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�He who knows the various stages of pathogenesis viz, stage of accumulation, provocation, diffusion, location, manifestation and termination is entitled to be a physician� (Sus. Sutra 21,36)
�He who knows the various stages of pathogenesis viz, stage of accumulation, provocation, diffusion, location, manifestation and termination is entitled to be a physician� (Sus. Sutra 21,36)
1. The Stage of Accumulation
The first stage of increase or accumulation of quality or quantity has been described fully in the chapter on Imbalance condition. Stage of decrease or hypo will only manifest the signs and symptoms of deficiency either in space or action, but the stage of increase has far-reaching effects. Increase shall have to be accommo�dated somewhere and the body being a limited space for accommodation or to bear the pressure of the extra matter or power, some irregula�rity or disorder occurs in the body, material increase being a static and localized thing, there may be local increase or growth of the particular tissue, it may disturb the neighbouring tissue and cause Inconvenience by mechanical pressure. But increase and continued accumulation of dynamic force of the triumvirate which are all- pervaisive and whose equilibrium is maintained on a very subtle fulcrum can be tolerated only to a limited stage which does not transgress the threshold of accommodative capacity of pentad of reserve foci. This stage may or may not produce actual disease condition but definitely serves as aid and predisposing condition to trauma or other etiological factors which act as immediate excitant to the triumvirate and herald the vitiation process, and usher in the incursion of disease condition. The general postulate of diagnosis of stages of increase and decrease of the function of triumvirate is described as follows:
"Now the signs of decrease of Vata, Pitta and Kapha are described to be decrease of their respective actions. There may be the loss of their normal functions or even the increase of contrary ones Increase of natural actions is the position indicated in the increase of humors The norm, the decrease and increase of humors are thus diagnosed." (Car Sut 18, 52-53)
Susruta describes some more definite premonitory symptoms when triumvirate imbalance is just on the threshold of vitiation. Recognition of these prodromal symptoms is given all importance by the author who considers this stage as the first or earliest therapeutic period.
�These are the seats of affection. In these the vitia get accu�mulated The cause of accumulation has been already stated. The symptoms of accumulated vitia are: stiffness and fullness of abdomen (due to Vata ), yellow tinge of the skin ( due to Pitta ), low tempe�rature. heaviness of limbs and lethargy ( due to Kapha ) and instinct of repugnance for the causative factors of accumulation of the respective vitia. This is the first stage for treatment.� (Sus. Sut 21, 18)
Careful personal regimen and simple prophylactic measures will ward off completely or to some extent the incidence of disease condition, if the condition is recognised at this stage and treatment started.
II The Stage of Provocation
This is the provocative reaction of the member of the triumvirate. This is generally subsequent to the triumvirate having reached the maximum point of increase or decrease and being at this moment irritated or provoked by an extraneous excitant etiological factor, endogenous or exogenous. This provocative reaction also may occur without previous imbalance condition if the immediate excitat factor is too strong for the triumvirate for adaptive reaction.
Incidence of additional pathogenetic factor to the already 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, imb be them, and get themselves intoxicated and thus become vitiated. Once vitiated, it loses self-control and forgets normal duties and functions. It becomes erratic, irregular, disorganized, abnormal and morbific in function. Saviour of the body becomes the sinner of the body. It becomes a convert and an ally of the enemy. The hero of the physiology begins to play the part of the villain in the drama of 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 fully under intoxication or vitiation effects, it behaves as if possessed by the hostile excitant and does all the harm to its old master, the body.
This tragic conversion of the benevolent triumvirate into malevolent organization is the beginning of real vitiation pathogenesis This provoked condition is indeed the initiation of disease condition and the stage of diffusion, location, manifestation and termination are the further development of the behaviour of the provoked vitium or villa. If at 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 as the prodigal son and resumes his benevolent role of supporting the body.
Susruta ascribes definite syndromes to the provocation stage of each of the triumvirate, and considers this stage to be the second m importance for the practical therapeutics.(Sutra 21, 27)
Vagbhata�s definition of provocation is still more elucidating. He states
�Provocatian is that stage when a vitium moves in a wrong direction and manifests symptoms of its morbid condition and the feeling of illness denotes the occurrence of disease.� (Ast. Hid 12,23)
III The Stage of Diffusion or Pervasion of Vitiation Process
Susruta strikes an exceedingly astonishing concept when he tries to explain this process of diffusion �Now we shall describe the process of diffusion of vitiation process. Triumvirate provoked by the excitant etiological factors begin to increase just as the combination of rice-flour water and yeast give rise to increase (fermentation). And this increase naturally leads to overflow and spreading in the body�. (Sus Sutra. 21, 28)
Susruta compares this continuous process of increase to the phenomena of growth in yeast fermentation, thus anticipating by two thousand years the great discoverer of bacterial science, Louis Pasteur, who proved the truth of this concept to the world by physical methods. Equally astonishing is the biological postulate of growth and reproduc�tion which in Caraka�s words runs as follows:
�There is no seedling in the absence of seed�.
Which needed Virchow (1855 A. d ) and Flemming (1882 a. d ) to expound it again in the 19th century as important biological laws �Omnis cellula e cellula" and �omnis nucleus e nucleo" respectively and prove it by modern scientific means.
In this spreading stage, if the vitiating effect are too strong, the whole body may be overpowered and general or constitutional disease condition will result.
If the vitiating effects are not so strong as to disable the whole body, it may continue to move in the body, just as clouds do in the sky, till they find sufficient attraction for settling or definite obstruction to proceed further and produce disease condition at that site.
Susruta describes definite syndromes indicative of diffusive stage of each of the triumvirate and considers this stage as the third in importance from the therapeutic point of view (Sutra. 21, 32)
IV. The Stage of Location
This location may occur at any and every place Susruta says:
�Like the cloud in the sky, the vitium showers disease on the entire body or on a half of it or in whatever part or organ it is greatly provoked�� (Sus. Sut 21, 29)
Caraka says:
�Affecting either the entire body, or half the body or only one limb or region of the body". (Car. Cik. 21, 7)
Why does it get located at a particular place?
Locus minoris resistentae of the particular system-organ or tissue or obstruction in the body channels may determine the location of the vitiating elements. This locus minoris resistentiae may be due to particular constitution of that system, organ, part or cell or it might be due to biological inferiority in growth or it might have been caused by damage to them, by previous trauma, stress, disease, or otherwise.
Susruta explains the reason of Location thus:
�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�. (Sus. Sutra 24, 10)
Caraka also states in the same way the reason of location in one place.
