurveda is the earliest constitutional concept. Its source can be seen even in the Ṝgveda but it was systematized and evolved as a scientific concept during the golden period of Ayurveda. If the true connotation of the terms of this concept is fully understood with the reference of the background of its origin and growth, many needless arguments and opposition based on this misunderstanding will be eliminated.
India, The Source
India is probably the source of the humoral theory of the Greeks and the Romans. Dr Cyril Elwood M D. in his book 'Medicine in Persia', states that this doctrine was taught in the India which is also mentioned in the holy books of the Hindus. From India it was carried to the Greeks through Persia.
Dr. George Draper, M D in the book 'Human Constitution in Clinical Medicine', makes a similar statement. Indeed in ancient country, the school of Ayurvedic medicine gave instructions for evaluating a patient's nature. Later, in the medical disciplines of Persia and still later in the teachings of Hippocrates, similar advice is given to the pupils of Aesculapius.
It is interesting to note that Castiglioni in the 'History of Medicine' declares while giving a resume of the Ayurvedic system, The Ayurvedic system, according to those who have studied it carefully and appreciate its value, is important for its fundamental teaching. The theory of Tridosa is a kind of humoral doctrine which even today or perhaps especially today affords great interest for the students. It affirms the existence of three doṣas or essential principles which pervade all the tissues, secretions, excretions and determine the health and disease.
Due to this reason the present attempt is confined to the providing of such a picture of the background of the origin and gradual evolution of the concept of the triumvirate of pathogenesis i.e. of the Tridoṣa pathogenesis, the three determinants of pathogenetic and pathognomonic phenomena comprising what is generally called as Constitutional Pathology. These determinants of the pathological variations, when in a normal and a well-balanced condition, work for the fundamental functionaries of the physiological state of the living organism. Harmonious working of these three functionaries is health and their discordance is disease.
Remarks of Learned Philosophers
Sir Michael Foster's remarks that the science of meteorology cannot be divided into the science of good and bad weather. It can be aptly related with the subject of health which cannot be divided in the science of good and bad health.
Claude Bernard, the great physiologist, believed in the unit of science of physiology and pathology. He began the course of his lectures with the explanation that there is only one physiology whose domain is the study of normal and pathological functions. Factually, his work was almost as much concerned with the pathological physiology as with the normal physiology. Thus the Tridosa is a concept of trinity of functional organisations applicable to and operative in both the realms of health and disease.
It implies the physiology and pathology of each and every form of life from the amoeba to man. Thus pathology becomes physiological in outlook enabling one to study disease conditions from the physiological point of view. The pathological processes are so co-ordinated with the vital physiological processes that they can be interpreted in a common terminology.
The Origin of inquiry into Pathogenetics
It is quite apparent to imply that every inquiry into the nature of phenomena starts from the nature's quality of opposition to the fullest and happy flow and expression of the current life throughout. Pain and suffering, death and disease, fear and frustration arouse the spirit of inquiry and investigation into the man. The philosophers of the Sankhya school started their research in accordance with the nature of life instigated by the presence of suffering.
Due to the affliction from the threefold misery, study was initiated for the removal of all the kinds of physical sufferings. Caraka Samhita also ascribes to the emergence of the disease among men along with the fulfillment of the purpose of their lives, the effort of the sage-scholars in acquiring the right knowledge of disease and its correlated remedial measures.
Health is the supreme foundation for the virtue, wealth, enjoyment and salvation. Diseases are the destroyers of a healthy good being. Hence for the impediment of the humanity, its remedy was inevitable. Hence the scholars sat in the meditation. It was then correctly inferred by the single-minded devotion towards the whole science of life.
Hence it is thus distressed and goaded by the pain and suffering afflicted through physical and mental state which let to the efforts of inquiry. This investigation probed further into details which bore fruit of the three-fold determinants of all the physiological and pathological processes of life.
Inquiry must be Adequate and Scientific
Just the efforts whether the inquiry is merely sincere and intense are not enough in guaranteeing the accurateness of the results conferred. The method adopted must also be sound, adequate, rational and consistent with the fundamental principals of the physical and biological laws of the universe. The first such positive scientific efforts were made by the Sānkhya intellectuals. They emphasized the necessity of scientific knowledge. There are verses in Caraka Samhita which are the patronizing maxim of the guiding principles of all the investigations. These verses emphasize that the whole suffering which cleaves to the mind and body has ignorance in its base, thence conversely whole health and well being is founded in clear scientific knowledge.
What is Science?
From the various definitions and explanations given of the science it becomes clear that science is a method. It can be deduced in three different ways as follows:
* Any department of systematized knowledge.
* A branch of study concerned with observation and classification of facts based especially on the establishment of verifiable general laws.
* Accumulated knowledge systematized and formulated with reference to the discovery of general truths or the operation of general laws.
These are some of the dictionary meanings of the word 'Science'.
In practical life and in the usage of common parlance too, we understand by scientific thought, speech or action, a systematic process of evolution wherein each succeeding part is derived from its preceding part by the inevitable compulsion of logic. It is further maintained at any time or place, given the attendant circumstances. Hence, Science is the critical systematic knowledge based on generalizations. It is an investigation into the nature of facts, facts not selected randomly but in their comprehensive entirety.
Method of Conclusion
The scientist systematizes the data, records the observations and draws conclusions therefrom which ultimately assume the form of a formula or a universal truth. He proceeds rationally and logically through all his investigations. It is the cumulative product of both the processes of analysis and synthesis, the knowledge of individual ideas and things against the background of universal laws and concepts.
Karl Pearson in his 'Grammar of Science' states, "The man who classifies facts of any kind whatever, who sees their mutual relations and describes their sequences is applying the scientific method and is a man of science."
The Totality of Knowledge
It is necessary again to remember that the totality of knowledge of things was aimed by these ancient scientific sophists. The understanding of any part merely in creation without the knowledge of the whole and the inter-relations of the parts was inadequate and liable to lead to the wrong conclusions. The knowledge of the whole cannot be accrued from the knowledge of merely a part.
The total concept led them to a comprehensive and synthetic method of the study. The knowledge of the past was acquired but with special consideration and reference to the relation it bore to the present and the future. The knowledge of the parts was co-ordinated and placed in the proper perspective of the whole. Then they studied the nature of the whole in its entirety. This concept led us to the study of man as a whole, i. e as a complete unit.
The Study of A Man
Man was studied as a whole personality which is the dynamic organization within the individual of those psycho-physical systems that determine his unique adjustment to his environment. This led to the study of his constitution which includes the aggregate of inherited characteristics, modified by the environment, determine the man's reaction to environmental factors.
The Study of the Universe for the Discovery of all the Sources
The whole series of causes and sources of pain and suffering extending over the whole universe is included in the investigation:
- Totality of Man-cum environment
- Totality of environmental factors which become sources of pain or disease.
- Totality of methods of investigation which covered all the aspects of time and space.
- Totality of things that were used as medication.
According to the Sankhya view, all the misery can be classified into three kinds:
- Internal = This is includes the miseries of the body and mind.
- External = This includes the miseries of the physical world.
- Spiritual = This includes the miseries from the supernatural sources.
Śuśruta further sub-divides these three categories into seven which is described in details in the later section on the Etiological factors. Thus there remains nothing left un-investigated in the universe which can cause pain or suffering to man. It is an all-comprehensive classification.
Comprehensive Method of Investigation
This method of investigation evolved a system which encompassed all the possible states of time and space. Time whether present, past or future and space whether near or remote as well as things visible or invisible normal or abnormal, were all made possible of study by this system of investigation. These are the methods of investigation and there is no other left, which constitute the means by which all things are examined.
Medication Substances in the World
The therapeutic science has left no natural element unused to decipher it's medicinal properties. There is no substance left in the world which was not checked for it's therapeutic usage as medicine. Thus to understand man and the subject of medical science, one has to understand not only the whole man but also the environment which begot and which sustains him and which can be the cause of disease. It can also be the source of medicaments. Hence, this whole environment therefore consists of the universe surrounding him.
The Need for Analysis
To achieve the comprehensive and complete therapeutic knowledge, a very varied and extensive field of the study is required for its attainment. It also comprised some of the methods of simplifying the study by classification of the analytic method. This step became very inevitable. This orderly arrangement and systematization gave some basic formula for the generalization and a progressive field for research. The analytical process was carried on till the common measure of the classification was achieved.
Specific Biological Terms
Combination of Proto-Elements
As the physical body forms a part of the biological living organism, the physical formula has to be co-ordinated and incorporated into this triumvirate of the biological organizations to evolve a specific biological formula of the triad of Vāta, Pitta and Kapha. The five categories of the physical matters are integrated into three. It is merged by the method of earth and water being grouped into one and air and ether being combined together into another group. Due to this condition, all the five physical proto-elements evident in the living organism will be transformed into the biological forces of Vāta, Pitta and Kapha. It can be deduced that the air and ether are being combined into Vāta, fire turned into Pitta and water and earth combined into Kapha.
Evolution of Terminology
A specific terminology was evolved for this triumvirate of biological categories, which is significant both of static existence as well as dynamic force viz. Kapha; it signifies aqueous proto-elements of the physical formula. It also signifies the evolutionary process of the biological formula. Thus the whole word gives the sense of the organization of fluid matrix wherein the biological process of the evolution of the life is carried out. This synonym is even more significant of the biological process of the cohesion denoting it to be the colloidal matrix or milieu for the vital play. Pitta is derived from the word 'heat' which is significant of the function of heat. Vāta is derived from the word 'to move' and is suggestive of dynamic or functional process.
Inception of Medicine Science
Thus these sophists were forced to analyse and classify the elements of the phenomenal universe and their direct and indirect products and their various modes and forms of combination in bringing about the substances, dualities and actions that the physical sciences and medicine particularly have to deal with as their subjects. It also includes the biological organizations into which they were transformed by the effect of the vital forces. This endeavor to analyse, re-group, classify and denominate the physical and biological facts and laws heralded the inheritance of the medicine into the stage of a science.
The Characteristics of the Golden Age
The base theory of Ayurveda is the theory of the triumvirate of Vāta, Pitta and Kapha. It is the product of an age which is universally acclaimed to be the most brilliant in the longest annals of man. This age which was marked by the most intense intellectual activity in the East as well as in the West, particularly in India and Greece, not only laid the foundations of thought on which the world has continued to build but has to its credit the achievements which are still the crowning glory in art, literature, philosophy and medicine.
The age in which Greece had intellectual giants like Plato, Aristotle Pythagoras and Hippocrates, India had great philosophers who were the seers of Upaniṣads and Ayurveda. This was the best time for philosophical growth with the supreme pursuit. Due to these philosopher's anticipation, the people came to know the ultimate concepts of life. The arts and the sciences were actively cultivated, but they played a subservient role to philosophy.
This meant that specialization was probed but the final verdict was not only of the the specialist but also of the general overseer, the philosopher, who alone was in a position to assess the value of the contributions made by the specialists. The result was the development of a co-ordinated outlook which was based not only on the studies of the parts but also the studies of them as forming the whole. It was this synthetic or integrated outlook which has given us the Tridoṣa concept of Ayurveda.
