- 1 Preface
- 2 Accumulation Phase
- 3 II The Stage of Provocation
- 4 III Stage of Diffusion
- 5 IV. The Stage of Location
- 6 V. The Stage of Manifestation
- 6.1 Classification of Disease
- 6.2 Categories of General Disease
- 6.3 Categories of Local Diseases
- 6.4 Acute General
- 6.5 Chronic General
- 6.6 Local Diseased Condition
- 6.7 Local Acute Inflammatory Condition
- 6.8 Local Chronic Inflammatory Condition
- 6.9 Controversy on Blood
- 6.10 Classification of Inflammation
- 6.11 Pathogenic Symptoms of the Triumvirate
- 6.12 Significance of Vaso-Neuropathy
- 7 VI The Stage of Termination
- 8 The Concept of Epidemic and Pandemic Diseases
- 9 Concept of Sources and Spread of infection or Contagion
- 10 Concept of Growth and Action of Morbific elements in the Body
- 11 Abnormal Conditions of Body-appearance
- 12 Significance of Knowledge of Disease Constitution for the Practical Therapeutics
- 13 Administration of Drug in Ancient Times
- 14 The Soil
- 15 The Etiological Factors of the Disease
- 16 XII NOSOLOGY AND THE TRIUMVIRATE
- 17 References
The whole vitiation process is divided into various stages of its happening. They can be demarcated by the action or course going on at the each stage of whole process. It is apportioned into six phases of its operation as follows:
Stage of decrease will manifest the signs and symptoms of deficiency either at the local space or localized action while the stage of increase has many far-reaching effects. Increased quantity needs to be accommodated somewhere and the body being a defined space if there is any more pressure at a particular space it does not bear it. Some kind of irregularity or disorder definitely occurs in the body.
If any material increases in a particular local part of the body, there may be an increase or growth of that particular tissue. This activity may disturb the neighboring tissues and cause inconvenience by the mechanical pressure. But the increase and continued accumulation of the dynamic force of the triumvirate, which are all-pervasive and whose equilibrium is maintained on a very subtle fulcrum, can be tolerated only to a limited extent. It cannot be transgressed beyond it's capacity.
This stage may or may not produce actual disease condition but definitely serve as a catalyst in predisposing traumatic condition or other etiological factors which act as an immediate excitant to the triumvirate, herald the vitiation process and usher in the incursion of the diseased condition. The general postulate of diagnosis of the stages of increase and decrease of the function of triumvirate is described in the passages below.
The signs of decrease of Vāta, Pitta and Kapha are described to denote the decrease of their respective actions. There may be either the loss of their normal functions or increase on the contrary ones. Increase of natural actions is the position indicated in the increase of humors. The decrease and increase of humors are diagnosed in this manner.
Susruta describes some more definite premonitory symptoms when triumvirate imbalance is just on the threshold of vitiation. Recognition of these pre-dominant symptoms is given a lot of importance by the author who considers this stage as the first or the earliest therapeutic period. In this, the vitia gets accumulated. The symptoms of accumulated vitia are:
- Stiffness and fullness of abdomen due to Vāta
- Yellow tinge of the skin due to Pitta
- Low temperature
- Heaviness of limbs
- Lethargy due to Kapha
- Instinct of repugnance
The above mentioned indications are the causative factors of accumulation of the respective vitia. This is the first stage for the treatment. Careful personal regimen and simple prophylactic measures will completely ward of the primary symptoms and the incidence of the diseased condition to some extent, if the condition is recognized at a very preliminary stage and treatment is started immediately.
II The Stage of Provocation
This is the stage of the provocation of the triumvirate members. It is generally subsequent to the triumvirate having increased to the maximum point of increase or decrease and being irritated or provoked at this moment by an extraneous excitant etiological factor whether they are endogenous or exogenous. This provocative reaction also may occur without previous imbalance condition, if the immediate excitant factor is too strong for the triumvirate for the adaptive reaction.
Incidence of additional pathogenetic factor to be over-stressed and imbalanced triumvirate, produces baneful poisonous or toxic effect on that body. Triumvirate come easily under the influence of these newly produced toxic effects in them and get themselves intoxicated and thence become vitiated. Once vitiated, it loses self-control and forgets it's normal behavior and functions. It becomes erratic, irregular, disorganized, abnormal and morbific in function.
These triumvirate members who are the savior of the body reacts to damage the body. It generally has positive effects on the physiology but starts reacting negatively on the pathology. It being itself vitiated, spreads the maleficent effects all over the body and causes vitiation of body-elements or body-channels wherever possible. When it is fully intoxicated or vitiated, it behaves as if possessed by the hostile existent and starts harming the body. This tragic conversion of the benevolent triumvirate into malevolent is the beginning of the real vitiation pathogenesis. This provoked condition is indeed the initiation of the diseased stage and the culmination of diffusion, location, manifestation and termination are the further development of the provoked vitium.
If during the termination of this pathological process, vitiation effects are encountered successfully and nullified by the body vitality, the triumvirate is extricated from the pathological stage. Triumvirate then returns to its primary stage of duties and starts acting as a support system to body rather than damaging it.
- Śuśruta ascribes definite syndromes to the provocation stage of each of the triumvirate and considers this stage to be the second in importance for the practical therapeutics.
- Vāgbhata's definition of provocation is still more elucidating. He states that the provocation is the stage when a vitium moves in the wrong direction and manifests symptoms of its morbid condition and the feeling of illness denotes the occurrence of disease.
III Stage of Diffusion
In this spreading stage, if the vitiating effects are too strong, the whole body may be overpowered. Then the constitutional diseased condition will result. If the vitiating effects are not too strong that it disables the whole body, it may continue to move in the body till they find an appropriate place for settling. This is the definite obstruction to proceed further and produce diseased condition at that particular site in the body.
As per Śuśruta
Śuśruta strikes an exceedingly astonishing concept when he tries to explain the process of diffusion. Triumvirate provoked by the excitant etiological factors begin to increase like the process of fermentation. This increase is lead by it's spread in all over the body. He even compares this continuous process of increase to the phenomena of growth in yeast fermentation which was anticipated for two thousand years. He describes these definite syndromes to be indicative of diffusive stage of each of the triumvirate and considers this stage as the third in importance from the therapeutic point of view.
Louis Paster, the discoverer of bacterial science, proved the truth of this concept to the world by the physical methods. The biological postulates of growth and reproduction in the aspect of Caraka is equally astonishing. He believed in the concept that 'There is no seedling in the absence of seed'.
As per Virchow and Flemming
Virchow and Flemming expounded this theory again in the 19th century as the important biological law like "Omnis cellula e cellula and omnis nucleus e nucleo" respectively and proved it by modern scientific means.
IV. The Stage of Location
Location of the disease can occur at any and every place as per Śuśruta. This condition is like the rainy clouds in the sky, the vitium effects the disease symptoms on the entire body or on a half of it or in whatever part or organ it is greatly provoked. Even Caraka advocates this theory saying that it might affect either the entire body, or half the body or only one limb or region of the body.
Location At A Particular Place
Locus minoris resistance of the particular system-organ or tissue or obstruction in the body channels may determine the location of the vitiating elements. This locus minoris resistance may be due to a particular constitution of that system, organ, part or cell. This can happen even due to biological inferiority in growth or through the damage caused to them by the previous trauma, stress, disease or otherwise.
Śuśruta explains the reason of location with his theory stating that wherever the all-pervading vitia in their provoked state come into contact with an organ or tissue or part that is already impaired and hence susceptible, there occurs disease-phenomenon. In the same way, Caraka also states the reason of location in one place. The vitium locates its vitiating element whenever it comes in contact with a susceptible spot and causes diseased condition there. This is the mode of local provocation of vitia. This stage of location is of the great clinical importance for early diagnosis of the diseased condition.