�The vitium pours down its vitiating element whenever it contacts a susceptible spot and causes disease condition there as a cloud pours down rain in a favorable region. This is the mode of local provocation of vitia.�� (Car. Cik 15, 37)
This stage of location is of great clinical importance for early diagnosis of disease 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 vttium or vitia, but also will be indicative of location or site where vitiation process has begun to spread. These combined symptoms help to localize the site of disease-condition. Susruta, the master clinician, differentiates the symptoms produced during this stage of location of vitiation process as the definite premonitory symptoms�����
�The premonitory symptoms manifest when the vitiation process is located From them the disease is recognised This is the fourth stage of therapeusis. �� (Sus Sat 21, 33)
And this stage of location manifested clinically by definite premonitory symptoms is the fourth period of importance for therapeutic purpose.
V. The Stage of Manifestation
Vyakti is the stage of manifestation of actual disease condition. Susruta correlates this pathological stage with the actual appearance of clinical phenomena of the disease.
��We shall hereafter describe the actual manifestation of disease�
This disease condition may be a general disease or a syste�matic disease, or a 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 in the body.
The disease-cndition may be classified in two groups general or local and both these groups, can again be subdivided into acute and chronic types.
A General
1. Acute types
If the vitiation elements are too strong, time and place very favourable to them, and the body constitution very weak or susceptible to disease condition, vitiation or morbific process spreads over the entire body very abruptly and the body is overpowered immediately. The body then succumbs completely and passes in full vitiation stage to be followed generally by dissolution.
Such conditions are described by Caraka as follows.
�O Worshipful one! I see in the bodies of human beings a fell disease which spreads with the virulence of snake-venom. Those men who are attacked by this fulminating disease succumb to it speedily, unless treated promptly Now concerning this disease, we are ''m'' great need of enlightenment� (Car Cik. 21, 6-7)
If after the immediate stunning, stupefaction and vitiation, the vital power of the body rises to the occasion and rallies all his anti-forces or antibodies to save the situation, and extraneous factors of time and environment become helpful to the body, the issue takes the reverse turn and vitiation process becomes lessened and if the counter-action will continue successfully, the body with its triumvirate organization becomes free from vitiation altogether and the man survives. (Car Cik ''6'' 54-56)
2 Chronic types
The general disease condition may have periodical or chrome clinical course if the fighting forces on either side are nearly of equal strength. Fighting forces are vitiation elements versus body-constitu�tion and body-elements, season, time and other environmental factors may be helpful to 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 disease condition. Such kind of warfare continues for a long time till one side gets sufficiently powerful to subdue the other Caraka describes such oscillations in disease condition as under:
"The morbid toxic factors having opposition from the anti-bodies, cause remittent fever which periodically rises and remits.� (Car. Cik. 3, 62)
B Local Disease 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 external source. These exogenous etiological factor are tenned Agantuka to be differentiated from the endogenous ones which are termed Nlja. A long list of such exogenous and endogenous etiological factors is given in Caraka Samhita. (Car Sutra 18, 4 and 6)
The differential diagnosis between disease conditions produced by endogenous causes and by exogenous causes is described by Caraka as under:
The exogenous one begins with pain and later on leads to the discordance of Vata, Pitta and Kapha. But in the endogenous one, discordance of Vata Pitta and Kapha occurs first and later of gives rise to pain. (Car. Sutra 20, 7)
Fight in a localized area of the body has the advantage of receiving great help from the body in general. The entire body concentrates all his fighting forces at the war-site to give a regular pitched battle.
The local concentration of warfare phenomena makes the localization of disease area an easy task to the clinician. When the regular pitched battle is decided at the site, all fighting forces and equipment are brought and concentrated at the spot. Thus the part becomes enlarged and appears swollen. There is an acute stage of whole atmosphere. All these signs of local warfare 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 such local warfare reaction
Caraka describes as follows �
�The swelling which is characterized by pain, burning, redness and pricking pain should be diagnosed to be a suppurated swelling�� (Car Cik. 25, 52)
Similarly Celsus in A. D 50 described calor, rubor, tumor and dolor as four cardinal signs manifesting the local phenomena of inflammatory reaction. Caraka considers swelling (tumor) as the pathognomic of such conditions.
��It causes edema with its pathognomic symptoms of swelling". (Car Cik 12, 8)
� It is marked by steady swelling, so it is edema with swelling�� (Commentary by Cakrapani).
And so such conditions are termed or in Ayurveda.
Susruta calls this local phenomenon of swelling as ________ .(Sus Sutra 17-3)
Clinicians in Greece gave dominance to the other signs viz, redness and heat and called this local phenomenon as inflammatory reaction, redness and heat being the qualities of the �flame.
This difference in dominance of particular signs in two countries may be an interesting subject to the student of ethnology. As race with Kapha constitution will react with swelling as more prominent sign and race with Pitta will have heat and redness as more dominant signs.
(1) Acute inflammatory conditions.
The same process as it occurs in general disease condition takes place in localized disease condition but on a smaller scale.
It has the advantage of getting help from the body but it may put the whole body to a disadvantage if vitiation or morbific elements get an upper hand and crossing the limit of war-area spread in the neighbouring parts or in the whole body.
These are described as complications of local inflammatory reactions. Caraka mentions the following complications:
�Acute spreading affection, hemiplegia, vascular thrombosis, convulsions, stupefaction, insanity, acute pain in the wound, fever, thirst, lock-jaw, cough, vomiting, diarrhea, hiccup, dyspnea and tremors are the sixteen complications of wounds, described by the specialists m the subject of wounds�. (Car Cik. 25, 29-30)
The local disease conditions terminate in the same way as the general disease condition. But the results are less serious ReBolu tion and dissolution of the local part indicate the success or failure of the body in the encounter.
(2) 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 the fifth best of the therapeutic period. Though it is late, it is better than too late which is the sixth or last period of treatment as the terminating stage of the disease.
We shall now give some of the comparative data of descri�ption of such local inflammatory processes found in Ayurveda and modern medical treatise.
Inflammation - Variation in Intensity of Classical signs is due to the Domineering Action of Particular Vitium
Celsus in A. D 50 described the four cardinal signs mani�festing the local phenomena of inflammatory reaction. They are calor, rubor, tumor and dolor and they were co-related with the four humors of the microcosm i. e, body-constitution, the four corner stones in the humoral pathology of Hippocrates these were again correlated to the four proto-elements of the macrocosm i. e. the world as described by the philosopher-physician Empedocles who regarded these four proto-elements as the roots of all things.