This view is based on the concept that any manifestation of life must involve the coming together of the three factors of the spirit, the mind, the body, the tripod on which the world is based. This coming together or assemblage of spirit, mind and the Sankhya classifies the universe into three categories:
- The phenomenal physical world
- The subtle or imperceptible world
- The principle of spirit that underlies the manifold vital forms and activities
From Metaphysics to Science
The medical propounders accounted the classification of things as held by both the Sankhya and the Vaisesika schools. The Vaisesika school enlisted the totality of things under the categories of substance, quality, action, generality, particularity and co-existence. From purely metaphysical methods, Ayurveda was passed on to the physical and expert mental methods that involved the physical categories and terms such as substance, quality and action.
As per Atreya Philosophy
Atreya reduces the universe to nine substances. These combine to form the two main groups of things inanimate and animate. All the physical substances are reduced to the five categories of proto-elements and each proto-element is ascribed certain specific qualities, the total number of all the qualities coming to twenty in number. Thus the body-substance, environmental factors necessary for life-process, causative or curative factors of diseases all these were reduced to a specific number of qualities whose use or avoidance could be prescribed in an arithmetical ratio. As a result of the analytical process, they arrived at the conclusion that each substance or thing consisted of an aggregate of five inter-related stems each possessing quite different and specific qualities.
Significance of Proto-Elements in Metaphysics
These systems were termed as proto-elements. Then the quality of each proto-element was determined and the manifestation of that particular quality of its specific grade or intensity in a substance is depended upon the relative proportion of the proto-elements in that particular substance. This formula of proto-elements served the purpose in dealing with the physical idealities. But the biological entities had two more factors to reckon with; mind and spirit. Both of these are utilized and transformed by the physical matter to suit life's purposes. Both these are dynamic forces and cannot be observed by the physical means. They are known by the effects they produce on the body and their nature is the object of inferential knowledge.
Growth of Organic Existence
The combination of physical and vital forces in the biological world gave rise to the individuality of organic existence which needs special organizations to maintain the harmonious and co-ordinated working of both the physical and vital systems of an organism. The organization of bodily constituents is a mark of all the living creatures. This was the benchmark which differs it especially from inanimate things.
Composition of Biological Functions
Time phenomena of the physical matter cannot be adequately explained by the consequence of the biological world which is characterized by the organization. One is of static existence while the other is of dynamic creative process. Hence the need to evolve the formula of biological functions was inevitable. All the living organisms need below mentioned minimum triple organization for their life processes:
- The organization of fluid-balance of the body - It is also denoted as water-balance system. A specific fluid matrix is essential for the comprehensive expression of life phenomena. This organization has to maintain the specific consistency and structure of the fluid matrix under the stresses of varying environmental factors.
- The organization of Thermal balance - Specific heat is necessary to digest and assimilate material from the environmental world and convert it into one's own body part and also maintain the optimal heat of the body for full expression of life phenomena.
- The Organization of Vital balance - Vital force is an essential part for the purpose of creative evolution, progress, power of organization. Such other vital processes characterize life and differentiate animate from inanimate things.
History of Solar System
It would seem from the opinion of science that life is alien altogether to the physical forces of the universe and can choose its habitation and its field of play and growth within very narrow limits of elemental geography. At a particular stage in the history of our universe or solar system, the earth developed its present elemental geography, temperature, contents of solid, liquid and gaseous matter, mountains, earthy crust, oceans and atmosphere of air. That was the benchmark hour in the history as the initiation of life took place from therein. Ever since then the unfoldment of life has undergone various stages of evolution in vegetable, animalculum, animals and humans. Till the human stage, the urge of life has been an inner compulsion, blind, powerful and contemplative. Only the urge has been there instinctive just like the powerful drive of the powder behind the lead in the bullet.
In the present era, man is surprised and self-contemplative. The psyche in him demands the self-indulgence of a reflecting mirror of thought which contemplates the graces and freedom to choose the direction to make the next step. i.e from a mere green grass of moss and a speck of protoplasm has grown through the states of a floating jelly, the creeping reptile, the soaring bird, the unwieldy dinosaur, the half uplifted ape into the full stature of an upright standing man scanning the mystery of the endless vistas of space and time.
Evolution of Life
The first stage of evolution of life began when there appeared the covering expanse of the rolling waters and moving atmosphere that blanketed the planet. These oceans were filling the inter-spaces between the earth and the sun. The sun, foundation of this planetary system, pour out it's radiant energy upon the earth and its waters though the intermediate atmosphere. This process gave rise to the primary forms of life and sustained them in all their later stages of growth and evolution.
Sun remains to be the main source of evolution and sustenance of life till date. The sun is the soul of all living beings in the world immaterial of their mobility. But the interplay of the solar radiations and the aquatic elements of the earth along with its kinetic atmosphere has been essential for the maintenance of life in all its forms. The sun impregnated the waters of the ocean. It alone could receive the seed, and clothe it with the habiliment of life, with the form and structure needed for abiding and growth. It is the field and scope for the vital dynamics of life unfolded gradually into cognition, conation, intellection and spiritual fulfillment.
Whether life is like an exotic visitor waiting to make its entry on this planet till the favorable circumstance when the optimal condition for its play are evolved, or is a peculiar offspring of such an accidental condition incidental in the history of stellar and planetary evolution; is still a controversial point. There is a third opinion put forth by the ancient Sankhya seers that at the beginning of each cycle of time, the primordial principle of matter gets impelled into evolutionary activity of gradual unfoldment by a peculiar change in the eternal propinquity of the Puruṣa, who is the unchanging witness of nature. This power was not in the hands of man is the certainty.
Whatever be the origin of life whether extrinsic or intrinsic to matter, the distinguishing mark of all the forms of life has been the power of organization. Lovatt Evans in his work on "Starling's principles of human physiology" writes on what are the fundamental phenomena which distinguishes living things. Their distinctive feature is perhaps this organization and in the higher cadre members of this organization it becomes more and more distinct. This greater complexity of organizations run parallel with the increasing range and power of adaptation. It is attained by setting apart the special organs for the performance of definite functions.
Characteristic of Life
The peculiar characteristic of life is its power to organize. Its internal conditions are with regards to the structure and function so as to cope with its external conditions. Such body which we know as life, was studied both in its constituents and as a whole. The individual study of the parts gave rise to several special branches of study such as metaphysics, psychology and the physical or natural sciences, while the attempt to study the living conglomerate as a whole identity became the special concern of the physician who kept it going on in the perfect condition as long as it was possible.
Importance of Philosopher Physicians
During the time of Caraka, the physician occupied the exalted place, when medicine and metaphysics were equal domains of the Vaidya. The Ayurvedic classics were written by men who were admittedly the wisest of the age. Hippocrates says that a man, who was the combination of physician and also a philosopher, was considered to be very divine. He was accounted next to God. Hence the sages like Atreya and Dhanvantari also had a very divine post in their times.
We owe these physician-philosophers, of the golden age of the country, the concept of life as embodied in the Caraka and the Śuśruta, a complete and integrated concept. This concept is so broad-based that in its main outline it must hold good for all times. It is true that the perception of these sages couldn't claim the advantage of the elaborations due to mechanical devices that are possible today. But their integrated and total vision of the organism along with the modus operandi of its threefold organization and the means adopted to preserve and prolong its existence and functioning, is as supreme today in its validity as it was when it was first promulgated.
The Story Of Life
The Meaning of Life
The authors of Ayurveda, projects it to be much more than mere skill of treatment or diagnosis of a diseased condition. It is entitled to be comprehensive concept of life which includes both man and his connected environment. The well-being of man and the aggregate of body, mind and soul cannot be confined to mere physical health but it extends to the complete sense of physical, mental and spiritual satisfaction. An enrichment was born as a result of wholesome and mutually beneficial interactions between the individual and his environment immaterial of it being social, physical or spiritual.
Man as a biological entity needs to adjust to the physical environment and as a social and spiritual entity needs to adjust and react wholesomely to the society in which he lives. It also needs to upheld the spiritual ideal owned by it. Such well being is the real and true identity of man in his entirety. This is the main purport of the 'Science of Life'. Caraka therefore declares:
Science of life is such wherein are laid down the principles of good and the bad life, the happy and the unhappy life and what is wholesome and what is unwholesome in relation to life and measures of life.
Having visualized this total picture of life, we shall now analyze the two parts of it individually:
- The universe that forms the environment and which has given rise to life
- The individual organization, its composition, structure, mode of functioning and its progressive evolution from amoeba to man
Life and the Triumvirate of Organizations
It is the belief of science with the evidence at its disposal that life is an incident in the history of the universe. It is perhaps confined to only our planet where conditions favorable to its emergence, existence and growth began to surface some millions of years ago. Science also expects life to disappear with the disappearance of these evolutionary circumstances. The vanishing or disappearance of life on the planet is a certainty according to it in a few million more years.
Base of Functioning in Organisms
From a common point of view, it becomes more difficult to understand that out of innumerable solar systems whirling about in space, which solar system has the volume which can be counted in light years. A tiny speck of a planet was chosen to cradle this mysterious phenomenon of life, while organization entitles it under the name of the organic life. Such life-activity involves a continuous maintenance of it's body structure by the means of periodic replenishment of it's wear and tear, a constant supply of energy for maintaining the optimal temperature and tension and an unfailing mechanism for correlation of the distinctive functions of each limb of its complex structure. This aids in helping the organism to react as a whole both in its internal and external movements. Such threefold organization is the sine qua non of all the organisms immaterial of their size.
Complete structure of life or every organism is engaged continuously in converting the matter of the outside world into a new pattern and texture that it may serve the purpose of life. This transformation of matter into its own field of extension is the distinctive function of life. A recent writer named Jerome Alexandar in his book 'Life, its nature and origin' declares that the distinguishing nature of life is bio-catalysis. Bio-catalysis is the power to bring about chemical change in bodies without practically undergoing any change within itself. This bio-catalytic action is the one responsible for enabling life to maintain and extend its field in the alien world of matter.
Life is continually annexing matter by it's catalytic activity and extending it's dominion over space-time. Life, viewed from this point, is a catalytic struggle with the environment. This struggle is a process of annexation into its expanding boundaries of the non-responsive and ever hostile forces of the material world. This is a view which fully accords with that of the Sankhya school of philosophy, base of Ayurveda. The infinite number of Puruṣas, known as bions in the modern biological languages are caught up in the meshes of matter. In the presence of these bions, matter undergoes changes in order to give these life-units their objective of life. It is the perpetual unfoldment of sensations, images and pain-pleasure conditions. But the Puruṣas remain unaffected. Matter which holds these bions are called Puruṣas.
Segmentation of Bio-catalytic Process
The spirit or soul perceives 'Nature'. Thus life acts in involving a recasting of matter into new patterns to suit the base purpose of these bions, while they themselves remain unchanged witnesses of the varying life phenomena. The activity of these bions is indeed best illustrated by the process of bio-catalysis. This bio-catalytic processes involve the threefold organization calculated to sub-serve the vital purposes of material. They are:
- Progress and growth
- Maintenance of thermal and metabolic processes
- Co-ordination of the internal and external movements suitable to the changes of environment
Without these threefold functions no organism can survive. All the processes of assimilation and dissimilation so essential to keep the ongoing progress of its structure and tone are rooted into such organizations. It is therefore very evident to analyze the description by Ayurveda. It is important to know whether it fits into its general outline of life-processes of this three-fold phenomenon of organization or not.