Vitiation elements having attained foot-hold somewhere get gradually established therein and produce symptoms which will be indicative not only of the vitiation of the particular vitium or vitia, but also of the location or site where this vitiation process has begun to spread. These combined symptoms help to localize the site of the diseased-condition. Śuśruta, the master clinician, differentiates the symptoms produced during this stage of location of vitiation process as the definite premonitory symptom.
These premonitory symptoms manifest when the vitiation process is located. From then the disease is recognized. This is the fourth stage of therapeusis. This stage of location manifested clinically by definite premonitory symptoms is the fourth stage of importance for the therapeutic purpose.
V. The Stage of Manifestation
Vyakti is termed as the stage of manifestation of the actual diseased condition. Śuśruta correlates this pathological stage with the actual appearance of clinical phenomena of the disease. This diseased condition may be a general disease or a systematic disease or even the disease of one part or limb according to the location of settling and establishing of the vitiation elements. This is the beginning of organic or structural changes or deformities in the body.
Classification of Disease
The diseased condition may be classified in two groups:
Both these groups can again be further subdivided into two further types.
Categories of General Disease
For general condition it is:
- Acute diseased condition
- Chronic diseased condition
Categories of Local Diseases
For Local Condition it is:
- Acute diseased condition
- Chronic diseased condition
The vitiation process spreads across the entire body only if the vitiation elements are very strong; time and place very much favorable to them and the body constitution being very weak or susceptible to the diseased condition. It then spreads over the entire body very abruptly and overpowers it immediately.The body then succumbs completely and transfers in full vitiation stage generally followed by dissolution. Such condition is described by Caraka through the example of spread of snake venom in the human body. Men who are attacked by this fulminating disease succumb to it speedily, unless treated promptly. Hence enlightenment regarding the knowledge of disease is very essential.
If after the immediate stunning, stupefaction and vitiation, the vital power of the body creates antibodies to save from the diseased situation then the extraneous factors of time and environment becomes helpful to the body, the whole process of vitiation reverses and the process is slowed down. If the counter-action continues successfully, the body with its triumvirate organization becomes free from vitiation altogether resulting into the survival of man.
The general diseased condition may have periodical clinical course if the fighting forces on the either side are nearly of the equal strength. Fighting forces are the vitiation elements versus body-constitution and body-elements. Season, time and other environmental factors may be helpful to the either side. Fluctuation in the strength of either side of the fighting forces or supporting help from extraneous sources may cause abatement or aggravation of the diseased condition. Such condition continues for a long time till one side gets sufficiently powerful to subdue the other. Caraka describes such oscillations in disease condition as the morbid toxic factors having opposition from the anti-bodies, cause remittent fever which periodically rises and remits.
Local Diseased Condition
If the vitiation process locates and gets established in a localized area, organ or tissue, the same phenomenon of encounter occurs but on a smaller scale and in limited space. Such localized reaction may also occur in the body without the previous internal vitiation process; if that local part receives a powerful trauma physical, chemical or biological from the external source. These exogenous etiological factors are termed in different manners as per their occurrence. They have to be differentiated from the endogenous ones which are termed as 'Nija'. A detailed list of such exogenous and endogenous etiological factors is given in Caraka Samhitā. The differential diagnosis between the diseased conditions produced by endogenous and exogenous causes is described by Caraka as under:
The exogenous one begins with pain and later on leads to the discordance of Vāta, Pitta and Kapha. But in the endogenous one, discordance of Vāta, Pitta and Kapha occurs first and later on it gives rise to pain.
Fight in a local area of the body has the advantage of receiving aid from the rest of the body. The entire body concentrates all it's resistance power towards the affected area to give a regular pitched resistance. The local concentration of the struggling phenomena cures the localized disease area which becomes an easy task for the clinicians. Our body, just like a regular pitched battle is decided at the site and all the fighting forces and equipments are brought and concentrated at the spot; also reacts the same way. Thus that particular part becomes enlarged and appears swollen. All these signs are easily observed by the clinician. It is a happy coincidence to find that the ancient clinicians both of the east and west have grouped these clinical appearances in four groups and described them as the classical signs of the localized diseased condition.
Caraka describes that the swelling which is characterized by pain, burning, redness and pricking pain should be diagnosed to be a suppurated swelling. He also considers swelling as the pathognomic of such conditions. It causes edema with its pathognomic symptoms of swelling. Similarly Celsus in A. D. 50 described calor, rubor, tumor and dolor as the four cardinal signs manifesting the local phenomena of inflammatory reaction. Cakrapani denotes that it is marked by steady swelling, so it is edema with swelling.
Clinicians in Greece gave importance to the other physical symptoms like redness and heat and called this local phenomenon as inflammatory reaction. They regarded redness and heat being the qualities of the flame. This difference in significance of particular symptoms in two countries may be an interesting subject to the student of ethnology. Symptoms with Kapha constitution will react with swelling as more prominent sign and symptoms with Pitta will have heat and redness as more dominant signs.
Local Acute Inflammatory Condition
The same process as it occurs in general diseased condition takes place in localized disease condition but on a smaller scale. It has an advantage of getting help from the body but it may put the whole body to jeopardy, if vitiation or morbific elements get an upper hand and it crosses over and spreads to the neighboring parts or organs of the body. It can even metastasize into the whole body.
Below mentioned symptoms are described as the complications of local inflammatory reactions. Caraka mentions the sixteen complications of wounds, described by the specialists in the subject of wounds:
- Acute spreading affection
- Vascular thrombosis
- Acute pain in the wound
The local diseased conditions terminate in the same way as the general diseased condition. The results of the success or failure of the body resistance power encounter is indicated by the intensity of resolution and dissolution of the local parts.
Local Chronic Inflammatory Condition
When the fighting forces are nearly equi-balanced, prolonged war with fluctuation on either side continues till some decisive factor comes in aid of either party and concludes the scene of warfare. This is considered as the fifth best of the therapeutic period. Though being late, it is better than the sixth or the last phase of treatment, which is the termination stage of the disease.
Here is some of the comparative data of description of such local inflammatory processes found in Ayurveda and modern medical treatise. Inflammation or variation in the intensity of classical signs is due to the domineering action of particular vitium. In A. D. 50, Celsus describes the four cardinal signs manifesting the local phenomena of inflammatory reaction. They are color, rubor, tumor and dolor which are further co-related with the four humors of the microcosm. These refers to the body-constitution and four corner stones in the humoral pathology of Hippocrates which were again correlated to the four proto-elements of the macrocosm. It is the world of organic existence as described by the philosopher-physician Empedocles who regarded these four proto-elements as the roots of all the things.
In India, macrocosmic and microcosmic concepts were based on the triad of vāta, pitta and kapha; but the surgeons find blood which is rather a structural system to be more convenient and useful in diagnosis and treatment specially of local diseased conditions. Śuśruta thus tried to give nearly the same status to blood as to triumvirate and then described four categories. The diseases pertaining to the body have their origin in blood and drink ingested. It is due to the vitiation and discordance of vāta, pitta, kapha and blood.
Controversy on Blood
There is an age old conflict whether to consider blood as a part of the base constituent or not. While commencing on one of his verse, Dālhana gives the explanation that why one should include blood in the categories of constitutional classification. The blood is included because in a wound there is the dominance of blood among the vitia. To this theory, Śuśruta clarified this point by stating that blood is secondary and dependent upon the primary triumvirate of vitial categories because the blood is never provoked without the vitia. Blood is included under the pitta category when the three vitial categories are taken into consideration. A person having pitta tendency also has the same abnormality in the blood.
It is really intriguing that an equal importance is given to the description of inflammation in Śuśruta Samhita, a treatise on Surgery. It is given the same cadre even in the modern surgical text books. In both the reference books, we find that the description of diseases is initiated with this subject and many chapters are dedicated to each topic to give a detailed description of this inflammatory phenomenon in general. Nearly 1/15 of the text in each books deal with this pathological process. Śuśruta concludes this subject by generalization of the local pathological process.