In India macrocosmic and microcosmic concept was of a triad, but practical surgeons often found blood which is rather a structural system more convenient and useful in diagnosis and treatment specially of local disease-conditions. Susruta thus tried to give nearly the same status to blood as to triumvirate and described four categories
�The diseases pertaining to the body have their origin in blood and drink ingested on account of the vitiation and discordance of Vata, Pitta, Kapha and he Blood'. (Sus Sut 1, 25)
While commencing on (his verse, Dalhana gives the following explanation for including Blood in the categories of constitutional classification
�The Blood is included because in a wound there is the dominance of blood among the vitia�. (Commentary by Dalhana)
Susruta clarified this point by stating that blood is secondary to and dependent upon the primary triumvirate of vitial categories,
�Because the blood is never provoked without the vitia (Sus Sut 21, 25)
Blood is included under the Pitta category when the three vitial categories are taken in consideration.
�That born of Blood is like that of Pitta.�
�That born of Blood is to be known like that of Pitta."
It is really interesting to find that equal importance is given to the description of inflammation in Susruta Samhita, a treatise on Surgery, as is done in the modern surgical text books. In both we find that the description of diseases is initiated with this subject and a large number of chapters is devoted in each to give detailed and exhaustive description of this inflammatory phenomenon in general. Nearly 1/15 of the text in each, deals with this pathological process alone. Susruta concludes this subject by generalization of the local pathological process in the following words.
�This summary of the types of pain and color is not limited to wounds but is applicable to all types of inflammation. Hence the physician should regard all inflammations like wounds."(Sus. Sut. 22, 13)
Classification of a subject may be made from various points of view to help the understanding of the subject. Modern surgical text books classify inflammation generally in the following types:
A Acute or subacute
B Acute or Chronic
C Parenchymatous or Interstitial
D. Serous-Catarrhal-Fibrinotis-Hemorrhagic or Suppurative
These classifications are done either according to the intensity of the process, or to the tune it takes to develop, or according to the tissues it attacks or the exudation which it gives rise to Ayurveda classifies the inflammation in three groups of constitutional triumvirate.
This triumvirate classification has greater significance in clinical diagnosis and practical therapeutics It is done from clinical- pathological-cum-physiological point of view.
If the etiological factor is excitant of a particular vitium, or any particular vitium of the constitution is predisposed to disease condition, the signs and symptoms characteristic and pathognomic of that particular vitium will be more dominant than the signs of other two vitia.
If two vitia are dominant and acting in combination, signs of two will be manifested dominantly. If all three, all signs will be aggravated.
The pathognomic signs of each of triumvirate are as follows:
�There is no pain without Vata, and burning without Pitta and no swelling without Kapha, nor is there redness and suppura�tion without blood. These are the respective signs of the vitia and the blood� (Ast. Hrd Sutra 29, 6)
Vata�pain (dolor).
Pitta and blood�heat and redness (rudor) (calor)
Kapha�swelling (tumor).
These four signs correspond very closely to the triple response of Thomas Lewis. It is the clinical experience of every physician and surgeon that there is wide variation in intensity and rate of development of these classical signs. This can be well explained if we understand the full concept of Vaso neurotic constitution.
The phenomenon of inflammatory reaction is the resultant of the action of etiological excitant and reaction of Vaso-neurotic constitution. Threshold of contraction and dilatation of arterioles and capillaries vary in each individual and also the capillary permeability. This is due to Vaso-neurotic individual constitution.
Thus Vaso-neurolic constitution of the individual plays an important part in the phenomena of Inflammation, Krogh while describing the Vaso-neurotic constitution declares:
�I shall say, finally, a few words about the so-called Vaso- neurotic constitution."
It is characterized by the great lability or downright instabi�lity of the innervation of the vascular system which manifests itself in the capillaries as well as in the arteries. Frequent changes in the lunervation occur either spontaneously or from comparatively trivial causes.''�''
The redness is brought about by opening up and dilatation of capillaries and venules, the heat by the increased flow of blood due to dilatation of arterioles, and the SWEEPING by exudation of fluid from vessels due to their increased permeability, and the PAIN finally by the stimulation of nerves.
Though these reactions occur in the interest of the body it is possible that some of the reaction if occurring in excess may often be harmful, similarly some occurring poorly may not be of effective use. The knowledge of constitutional tendency of the man as a whole as of the Vaso-neurotic constitution of the local organ or part affected and also of the particular exciting action of the etiological factors may help to control or rectify this protective and restorative reaction to the best advantage of the body. Here is the need of the study of the constitutional triumvirate. Triumvirate concept may open up a subtler field of research in the action of etiological factors as well as behaviour of body tissues.
VI The Stage of Termination
This is the end or termination of the vitiation process. In general disease-condition the person may completely recover. If his body vitality can counteract the incursion successfully or may suffer dissolution if the invading forces are too powerful for his body vitality.
If any of them is not able to subdue the other totally and bring about decisive conclusion, the disease condition may persist for a prolonged period.
Similarly in local disease condition too, there may occur complete resolution or dissolution or death of the local part (Necrosis, gangrene or ulcer). Local disease condition has one special method of termination and disposal or elimination of waste or morbified matter. It is the process of suppuration.
�It tends to suppurate if it is not possible to sedate it by special external or internal treatment, or if the treatment given is wrong or if the morbidity is in excess.� (Sus Sut. 17, 5)
This will end in producing the condition of wound. If the conclusive termination is not brought about by either party being subactive and not able to subdue totally the other, the chronic inflammatory condition or chronic wound condition such as fistula or sinus my continue for a long period.
This is the last or sixth stage of therapeutic period advised by Susruta. 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 started in the earlier stage will be easier and simpler than if started late when vitiation process has gained strength and intensified.
��Vitiation process checked or subdued in the accumulation process, fails to produce any further development, but allowed to progress, it gains in strength and intensity in the course of its further development." (Sus Sutra 21, 37)
The principles of treatment during the vitiation process are formulated primarily with a view to eliminate or get rid of the vitiated morbid matter resulting from the pathological processes and accumulated in the body. For the purpose of such elimination, the neatest and simplest outlet or body channel was chosen. Thus came into practice the treatment known as the pentad of eliminatory or purificatory procedures.
Caraka declares:
�These drugs should be used as emetics by the physician, in way not harmful to the body, in gastrogenic disorders characterized by morbid accumulation of Kapha and Pitta" (Car Sut. 2, 8)
� should be prescribed for purgation when the morbid humors have accumulated in the colon.� (Car. Sutra 2, 10)