Ayurvedic Spectrum of Bio-catalytic ProcessCaraka lays down the distinction between organic and inorganic life denoting thus:
'The thing that is endowed with the sensory organization is organic or sentient and that which is not endowed thus is inorganic or non-sentient.'
The sentient organism involves a complex organization of structural, metabolic and kinetic processes. It also involves either mind or a co-ordinating principle however elementary or intricate it may be. Ayurveda holds such an organization to be universally obtained in all the forms of life, from the most rudimentary to the most complex. Thus its physiology and pathology is uniformly applied in the broadest outline to all the forms of life.
Though life is mysterious and undefinable, the phenomena which signifies the existence of life are evident for the purpose of observation and study. All the phenomena which distinguishes the animate from inanimate are ingestion, assimilation, respiration, movement, growth, creative evolution, reproduction and potency of each organization.
Life has been endeavoring and struggling to create and preserve optimal environmental conditions for itself which would help its evolutionary purpose. It corresponds to certain modifications in the process as per variations in time and space. Besides, it has also developed its own organization of existence, growth, perpetuation and expression so that it can accord to such probable environmental variations. The variations definitely happens within certain limits. It has also created protective measures and techniques for its survival and evolution.
Evolution in Plant and Animal Life
In the plant life, we observe that the sap is encased in a hard case of bark-crust to protect it from the external heat, cold as well as hostile incursions. Plant life is an excellent example of the survival-techniques of life's organization. In spite of the big size and strength developed from within, this form was not conducive of the varied richness of life-processes struggling for expression. Hence a subtler and more malleable patterns endowed with movement, agility and resourcefulness for the preservation of its life and even for overcoming hostile forces either by resistance or by accommodation was developed. This gave rise to evolution of animal life.
The animal pattern of survival was considered to be more advanced. The cadre of animal evolution included every being from the smallest animal to the complex organism of man with the mind-principle fully dominant. The process of such evolution is the direct result of the integrative organization which every living organism possesses and is able to evolve. The higher the complexity of life, the more subtle and distinct becomes these organizations.
These organizations become more and more complex as evolution advances and form separate structures. There are special organs for the performance of these definite functions. But the fundamental principle of organization which maintains the integration of the individual remains the same for all living organisms, whether minute or large. Even in the unicellular life, all the fundamental phenomena of life are carried out in the same pattern though there is no difference in appearance or structure of protoplasm.
Vital or Motivating Organization
This is the master organization which initiates and directs all the activities and maintains the specificity of all the vital processes which characterize living organisms. They can be classified into two parts:
- Physical or material organization- It is the system which maintains the specificity of fluid matrix of protoplasm wherein life-phenomena are played.
- Thermal or metabolic organization - It is the system which maintains specificity of heat by carrying out anabolic and catabolic processes.
The Triumvirate of Organizations
The miraculous story of life's evolution or unfoldment is recorded by biologists. The process of such evolution has always necessitated the pursuit of the technique of the threefold system of organizations viz:
- The structural or material pattern
- The maintenance-device of the thermal optimum for metabolic functions and adjustment to environmental temperature
- Kinetic or motivating organization of the entire structure for purposes of growth, perpetuation and enterprise
Without these forms of its dynamics, life could not have achieved its survival and progress. Nature and texture of each of the three organizations have played a significant role in survival and progressive growth of life.
Matrix or Material organization
Beginning of Evolution
There is common ground between science and religion on the question of the primeval abode of life. The aqueous elements were the first one to get evolved. Both vegetable as well as animal life-forms have been born and have dwelt in water before they grew into amphibious and terrestrial species. The seers of the Veda declare that there was existence of only clear waters in the beginning. God created all the living things on the earth from water. It is the faith of all the religions that life spirit dwelt and moved on the dark primeval waters.
In the mythology, it is believed that Lord Viṣṇu, while lying on the milky ocean, bestirred himself into a creative mood. This is how the creation of living beings on the Earth took place. Even the science supports this theory of evolution to be the origin and abode of life.
Stream of Life
The matrix of the material pattern that life requires for its abiding is provided by only the water element of this universe. That is the medium best suited for the vibrant throb of life and transmission of its impulses. Human, plant and animal life is run by the immaterial spirit of life. This fluid matrix can be poured into the vessels of various shapes and its consistency is increased or lessened. Life has attempted all those shapes, patterns and the densities needed for its consummate expression and release of the dormant spiritual force. The last output of life's enterprise is Man.
Like a spider that has woven its web and retired to its center, so has life woven around itself the web of the human organisms with its automatic systems like circulatory, respiration, nervous system and mind which mechanically operates centering the higher life as it's goal in the course of further evolution. Thus, there is a whole complex system distributed in its outline under this threefold divisions of body-organization with the sole purpose of maintaining a uniform and unchanging environment for life. This environment contains in itself its power of accommodation and adjustment to exogenous as well as endogenous interferences.
This leaves the spiritual mind of man free to reflect and weave out his patterns of thought for spiritual fulfillment and creative imagery in art, literature and science. All these creative skills expands the scope and variety of life expression. It is obvious that all the three aspects being component of an indivisible whole are vitally inter-related as integral part and change in any one is bound to affect the rest. But for the purpose of their knowledge in specific, the nature of each of these is referred to in the terms of quantity or form, the degree of intensity and degree of tempo respectively.
Modern Anatomy and Physiology Perspective
Modern anatomy and physiology have credited a long and persistent series of investigations and study of the human constitution in its complexity and minuteness. They have tracked down the secrets of human structure and function to the microscopic cells and even beyond. With utmost diligence it was experimented on animals and ascertained with almost full approximating certainty. It is very essential to understand a comprehensive human dynamics for the probable reactions and effects under the given circumstances to achieve a specific stimuli. Man is the most tangible structure made by an aggregate of mere cells. In R G. Hoskins book, it has been said that Medicine is now in a transitional phase.
The ineptitude of regarding man as constitution of different interesting organs working differently for a united goal of living is becoming increasingly clear. The personality of their nature is more important than his organs; no matter whatever fascinating pathological conditions or versatility they may disclose. The influence of soma on body is an another misunderstood factor of psyche which is gaining increasing recognition daily. There seem to be more factors yet not understood, but whose workings are only suspected and observed in crucial moments and special exigencies. Though the intrinsic nature and technique of functioning may defy our present powers of comprehension, yet their net effects are obvious to the discriminative eye.
Complexity and Inter-dependability of Human Organs
Positive side of this theory is that it clears the mind that is able to observe and appraise these influences from an internal viewpoint of the human organisms. For the clinicians, this information is accessible through the intelligent inquiring methods. This phenomena presupposes an extensive and exclusive view of the structure and function of the individual parts of the body. Otherwise the excellence of each part is vitally related to that of every other part and the body as a whole.
There is an intelligent and highly sensitive adaptive principle to which all the body-functions and life-purposes converge. From this there emanates the subtle and vital vibrations that uphold and preserve life both in health and disease. This pre-supposes a comprehensive or integrated concept of physiology, the doctrine of vitality against the phenomena of mechanism. Man is more than a machine. Over and above the psycho-somatic organization there subsists presiding principle which is instinct with awareness and wisdom beyond the conscious mind.
At the first instant it sounds that the doctrine of vitality was a superfluity intruding into a realm where it was not allowed. But on comprehensive consideration it is seen that without the recognition of this element, there is a void and inadequacy, a scattered and disintegrated jumble that is belied by the fact of the universal subjective experience of men of an integrated and compact unity of personality. This points out to the the ancients, Caraka and Śuśruta of India and to Hippocrates of Greece and Galen of Rome. But this by any means is not suggestive of the same path being followed by both the countries. Apart from it nevertheless of their inspiration which was derived from a common viewpoint of regarding man as a whole and in the vital inter-relation of his various organs of the extensive or inclusive nature of the functions of each of them in health and in disease.
Results of Complexity in Human Structure
These analytical results should be cast again into the mould of the synthetic or the integrative view of man. Instead of the data being priced, their ultimate net values ought to be worked out and cherished. The inter-relation of each limb and part of the body has inevitable repercussions on the total well-being of the psycho-somatic whole which is man and vice versa. With this motto in mind, the natural corollary is to set about discovering the main springs of human well-being and reactions, the sources of living, action along with resisting disease and rebuilding of loss.
Once the main springs of life and action are discovered, understood and assessed properly in their values, the rest follows easily and naturally. In the light of this radical knowledge of man, the data gathered assiduously about the various individual components of the body, big and small, get reoriented and yield a richer wealth of wisdom pertaining to the body as a whole as well as of its parts.
As per the ancient medical thoughts from Caraka, Śuśruta and other works, knowledge and observation of the main springs of human life and action and the full appraisement of the functional values of life-expression, the full and detailed classification of the varied signs and symptoms, visible and expressed psychically and somatically of life were all important. It was not mere theory. In practical therapeutics also it has lot of weightage.
Through observation and prolonged study of human behavior and reactions in health and disease and also by general inference based on the understanding of the unity and uniformity of the principles governing the cosmos as a whole; man was governed by a triumvirate of forces and elements well organised. The action of the sun, water and air were the proto-types to them of the aqueous, thermal and kinetic organizations respectively of the human body.
Significance of Water in Sustenance
Water was regarded as the prime source as sustainer of life, the daily purifier and refresher and the elixir of life. Water was held so sacred by most ancient races that it became was worshiped as god and a religion grew about it. Holiness and purity were acquired through bathing and sipping water. Even water was poured from the hands as the oblation to God and vows made.
The counter-part in the body of the water in the nature was the body-fluid, the colloidal fluid known as protoplasm. Among the triumvirate that governs the body this factor was the first essential. This provided the field for governance and was the substantial structure for the state itself. This is the material organization of the kingdom. This vital fluid forming the vehicle of the life-spirit contains proteins, fats, carbo-hydrates, vitamin, salt and it constantly fluctuates to adjust and counter internal as well as the external disturbances.
This integrative organization regulates constantly the physical and chemical structure of the body-fluid as well as its circulation. It maintains the proper balance between the fluids in the various parts of the body viz:
- Water in the colloidal system of protoplasm
- Water between the cells and fibres
- Stored water in any water-depot of the body
Significance of Temperature in Sustenance
Temperature is an essential factor in the maintenance of this natural and uniform pattern. It is very important in providing life, the scope for vital play. The body is found to possess the mechanism of internal combustion. It has heat-generating thermal mechanism distributed in the entire body. This is a radical aspect and not an exclusive function or peculiarity of any one limb or part of the organism.
It might be possible that this phenomena of body thermal mechanism would be more at some place and very less at other. But in its total aspect it balances the thermal production and output to maintain the thermal constant of the whole body. This bio-combustion process is termed as the metabolic process. The internal thermal balance is sustained by the anabolic and catabolic processes constantly taking place in the body. Though this thermal element is diffused in the entire body, it also has its regions or points of focus.