Classification of Inflammation
The summary of the types of pain and color is not limited to wounds but is applicable to all the types of inflammation. Hence the physician should regard all types inflammations like wounds. Classification of a subject may be made from various points of view to help in understanding of the subject. Modern surgical text books classify inflammation generally in the following types:
- Acute or sub-acute
- Acute or Chronic
- Parenchymatous or Interstitial
- Serous-Catarrhal-Fibrinosis-Hemorrhagic or Suppurative
These classifications are done either according to the intensity of the process or according to the development of the tissues which it attacks. It is even based on the exudation which further gives rise to Ayurveda classification of the inflammation. Ayurveda classifies it into three groups of constitutional triumvirate. This triumvirate classification has greater significance in clinical diagnosis and even practical therapeutics. It is done from clinical pathological-cum-physiological point of view.
Pathogenic Symptoms of the Triumvirate
If the etiological factor is excitant of a particular vitium or any particular vitium of the constitution is predisposed to the diseased condition, then the signs, symptoms, characteristic and pathognomonic of that particular vitium will be more dominant than the signs of other two vitia. If two vitia are dominant and acts in combination with the signs of two, it will be manifested dominantly. If all the three are there, all the signs will be aggravated. The pathognomonic signs of each triumvirate are as follows:
- Vāta is the present if there are symptoms of pain.
- If there are burning symptoms then pitta is in the root cause of the disease.
- If there is swelling then it is due to kapha.
- The symptoms of redness and suppuration denote abnormalities in the blood.
These are the respective signs and symptoms of the vitia and blood as per Astānga Hṛdaya Sutra. The below mentioned four signs correspond very closely to the triple response theory of Thomas Lewis:
- Vāta - It exhibits pain.
- Pitta - It denotes heat.
- Blood - It implies redness.
- Kapha - It shows swelling.
Significance of Vaso-Neuropathy
It is the clinical experience of each physician and surgeon that there is a wide variation in the intensity as well as the development rate of these classical signs. This can be well explained if we understand the full concept of Vaso-neurotic constitution. The phenomena of inflammatory reaction is resultant of the action of etiological excitant and reaction of Vaso-neurotic constitution. Threshold of contraction and dilatation of the arterioles and capillaries vary in each individual along with the capillary permeability. This is due to the difference in Vaso-neurotic constitution in each individual.
Thus Vaso-neurotic constitution of an individual plays a very important role in the phenomena of inflammation. Writer Krogh while describing the Vaso-neurotic constitution declares:
I shall say a few words about the condition of Vaso-neurotic constitution. It is characterized by the great liability or downright instability of the innervation of the vascular system which manifests itself in the capillaries and arteries. Frequent changes in this cycle either occur spontaneously or from relatively trivial cause. The redness is brought about by opening up and dilatation of the capillaries and venules. The heat is the result of the increased flow of blood due to dilatation of arterioles. The sweeping happens by exudation of fluid from vessels due to their increased permeability. Pain is caused by the stimulation of nerves.
Though these reactions occur in the interest of the body, it is possible that some of the reactions if occurring in excess, may be harmful. Similarly some occurring poorly or inadequately may not be effective. The knowledge of the constitutional tendency of the comprehensive botany of man as a whole and of the Vaso-neurotic constitution of the local organ or part affected along with the particular provoking actions of the etiological factors may aid in controlling or rectifying this protective and restorative reaction to the best advantage of the body. Hence the study of the constitutional triumvirate is of great significance for understanding the physiology of a man. Triumvirate concept may open up a subtler field of research in the activity of etiological factors as well as the behavior of body tissues.
VI The Stage of Termination
This is the last stage referred as termination of the vitiation process. In general, for the diseased-condition, the person may completely recover if his body vitality can counteract the incursion successfully or succumb if the invading forces are too powerful for his body's vitality. If any one factor is not enough to subdue the other cause totally, then the diseased condition may persist for a prolonged period.
Process of Suppuration
Just like the local diseased condition, there may occur complete resolution or dissolution or death of the local part or organ which is defined as Necrosis, gangrene or ulcer. Local diseased condition has one special method of termination and disposal of the waste or mortified matter. This method is the process of suppuration. It tends to suppurate if it is not possible to sedate it by special external or internal treatment. This process initiates even if the wrong treatment is given or morbidity is in excess. This will end in producing the condition of wound.
Termination as per Śuśruta
If the conclusive termination is not brought about by either party being sub-active and not able to subdue totally the other, the chronic inflammatory condition or chronic wound condition such as fistula or sinus may continue for a prolonged period. This is the last or sixth stage of therapeutic period advised by Śuśruta. The description of various stages of vitiation pathology ends with a verse that explains the reasons of thorough study and diagnosis of each stage from practical therapeutic point of view.
Treatment if started in the earlier stages will be easier and simpler compared to the treatment after the vitiation process has gained strength and intensified. Vitiation process checked or subdued in the accumulation process fails to produce any further development but if allowed to progress, it gains strength and intensity in the course of it's further development.
Determination of Purification process
The principles of treatment during the vitiation process were formulated primarily with a view to eliminate the vitiated morbid matter resulting from the pathological processes which are accumulated in the body. For this type of elimination, the neatest and the simplest outlet or body channel was chosen. This gave rise to the need of creating the treatment for eliminating this morbid matter and thereby purifying the whole body.
This purification therapy was executed intensely to accomplish the complete elimination of the morbid matter from the body. The procedure required the body to be previously prepared before undergoing a strong procedure of treatment by oleation and sudation procedures. These procedures facilitated the easy elimination of any kind of morbid matter.
Significance of Purification as per Caraka
Caraka declares that these drugs should be used as emetics by the physician in a way conducive to body in gastro-related disorders, characterized by morbid accumulation of kapha and pitta. Patient was prescribed for the purgation when the morbid humors are accumulated in the colon. Oleation cures the morbidity of vāta, makes the body light and disintegrates the accumulation of the morbid matter. Sudation process liquefies the morbid matter stuck up in the minute channels of the body of the person who has undergone oleation therapy. Hence one should undergo oleation process and then sudation process for complete purification of the body.
Process of Detoxification
When the body is found to be not fit and intolerant of the radical treatment, the line of treatment chosen was to initiate the gradual digestion of the morbid matter, a concept very similar to the detoxication conjugation concept of modern physiology. The liver plays an important part in protecting the organism from various toxic substances. This detoxifying function involves the process of oxidation and conjugation into relatively non-toxic substances which are subsequently eliminated in the bile and the urine. In the early stage of fever, starvation and sudation; gruel diet and the food items having bitter taste, digest the imperfectly digested morbid matter in the body.
Process of Rehabilitation
After the complete elimination of this morbid matter, the treatment consists of supplying the deficit nutrients and strengthening the body vitality by drugs as well as dietetic regimen. This process is called rehabilitation.
Other Pathological Processes
Ancients held some more concepts of pathological conditions or processes in Ayurveda are as under:
- The concept of epidemic and pandemic diseases
- The concept of sources and spread of infection or contagion.
- The concept of growth and multiplication of morbific elements in the body and their mode of spread and action.
- Certain abnormal conditions of the body-appearance
The Concept of Epidemic and Pandemic Diseases
In epidemic diseases it has been observed that the constitution of the body is not able to play any part in counter-acting the incursion of the infesting elements. The etiological factors have a complete hold over the disease-phenomena. Hence the symptoms and clinical courses are observed as the etiological factor which are uniform. Constitution which is an individual concern is out of place at that time, hence minute individual variation can occur on the clinical grounds and course of the disease.
In chrome diseases, individual constitution is able to create resistance and in such condition pronounced individual differences in the clinical course can occur. Caraka Samhitā devotes one chapter to explain the concept of Epidemiology. It is a thought provoking concept and probably a new insight into radiation physics. Radiation physics may find the equivalence in value between the physical and spiritual universe and rediscover the truth laid down by Atreya.