This purificatory therapy was put into operation in a rather strong degree in order to accomplish the complete elimination of the morbid matter. The procedure required that the body be previously prepared, before undergoing such a strong method of treatment, by oleatlon and sudation procedures. These procedures facilitated the easy elimination of morbid matter. Caraka says :
�Oleation cures the morbidity of Vata, makes the body soft and disintegrates the accumulation of morbid matter, while sudation liquefies the morbid matter which is stuck up in the minute channels of the body of the person who has undergone oleation therapy.� (Car Siddhi 1, 7)
When the body is found to be not fit and intolerant of such a radical treatment, the line chosen was to bring about the gradual digestion of the morbid matter, a concept so similar to the detoxication conjugation concept of modern physiology. The liver is believed to play an important part in protecting the organism from various toxic substances. This detoxifying function is believed to involve 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, sudation, time-effect, diet of gruels and articles of bitter taste, digest the imperfectly digested morbid matter in the body�. (Car Cik. 3, 142)
After the complete riddance from morbid matter, the treatment consists in supplying the deficit and strengthening the body vitality by drugs as well as dietetic regimen. This process is called rehabilitation. (Car Sutra 15, 16)
Some more Concepts of Pathological Conditions or Processes in Ayurveda
We shall now review briefly the concepts the ancients held regarding the following pathological conditions or processes.
'''25.         ''' �The concept of epidemic and pandemic diseases
'''26.         ''' �The concept of sources and spread of infection or contagion.
3-4. The concept of growth and multiplication of morbific elements m the body and their mode of spread and action.
5. Certain abnormal conditions of the body-appearance
The Concept of Epidemic and Pandemic Diseases
In epidemic diseases they observed that the constitution of the body is not able to play any part in counter-acting the incursion of infesting elements. The etiological factor has all the voice in the disease-phenomena. Hence the uniformity of symptoms and clinical courses observed as the etiological factor, is uniform. Constitution which is an individual concern is out of game, hence very little individual variation can occur in the clinical picture 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 Samhita devotes one chapter to explain the concept of Epidemiology (Vimana 3). It is a thought provoking concept and probably progress in radiation physics may be able one day to find the equivalence in value between the physical and spiritual universe and rediscover the truth laid down by Atreya.
We shall cite now the passages that explain the reasons 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 in men and what are the main sources of such ailments. Caraka in Vimana 3 treats the subject thus.
''"5'' But, how does the simultaneous destruction of commun�ities, consisting as they do of individuals who differ from one another in constitution, diet, physique, vitality, habits, psychic make-up and age, take place by the incidence of one single disease?
6-(i) Unto him replied the worshipful Atreya, O, Agnivesa! though a community may be heterogeneous in respect of the constitution etc, of its individual members, there are other common factors which being adversely affected will cause simultaneous outbreak of diseases having similar symptoms. It is these that devastate whole populations.
6. The factors that affect a people in common are: the winds, the waters, the country and the seasons.
[1] (l) of these, the wind, if of the following description, is to be known as disease-inducing viz. unseasonal, totally becalmed, violently blowing, exceedingly rough, intensely cola, intensely hot, excessively dry, excessively humid, fearfully clamorous, blowing from contrary directions and clashing with itself, extremely rotatory (whirlwind), and charged with unwholesome odors, moisture, sand, dust and smoke.
7-(ii). The water of the following description is to be known as bereft of virtue, having an extremely aberrant smell, color, taste and touch, abounding with putrescent matter, deserted by aquatic birds, in which the aquatic creatures are atrophied and which is unpleasant.
7 (iii) The country of the following description is to be known as unwholesome, 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 and 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 amidst the people, morality, truth, modesty, custom, character and virtue have either declined or been given up, where the waters are always agitated and upheaving, 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 and which lastly, is as if full of constant alarm and lamentation, crying, fright and darkness as if visited by gnomes, and as if abounding in sounds of lamentation
7 (iv). A season which is of the following description is to be known as unwholesome; evincing characteristics that are opposite to normal, or evincing its characteristics in an excessive or deficient degree.
[1] The learned declare these very four factors when possessed of the morbidity described above, to be destructive of populations, when not so blemished they are said to be wholesome.
8. But even when these depopulating factors have turned inauspicious, there is no fear of diseases to those persons who are served with medicines that have been culled beforehand.
12 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.
14 For them moreover, the rightful use of vitalizing medications is recommended, the maintenance of the body by means of the medicinal herbs culled beforehand is also commended (Car. Vimana 3, 5- 14)
2 The Concept of Sources and Spread of infection or Contagion
A Sources of Infection or Contagion
Regarding the sources of infection in epidemic diseases Caraka lays down that the wholesale vitiation of the air, water, country and season are the sources of vitiation.
��The factors that affect a people in common are the winds, the waters, the country and the season.� (Car. Vim. 3, 6)
"The learned declare these very four factors when possessed of the morbiditv described above, to be destructive of populations, when not so blemished, they are said to be wholesome." (Car. Vim 3, 7)
Susruta states that epidemic diseases spread from man to man.
�Dermatosis, fever, consumption and eye-sore are infectious diseases and spread from man to man.�� (Sus Sutra 5, 34)
3. Concept of Growth and Multiplication of Morbific elements in the Body And their Mode of Spread and Action
Susruta compares the growth of vitiating elements to yeast fermentation which has already been explained in the chapter of vitiating pathogenesis (Sus Sutra 21, 28). Here the simile of yeast fermentation used to explain the increase of growth of morbific elements is quite suggestive.
Caraka seems to have a clearer awareness of the biological factor involved fn the vitiating elements. He refers the phenomenon of the periodicity of fever to the recurring cycles of growth, spread, spending itself out and withdrawal of the vitiating element. This description agrees fully 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.
�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 ripe.
Thus the morbific factor gathering strength and biding the propitious time, manifests itself as the tertian or the quartan fever as soon as the disease-resisting 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 mustering up their strength, once again, these toxic elements afflict the patient with fever at their own ripe times.� (Car Cik 3, 68-70)
As the seed begins to grow at its proper time so does the morbid factor. Morbid factor having increased in amount and gaining strength and getting the favourable time for action and not being counter-acted by anti-bodies, causes the disease symptoms. Having expended all the power and getting powerless ''it'' reconciles or returns to its original soil and growth, and repeats the cycle of growth, spread, action and return.
''(4) Certain'' Abnormal ''Conditions of'' Body-appearance
They had observed certain abnormalities in appearance of the persons who where otherwise living in good health. So these condi�tions are not grouped under the disease list but they are described in a separate chapter just after the enumeration of all the disease conditions.