These foci are important to the clinicians because the pathogenic and restorative processes are centered around these points of foci in particular and the entire system in general. These general foci are distributed in the body so as to meet the exigencies and functions of each structural system of the body. The kapha, pitta as well as vāta, the three factors of the triumvirate that governs the psycho-somatic organism, are each apportioned with its pentad of foci in the body. These have special clinical significance and are guides and aids in the practical diagnostics and therapeutics.
Role of Psycho Somatic Organization
We now come to the last and the most important factor of the triumvirate, the factor closest allied to the life-principle and which is supreme; vital function of the psycho somatic organization. Life is never static. Even in its most rudimentary states even simple existence presupposes an internal dynamics, where action, aspiration and adaptation to environment are involved. The dynamics of it are very complicated.
Wherever the psyche is dominant it charges the body with the impulses of hope, despair, anticipation, fear, desire for efficiency, triumph over opposition and the joy of achievement. The dynamic organization involving such kinesthetic force must be subtle, self-sufficient and creative. This attribute is possessed collectively by the body and mind which is known as vāta or vāyu. Here it means to move or convey. The kapha and the pitta are relatively static. At every single point of their existence and functioning they need the co-ordination of vāta. Pitta and kapha exhibit at the places wherever the vāta carries them.
As per Other Philosophers
Claude Bernard states that vital force directs phenomena which it does not produce. Physical agencies produce the phenomena in living things which they cannot direct. This apt remark has much similarity with the statement of Kapila, the propounder of the school of Sankhya. He suggests that the union of the spirit with the nature is for the contemplation of the Nature. The union of the Nature with the spirit is for liberation. The union of both 'the spirit and the Nature' is like that of a lame man with a blind man. The creation is brought about by the last union.
Significance of Vāta
Life is dependent on vāta because it is the impeller, sustainer and operator of life. It is known as the Tantra-Yantra-Dhara. In a chapter, classic in its pattern and expression of thoughts, Caraka describes the nature and functions of Vāyu both in the cosmic as well as its biological aspects. It is the master of the supreme principles of life. The salutary as well as the pathological aspects of the vāta principle are described by the royal sage Varyovida in the eloquent terms.
The vāta is the upholder of both, structure and function in the body. It is the very self of the five forms of vāta in the body:
Functions of Vāta
Normal function of vāta includes the following activities:
- Impeller of upward and downward movements
- Controller and conductor of the mind
- Spirit of all the senses
- Conveyer of all the sense stimuli
- Protector of the body-elements
- Synthesizing principle in the body
- Impeller of speech
- Cause of feeling and audition
- Source of the auditory and tactile senses
- Origin of all the excitement and animation
- Stimulator of the gastric fire
- Desiccator of the morbid vitia
- Eliminator of excrement
- Obstruction of the gross and subtle body-channels
- Maker of the fetal form
- Sustaining principle of life
Abnormalities of Vāta
When the vāta becomes abnormal in the body, it afflicts the organism with diverse kinds of disorders, tending to impair its strength, complexion, well-being and life. It depresses the mind; impairs all the senses, destroys the fetus in uterus, produces deformity in it or unduly prolongs the period of gestation. It also results in giving rise to fear, grief, stupefaction, depression of the spirits. Hence in this manner any abnormality in vāta causes delirium and obstructs the vital functions of the body.
Evolution of Science of Physiology
The science of physiology has passed through the several stages of evolution. It was first a static view of an individual of specific functions of various organs and tissues of the body. Later it was realized that there was an integrative control through the nervous system and psychic influences. These parts can not be considered to be functioning separately. Yet the endocrine secretions opened up newer processes of physiologic as well as metabolic conditions. This had an integrative chemical control over the body. This phenomena highlighted the cellular structure and function.
Not even one internal part of the limb or gland or cell of the body can be viewed. One kind of secretion is balanced by another and the glands, the tissues, cells and all the other elements are interrelated and controlled by the fulcrum of personality on which the whole organism is fixed. Thus physiology is a total and integrated life-process and though viewed analytically for study-purposes, the comprehensive constitutional view should not be ignored.
The triumvirate of kapha, pitta and vāta form the general outline of that constitutional pattern or scheme. Hence the phenomena like constructive, integrative, assimilation, recuperative and elimination processes are to be understood in terms of their basic nature. They should be studied by their working of these three principles individually as well as the inter-connectivity of these three among each other. They are all inclusive and complete in their comprehension of the body-mind processes as a whole.
Time and space factors vary every moment and hence it is not possible to maintain optimal environmental conditions. Hence, the life develops within itself such active organization which enables the body to adjust immediately as per the changing circumstances. It is an adept to the variation in the external relation. Moreover life also evolves a special protective and survival technique to counteract the inimical environmental incursions.
The Three States of Life functioning in Men
We know that for every animate life to exist and grow, it requires three different forms, the stationary life of plants, mobile but passive and reflex life of the animals and the discursive, active and creative life of the humans. The human body evolved from the most rudimentary life contains the vital processes of all these three types of life.
Human Life Functioning as per the Surrounding Flora
Human body also contains the parts and organs that grow, abide and function like the plants. It absorbs food, turn it into energy and discharge the waste products thereby automatically maintaining the basic structure non-interfered and unaided by the higher aspect of the mind on general.
Human Life Functioning as per the Surrounding Fauna
Right from the evolution of life the heart, stomach, intestines, liver and other glands keep on functioning in their own autonomous nature without constant active impulsion or inhibition from the mind. Nature has managed to keep this basic body-mechanism beyond every man's reach and control. There is a reflex life of the man wherein the limb and sense organs execute protective movements in the response to the external stimuli. It is the defense mechanism of the body which is inbuilt against extraneous incursions and interferences. Many of the man's normal physical activities and mental and emotional impulses are the reflexes. Therefore a passive reaction is projected to the external world of stimuli. The reflex organization controlled by the central nervous system represents the next higher stage of man's evolution as an animal which reacts suitably to the environment and acts and learns by adjusting to external stimuli. This is the animal aspect of man.
Functioning of Human Life as per Brain
Above these two forms of life, stands the real human life i.e. the purport, creativity and self-conscious propulsion of the higher mind. Man can asset his essential humanity due to the functioning of mind which executes the essential actions and commands. This is the significant purport of psyche performing will, determination and discrimination.
The basic survival functions work beyond the control of the individual as they are autonomous set of organizations. Thus man's survival is assured against his will. This autonomous nervous system includes the functioning of the heart, liver, intestine and such other vital organs. These organs have an independent functioning of their own and continue to work even outside the human body if given suitable environment. Thus they represent the most primary unicellular life-forms which forms the unit of life. It is a passive activity in response to the environment. The full psychic life where the creative forces of his imagination and reason come into play and launch man's life upon the vast option of creative activity, discovering new factors and shaping the environment to this inner impulses. It is the fullest expression of man on the human platform.
Diagnosis based on this Phenomena
Thus a human being is effected and expresses himself in all these three aspects of his life immaterial of him being healthy or diseased. For the people concerned with man's pathological manifestations, the varied changes and symptoms which are displayed in these three aspects are very important for the diagnosis and treatment. The most sensitive part of a person is psyche. Hence internal symptoms such as malaise, mental images and status, dreams, desires and impulses form the base for evaluating the situation. These factors are accessible to the physician only through close questioning and conversation with the patient. It forms a base of certain degree of observation, introspection and intelligence on the patient's part. In the absence of these factors, the proper appraisement of a diseased condition in its early state is difficult. Thus the psychic disturbances serve as the earliest symptoms that can guide the physician in the diagnosis of a disease condition.
The next stage of diagnosis is referred to be the vegetative aspect of our body-organization. Since these functions are mainly independent of the mind and central nervous system, they evince individual and automatic reactions to the disease affection and try to make suitable adjustments in it. This can manifest in various forms like instinctive inclinations for or against certain tastes, things, diet, heat and cold in order to correct the decrease or increase of a particular structure or function in the body. These two groups of symptoms, whether psychic modifications or instinctive inclinations, are very predominant symptoms which are helpful in the early diagnosis of the disturbed health. Ayurveda has always emphasized on the study of premonitory symptoms which forms an important category in the pentad of diagnostic methods.
The Study of Environment
Life and Environment
To understand the nature and functions of life, it is essential to study and appreciate the factors of environment. Indeed both the factors are one like the two different sides of a coin. To think of life apart from environment is impossible. It can be compared with the light without it's surrounding sphere of illumination. For the medical science in particular, life always run in accordance with it's environment. Every organism, especially man must be understood in the relation to his environment because all his life-functions are engrossed in a continual flux to meet the challenge or reap the benefits of the factors of the environment in the various forms of weather, geographical conditions, nature of soil and its tendencies, bacterial saturation and similar other conditions. In fact, the life of any organism depends on its reactions to the constant or changing environment. Environment is not only its prime cause of being but also responsible for its disorders and perfection. Caraka expresses this truth as a philosophical axiom and asserts that the existence of all the beings is derived from the nature of their reaction to environment.
A continuous existence of all the creatures is dependent on proper, inadequate, excessive or wrong interaction between them and their environmental factors. Their well-being and ill-being or existence and non-existence is dependent on the right degree and nature of contact with environment. Thus in the medical science, man-cum-environment is the unit of study.
Life is not a static condition but a dynamic process of continual adjustment with environment. Time and space which constitutes the environment, are perpetually varying factors of the universe which facilitate the constant vigilance, activity and modification in the reactions of the organism. Caraka therefore uses the various synonyms of life denoting it to be the constantly changing, dynamic and of progressive nature.
Disease factors of Environment
When the organism fails to adjust or adapt due to either some innate deficiency or overwhelming force of the environment, the result is diseased-condition which is the subject matter of medicine. Such environmental factors are known as exogenous disease factors. They are of the nature of space and time which include varying places and positions of things and seasonal variations as well as physical chemical and biological invasions.
The organism can be taught to adjust and prepare against such hostile forces in an extensive way. All these conducive practices of diet, behavior and seasonal regimen that are entitled to be wholesome life in the texts of Ayurveda are formed to help the organism to adjust and overcome these impediments to health from the changing environment. This is a lesson in acquiring immunity against probable antagonistic features of time and space.
Guiding factor in Adaptation
The above is true only in a general sense, because the reaction to environment is different from one individual to another. No two people are the same in looks, tastes and degree of tolerance to heat and cold. Consequently the degrees of their individual adjustment and adaptive reaction must also be different and while trying to bring about similar results, varying methods and degrees of effort have to be pursued. On what does this difference depend? What is the guide in determining the different degree and quality? What causes have brought about these differences in reaction to a common environment? In answer to these questions we stumble upon the central truth of the medical science i. e individual constitution. Complete adjustment of the individual with his environment is possible only on the basis and appreciation of the facts of his individual constitution. It is only by viewing the environment and constitution together that we can accomplish the complete and successful harmony of man with his environment, which is the sole aim and justification of medicine.
V The Study of Constitution
The outstanding fact of life is that no two individuals are exactly alike either in appearance or physical and mental aptitudes, abilities and gifts. This is because each person occupies a point in space-time different from that of every one else. This endows on each person at the very moment of his coming into being, a peculiar group of qualities and tendencies through the genes. Each person thus enters into life with a peculiar viewpoint, mode of reaction to environment and susceptibility to physical and psychic influences. That is why we find that though people live in a common environment no two of them react in identical fashion. The great physican Osier says, No two persons react equally to incursion of injury. No two person suffering from the same disease run exactly similar clinical courses. All this emphasizes the supreme importance of the knowledge of individual constitution in medicine.