Causes of Epidemic Diseases
It is important to understand the reason why a large number of people are affected by a common ailment at one and the same time and why there is uniformity of clinical course of disease in spite of the individual variations of constitution. It is evident to know also that what are the main sources of such ailments. Caraka in Vimāna three treats the subject comprehensively.Sage Agnivesa asks the reason behind the destruction of communities by epidemic consisting of individuals who differ from one another in constitution, diet, physique, vitality, habits, psychic make-up and age. This query was answered by Atreya saying,
"O, Agnivesa! though a community may be heterogeneous in respect of the constitution of its individual members, there are other common factors that are being adversely affected which will cause simultaneous outbreak of diseases having similar symptoms. Due to this reason the whole population gets devastated. The factors that affect a people in common are: the wind, water, country and seasons.
Epidemic due to Wind
The diseases which can be caused through wind have a specific peculiarity in it's movement:
- Totally becalmed
- Violently blowing
- Exceedingly rough
- Intensely cold
- Intensely hot
- Excessively dry
- Excessively humid
- Fearfully clamorous
- Blowing from contrary directions
- Clashing with itself
- Extremely rotatory
- Having unwholesome odors, moisture, sand, dust and smoke
Epidemic due to Water
Water with the below mentioned qualities is believed to be the root cause of epidemic diseases. They are:
- Without good qualities of normal water
- Having an extremely aberrant smell, color, taste and touch
- Abounding with putrescent matter
- Deserted by aquatic birds and aquatic creatures
Epidemic due to Country
The country of the following description is to be known as unwholesome to reside and one of the cause of epidemics:
- Having color, taste and touch that are unnatural
- Excessively damp
- Abounding in serpents beasts of prey, mosquitoes, locusts, flies mice, owls, birds and animals such as the jackal
- Abounding in woods of weeds and Ulupa grass
- Abounding in creepers where crops have either fallen, withered or been destroyed in an unprecedented manner
- Where the winds are smoky
- Where the sound of birds is unceasing
- Where the baying of dogs always assails the ears
- Where herds of animals and flocks of birds of various kinds are always in a state of alarm and pain
- Where people does not display positive traits like morality, truth, modesty, custom, character and virtue
- Where the waters are always agitated and up-heaving
- Which is frequently subjected to the incidence of meteorites thunderbolts and earthquakes
- Where nature is full of menacing sounds and sights
- Where the sun, the moon and the stars are frequently covered by dry, coppery, ruddy and grey clouds
- Which is full of constant alarm and lamentation, crying, fright and darkness as if visited by gnomes
- Abounding in sounds of lamentation
Epidemic due to Season
A season which has the following traits is to be known as unwholesome which exhibits evincing characteristics that are opposite to it's typical seasonal peculiarities.
The learned declare these very four factors to be destructive of population, when not so blemished they are said to be wholesome. But even when these factors are accelerated there is no fear of disease to those persons who have their medical treatment beforehand. Even if all the four factors including time, become vitiated, as long as men are sustained by medicines, so long will they remain free of disease. For them moreover, the rightful use of vitalizing medications is recommended and the maintenance of the body by means of the medicinal herbs culled beforehand is also commended.
Concept of Sources and Spread of infection or Contagion
Regarding the sources of infection in epidemic diseases, Caraka lays down that a combined vitiation of the air, water, country and season are the sources of vitiation. The factors that affect a people in common are the wind, water, country and season. The learned declare these very four factors when possessed of the morbidity described above become the cause of destruction of the whole population through the epidemics.
As per Śuśruta
Śuśruta states that epidemic diseases spread from man to man. Dermatosis, fever and eye-sore are the infectious symptoms that spread very rapidly as they are the most contagious among all of them in the outbreak of epidemics.
Concept of Growth and Action of Morbific elements in the Body
Just as the seed lies dormant in the soil and germinates in season, in the same manner the toxic matter lies quiescent in the body-element and flares up when the time is catalytic for it's growth. Thus the morbific factor gather strength and bid in the propitious time. Then it manifests itself by the outcome of fever as soon as the disease-resistance power in the body is lowered. In this manner, the disease-generating factors, having worked themselves out, lapse into quiescence and retire to their respective stations in the body. Then it musters up complete strength once again. These toxic elements afflict the patient with fever when they are at the utmost level.
As per Śuśruta
Śuśruta compares the growth of vitiating elements to the yeast fermentation which has already been explained in the chapter of vitiating pathogenesis. Here the simile of yeast fermentation for the explanation of the increase of growth of morbific elements is quite suggestive.
As per Caraka
Caraka had a clearer awareness of the biological factors involved in the vitiating elements. He refers the phenomenon of the periodicity of fever to the recurring cycles of growth, spread, and withdrawal of the vitiating element. This description concede with the cycle of evolution of malarial parasite in the human body. Caraka illustrates this by using the simile of the seed and the soil.
Abnormal Conditions of Body-appearance
It has been observed that there occur certain abnormalities in appearance of the persons who where otherwise living in good health. Thence these conditions are not grouped under the disease list but described in a separate chapter just after the enumeration of all the diseased conditions. These conditions are probably connected with some abnormality of the function of Glandular system of the body. The eight censurable body conditions described therein are as follows.:
Significance of Knowledge of Disease Constitution for the Practical Therapeutics
To diagnose a diseased condition and treat it to achieve complete health back it is very significant to acquire the knowledge of the whole body constitution as well as the constitutional factors of the disease. It can be divided into four parts as follows:
- Significance of Constitutional Factors in the Etiology of disease
- Significance of Constitutional factors in the Clinical course of disease
- Significance of Constitutional factors in prognostics
- Significance of Constitutional factors in practical Therapeutics
Significance of Constitutional Factors in the Etiology of Disease
If the balance-constant of the vitium which is dominant in the body of an individual is placed on a higher threshold, the person is more sensitive or affective to the etiological factors which are the excitants of that particular vitium. The threshold of tolerance is transgressed even with a smaller degree of exciting factors. This is the relative condition of predisposition or susceptibility.
The constituent vitium whose threshold of sensitivity is on a lower level, will require unusually a larger degree of probing factors to manifest diseased condition. This is the relative condition of immunity. Caraka states that:
In a person of the vāta habitus who is indulged in vāta-provoking things, the vāta is readily aggravated; not the other two humors. Similarly in the pitta patient, indulged in pitta-provoking things, the pitta is readily aggravated, not the other two humors. Similarly in the person of kapha habitus given to indulgence in kapha-provoking things, kapha is readily aggravated; not the other two humors.
Significance of Constitutional Factors in Clinical Course of Disease
Caraka Samhitā gives a succinct but a clear account on the role that body constitution plays in enhancing the clinical picture of the disease. It also lays down a general clinical law that manifestation of actual disease condition is the result of varying interactions in the etiological factors, the triumvirate of constitution and the body-tissues.
Let us describe the incidence of the disease which occurs as a result of the variations in the etiological factors, intensity of morbid humors and susceptibility of the body elements. If these three factors, which are mainly the etiological factors, do not mutually support each other, or if they do so after a prolonged period, or in a very mild form, either there occurs no manifestation of the disease at all or the disease takes a long period to evolve. In this case disease might appear in an ambulatory or abortive form also. Under the contrary conditions, there occur contrary results. Thus are laid down the different causes of the modes of all the diseases.
Concerning the result of the encounter of the etiological factors with the vitia and susceptible body tissues, the author describes the following possibilities:
- If the etiological excitant and constitutional vitia and body tissues are not mutually agreeable at all, that becomes the provoking factor and vitia are of the opposite types and the body tissues are resistant or more or less immune to them, then there does not occur any manifestation of the disease-condition.
- If the excitant and vitia and body tissues are mutually agreeable but all of them are so mild or weak that all combined together do not suffice to produce a full diseased condition, there will be manifestation of a mild abortive or ambulatory type of disease condition.
- If mutual agreement and combination of all these three factors are engulfed by a long interval, there will be a delayed development of the disease. This condition has a prolonged clinical course. Incubation period is long and clinical course is prolonged chronic.