The eight censurable body conditions described therein are as follows. Obesity or Tenuity, Dwarfism or Gigantism, Albinism or Pigmentation and Hirsuites or Baldness. (Car Sutra 21-3) These are probably connected with some abnormality of the function of Glandular system of the body The body has however adjusted to live in health.
'''27.         ''' Significance of Constitutional Factors in the ''Etiology'' of
'''28.         ''' Significance of Constitutional factors in the Clinical course of
'''29.         ''' Significance of Constitutional factors in prognostics.
'''30.         ''' Significance of Constitutional factors in practical Therapeutics
1. Significance of Constitutional Factors in the Etiology of Disease
If the balance-constant of the vitium which is dominant in the constitution of the 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 a smaller degree of exciting factors. This is the relative condition of predisposition or susceptibility.
The constituent vitium whose threshold of sensitivity or affectlvity is on a lower level, will require unusually a larger degree of exciting factors to manifest disease condition. This is the relative condition of immunity.
Caraka states :
�In a person of the Vata habitus who is given to indulgence in Vata-provoking things, the Vata is readily aggravated; not so the other two humors��.
Similarly in the Pitta patient, who is given to the indulgence of Pitta-provoking things, the Pitta is readily aggravated, not so the the other two humors.
Similarly in the person of Kapha habitus given to indulgence in Kapha-piovokmg things, Kapha is readily aggravated; not so the other two humors� (Car. Vim. 6, 16-18)
ii. Significance of Constitutional Factors in Clinical Course of Disease
Caraka Samhita gives a succint but a clear account of the part constitution plays in the production of the clinical picture of the disease and lays down as a general clinical law that manifestation of actual disease condition is the resultant of the varying interaction of the etiological factors, the triumvirate of constitution and the body-tissues.
"Here we shall describe the suppression or 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, mainly the etiological factors etc, do not mutually associate or support, or if they do so after a long lapse of time, or m a very mild form, either there occurs no manifestation of the disease at all or the disease takes a long period to evolve, or appears in an ambulatory or abortive form. Under the contrary condi�tions, there occur contrary results. Thus are laid down the different causes of the modes of incidence or suppression of all diseases". (Car. Nid. 4, 4)
Concerning the resultant of the encounter of etiological factors with the vitia and susceptible body tissues, the author describes the following possibilities �
1. If the etiological excitant and constitutional vitia and body tissues are not mutually agreeable at all, that is the excitant factors 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 disease-condition. (no manifestation of disease-condition)
2 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 disease condition, there will be manifestation of a mild abortive or ambulatory type of disease condition mild or latent or ambulatory type of disease-condition)
3. If mutual agreement and combination of all these three factors are gulfed by a long interval, there will be a delayed development of disease. The disease condition has a prolonged clinical course. Incubation period is long and clinical course is chronic or prolonged chronic disease condition).
Under the above mentioned two conditions the disease does not run a fixed, regular or constant clinical course. It rather manifests diversified clinical pictures. It may not manifest all the classical symptoms of the disease condition, or it may manifest them in irregular way. There may not be orderly sequence maintained in the development of symptoms or the symptoms may be intensely manifested in one part of the body tissue or system and there may be no symptoms at all in other parts, or manifestation of symptoms may be delayed or prolonged. (Manifestation of symptoms in an irregular way).
4 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 classical symptoms in due order of time and in degree of intensity giving a text-book-type picture of the disease-condition. (Disease condition with typical manifestation of symptoms).
5. If the etiological excitant is more severe and acute, the vitia just on the threshold of excitement, 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 great exaggeration of general or local symptoms. (Disease conditions with acute or grave clinical course manifesting all symptoms).
These are the general postulates of manifestation of clinical course in any disease condition. Constitutional factor being an individual factor, there will always result individual differences in the clinical picture course and termination of the disease.
There are some disease conditions where constitutional factors are unable to play any part or counteract the incursion of the etiological factors. Caraka describes such a state of things to occur in epidemic and pandemic diseases where the incursion is so strong, powerful and sudden that the constitutional factors are not able to counteract at all, and so all people with varying constitution suffer simultaneously from a severe type of disease condition and run nearly uniform clinical course.
�There are other common factors which being adversely affected, will cause simultaneous outbreak of diseases having similar symptoms It is these that devastate whole populations." (Car Vim 3,6)
These postulates can well be interpreted in simple mathematical formula as under:�
Disease = Etological factors
���������������� Vitia and body-tissues
III Significance of Constitutional Factors in Prognostics
Caraka gives great consideration to constitutional factors in foretelling the prognosis Constitution is given equally an important place in the branch of prognostics by Hippocrates Caraka emphasizing the value of the knowledge of prognostics to the physician to attain full success in practice, states.
�The physician who knows the differential diagnosis between the curable and the incurable diseases and begins treatment with full knowledge of the case and in time, obtains success for his effort without fail' (Car. Sut. 10, 7)
He divides the disease condition in four categories from prognostic point of view.
�The curable diseases are of two kinds: those that are easily cured and those that are cured with difficulty. The incurable diseases also fall into two categories' those that are palliable and those that are absolutely irremediable" (Car. Sut 10, 9)
Constitutional factors play an important part in determining these four prognostic categories, moreover the knowledge of constitu�tional factors helps the physician to some extent to know the prognosis and thus enables Him to fore-arm and prepare for future line of treatment of disease-condition.
IV. Significance of Constitutional Factors in Practical Therapeutics
The diligence of the skilful clinicians who previously determined the exact role placed by each viz., etiological excitant, constitutional triumvirate and nature of body-tissue, becomes fully fruitful when practical therapeutics are to be prescribed.
The text books of modern medicine prescribe treatment for Homo-sapiens in general giving the limit of minimum and maximum dose which can be safely administered to man without harm. This is the scientific formula worked out fully by experimental and observational methods and properly standardized, and is hence all-essential for correct guidance and is valid for the average. But practical application and use of this scientific knowledge in the best interest of each individual�s the real art of medicine.
All the achievements of the practical knowledge of disease or drugs or even diagnostic skill, will be to no purpose if it is not combined with practical art of scientific application of therapeutic measures which alone can bring the full success in treatment.
Caraka states this very forcibly.