It is difficult to say at the present stage of human knowledge, how and what factors go into the making of this unique bundle of tendencies and qualities, why certain ancestral and race traits get to be recessive in one child and 'dominant in another. But that such is the case ts evident from the investigations of Mendel and other scientists who have tried to reduce the subject into a biological law.
Classification of Types
If one is over-scrupulous in statement there are as many types as there are individuals. But that is unhelpful in reducing the subject to some approximate formula. Therefore some biologists and medical scientists have classified these types, racewise, groupwise regionwise and in some other ways. But the inadequacy of these classifications becomes evident from the medical clinicians point of view when individuals of the same race, group or region show divergent reactions and degrees of tolerance to common disease-factors. Hence a totally biological classification and grouping alone is entitled to the clinician�s credence and appreciation.
In the ancient pathology of India and to an approximate degree in that of ancient Greece, such a biological view and classification do obtain In India or constitution has been broadly classified into three groups allowing of innumerable minor groupings according to the varied combinations of these three main categories. This classification was done both from the physiolo�gical and pathological points of view, in the light of the triumvirate of biological organizations. This classification became the guiding spirit of the clinician and the patient in the maintenance of positive health and in prophylactic as well as curative measures of disease. It was also the beacon light in the realm of diagnostics and practical therapeutics.
In the daily regimen of diet and behaviour meant for balancing and correcting the predisposing factors of disease, this constitutional perspective was considered of supreme significance. Caraka says,
A practice of things antagonistic in effect to one�s predisposing factors, is recommended in the whole�some living " (Car Sutra 7-41) This contains the beginnings of the science of immunity in its active aspect where the individual is enabled to react powerfully with all his vital1 power of resistance.
The term �constitution� is used in physiology nearly in the same sense as in sociology wherein it is defined as the fundamental law according to which the government of a state is organized and the relations of individuals with society as a whole are regulated. This regulation is accomplished by the legislature, the administration and the judiciary, all of them co operating with and dependent on each other. Thus it is with the integrated physiology The millions of body-cells, the nervous system, the heart, the lungs and the intestines, all act in a coalition-government and mutually impel and check and balance and produce an integrated and harmonised result that is life and good health. Ayurveda depicts this integrated function in terms of the triumvirate of biological organizations and their mutual interaction.
Prakriti or Constitution in Ayurveda
Constitution is called Prakriti in Ayurveda. It is the sum total of the crystallized results of all the influences of time and space on individual human life. It is easy to see that since no two individuals can occupy the same point in this time space world, no two individuals are identical in all respects. It is now for us to understand the various factors that constitute this time-space in order to ascertain and define its variable influences on constitutions, as also the multiple of its types.
Space connotes the geographical and climatic conditions of the region of the individuals residence and all the characteristics of the social and physical environment of the man, while time; refers to the age of the individual, the seasonal characteristics and the sum total of the influences from the inception of the man commencing from the moment of impregnation of the mother's ovum or even much earlier. The germ-cell contains the tendencies developed through all previous incarnations and thus is traced ultimately to the very beginning of time. It is common knowledge now that the fetus undergoes all the evolutionary metamorphoses of its biological ancestry in the uterus before it emerges as a full-fledged human. Thus the whole experience of the species is in the germ-cell. This is known as genes. The peculiar influence inherited from both the parents and the combination of the formative forces, such as climate, season and environment, obtaining at the time of impregnation - all these, go to shape the constitutional destiny of the individual. The inheritance of previous incarnations, being subtle, is psychic, but they in turn have their influence on the somatic reactions. Thus at birth, a whole world of influences has already been at work in giving the individual a definite predisposition, a definite pattern of tendencies set in motion, which determines his, or her degree of tolerance and resistance to external and internal disease factors. The varying effects of climate on the gravida and her habits and tendencies and social and seasonal environment are bound to have profound consequences and _____. Thus at the very moment of birth, the individual is a complex being, a bundle of tendencies bearing the seal of destiny, with of course, a margin for freedom of will and action.
Constitution is an inherited or genotypical condition, that cannot be altered fundamentally and is a life-long concern and of supreme significance in determining the conditions of health and disease in man. This is well expressed in the following verses of Caraka and Susruta. From the moment of conception some men are equi-balanced as regards the three vitia Vata, Pitta and Kapha and some have a predominance of Vata, some, of Pitta and some of Kapha.
Of them the first alone enjoy perfect health while the rest are ever liable to disease. Their body-habitus is named according to the continual predominance of a particular vitiura in the body.
These are the symptoms of the hereditary disposition or constitution formed by the predominant vital habitus formed at the time of the fertilization of the ovum by the sperm.
There any part of the healthy seed is vitiated by the nature and action of the Vitia, i.e. Vata and the rest, that part of the germ-cell determines the future constitutional type of the person. 
The constitutional condition does not get changed, nor increased nor diminished generally except at the end of life.
Thus the importance of knowledge of constitution is established both in physiology as well as pathology.
Caraka propounds that there are three main classes of persons. They are the Vatala, the Pittala and Slesmala i. e. the one fit Vata habitus, that of Pitta habitus and that of Slesma habitus these are the three main constitutional groups in each of whom one join the triumvirate of biological organizations is predominantly active or pronounced. There are various degrees of combinations of these vitia as these habituses are called of two or three of these being jointly. In a hyper or hypo condition. When the symptoms associated with and characteristic of each of these vitia are known, the degree of their combination can be inferred from them. Laying out the general outline of three main categories of constitution, Caraka declares that in the clinical investigation of these three types of constitution the following are their characteristic traits and qualities.
7. (I) We shall now explain the characteristics of habitus etc. It it thus. The fetal body develops its habitus from the nature of the mother�s diet and behaviour, and the nature of the proto-elemental combinations.
95-(II). Among these factors, whichever elements are predominant, will be observed to influence the nature of the fetus; therefore are men spoken of, as of such and such habitus and vltial susceptibility beginning from their fetal life.
3. �Hence some are of Kapha habitus, some are of Pitta habitus and some of Vata habitus; some are of the combined habitus. Some are possessed of vitial equipoise. The characteristics of these, we shall describe here.
8. (I) The Kapha is unctuous, smooth, soft, sweet, firm, dense, slow, stable, heavy, cold, viscid and clear.
96.(11) Kapha, being unctuous, those of Kapha habitus have glossy limbs; on account of its smoothness they have smooth limbs; owing to its softness they have pleasant, delicate and clear bodies, owing to its sweetness they have a profusion of semen, desire for the sex-act and children. On account of its firmness they have firm, well-knit and stable bodies; owing to the denseness of-Kapha, they are plump and rounded m all their limbs. Owing to its slowness, they are slow in their actions and speech; due to its stability, they are slow in their undertakings and in the change of moods and pathological condition; 'owing to its heaviness, they are of firm, large and stable gait, owing to Its coldness, their hunger, thirst, heat and perspiration are meagre; owing to its viscidity, they are firm and. well-knit in their joints. Similarly owing to its clearness they are of clear looks, of clear and mellow complexion and voice.
9. �Owing to the combination of such qualities, those of Kapha habitus are possessed of strength, wealth, knowledge, vitality, gentleness and long life. (I) Pitta is hot, acute, fluid, raw-meatish in smell, acid and pungent
4. (II) Owing to its heat, those of Pitta habitus are intolerant of heat, very hot in the mouth, of delicate and "clear bodies, and have profuse moles, freckles, spots and pimples on the body, excessive hunger and thirst, are subject to early wrinkles, grey hair and baldness, and are possessed generally of scanty, soft and tawny hair on the head, face and body. Owing to its acuteness, they are possessed of keen valour and acute digestive fire, are given to taking excessive quantity of food and drink, are subject to incapacity to bear suffering, and are constant eaters. Owing to its fluidity they have flabby and soft joints and flesh and profuse discharge of sweat, urine and feces. Owing to its raw meatish smell, they smell very much in their arm-pits, mouth, head and body. Owing to its pungent and acid taste they have a small quantity of semen, limited sex appetite and scanty offspring.
97 Owing to a combination of such qualities those of Pitta habitus are of moderate strength and life-span and of moderate knowledge, experience, wealth and means.
5. (X). Vata is dry, light, unsteady, abundant, swift, cold, rough and clear.
9S-(II) Owing to its dryness, those of Vata habitus are of dry, wasted and small bodies, of long-drawn, dry, low, broken, hollow and hoarse voice, and are always wakeful. Owing to its lighteness, they are light and inconstant of gait, behaviour, diet and speech. Owing to its unsteadiness, they are restless in their joints, eyes, brows/jaws, tongues, heads, shoulders, hands and feet. Due to its abundance, they are given to much talk and have prominent veins and tendons. Owing to its swiftness they are quick in their undertakings and variation of moods and pathological change. They are quickly affected by fear, likes and dislikes. They are quick in grasping and in forgetting too. Owing to its cold quality, they are intolerant of cold, and are greatly liable to suffer cold, shivering and stiffness. Owing to its roughness they have rough hair on the head, face and body, rough nails, teeth, mouth, hands and feet. Owing to its clearness they have cracked limbs and their joints always make noise as they walk.
98. Owing to the combination of such qualities, those of Vata habitus are generally of small strength, short life-span, scanty offspring and means, and of meagre wealth.
10. �In a combined habitus, the qualities are also combined.
11. �Those possessed of the equipoise of triumvirate of vitia are endowed with all the good qualities described. This should one examine from the point of view of habitus.
The perfect equilibrium of this vitia is the norm or perfect health.
Having now the full outline of this triumvirate of vitia that determine the total psycho-somatic texture of man, it is necessary to enter into a more detailed inquiry into the nature and mode of operation of this triumvirate of vitia, and into the justification of their nomenclature.
V Method of Nomenclature
We shall now proceed to study mans behavior in the maintenance of health and in his fight against diseases.
The living organism includes in its category unicellular the tiny speck of undifferential protoplasm as well as the man with his highly differentiated organs, tissues and cells. The cell is the functional and structural unit of life. Many lower forms of lives consist only of a single cell. Moreover, man who is so highly evolved a creature, has commenced his life at the unicellular stage, namely the fertilized ovum. The fundamental phenomena of life are identical in all living organisms.
In unicellular life, structure is hardly visible or definable but life-pbenomena are all the same as those observed in higher forms of life. Though the material form of existence is too insignificant, to be noticeable, it is made up of dynamic systems manifesting ceaseless �activities. These dynamic systems which fully sustain life and carry out effectively life-functions are the three primary organizations. As they are the fundamental physiological systems sustaining life in co-ordination with that insignificant speck of protoplasm they earn the significant name of wig or the upholders, a word derived from the root 'vr to support or sustain'.