- If the etiological exciting factors, constitutional vitia and the body tissue are mutually agreeable, there will be full development of the disease condition manifesting all the classical symptoms in due order of time and in degree of intensity giving a theoretical picture of the disease-condition.
- If the etiological excitant is more severe and acute, the vitia just on the threshold of provocation and body tissues quite predisposed, the result is the manifestation of very acute or even fulminant type of disease condition which runs a very acute course and there is a huge exaggeration of the general or local symptoms.
In the above mentioned fist two conditions the disease does not run a fixed, regular or constant clinical course. It rather manifests a diversified clinical picture. It may not manifest all the classical symptoms of the disease condition at one time. It may exhibit them in an irregular way. There may not be orderly sequence maintained in the development of symptoms like these symptoms may be highly intense in one part of the body, tissue or system while no display or irregular exhibition of the disease characteristics on other parts at one and the same time. 
These are the general postulates of manifestation of clinical course in any disease condition. Constitutional factor is an individual factor, which always results in the individual differences in the clinical picture course and termination of the disease. Hence we can conclude that any type of disease other than epidemic or pandemic type happens due to the outcome of imbalance in the etiological factors, vitia and body tissues.
During the outbreak of epidemic and pandemic diseases, constitutional factors are unable to play any part or counteract the incursion of the etiological factors. In this situation, the incursion is very strong, powerful and sudden. Hence, the constitutional factors cannot counteract at all. Hence even if the people has different body constitution they suffer simultaneously from a severe symptoms of epidemic diseased condition. They even have to run almost uniform clinical course of treatment. These type of epidemic and pandemic diseases are responsible for the devastation of whole population in the geographical area affected.
Significance of Constitutional Factors in Prognostics
Caraka gives a comprehensive consideration of the constitutional factors in foretelling the prognosis. Constitution is also given equal important place in the branch of prognostics by Hippocrates. Caraka emphasizes on the value of the knowledge of prognostics for the physician for full success in his practice. The physician who knows the differential diagnosis between the curable and the incurable diseases and begins the treatment with full knowledge of the case in time, obtains success for his effort without fail. He divides the disease condition into four categories from prognostic point of view. The curable diseases are of two kinds one which can be easily cured and other which are cured with difficulty. The incurable diseases also fall into two categories those that can be cured after extensive treatment and others which can never be cured.
Constitutional factors play an important part in determining these four prognostic categories. Moreover the knowledge of constitutional factors helps the physician to some extent to know the prognosis and thus enables him to prepare for present and future line of treatment of the specific disease condition.
Significance of Constitutional Factors in Practical Therapeutics
The diligence of the skillful clinicians which determined the exact role placed by each viz. etiological excitant, constitutional triumvirate and the nature of body-tissue, became extremely fruitful when practical therapeutics are prescribed. The text books of modern medicine prescribe the treatment for Homo-sapiens in general determining the limit of minimum and maximum dose which can be safely administered to humans without harm.
This is the scientific formula worked out comprehensively by experimental and observational methods and properly standardized. Hence all the essentials for correct guidance are valid for the average. But practical application and use of this scientific knowledge in the best interest of each individual is the real art of medicine. All the achievements of the practical knowledge of disease or drugs or even diagnostic skill, will be of no use if it is not combined with practical knowledge of scientific application of therapeutic measures which can bring the full success in the treatment.
Caraka asserts very dominantly that the art of prescription depends on the knowledge of dosage and time. In turn, this art is dependent on the success. Hence the skillful physician stands ever superior to those possessing merely a theoretical knowledge of drugs. It is essential to understand and study the environmental etiological excitant but the knowledge of the individual constitution of the patient also plays an important role in the phenomena of disease.
This process is not only necessary but also an indispensable pre-requisite to the exact determination of the dose for that particular stage of disease in that particular constitution of man. It is hardly necessary to emphasize the need for meticulous accuracy in dosage as deviation on either side fails to produce the desired results. A small dose is not sufficient to counteract the disease condition while larger dose may produce excessive effects on the body. It may also be very much harmful to the body at times. Rash administration of a very strong medication without examination, on a weak patient, will upset his body constitution. But in strong persons affected with a strong disease, weaker medicinal dose administered without examination also becomes useless.
The keenness in Ayurveda regarding the accuracy in dosage becomes too evident. The administration of drugs is denoted by using the term 'Maatra' meaning measure. The word is derived from the root 'Maa' which means to measure. Thus significant importance is laid on accurate dosage of drugs. While the word 'Dose' is derived from the Greek word 'Didomi' which means to give. It is also cognizant to the Sanskrit root which means to give. To have accuracy in dosage is the main purpose of the detailed study of the constitution of triumvirate. Treatment depends on the accurate recognition of the measure of humors and other factors.
Administration of Drug in Ancient Times
The significance of knowledge of constitution in determining the personal regimen of the individual has already been described. To attain the ideal of easy comprehension combined with exactitude, the ancients reduced the therapeutic science to mathematics. A formula ingestion of food and drug was the sole method of administration during that time. Hence the taste which was the main index, was grouped into six categories to fit easily with all the three triumvirates. They further evolve the general formula co-ordinating each triumvirate with a group of three taste categories. One group of three increases and the rest other group decreases the force of each vitia.
Doṣa and Rasa Phenomena
The mathematical formula concerning doṣa and rasa has elaborate work functioning. Doṣa and rasa both are worked out by the combination and permutation method to 63 forms. They were also considered in its comparative and superlative state. Thus specific determination of rasa and doṣa and reducing them to the mathematical formula of inter-relation is very significant to attain the exactness in conceived practical therapeutics achieved by the ancients.
Caraka devotes one full section named 'Vimāna' having 8 chapters which discloses the details of various factors concerned with the production of the disease as well as the factors important in diagnosis and treatment. It discusses this inter-relation of rasa and doṣa in details in the first chapter. Hence it emphasizes on the importance of accurate knowledge of constitutional factors for the practical therapeutics.
Remark of the great physician William Osier emphasized the importance of constitutional factors in the clinical manifestation of the disease very aptly. It gives the knowledge over inter-relations of the soil and the seed. There is a fundamental purpose of the ground upon which the seed falls. Some seeds drop on the ground by the wayside and also through fowls of the air. Some of the seeds wither away because they have no roots. Some fell among thorns which choke them. This situation is compared to the suppressed case of tuberculosis. Here thorns represent the resistance power of the body. In this case seed finds the soil suitable and grows. This tuberculosis situation is in parallel with any other diseased condition used by author to generalize a thought. The seed is the bacteria and the soil is the body constitution.
The Etiological Factors of the Disease
As per Caraka
Caraka classifies all the etiological factors of diseases in two parts on general basis..
As per Śuśruta
Śuśruta pursues the subject further into its metaphysical origins and declares in his treatise, while keeping with the general concepts in all the branches of science, that disease is the occurrence of sufferings. which is of three kinds. The first kind has a source in itself. The second kind has it's source in physical elements and creatures of the world. The third one has it's source in natural and supernatural agencies. This triad of etiological categories is in accordance with the Sankhya concept. Śuśruta makes further subdivision of this triad and froms a practical point of view to make seven further categories in etiological factors of a disease.
Endogenous Etiological Factors
Endogenous etiological factors which causes the diseases can be further sub divided into three conditions:
- Hereditary diseases - These type of diseases are inherited due to defect in genesis of one's parents. These are genetic etiological factors.
- Congenital disease - The disease conditions which occurs during the fetal period of life in the mother's womb is termed as congenital disease. The factors aggravating this disease are congenital etiological factors.
- Nutritional or metabolic diseases - It includes psychic and somatic conditions due to the internal derangement of function or structures. These are the nutritional or metabolic etiological factors.