�The art of prescription depends on the knowledge of dosage and time, and on this art, in turn, depends success; hence the skilful physician stands ever superior to those possessing merely a theoretical knowledge of drugs��. (Car Sutra 2, 16)
It is essential to understand and study environmental etiological excitant but the knowledge of individual constitution of the patient which plays such an important role in the phenomena of disease is not only equally necessary but rather 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 emphasise the need for meticulous accuracy in dosage as deviation on either side fails to produce fully the desired results. A small dose is not sufficient to counteract the disease condition while larger dose may produce excessive effects ou the body and may even be harmful to the body at times.
''�A'' rash administration of a very strong medication without examination, on a weak patient, will upset him
But in strong persons affected with a strong disease, weak medicine administered without examination becomes useless�.(Car Vim 8, 94)
The keenness in Ayurveda regarding the accuracy in dosage becomes too evident even in the term 'Maatra' meaning measure, which has been selected for denoting dosage, the word is derived from the root �Maa to measure' thus significant stress is laid on accurate measuring.
While the word Dose is derived from Greek (doses-didomi= give ) which is cognate to the Sanskrit root (da=to give) where the significant meaning is mere giving.
And to attain 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 the other factors". (Car. Vim 1, 3)
The significance of knowledge of constitution in determining the personal regimen of the individual has already been described. ( Car Sutra 1-6''2'' >
To attain the ideal of easy comprehension combined with exactitude, the ancients reduced the therapeutic science nearly to mathematic. ''A'' formula Ingestion of food and drug was the sole method of admini�stration at that time; and hence taste which was the main index, was grouped into six categories to fit easily with the three categories of triumvirate of constitution, and they evolved further the general formula co-ordinating each of the triumvirate with a group of three of the taste categories. One group of three increasing and the remaining other group decreasing the force of each of the vitia. (Car Vim. 1, 6)
The mathematical formula concerning Dosa and Rasa did not end here. As Dosa was worked out by combination and permu�tation method to 63 forms, so Rasa was also worked out to 63 forms by the same method (Car Sutra. 26, 22).
Rasa was also considered in its 'Tara' and 'Tama' comparative and superlative state as was Dosa considered. (Car. Sutra. 26, 23)
Thus specific determination of Rasa and Dosa and reducing them to mathematical formula of inter-relation is the most significant attainment of exactness in practical therapeutics conceived and achieved by the ancients. Caraka who devotes one full section Vimana of 8 chapters to this specific determination of all details of various factors concerned in production of disease as well as the factors important in diagnosis and treatment, discusses this interrela�tion of Rasa and Dosa in great detail in the first chapter of Vimana and thus emphasizes the great importance of accurate knowledge of constitutional factors for practical therapeutics.
The following remark of the great physician William Osier well emphasizes the importance of constitutional factors in the clinical manifestation of disease. It gives the inter-relations of the soil and the seed.
The Soil
�Many years ago I drew the parallel between infection in tuberculosis and the parable of the sower, which though now some what hackneyed illustrates in an effective way the importance o the nature of the ground upon which the seed falls. �Some seeds by the wayside and the fowls of the air came and devoured them up.' These are the bacilli scattered broadcast outside the body, an immense majority of which die. Some fell upon stony places. These are the bacilli that find lodgment in many of us, perhaps, with the production of a small focus, but nothing comes of it; they wither away because they have no root.' 'Some fell among thorns, and the thorn sprang up and choked them.� This represents the cases of tuberculosis, latent or active, in which the seed finds the soil suitable and grows, but the conditions are not favourable, as the thorns, representing the protecting force of the body, get the better in the struggle. �But others fell on good ground and sprang up and bore fruit an hundredfold.�
This parallel which the author applied to the tuberculosis may be generalized for all disease conditions. The seed is the bacteria and the soil the body constitution.
Caraka classifies all etiological factors of diseases generally into two types, i.e. endogenous and exogenous (Car. Sutra 18, ''4'' and 6). Susruta pursues the subject further into its metaphysical origins and declares in his treatise in keeping with the general concept in all branches of the science that disease is the occurrence of suffering (Sus Sutra 24, 4). That suffering is of three kinds.
(1) Having its source in oneself
(2) Having its source in physical elements and creatures of the world
(3) Having its source in natural and supernatural agencies.
This triad of etiological categories is in accordance with the Sankhya concept of the triad of the causes of all suffering Susruta makes further subdivision from a practical point of view of this triad so as to make seven categories of disease in the light of their etiological factors.
They are thus:
A Endogenous Category
1. Hereditary diseases. Inherited disease conditions from inherent defect in genesis of one�s parents. These are genetic etiological factors.
2 Congenital disease - The disease conditions which result during the fetal period of life in the mother�s womb. These are congenital etiological factors.
3. Nutritional or metabolic diseases - It also includes psychic and somatic conditions due to internal derangement of function or structures. These are the nutritional or metabolic etiological factors.
B Exogenous Category
I Aadhimautika:
The group of diseases that are due to all kinds of trauma or injury from physical, chemical and biological sources. (Car Sutra 18, 4)
II Aadhidaivika
'''31.         ''' �Diseases resulting from abnormality of climate and season.
'''32.         ''' �Those of supernormal origin or nature such as pandemics, epidemics, emergent conditions due to atmospheric upheaval and such other dreadful disease-conditions difficult to explain ordinarily
'''33.         ''' �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 cl<sup>a</sup>ssifications are exhaustive and the entire varieties of etiological factors both biological and material are comprehended by them.
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.� (Sas. Sutra 24, 8)
Caraka modifies this statement slightly differentiating endo�genous 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.&quot;
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.&quot;
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&quot; (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.
Susruta says:
''�''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.
Triumvirate-wise Nomenclature
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).
Vitium-wise Nomenclature
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
Tissue-wise Nomenclature
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.
Susruta states:
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.&quot; (Su-&gt; 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
Cause-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.
&quot;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.&quot; (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.
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 &quot;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.&quot; (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.&quot; (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,&quot; (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.
&quot;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 )