In higher life this protoplasm becomes greatly increased in proportion and gets differentiated into various forms in order to carry out the special functions assigned to them; and we find in man several different kinds of tissues or body-elements evolved playing a significant role in the maintenance of the physical body. This differentiation and specialization of tissues is to augment the power of the primary triumvirate of organizations. Hence in man the three primary organizations, Vata, Pitta and Kapha, as well as specialized tissues of his physical body viz, etc, evolved for special functions, are both given equal importance and included in the category of or the upholders or sustainers of life.
The highly logical spirit of that age impelled them to be very accurate and meticulous in all matters, especially in definitions and nomenclature. The human body lives on the food which it ingests everyday. It assimilates out of the food ingested some portion and throws out the rest. Among the primitive unicellular life, this process occurs immediately. But in man with his highly specialized tissues and systems the process of separating the useful from the unuseful material takes place at one region, the process of assimilation at another and that of elimination at yet another region.
The body absorbs according to its needs and capacity, a portion of the useful, the remaining unused aud unuseful portion is gradually thrown out by the body. The process of elimination takes some time in the complex machinery of the human body. The matter separated for elimination is often useful and definitely not harmful. In the usual course and which during its sojourn through the excretory channels may be even rendering some service to the body-elements, or body-organizations. Thus this waste matter meant for ultimate elimination, though not forming a part of the regular body-elements, does exist in the body enjoying perfect health and is probably rendering service to it. Hence it is also included in the category of in a general way though it Is usually given the significant name of or waste matter in particular.
Thus the word Dhatu includes in its category:
12. The primary three functional organizations, i.e. the triumvirate which is the primary organization in each and every unit of life.
13. . The seven body-elements or tissues of the physical body and structural systems evolved to augment and refine the work of the primary organizations of the triumvirate.
14. . The waste or excretory material, healthful in action.
All the Dhatus may become vitiated and may vitiate locally their neighbouring parts, but the general vitiators of the whole body are the triumvirate of organizations. This generalized or vitiating nature is the most common in the triumvirate organization because they are all-persuasive and in constant action to maintain perfect effectiveness of the whole body in ever changing environmental factors,
Thus the word dosa is used for:
6. . The three biological organizations of triumvirate.
7. Secretions and excretions, which are formed as immediate, intermediary or end products as the result of the functioning, of these three biological organizations are also identified with Dosa toxic matter and are often termed Dosa.
(3) Mala or the waste matter is also often designated. Dosa as its dominant quality is to pollute.
The word (Mala) is also used in two senses:
- The end-products of the digestive process are classified in two parts: one that is assimilated in the body and which becomes a part of the body elements is called Prasad while the other part not so assimilated gets converted into some secretory and excretoy products serving some auxiliary purpose in the body-functions and gets finally disposed of or eliminated from the body. This is called Mala or unclean matter. But this being the normal or physiological function, this or Mala waste matter is included under the term Dhatu or upholder of body.
- The other meaning of mala as given in Caraka is all morbid matter in the body which is harmful to it. Under this heading the author puts the following things,
a. Excretory matter issuing outwards from the orifices of the body in various forms.
b. Over-mature body-elements.
c. Irritated Vata, Pitta and Kapha.
d. Such other things residing in the body tending to injure it.
Thus healthful Mala is un-assimilated portion of food ingested, existing in the healthy body while harmful Mala is harmful matter of any kind existing in the body and doing harm to it. The word 'Dosa; is derived from Drup to vitiate or pollute, to become impure, to be bad or corrupted.
Each or all the Dhatus or upholders of the body just described viz , the triumvirate organization, body-tissues and the excretory and secretory matter become vitiated in disease condition. But the main part as vitiator is played by the triumvirate organization. Once they are vitiated, they spread their vitiating effects to all the other body-parts and channels, for they are pervading in the whole body.
The vitiated body-channels spread the corruption to other body-channels alone, and the vitiated body-elements to other body elements where as the three vitia, Vata, Pitta, and Kapha, if vitiated, pollute the entire organism, being as they are of a vitiating nature.
Vata, Pitta and Kapha moving in the whole body produce good and ill effects on the entire system according as they are normal or provoked.
From the definitions of Dosa, Dhatu and Mala discussed above, we see that the term Dosa is used:
15. . Mainly for the three primary organizations which are specially liable to be disorganized and which spread their effects in the whole body and vitiate any or all other parts of the body.
16. . The body secretions pertaining to the functions of each of the triumvirate organization are given the same term as Vata, Pitta and Kapha, the physilogical triumvirate of organizations. As for example
Just after ingestion, the food prepared from the sis categories of tastes becomes first sweet of taste being digested and leads to the formation of Kapha or of mucus-like fluid which is of frothy appearance.
Further digestion being continued, the food becomes acid in the next stage of digestion and while it is coming out of the stomach it excites the secretion of limpid bile.
Thus the food having reached the large intestines and being dehydrated by the body-heat, is converted into fecal lumps. These being of pungent taste, there occurs increase of Vata.
(3) Excretory matters, normal or abnormal pertaining either to the functioning of the triumvirate organization or to the secretory products related to those primary organizations, are given the same designation of Dosa in general and of Vata, Pitta and Kapha in particular.
These, drugs should be used as emetic by the physician in a way not harmful to the body in gastrogenic disorders characterized by morbid accumulations of Kapha and Pitta.
Those should be prescribed for purgation when the morbid matter has accumulated in the colon.
Evacuate enema, if given when the morbid matter has been fully digested, will immediately increase the vitality and digestive power and produce apyrexia, good cheer and appetite. Laxation will eliminate Pitta or Kapha, Pitta lodged in the habitat of the Pitta, while enemata will eliminate all the three kinds of morbid matter lodged in the colon.
In the last verse cited above Vata etc are used in their excretory aspect. Thus in order to avoid ambiguity in sense, a thing is given a specific designation in view of its preponderant or special tendency towards a form or function.
These vitia are go called because they are considerd to be the first things to be modified or morbified by diet, behaviour or other environmental factors, or by internal factors of emotions, restraint of natural urges etc. They do not stop at that, but once they are themselves morbified they proceed to vitiate gradually any of the seven body-elements. Thus these vitia are by virtue of their high degree of susceptibility to vitiation and also by virtue, of their active tendency to contaminate the body-elements, are specially designated as vitia owing to their doubly condemnable vice. But these very vitia, when in their normal unvitiated state, support, enliven and rear the other elements of the body and are a source of the blessings of health and happiness. They then are indeed the basic elements, the rock-bottom of life in man and though termed vitia owing to their extreme liability to vitiate, deserve to be called the elements. In their balanced state they are indeed Dhatus, but for convenience of exposition and uniformity of application they are called vitia even in their benevolent or sanagenic state. In their morbified state they are pathogenic and in a science dealing primarily with the pathogenic factors and their various manifestations and operations it is convenient to fix them up in their pathological state and refer to their physiological status too by the same term prefixed by its non-morbid quality. Thus the unvitiated vitium; is called the vitium in its normal state, and the vitiated one as the morbid vitium. Etymologically, it is interesting to know that the Greek prefix dys as in dysfunction, dysuria, dyspepsia etc, is akin to Sanskrit dus meaning to be bad, corrupted, spoiled or vitiated.
Samgadhara summarizes the three aspects of these vitia in a terse thus: "Vata, Pitta and Kapha are called vitia because they vitiate the body, they are called body-elements or supports because they uphold the body, and they are also known as waste or toxic matter because they pollute the body.
Thus in order to use a specific terminology the words dhatu and Mala are generally used in the following sense.
Dosa - The triumvirate of body-organizations or the triad of vitia
Dhatu - The body-elements
Mala - The waste or toxic matter.
VII The Nature and Functions of the Body Triymvirate
Vata, Pitta and Kapha are the names of the three organizations of the body known as the 'Triumvirate'. Their individual nature, function and mode of operation have been till now discussed in a general way. Now we shall try to review them in greater detail from physiological, pathological, clinical and therapeutic points of view.
The General Nature and Concept of the Triumvirate
The three organizations of the triumvirate are the very warp and woof of the texture of life. The triumvirate is considered the sole support of the body. Its physiological or pathological condition is the root cause of existence or dissolution of the body Susruta significantly remarks:
It is Vata, Pitta and Slesma alone that bring the body into being. This body is upborne by them in their normal or healthy state established in the lower, the middle and the upper regions of the body respectively, even as a hut is upheld by three poles. Therefore are these called the three poles or supports.
Thus these three organizations, though viewed individually for the purpose of a clear grasp of their peculiar nature and functions, must yet be appreciated in their united and integrated whole as mutually checking and balancing forces in the body. Their sanagenic influence is due to their integrated mode of functioning.
Caraka says that when the triumvirate is in its normal or physiological condition, the man enjoys perfect health; and when it is in the abnormal or pathological state the man suffers from disease.
To be correct, it is all the three Vata, Pitta and Kapha in their normal condition that combine to make a man whole of his senses, possessed of strength, good complexion and ease and assured of great longevity, even as the triad of Dharma, Artha and Kama, when properly cherished, secure for him the highest good both here and in the other world. The same three if rendered morbid, bring upon the man great tribulation.
And the vitia are three: Vata, Pitta and Kapha. When normal they cause the proper functioning of the body, when they have become abnormal they certainly afflict the body by causing disorders of various types. Caraka further states that the triumvirate is ever present in the body either in physiological state or the pathological state. Vata, Pitta and Kapha, reside either in their normal or pathological state in the bodies of all creatures. Hence the learned physician should desire to recognise them.
The importance of the triumvirate in supporting the body is well brought home by Susruta in the following simile. Just as the moon, sun and wind uphold the world by their action of release, absorption and dissemination respectively even so do Kapha, Pitta and Vata act with regard to the body.
The triumvirate is all-pervasive and circulate to every part of the body. As the vitia are circulating in the entire body, their normal or provoked condition gives rise to good or bad health respectively. Vata, Pitta and Kapha moving in the whole body produce good or ill effects on the entire system, according as they are normal or provoked. The function of the triumvirate is integrative though pentad of foci are described for each vitium where dominance of the function of that particular vitium is observed.
Susruta states "The fivefold Vata upholds the body by its characteristic functions of throbbing, transmission filing up, separation and retention."
The fivefold Pitta which causes pigmentation, digestion, vital essence, lustre, intelligence and heat, nourishes the body by its thermogenic function. The fivefold Slesma which causes the cohesion of the joints, unctuousness, growth, replenishment, strength and firmness, nourishes the body by its (colloidal) watering function.
Vagbhata says, "Thus the focal places of this generally all-pervasive vitia are to be known as also the different actions of the vitia.
Pentad of foci of each of the vitia has great diagnostic importance as the signs of discondance of the vitia are manifested first and certainty in their respective pentad of foci. Thus it helps to diagnose the disease in its earliest stage. Caraka states-
The Vata necessarily gets increased in its own habitat consequent upon the decrease of Kapha. Moreover the general line of treatment shall have to be modified when it is to be practically applied to disease conditions originating in or affecting dominantly the particular pentad of foci.
Vagbhata says- "Therefore special line of therapeutics has to be pursued to suit the special site of affection."