B Exogenous Category Aadhimautika: The group of diseases that are due to all kinds of trauma or injury from physical, chemical and biological sources. Aadhidaivika Diseases resulting from abnormality of climate and season. 8. Those of super natural origin or nature such as pandemics, epidemics, emergent conditions due to atmospheric upheaval and such other dreadful disease-conditions difficult to explain ordinarily Natural conditions or disabilities characterizing human life such as hunger, thirst, sleep, fatigue, decay, senescence and death. These types of conditions may act either as exciting factors or as predisposing factors. (Car Sutra 20, 4-5) and they may act either as immediate or as remote causes.
Those above-mentioned classifications are exhaustive and the entire varieties of etiological factors both biological and material are comprehended by them.
XII NOSOLOGY AND THE TRIUMVIRATE
In the drama of vitiation though a number of factors or actors take part, the main plot ever remains connected with or swings round the behaviour of the triumvirate. Once the members of the triumvirate are set into the stage of excitement by the endogenous or exogenous vitiating or toxic factors, the whole body or part of the body becomes the stage or site where the triumvirate pours out and diffuses the vitiating elements and there develops the general or special or local scenes depending upon the site and strength of the body versus the intensity of invading vitiating factors and the method and technique of war adopted by each of them as well as the effects of environmental factors.
All pathological processes and the consequent disease-conditions are represented by the signs and symptoms associated primarily with the triad of vitia. Thus in the broadest outline all disease-conditions are comprehended by this triad
Susruta says Vata, Pitta and Kapha are the cause of all diseases, for the latter show their symptoms, and are found to be caused by direct observation and by the authority of tradition. Just as the entire universe of evolutes cannot transcend the triad of natural forces of Sattva, Rajas and Tamas, similarly the totality of diseases cannot trancend but fall within the triad of Vata, Pitta and Kapha.
Caraka modifies this statement slightly differentiating endogenous diseases which are primarily due to triumvirate discordance from exogenous diseases where external trauma is primary and triumvirate discordance develops later on.
�All endogenous diseases never occur without the discordance of Vata, Pitta and Kapha�.
�Only the disorders produced by the exogenous causes are different."
Yet in view of their special sites of localisation and affection, and the consequent variation in manifestations of forms and in view of the various etiological factors giving rise to diseases, the physician may have to give different names to specify each of such conditions.
The body consists of so many varieties of tissues, organs and structural and functional systems and of millions of cells each of which may be said to have its own separate life, that the pathological conditions affecting them in their individual or even combined forms would be innumerable. And so varied are the manifestations of each of these vitia and of their combined conditions that every degree of variation or proportion in their combination would require a special name, thus giving rise to an endless number of names. Expressing the impracticability of this, Caraka says, �When classified according to cause, pain, color, site, form and nomenclature, the number of these diseases becomes really countless."
Thus a simpler and more comprehensive classification is necessary for purposes of practical therapeusis. Only, the classifications should be all-comprehensive while yet allowing of the recognition of peculiar deviations from their fold.
And so some systems should be adapted for general classification which would be comprehensive of all diseases conditions and at the same time simple but significant guide in the selection of curative measures which is the ultimate aim of the science of medicine.
The classical writers like Caraka and Susruta suggest various methods of classification of diseases for the purpose of nomenclature. Caraka, after enumerating various ways of grouping the disease conditions (Vimana 6, 3) declares at the end of the discourse that the triumvirate-wise classification is the only possible practical method which is all-comprehensive and of significance in diagnosis and practical therapeutics.
�Now the diseases are innumerable, there being an unlimited number of them The morbific humors, on the contrary, are strictly numerable there being a limited number of them" (Car. Vim. 6, 5)
It is therefore the right thing to classify diseases only in the light of their vitial aspect as that is the pathological plank on which the science itself stands.
It is only after the basic system is formulated of classifica�tion in the light of pathological processes, that a resort should be taken to specify and designate particular disease conditions in order to enhance the detailed knowledge of diseases and facilitate the specific line of treatment. But to simply multiply the labels of disease names and describe their individual signs and symptoms without an appreciation of the basic category to which all such symptoms are common, is an unimaginative and unscientific approach to the subject.
After having a comprehensive system or framework of general disease-classification, names of particular disease condition may be added on as the knowledge of that condition is fully understood
It is not to be inferred that no progress or evolution was made in the nosological science after establishing the triad of vitial classification. That the science was kept ever progressive becomes evident when one finds that total number of disease conditions which have been given definite names, number about 1120.
�The number of disease conditions is 1120�
The whole list has been enumerated by the commentator Dalhana in 40 verses.
The basic categories were according to the triumvirate organization, and hence any disease condition was first grouped under that organization which was predominantly disorganized. With the advance of knowledge, the sub-grouping was made vitiumwise, tissue-wise, organwise or according to specific condition. But whatever be the progress made in detailed knowledge of disease, it will not diminish the importance of triumvirate-wise classification which has fundamental importance in diagnosis, prognosis and complete success of treatment.
Each and every disease condition falls under this heading. It may be the discordance of one vitium or the discordance of two or all three, the condition of bi-discordance is termed (Sansarga) and the condition of tri-discordance is termed (Sannipata).
There are certain disease conditions which affect only one vitium. They are the specific affection of that paricular vitium. They are termed (specific) to differentiate them from (general).
This is the system-wise classification. There are 80 disease conditions due to Vata, 40 disease conditions due to Pitta and 20 disease conditions due to Kapha. This is the organization-wise or vitium-wise classification
When body-tissues where vitiation process is located play a more important and urgent part than the triumvirate, the disease is named that particular body-tissue. This is the tissue-wise classification.
Where the body elements or tissues get vitiated and play a major part in the birth of disease, the conditions are referred to the particular tissue concerned, such as disease of the nutrient fluid, of the blood, of the flesh, of the fat, of the bone, of the marrow or of the semen." (Su-> Sutra 24, 8)
Dalhana while commenting on this, clarifies saying that though the disease conditions are classified and named according to the body - tissues vs here vitiation process is located, it is only a secondary denomination of the primary vitial classification. This is how it should be understood. He gives an interesting simile to explain this.
�Just as when a person is said to be scalded by heated ghee, heated oil, heated copper or iron, he is really scalded by heat through these various media, similarly when the disease is said to be due to body-tissues like blood, nutrient fluid etc., it is really due to the vitia of Vata etc, working through these tissues.�
Organ wise Nomenclature
Similarly organ-wise classification and nomenclature is done whenever the structure and functions of that particular organ play an important part in producing the signs and symptoms of the disease viz, 94 diseases of the eye, 18 diseases of the ear 18 diseases of the nose, 74 diseases of the mouth etc.
Symptom-wise or Sign-wise Nomenclature
Where one particular symptom or sign was too dominant to color the whole clinical picture, the disease was named after that symptom or sign viz., fever, diarrhea, and wound, swelling, fractures. This is the symptom-wise or sign-wise nomenclature
If the etiological factor was claying an exclusive part in the production of disease, the disease was designated after that etiological factor viz. Helminthiasis, Toxicosis, alcoholism, Liathiasis etc
The local part or condition or any special factor playing a more dominant and urgent part than the triumvirate may be allowed to have its own special name applied to the disease condition to facilitate the understanding of the disease and the immediate practical line of treatment to be adopted, but this cannot be done at the cost of or by complete avoidance of triumvirate-wise consideration. Triumvir ate wise classification is the fountain-head of all sub-classifications. Triumvirate pervades every cell and intercellular space of the body.
and controls every function. Nothing can happen or exist which does not fall under this heading.
The above mentioned conditions or factors may be for the time being dominant and more urgent, but the clinical course of the disease condition has many factors to count, adaptive or the reserve power of the body, regenerative or recuperative power, resistant or digestive power of the body, all these things which are the essentials of vitial phenomena will be better understood if primary triumvirate- wise classification is constantly kept in view.
The triumvirate, thus being the grammar of all pathological processes occurring in the bodv, becomes the primer of Nosology.