Revision as of 21:45, 13 June 2018



The Science of the Triumvirate of Pathogenesis or of Constitutional Pathology


The Background


It is necessary to understand the background of the origin and growth of an idea or concept to be able to fully adjudge the degree of its validity. This is even more true in the case of a concept which relates to the working and maintenance of the life currents of the psychosomatic constitution of man specially in the case of that concept which under the title of Tridosa in India and under that of Hippocratic constitutional or humoral theory in the West has remained for centuries the central doctrine of health and disease. The meaning and interpretation of the terminology, having got degenerated and distorted during the long period of two thousand years, received a temporary setback during the dominance of the analytical age of localistic study of individual organs, tissues and cells.


But the recent evolution of microbiology, the progess of knowledge of nutrition and metabolism, the concept of integrative functioning of endocrine glands and the vegetative nervous system and the studies of allergy and immunity have revived the clinical interest in the study of constitutional or integrated or synthetic concept of the personality of man as a whole.


Arturo Castighom, the great medical historian, describing this modern revival of ancient constitutional concept as neo-Hippocratism says, "Such principles indicate the orientatation of Modern Medicine toward a neo-Hippocratism (a term introduced by the author in 1925), return to some of the classical principles of medical thought Modern medicine, today turns to a dynamic, synthetic and Unitarian direction after a period in which a morphologic, analytical, localistic tendency dominated. It is a return to the classical concepts of the ancient sage of Cos, focussed on the well-being of the individual and the improvement of the race, seeking for the cause of the disease, its prevention and cure, both in the individual and in his environment. 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 also are important. It is significant that the best type of clinician is learning and teaching how best to utilize all the weapons at hand in the laboratory as well as at the bedside to focus more efficiently on the one vital item, the study and treatment of the patient. The careful physician is convinced that no test, however important and decisive it may be, can take the place of a synthetic clinical opinion and the personal judgement of an intelligent and experienced clinician as to the condition of the patient and of the community.��


At this junctre of an era of revival of the constitutional concept, not only in India but in the whole world, it will be certainly interesting and instructive to study the Tridosa doctrine. The Tridosa concept of Ayurveda is the earliest constitutional concept. Its germ can be seen even in the Rgveda but it was systematized and evolved as a scientific concept during the golden period of Ayurveda in India. If the true connotation of the terms in which such a concept is embodied is fully understood against the background of its origin and growth, much needless argumentation and opposition based on misunderatanding 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 un�mistakable terms in the holy books of the Hindus From India it was carried to the Groeks by way of Persia.��


Dr. George Draper M D in the book �Human Constitution in Clinical Medicine� makes a similar statement. �Indeed in ancient India the school of Ayurvedic medicine gave instructions for evalua�ting 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 students. It affirms the existence of three Dosas or essential principles which pervade all the tissues, secretions and excretions and determine health and disease."


The Triumvirate


For 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 Tridosa pathogenesis, the three determinants of pathogenetic and pathognomic phenomena comprising what is generally called Constitutional Pathology. These determinants of pathological variations, are in fact, when in a normal and well-balanced condition, the fundamental functionaries of the physiological state of the living organism Harmonious working of these three functionaries is health and their discordance is disease."


Sir Michael Foster's remark, �the science of meteorology that cannot be divided into the science of good weather and the science of bad weather,� can he aptly applied to the subject of health which cannot be divided in the science of good health and the science of 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. In actual fact, his work was almost as much concerned with 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 i. e. physiology and pathology of each and every form of life, from the ameba 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 vital physiological processes that they can be interpreted in a common terminology.


The Origin of inquiry into Pathogenetics


It is but stating the obvious to say that all inquiry into the nature of phenomena starts from the latter�s quality of opposition to the full and happy flow and expression of life. Pain and suffering, death and disease, fear and frustration arouse the spirit of inquiry and investigation in man. The philosophers of the Sankhya school start their inquiry into the nature of life provoked by the presence of suffering.


�On account of affliction from the threefold misery, inquiry (should be instituted) into the means for its removal.�


The Caraka Samhita also ascribes, to the emergence of disease among men interfering with the fulfilment of the purposiveness of their lives, the effort of the sage-scholars in acquiring the right knowledge of disease and its remedial measures.


�Health is the supreme foundation of virtue, wealth, enjoyment and salvation. Now, diseases are the destroyers of health, of the good life and even of life itself. Thus has arisen the great impediment to the progress of humanity. What shall be the means of remedying it? Having observed thus they sat in meditation.� (Car Sutra 1, 15-17). �He, the sage of great understanding soon learned correctly by single-minded devotion the whole science of life tribased and exten�ding without end." (Car. Sutra 1-25)


It is thus that distressed and goaded by pain and suffering, physical and mental, the effort of inquiry started and bore fruit in the shape of the discovery of the three-fold determinants of all Physiological and Pathological processes of life.


Inquiry must be Adequate and Scientific

It is not enough if the effort of inquiry is merely sincere and intense in guaranteeing the correctness of the results. The method adopted must be sound, adequate, rational and consistent with the funda�mental facts of the physical and biological laws of the universe. The first of such positively scientific efforts was made by the Sankhya thinkers. They emphasised the necessity of scientific knowledge and the following verse from the Caraka Samhita will ever remain the arch-aphorism as the guiding principle of all inquiry.


�The whole of suffering which cleaves to the mind and body has ignorance for its basis and conversely all happiness is founded in clear scientific knowledge.� (Sutra 30,84)



What is Science?

From the various definitions and explanations given of science it becomes clear that science is in the method and not in the thing Science is�-


1.            �"Any department of systematised knowledge."

2.            ��A branch of study concerned with observation and with classification of facts specially with the establishment of verifiable general laws�.

[1] "Accumulated knowledge systematised 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 and which relation such parts will maintain at any time or place, given the attendant circumstances.

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."

Science, thus, is the critical systematic knowledge based on generalizations. It is an investigation into the nature of facts, facts not selected at random but in their comprehensive entirety. The scientist systematises 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.


The Totality of Knowledge

It is necessary again to remember that the totality of know�ledge of things was aimed at by these ancient scientific thinkers. 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 wrong conclusions


�The knowledge of the whole cannot accrue from the knowledge of merely a part "(Car Vimana4-5)


The total concept led them to an all-comprehensive and synthetic method of study. The knowledge of the past was acquired but with special reference to the relation it bore to the whole i.e. to the present and the future. The knowledge of the parts was co-ordinated and placed in the proper perspective of the whole. They studied the nature of the whole in its entirety. This concept led to the study of man as a whole, i. e as complete unit.


3.            The Study of Man as a whole


Man was studied in his 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 i e that aggregate of inherited characteristics, which, modified by environment, determine the man�s reaction to environmental factors.