Vata we know as the vital, mobile and motivating principle of all life functions Its pervasion is throughout the body, for no part or cell of the body can function without its motivation. Its function is to cause all movement including that of the conveying of sense- impressions and thought and emotional impulses. Thus all neuro-muscular activity, voluntary as well as involuntary is at its bidding and all sense functions that form the very basis of life-play are the functions of Vata. All the life-functions including the daily metabolic processes of maintaining the proportion and tone of body-elements belong to Vata. It is indeed the verv life-principle, the overlord of the body. That is why Atreya calls it Prabhu and tone the all controller of the body.
The Actions of the Organizations of Normal Vata as described by Caraka.
1. The Vata is the upholder of both, structure and function in the body.
2. It is the very self of the five forms of Vata in the body viz., Prana, Udana, Samana, Vyana and Apana.
3. It is the impeller of upward and downward movements.
4. The controller and conductor of the mind.
5. The inspiritor of all the senses.
6. The convener of all the sense-stimuli.
7. The marshaller of the body elements.
8. The synthesizing principle in the body.
9. The impeller of speech.
10. The cause of feeling and audition.
11. The source of the auditory and tactile senses
12. The origin of all excitation and animation.
13. The stimulator of the gastric fire
14. The desiccator of the morbid vitia.
15. The eliminator of excrement.
16. The deobstruent of the gross and subtle body-channels.
17. The modeller of the fetal form
18. The sustaining principle of life.
Caraka describes the functions of Vaata in short as follows:
"Actions of the normal Vata are animation, inspiration and expiration (respiratory movement), body movement, regular circulation of body elements and regular elimination of excrections. And finally lie makes an aphoristic statement all-comprehensive of the function of Vata. All the life-activities of the body are performed by the normal Vata which is said to be the life of living beings.
Susruta describes the function of Vata as under:
The five-fold Vata upholds the body by its characteristic functions of throbbing, transmission, filling up, separation and retention.
Vata is given the supreme importance in the series of the triumvirate. Caraka says: "Vayu is life and vitality, Vayu is the supporter of all embodied beings, Vayu is verily the whole universe, and Vayu is the lord of all Thus is Vayu extolled.
Susruta describes Vata or Vayu in a highly eulogistic words. Vayu is praised as the seif born and worshipful one. As it is free, eternal and all-pervasive, it is the soul of all beings and worshiped by all the world. It is the cause of the creation, subsistence and dissolution of all beings.
The supreme status of Vata may be also attributed to its being the propeller and director of the movement of the other two members of the triumvirate: Pitta is lame, Kapha is lame and lame too are the excretions and the body-elements. These, like a cloud, go wherever they are carried by Vayu wind or Vata.
Pitta is indeed the thermal element or element of fire. The integrative organization of it does the following functions in the body.
Caraka states: It is Agni (Fire) alone that is immanent in the Pitta.
Susruta, in reply to a pertinent question raised by the pupil whether Pitta is different from fire-element or whether Pitta and fire- element are one and the same, declares: There is known to be no fire other than Pitta in the body.
This, as has already been stated, is the organization of the thermal balance of the body It is the total thermal function or process going on in the body including all the secretions internal or external that go to build up the metabolic process and maintenance of the thermal optimum necessary for the preservation and growth of all life-processes.
It has also the further function of giving coloration or of pigmentation the body-elements such as redness in the blood, flesh and marrow and the pigmentation of the excretions like feces and urine. The Pitta of the liver and the spleen is known as the pigmenting aspect of the thermal organization (Pitta). It is said to cause the red pigmentation of the nutrient fluid.
The actions of normal Pitta are described as follows: It is Agni (fire) alone that, located in the Pitta, gives rise to good and evil consequences according as it is in a normal or abnormal condition. These consequences are digestion and indigestion; vision and loss of vision; the normality and abnormality of temperature, the healthy and diseased look, intrepidity and fear, anger and delight, confusion and lucidity and such other pairs of opposite qualities.
It is by the heat of Pitta that digestion takes place in men, and when that very Pitta is in a provoked condition, is causes various diseases. Actions of the normal Pitta are power of vision, digestive fire, body-heat, hunger, thirst, softness of body, lustre, clarity of mind and intelligence.
Susruta describes the function of Pitta organization as under: The fivefold Pitta which is causative of pigmentation, digestion, vital essence, lustre, intelligence and heat nourishes (the body) by its thermogenic function.
Caraka calls Slesma, the colloidal water in the body as Soma. It is already described as the fluid matrix for the play of life. It is the living fluid or the protoplasm in which all the operations of life are made possible, it really serves as the stage for life.
Slesma holds the joints together, does all cohesive, nutritive, developing and stabilizing functions It promotes the well-being of the body by its watering activity. It thus supplies the living waters for the roots of life. In its physiological aspect it is the strength and stamina of man but becomes an impurity fit to be eliminated when it is vitiated.
It is Soma (the water-element) alone, located in the Kapha of the body, that gives rise to good and evil consequences.
The normal Kapha constitutes the body-strength while the morbidised. Kapha becomes a vitiated element It is said to be the vital essence of the body when normal, while it is described to be the source of ailment when morbid. Actions of the normal Kapha are causing viscousness, cohesion, firmness, heaviness, potency, strength, forgiveness, fortitude and greed.
The fivefold Slesma which is causative of the cohesion of the joints, unctuousness, growth, replenishment, strength and firmness, nourishes (the body) by its (colloidal) watering function.
These very physiological organizations when they become dis organized and vitiated behave pathologically in the body. We need not repeat the whole references as they are already quoted in previous pages. We shall give only the reference of chapter and verse.
Vimana 1 - 5
Susruta Sutra 21 - 3
Disease conditions produced by the pathological behavior of each member of the triumvirate:
Caraka describes the following disease condition produced when Vata behaves pathologically. When however, the Vata becomes abnormal in the body, it afflicts the organism with diverse kinds of disorders, tending to impair its strength, complexion, well-being and life, it depresses the mind; impairs all the senses; destroys the fetus in utero, produces deformity in it, or unduly prolongs the period of gestation gives rise to fear, grief, stupefaction, depression of the spirits and delirium and obstructs the vital functions.
He further states that abnormal functioning of Vata is the root cause in the following disease conditions.
They are - subluxation, dislocation, dilatation, contraction, laxation, depression, excitation, attraction, tremor, circular movement, motion, pricking pain, aching pain and movement, as also coarseness, harshness, clearness, porousness, dusky-redness, astringent taste, dsgeusia, dehydration, aching pains, numbness, contractions, rigidity, lameness, etc. These are the effects produced on the body by the actions of Vata. The condition accompanied with any of these signs or symptoms should be diagnosed as a Vata-disorder. And later on Caraka mentions some conditions that can be produced by Vata when it becomes located in particular regions or organs.
Burning, heat, suppuration, perspiration, softening, sloughing, itching, discharge, redness and the emanation of smell, color and taste are the effects produced on the body by the action of Pitta. Conditions accompanied with any of these symptoms should be diagnosed as a Pitta-disorder.
Caraka attributes the following conditions of health and disease to the physiological and pathological behaviour respectively of the Kapha. It is Soma (the water-element) alone, located in the Kapha of the body, that gives rise to good and evil consequences, according as it is m normal or abnormal condition. These are: compactness and flabbiness, plumpness and emaciation, zest and lassitude, virility and impotence, knowledge and ignorance, understanding and stupe�faction and such other pairs of opposite qualities. Caraka Sutra 12, 12</ref>
Moreover the following conditions will occur when the function of Kapha organization is deranged. Whiteness, coldness, itching, fixity, heaviness, unctuousness, numbness, humidity, excretory secretion, obstruction, sweetness and chronicity are the effects produced in the body by the action of Kapha. The condition accompanied with any of the above symptoms should be diagnosed as a Kapha-disorder.
Clinical Manifestations and their Interpretation in Physical Qualities
When one of the triumvirate is deranged or thrown off its norm, it invariably affects the balance of the other organizations ana thus setsin motion the triad of vitia operating in disease-conditions with one or two of them in a relatively pre-ponderant condition. When two vitia are provoked and act in combination, the condition is called or bi-discordance. When all the three are provoked and combine together to produce the disease, the condition is called tridiscordance. Such discordance of the triumvirate will give rise to clinical manifestation of physical signs which will be observed either in the whole body or in is parts viz., body-elements, secretions or excretions, in the form of exaggerated, diminished or deranged physical qualities.
The clinical investigation of a disease-aspect was thus always in terms of qualities augmented or diminished by the effect of the vitium and the determination of the treatment was for the specific quality aspect of the vitium or the vitia concerned. Thus the equation between the nature and degree of the symptom and the drug called for, was the main feature of clinical investigations. The pathological processes were recognized by the effects associated with the vitia in their operation on the psycho-somatic whole.
In psychic disorders the immediate intermediary and terminal results produced on the psyche by the various processes of each of the triumvirate in health and disease were observed minutely and correlated with the particular phase of the vitium as well as with the secondary changes in the physical body. The psychic symptoms included changes in character, behaviour, proclivities, inclination, urges, dreams etc.
In somatic disorders similar examination was made of the physical body. All body-tissues and systems were physically examined also all the secretions and excretions of the body were thoroughly examined. The results obtained by all these examinations were correlated with the particular phase of the vitium or vitia and were also coordinated with the secondary psychic changes.
The final results of all these examinations were reduced to and interpreted in quality equation for simplification of the methods of physical examination and of practical therapeutics. What the main physical qualities observed in the body signifying the presence or dominance of each of the triumvirate are and what the principles of practical therapeutics should be to counteract the over-dominance of that vitium are briefly but clearly described in the following three verses by Caraka. Vata is dry, cold, light, subtle, unstable, clear and rough; it is quieted by substances of antagonistic qualities.
Pitta is slightly unctuous, hot, acute, fluid, acid, mobile and pungent; it is readily quieted by substances of antagonistic qualities. Kapha is heavy, cold, soft, unctuous, sweet, stable and viscid; it is quieted by substances of antagonistic qualities.
All pathological conditions are grouped under two headings. 17. Imbalance condition due to increase or decrease 18. Vitiation condition
This is brought about by simple process of increase or decrease either in the function or the structure of the body. It is a minor pathological condition of hyper or hypo state, being merely deviation from the normal constant of the body-function or structure.
It will however cause some disturbance in the mutually well balanced state between the various functional and structural systems of the body. This disturbance of the equilibrium or balanced state is the imbalance condition.
This is the real or major pathological condition brought about by the vitial reaction or vitiation process. The triumvirate of organizations having passed beyond-the imbalance stage, become disorganized and turn into irritants and tend to vitiate the whole or part of the body functions or structures.
How constitutional factors of the individual resist the incursion of harmful factors in the body, how one, two, or all three vitia get provoked, irritated or inflamed, or get vitiated by endogenous or exogenous factors, how they overpower the whole body when all of them get highly provoked, how when not so highly provoked they circulate in the body and get located in susceptible parts, how the Constitution of local part reacts to and, legists these irritant vitia and what are the terminations of this struggle between the body and the noxious factors, make the most marvelous story of biological activities in Man
VIII Imbalance Condition Due to Increase or Decrease
Imbalance condition brought about by the increase or decrease of functional or structural system either in tempo or quantum is a simple pathological, process mainly concerned with the particular system affected. It is of greater importance from the point of view of maintenance of perfect health. It results generally from errors of regimen of personal hygiene and it. Can often be rectified and certainly prevented by careful observance of rules of personal regimen. If the condition of imbalance is allowed to progress further, it will lead to the next stage of vitiation process. The causes of imbalance are mainly some faults either in the natural environments of man or some faults in the observance of personal regimen.