With such basic importance of triumvirate-wise classification of disease-condition, it is but natural that the intensive study of the details of this triumvirate will be carried out,
The specific conditions of diseases notwithstanding it is helpful to arrive at the least common measure of all diseases. It is only thus that practical therapeusis can he scientific and intelligible to the expert and the average healer alike. The triumvirate of vitia offers such a basic scope for the reduction of diseases to their simplest classification.
The concept of nosology in its most comprehensive import has been laid down significantly by Caraka in the following verses.
"When classified according to cause, pain, colour, site, form and nomenclature, the number of these diseases becomes really countless. A physician need never be ashamed if he is not able to name a disease, as there can be no definite standardization of nomenclature of all diseases. The physician who after ascertaining all these three things, begins treatment intelligently and systematically will not err in therapeutic procedure.� (Car Sul. 18, 42-44-47)
Thus these medical thinkers thought of diseases and classified them from the point of view of both biological scientist as well as of the practical clinician. The particularly medical aspect of Ayurveda which in its entirety is the biological grasp of the secret workings of the life mechanism, is based on practical utility. Its understanding and approach to disease and its treatment, is immediate and ready-made It is calculated to avoid much waste of time and vacillation and to help the physician possessed of even the most elementary enlightenment to take note of the basic nature of the disorder by the symptoms in the light of the three basic genera of Vata, Pitta and Kapha and start suitable medication with the least delay. A further investigation into its general and local aspects can await delay without further aggravation of the condition, if this general line of therapeusis is already afoot. In seventy out of a hundred cases, this elementary method of tackling even is bound to produce salutary effect. It is for the intelligent physician, meanwhile to make closer scrutiny and investigation into the finer blends and overlappings of the vitia, the causative factors, the site of affection, the degree of the morbid condition and the indications and contra-indications in the measures of therapeusis and the likely complications.
Caraka described the actual nature of the cryptic method of his exposition and the suggestive nature of the system propounded, thus like the initial handful of grain carried by the mendicant and the seeds in�������� the hand ������ of the sower, these aphorisms though small in measure yield to the intelligent physician abundant result i.e. complete knowledge of the subject. It is thus a guide to the intelligent physician in the use of�������� his powers of imagination� and logic. But for the mediocre it is good to follow the method laid down. Following it in the prescribed way, such a physician accomplishes his task successfully or errs only very slightly if at all, owing to the succint nature of the exposition." (Car Vimana 8, 149.)
These teachers so formulated their instruction that even the man of moderate intelligence might fully benefit by it and the etiology, pathology and the principles of co ordination between the disease and the drug are all expounded in terms that are easy to understand and retain in mind, that are true to the manifestations in health and disease and that are capable of being put into practice with the least delay and demand on the physician�s intellectual initiative. Such a system though simple and un-intricate in its broad outline, is yet eminently fruitful in application and eliminates the grave risks of Incompetence and pretentious ignorance. It is an attempt to reduce medicine to a rule of thumb, a practical chart to guide the learned and the unlearned alike.
But it is elastic and comprehensive enough to allow of the most intricate and exhaustive details of the various branches of science. All the accumulated knowledge of experiment and microscopic observations can be made to enrich the picture bound by these outlines and can contribute to the furtherance of the objective of medicine if only the basic direction of the perspective and the light offered by the physiology and pathology of the triumvirate be never lost sight of. They are the stars that guide the helmsman at the head of the ship of life, and to ignore them is to allow the ship of life to drift and. be wrecked against the hidden rocks of disease and death. The attempt at completing the picture of Ayurveda, filling it with the rich detail that modern medicine has culled from the depths of life is the responsibly of the future medical student and scholar who asserts bis heirship to the wisdom of the east and the west, or the ancients and moderns alike.
This brief and general outline of the physio patholo�gical nature and significance of the triumvirate which forms the fulcrum of all life-processes is intended mainly for the general reader who is to be introduced to the Caraka Samhita. It is not fit here to go into the intricacies of detail on the subject as would interest the researcher and the learned practitioner.
The triumvirate of biological organizations determines, as we have seen, the constitution of each individual. And Caraka has dwelt elaborately on the attributes of the various types of human constitution both from the purely psychic point of view (Car Sar 4, 37-40) as well as from the somatic point of view (Car Vim 8, 95-100) in terms of habitus or the preponderant constituent vitium.
An intimate and deep knowledge of Ayurveda will enable the practical clinician of its immense value in the matter of early diagnosis i.e. long before any actual structural and deep-seated functional disorders have crept into the organism, as well as in the procedures of active immunization and prophylaxis. The daily diet and behaviour of the individual and his continual adjustment to the demands of the changing environment are to be built upon the facts of constitutional pecularity. The details of normal living, not to speak of the exigencies of therapeusis are to be patterned in view of the fundamental diathesis of the man. The understanding of constitu�tion in its fullness provides the key to allergic reactions and psychic and somatic is osyucracies. This aspect of medicine is thus all important to the clinician and Ayurveda with its various branches is the a wheel whose spokes are fixed firmly and converge to the navel of the concept of the three villa. Thus it is that this physio- pathological perspective is all-embracing in its scope and deserves the most intense and searching scrutiny by the modern medical scholar. It is only thus and then that its soundness as a faithful representa�tion of the body organization and mechanism of functioning, and the extent of its practical applicability and utility can be appreciated It is a subject for profound study and judgement for the sincere and serious-minded student of medicine.
XIV THE IDEAL OF HEALTH IN AYURVEDA
The ideal of health varies from a mere disease-free condition to that of positive and perfect health Ayurveda set up for itself the very lofty ideal of positive health, perfect to the minutest detail.
The concept of health is In its undivided and integrated form of body-mind The definition of man in Ayurveda is the aggre�gate of body, mind and spirit, and its concept of health if not only physical health but mental and spiritual health too Its personal hygiene known as Swastha-Vrtta is supplemented by
or the right life which inculcates the discipline of the senses and mind and the regulation of the moral life so as to accord with the happi�ness and good not of the individual merely but of the humanity as a whole. It is therefore social and universal in its conception and application, and comprehends a physical, mental and ethical framework of life. It is an entire concept of life that Ayurveda expounded embodying philosophy, eugenics and ethics.
Again the concept of health is individualized as no two persons are found alike in appearance or behaviour. The very word Swastha meaning healthy signifies by the term in one s own individual consti�tution. Thus was the concept of individual constitution or brought to bear upon the subject. Ancient Greek masters and the sages of India like Caraka and Susruta have built up their systems of health and disease on this bed-rock of constitution, and this concept of constitution remains as sound as ever in its logic and practical efficacy.
Its objective moreover aimed at the fullest survival and even to overcome the handicaps of nature and age. This concept gave rise to Vitalization and Virilification systems of therapy.
This setting up of a lofty standard of health had to be imple�mented by an equally high standard of diagnostic methods, so detailed and perfect in all their aspects as to detect even a very minute and ordinarily unnoticeable deviation from the specific norm of the individual. It is easy to set up norms for organizations which are simple and are on the lower rungs of the ladder of biological evolution. But the higher and subtler the organization are the greater will be the liability to disorganization, and it is in these cases that the diagnostic methods necessitate the highest sensitiveness in detecting deviations.
The three main organizations are of Vata, Pitta and Kapha These three co-exist in a single constitution. They are so diverse in nature and function that their equilibrium can be maintained only on a highly sensitive and delicate fulcrum. But this is not all the three are not static and they have continual to adapt themselves to the ever changing environmental factors. The environmental factors appearing in a little more, less or altered form are likely to cause the disturbance of this subtle equilibrium of the triumvirate.
The edge of this sensitiveness is blunted when the concept is not that of ideal health. The trivial deviations go unnoticed and are left uncared for. But when the ideal is that of perfect psycho-somatic health, the deviation, however small and insignificant it may seem, is noted and cared for. Anything which is not to the mark is considered a positive source of trouble. Even the slightest deviation is enough to start the ringing of warning bells of impending alarm.
The criterion of ideal health in Ayurveda is "the best mood in the working of the spirit, senses and mind.�
The Psyche is the most sensitive galvanometer in the body, the psychic changes are more or less subjective symptoms but fortuna�tely for the physician they are indicated reflexively on this external features of the body by way of inherent and prevailing spirit, life mood, reactive affectivity and tempo peculiar to the personality. The mani�festations, are perhaps too clear to go unnoticed by the attending persons, but it requires a keen clinical sense to transcribe this script of reflex indication into a comprehensible form by observation, interpretation and correlation. Lord Chesterfield has rightly remarked that if we wish to know the real sentiments of the person we are conversing with, we should look into his face, for he can more easily command his words than his features. Life is ever moulding our expressions, our inner thoughts are written indelibly on our faces.
Even transient disturbances are not allowed to escape unnoticed by Ayurveda It stresses upon the diagnosis of even transient distur�bances and attempts to restore the lost equilibrium. It also advises the prophylactic measures to counter such adverse environmental factors in This is the most glorious part of the highest concept of perfect health and the practical application of it in the maintenance thereof.
The maintenance of the norm and the prevention or deviation from the norm thus becomes the field of Ayurveda. What then is the norm or the normal condition according to Ayurveda? Definitions are always difficult to formulate and it is specially so in this case as it is a common experience that no two individuals are completely alike physically, physiologically, psychologically or in vital reactions. And hence the art of medicine necessitates the study of the individual man. Thus any definition of the Norm in Ayurveda will have to be defined from the individual point of view. Each individual is different from the other and so the norm of one will not be the norm of another.
For theoretical purposes, the norm of man in general can be described as a range of values to be aceepted as a standard found to be the average in persons who apoear healthy and free from disability or disease.
But for practical application the study of the individual will be necessary to achieve accuracy in diagnosis and therapeutics. Susruta while describing the norm of the individual states as under -
�It is not possible to lay down or standardize the exact measure of the triumvirate, body-elements or the excretory matter owing to their varying nature in the process of adaptation to the continually changing environmental factors as well as individual variations of the body constitution." (Sus Sut. 15,37)
If a physician wants to know the state of equilibrium of all these he can do it only by finding the signs of perfect health in that individual. The expert physician diagnoses indirectly their imbalance condition of these body-elements by finding the person not in perfect mood� (Sus, Set. 15, 38-39).
�A person possessing the equilibrium of the triumvirate, balance condition of gastric fire, and harmonious working of digestion, assimilation and elimination processes and the best mood of spirit, senses and mind, is said to be in perfect health." (Sus Sut. 15,41)
Thus Ayurveda has dynamic and creative view of health, for health can never be a mere static condition, it must grow like life or fall. Hence the need for constant vigilance in its promotion and for revitalizing it as a factor for intensive enjoyment of the delight of living. Life must be lived as a delight or it must yield place to disease and death. There is no no-man's land where it can remain neutral and static. In dealing with this aspect of health Ayurveda holds the palm over all other known systems of medical thought. The healthy man should be as vigilant and diligent in the maintenance and enhancement of his health as the sick one is in the riddance of disease. Such a double aspect has also been ascribed to medicament.
�Now medicine is of two kinds, one kind is promotive of vigour in the healthy, the other destructive of disease in the ailing," (Car Cik. 1,4)
The regimen of conduct known as hygiene, social and individual, and a good life which includes the control of the senses and the mind is calculated to turn man into a noble citizen of the world, and lead him a step higher in the ladder of evolution. This is medically very efficacious in lifting man above the dangers of psychic and nervous disorders that are on the increase as a result of the heavy drain on the nervous energies of man due to the distractions, cants and make-believes, enormous and injurious ambition and frustration that modern civilized life involves. This psychic regimen provides the wholesome nutrition for the mind even as the physical regimen does to the physical body.
Caraka draws a beautiful picture of the life of a man in possession of ideal physical and psychic health who not only enjoys fully the life himself, but at the same time adds to the happiness and comfort of the whole world.
"Now the life of such a man is called happy as is not afflicted with either bodily or mental ailments, as is, in particular, endowed with youth, strength, virility, reputation, enterprise and boldness befitting his abilities, is actuated in his deeds by the combined urge of knowledge, science, the senses and the sense-objects, is possessed of multifarious and delightful amenities accruing from great wealth, all whose efforts are prosperous and who can plan as he likes. A life that is contrary to this is deemed unhappy.
The life of that man is said to be good who is a well-wisher of all creatures, who does not covet other people�s goods, who is a teller of truth, who is peace-loving, who acts with deliberation, is not negli�gent, is devoted to the three ends ( viz., virtue, wealth and enjoy meat ) without letting any one end come into conflict with the other two, who is reverential to those who are worthy of reverence, of a scholarly, scientific and retiring disposition, partial to the companion of elders, of well curbed passions of desire, anger, envy, pride and conceit; constantly given to charitable acts; devoted always to austerity, knowledge and quietude, endowed with spiritual insight, one-minded, contemplative of the good in this world and the next, and endowed with memory and understanding. That life which is of the opposite nature is said to be �not good.' ( Car Sutra 30, 24 )
- Caraka Sutra 18, 52-53
- Susruta Sutra 21, 18
- Sutra 21, 27
- Astānga Hṛdaya 12,23
- Śuśruta Sutra 21, 28
- Śuśruta Sutra 21, 32
- He lived in 1855 A. D.
- He lived in 1882 A. D
- Susruta Sutra 21, 29
- Caraka Cikitsā 21, 7
- Śuśruta Sutra 24, 10
- Caraka Cikitsā 15, 37
- Śuśruta Sutra 21, 33
- Caraka Cikitsā 21, 6-7
- Caraka Cikitsā 6, 54-56
- Caraka Cikitsā 3, 62
- Caraka Sutra 18, 4 and 6
- Caraka Sutra 20, 7
- Caraka Cikitsā 25, 52
- It can also be accounted as tumor.
- Caraka Cikitsā 12, 8
- Commentary by Cakrapāni
- Caraka Cikitsā 25, 29-30
- Śuśruta Sutra 1, 25
- Commentary by Dalhana
- Śuśruta Sutra 21, 25
- Śuśruta Sutra 22, 13
- Astānga Hṛdaya Sutra 29, 6
- It refers to dolor.
- It refers to sudor.
- It refers to color.
- It means tumor.
- Śuśruta Sutra 17, 5
- Śuśruta Sutra 21, 37
- Caraka Sutra 2, 8
- Caraka Sutra 2, 10
- Caraka Siddhi 1, 7
- Caraka Cikitsā 3, 142
- Caraka Sutra 15, 16
- Vimāna 3
- It refers to the motion of whirlwind.
- Caraka Vimāna 3, 5- 14
- Caraka Vimāna 3, 6
- Caraka Vimāna 3, 7
- Śuśruta Sutra 5, 34
- Caraka Cikitsā 3, 68-70
- Śuśruta Sutra 21, 28
- Caraka Sutra 21-3
- Caraka Vimāna 6, 16-18
- Caraka Nidāna 4, 4
- Disease condition with typical manifestation of symptoms.
- Disease conditions with acute or grave clinical course manifesting all symptoms.
- Manifestation of the symptoms in an irregular way.
- Caraka Vimāna 3,6
- Caraka Sutra 10, 7
- Caraka Sutra 10, 9
- Caraka Sutra 2, 16
- Caraka Vimāna 8, 94
- Caraka Vimāna 1, 3
- Caraka Sutra 1-6 2
- Caraka Vimāna 1, 6
- Caraka Sutra 26, 22
- This is called as Tara state.
- This is called as Tama state.
- Caraka Sutra 26, 23
- Caraka Sutra 18, 4, 6
- Śuśruta Sutra 24, 4
- Caraka Sutra 18, 4
- sus Sutra 24, 8
- The Caraka Samhita published by Shree Gulabkunverba Ayurvedic Society, Jamnagar, India