Caraka states in general the causes of balance and imbalance conditions as under: The complex of causes with reference to disease, psychic and somatic, is either erroneous, inadequate or excessive interaction of time, mind, senses and sense-objects. The body and that which , is called the mind are both considered to be the abodes of diseases, likewise of well-being, right contact or interaction of the above is the cause of well-being. The cause of well-being is the harmonious or concordant interaction.
Homologous environmental factors maintain health, any variation disturbs the balance constant. The first factor is i.e. climatic or seasonal environment. India has three definite seasons in a year with specific characteristics of each i e. winter, summer and rainy season, with the dominance of cold, heat, and humidity respectively.
The body has to adjust its balance-constant in conformity with this periodic climatic changes. Thus imbalance can occur in two ways: 19. If climatic variations are not happening in a natural or normal way but become too intense or weak or perverted and the reserve power of the man's constitution cannot cope with such variations and hence the balance of his body-constants cannot be steadied or stabilized, the condition of Imbalance occurs. 20. Or the condition of imbalance may occur even with normality of natural climatic environment if body vitality has been lowered by age, disease or any other factor.
The- second factor is i. e. intelligence. This is further expounded by Caraka as follows: Misunderstanding by the intellect and wrongful conduct are to be understood as volitional transgression, because they-come under the ken of the mind.
Owing to the perception of things, in a manner that is contrary to their real state of existence, there result wrongful speech and conduct. Here the vital relationship subsisting between psychic and somatic life is clearly emphasized. Thus a somatic transgression has psychic repercussions and likewise psychic transgressions lead to somatic disturbances. Therefore volitional transgression of either kind leads to disorders affecting the entire psycho-somatic unit. The third factor is sense-objects.
These sense-objects are items of diet and pleasures of the senses, involving the diet and behavior of Man. The sense-object of taste is food and those of sight, smell, hearing and touch constitute pleasures of art, beauty, music and love; in all these contacts, moderation and agreeability to one's nature and capacity should be the guiding factors. Transgression of the bounds of moderation and agreeability relatively to one's nature and capacity are bound to lead to psycho-somatic strain and discordance resulting in disease.
Practical wisdom is discerned in the precept of Caraka who advises to prescribe personal regimen in accordance with individual constitution so that a person can ever maintain the absolute standard of perfect health. Having regard to the rules of healthful living, in the case of those who are characterized by the predominance of one vitium, the use of things antagonistic in quality to that particular vitium is beneficial. The causes of increase and decrease of body-elements is given by Caraka as follows: In this very manner, there is increase of the tendencies of the body-elements by the accession of like factors and decrease by the accession of unlike factors.
The mode of action of these causes of increase and decrease is described as follows by its qualities, by the nature of substances, by its specific action and by its normal action. All the functions and structures that sustain the body will be affected by this pathological condition of increase or decrease. The functions and body structures which sustain the body are described by Susruta as follows: The body indeed has its root-support in the vitia, the body- elements and the excretory substance. So there can be increase or decrease condition of any of them; and such change in turn will disturb the equilibrium between the various functional and structural systems of the body and will cause imbalance condition. The Dosas are three viz., Vata, Pitta, Kapha. The Dhatus are seven viz., Nutrient fluid, blood, flesh, fat, bone-marrow and semen.
The Mala are feces, urine, sweat, menstrual fluid, bile etc. The signs and symptoms produced by these conditions of increase and decrease in each of them are carefully observed and described in great detail in the classics of Ayurveda and the therapeutic measures given to rectify each condition. We replenish body-elements that have suffered decrease, and deplete those that have undergone increase.
The superb level to which the clinical science and practical therapeutics of the ancients had advanced becomes evident from the following verse of Susruta. The person whose vitia, body-elements, excretory matter and body-strength have suffered diminution, craves for such varieties of food as are the sources of these diminished objects. By satisfying the yearning for the type of food which supply those deficient constituents of the body, their diminution is corrected.
Vagbhata says: Whatever type of food a person dislikes and whatever he craves for, by avoiding and satisfying these respectively should he correct the excess and paucity respectively of the body-constituents. That this Imbalance condition due to increase or decrease has greater importance in the maintenance of positive and perfect health becomes evident when we find the 15th chapter of Sutrasthana which is devoted to the description of the condition of vruddhi and Kshaya by Susruta, ends with the masterly definition of perfect health.
He that is possessed of the proper balance of the vitia, the metabolic heat, the body-elements and the excretory functions and who is possessed of absolute clarity of the spirit, the senses and the mind, is said to be enjoying perfect health.
IX Vitiation process
When the imbalance condition of the triumvirate transgresses a particular limit of accumulation there happens disorganization of the triumvirate of organizations. As a result of rupture of the integrative functions of these, organizations, the circulation and distribution of these dynamic functional principles become irregular and misdirected. If at such unfavorable moment, there occurs the incidence of some exciting factor, the vitium or vitia become upset, provoked and vitiated and assume the vitiating mood. The body as a whole or some part of it may not tolerate the provoked, angry and vitiating character of the vitium and becomes irritated and thus the organization that was sustaining the very health of the body becomes an irritant and a pathogenic factor at this moment. This stage is called the stage of provocation of the vitia.
Vitiation Process or Pathogenesis
This is the real or major pathogenesis. It is quite different from minor pathological condition or imbalance condition brought about by the simple process of increase or decrease which is mere variation in quantity. It is a quantitative change, while the vitiation process is the morbid modification of the qualities dr functions of the triumvirate of organizations. It is a qualitative change in the functions of the vitia. The vitial pathological process is the drama of action and reaction of the triumvirate or the phenomena manifested in the body by them when once they are converted into pathological state from their physiological state.
The hero who rules and protects the body is encroached upon or assailed by vicious or malevolent exciting factors. These immediate exciting etiological factors may come from endogenous or exogenous sources and the battle-royal issues between the triumvirate and the etiological factors. The hero, the triumvirate, marshals all his forces and equipment and destroys the enemies or nullifies their injurious influences. But if the enemies turn out to be stronger than the hero or the incidence of attack is too sudden, the issue will be otherwise. The triumvirate will be vitiated and it will carry out vitiation all over the body.
The intensity and periodicity and results of this process depend upon the strength of etiological factors, vital triumvirate and of body-elements and the extraneous help them receives and the method of fight they adopt.
The following types of disease-conditions may be produced by vitiation pathogenesis. 21. Vitiation process spreads with all intensity and affects the entire body; the body gives no or poor resistance. There will be acute general disease-condition.
22. Vitiation process is strong enough to affect the whole body, but the body vitality encounters the incursion with nearly equal force, a prolonged fight ensues with fluctuation on either side; vitiation process waxing and waning according to the extraneous circumstances.
23. Vitiation process does not affect the whole body but becomes located in some system, part, organ or tissues; vitiation process begins to spread, the constitution of the local tissues tries to resist and local inflammatory reaction results. If the fight is acutely carried out there will result acute inflammation of the part.
24. If the local vitiation process is slow in progress there will be chronic inflammation.
This is a brief account of the interplay of triumvirate in the vitiation process that may affect the whole body or part of it and the clinical phenomena of various disease-conditions that may be produced by this vitiation pathogenesis. Having taken a bird's eye-view of the significant facts of vitiation pathogenesis and co-related disease conditions produced by them we shall endeavor to study the vitiation pathogenesis, stage by stage, and its intricate details regarding beginning, gradual or sudden evolution, development and final termination so as to have a more intimate understanding of the pathological process which may guide the practical application of therapeutic measures. The importance given by the ancient authors to the complete study of the pathological process in the understanding of disease-condition becomes quite evident in the aphoristic statement of Caraka. The knowledge of disease is obtained by the study of the following.
- Premonitory symptoms
- Signs and symptoms
- Homologatory signs
Thus it is considered one of the five methods necessary for the diagnosis of disease-condition. Moreover this fifth method is detailed and subdivided in various ways to have a thorough knowledge of pathogenesis. Pathogenesis is again classified according to number, predominant morbid humor, mode of classification, minutia and period of exacerbation. The very word Samprapti is indicative of all-comprehensiveness of the process of pathogenesis.
Susruta divides the vitiation pathogenesis process in six stages they are as follows: He who knows the various stages of pathogenesis viz, stage of accumulation, provocation, diffusion, location, manifestation and termination is entitled to be a physician.
- It is a term introduced by the author in 1925.
- Caraka Sutra 1, 15-17
- Caraka Sutra 1-25
- Caraka Samhita Sutra 30, 84
- Caraka Vimāna 4-5
- Caraka Sutra 11-26
- Caraka Sutra 26-12
- It has been declared in the Veda.
- Here nature refers to mother Nature.
- He was the man of Ayurvedic knowledge.
- Caraka Sutra 1, 41
- Caraka Sutra 1, 48
- Bṛhad 5-5
- Nārāyaṇa Upaniṣad 1-1
- These interferences are Homeostasis of Cannon.
- Thales of Greece and the Seers of India
- Caraka Sutra 12-8
- Caraka Sutra 11-44
- Caraka Sutra 7, 39-40
- Susruta Sarira 4-63
- It means germ-cell.
- Commentary by Dalhana on the above verse.
- Susruta Sarira 4-78
- Caraka Vimana 8
- It means clean matter.
- Caraka Sutra. 28, 4
- Sarira 6-17
- Caraka Vimana 5, 9
- Caraka Sutra 20, 9
- Car. Cik 15-9
- Caraka Cikitsa 15-10
- Caraka Cikitsa 15-11
- Caraka Sutra 2, 8
- Caraka Sutra 2, 10
- Caraka Vimana 3, 170-171
- Caraka Sutra 12,13
- Sar Pu. 5 24
- Susruta Sutra 21-3
- Caraka Sutra 12,13
- Caraka Vimana 1, 5
- Caraka Sutra 18, 48
- Susruta Sutra 21-8
- Caraka Sutra 20-9
- Susruta Sutra 15, 4
- With the reference to these foci.
- Caraka Cikitsa 19, 121
- Astanga Sang Sutra, 23
- Caraka Sutra 12, 8
- Caraka Sutra. 18-49
- Caraka Sutra, 17,118
- Caraka Cikitsa 28, 3
- Susruta Nidrana 1, 5-6
- Sarn Pu 5,25
- Susrata Sutra 21-10
- Caraka Sutra 12 - 13, 18 - 48, 20 - 9
- Caraka Sutra 20, 15
- Caraka Sutra 20,18
- Caraka Sutra 1,59-61
- Caraka Sutra 1, 54-55
- Caraka Sarira 1-109
- Commentary on the above verse by Cakrapani
- Caraka Sutra 7, 41
- Caraka sarira 6, 10
- Susruta Sutra 15, 32-33
- Astanga Hridaya Sutra 11,42
- Susruta Sutra 15-44
- Caraka Nidana 1, 6
- Caraka Nidana 1, 12/1
- Susruta Sutra 21,36
- The Caraka Samhita published by Shree Gulabkunverba Ayurvedic Society, Jamnagar, India