4.            The Study of the Universe for the discovery of all the Sources

or factors of pain


The whole series of causes and sources of pain and suffer�ing extending over the whole universe was included in the investi�gation

a. Totality of Man-cum environment

b. Totality of environmental factors which become sources of pain or disease.

c. Totality of methods of investigation which covered all aspects of time and space.

d. Totality of things that were used as medication.


According to the Sankhya view all misery is of three kinds viz.,


1.            Internal = of the body-mind.

2.            External = of the physical world.

3.�� Spiritual = from supernatural sources.


Susruta further sub-divides these three categories into seven which

will be described in detail later on in the section on Etiological factors


Thus there remains nothing left uninvestigated in the universe, which can cause pain or suffering to man. It is an all comprehensive classification.


3. The All-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. (Car Sutra 11-26)


4 Totality of Thing�s in the world used as Medication


The therapeutic science left no article or natural element unused.


There is found in the world no substance that may not be used as medicine.�� (Car Sutra 26-12)


Thus to understand man, 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 is the cause of ease�� or "disease�� and which is also the source of medi�caments. This environment therefore consists of the whole universe surrounding him.


The Need for Analysis


Thus the aim of the totality of knowledge required a very varied and extensive field of study for its attainment. It needed also some method of simplifying the study and classification or the analytic method became very necessary. This orderly arrangement and syste�matization gave some basic formula for generalization and a progressive field for research. The analytic process was carried on till the least common measure of classification was arrived at.

Specific Biological Terms


But as the physical body forms a part of the biological living organism, the physical formula has to be co-ordinated with and incorporated into this triumvirate of biological organizations to evolve a specific biological formula of the triad of Vata, Pitta and Kapha. The five categories of physical matter are transformed into three by the method of earth and water being grouped into one, and air and ether being combined together, with the result that all the five physical proto-elements found place in the living organism being translated into the biological forces of Vata, Pitta and Kapha, i e, air and ether being combined into Vata, fire turned into Pitta and water and earth combined into Kapha.


A specific terminology was evolved for this triumvirate of biological categories, which is significant both of static existence as well as dynamic force viz, of Kapha which signifies aqueous proto-element of the physical formula and which signifies the evolutionary process of biological formula. Thus the whole word gives the sense of the organization of fluid matrix wherein the biological process of the evolution of life is carried out. The synonym is even more significant of the biological process of cohesion denoting the colloidal matrix or milieu for the vital play.


Pitta derived from to heat is significant of the function of heat. Vata is derived from 'to move� and is quite suggestive of dynamic or functional process.


Thus these thinkers 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 and dualities and actions that the physical sciences and medicine particularly have to deal with as their subjects and also the biological organizations into which they were translated by the magic of the vital force


This endeavour to analyse, re group, classify and denominate the physical and biological facta and laws heralded the usherance of medicine into the stage of a science.


The Characteristics of the Golden Age


The central theory of Ayurveda, the theory of the triumvirate of Vata, Pitta and Kapha, is the product of an age which is universally regarded as the most brilliant in the long 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 achievements which are still the crowning glory in art, literature, philosophy and medicine.


The age which in Greece threw up intellectual giants like Plato and Aristotle Pythagoras and Hippocrates, was in India responsible for the rise of the seers of the Upanisads and of Ayurveda. Philosophy was at this time the supreme pursuit of the thinking man, and it was to the philosopher�s counter that people came for the ultimate concepts of life. The arts and the sciences were, to be sure actively cultivated, but they played a subservient role to philosophy, the undisputed queen in the realm of thought.


This meant that specialization was allowed but the final verdict did not be with the specialist but with 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 studied the parts but which also studied them as forming the whole. It was this synthetic or integrated outlook which has given us the Tridosa 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 and 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:


(1) the phenomenal physical world

(2) the subtle or imperceptible world

(3) the principle of spirit that underlies the manifold vital forms and activities


From Metaphysics to Science


The medical propounders took the aid of the classification of things as held by both the Sankhya and the Vaisesika schools, the latter enlisting the totality of things under the categories of Substance, Quality, Action, Generality, Particularity and Co-existence. From purely metaphysical methods Ayurveda passed of to the physical and expert mental methods that physical categories and terms such as Substance,' Quality and Action involve.


Atreya reduces the universe to nine substances viz., the five


These combine to form the two main groups of things inanimate and animate.


All physical substances are educed 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. These systems they termed proto-elements or the quality of each proto-element was determined and the manifestation of particular qualities of its specific grade or intensity in a substance depended upon the relative proportions of the proto-elements in that particular substance.

This formula of proto-elements served the purpose m dealing with the merely physical idealities. But biological entities had two more factors to reckon with mind and spirit, which utilised and transformed physical matter to suit life�s purposes. Both these are dynamic forces and cannot be observed by physical means. They are to be known by the effects they produce on the body and their nature is the object of inferential knowledge.

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 the vital systems of the organism. The organization of bodily constituents is the mark of all living creatures and it is in this that they differ especially from inanimate things.


Time formula of physical matter cannot adequately explain the phenomena of the biological world which is characterized by organization. One is a static existence while the other is a dynamic creative process. Hence was felt the need to evolve the formula of biological function. All living organisms need minimum triple organization for their life processes.

1. The organization of fluid-balance of the body (water-balance system) -A specific fluid matrix is essential to full expression of life phenomena. This organization has to maintain the specific consistency and structure of the fluid matrix under the stress of varying environmental factors.

2. 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 parts and also to maintain the optimal heat of the body for full expression of life phenomena.

3. The Organization of Vital balance - Vital force is essential for the purpose of creative evolution, progress, power of organization and such other vital processes which characterize life and differentiate animate from inanimate things.

the rest of the universe should be found inhospitable to it. Be it as it may, its history on our planet has been a most interesting one and a most tenacious and untiring struggle against the odds of ever- changing time and environment. It would seem from the opinion of science that life is alien altogether to the physical forces of the uni�verse 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, its present temperature, its contents of solid, liquid and gaseous matter, its mountains and earthy crust, its oceans, and its atmosphere of air. That hour in its history was the hour of lifting the curtain on the drama of life and ever since, life's unfoldment has gone on through the various stages of vegetable, animalcular, animal and human evolu�tion. Till the human stage the urge of life has been an inner compu�lsion, blind, powerful and un-self contemplative. Only the urge has been there instinctive like the powerful drive of the powder behind the lead m the bullet. But now, man stands surprised, wondering and self-contemplative; and the psyche in him demands the luxury of a reflecting mirror of thought, in which to contemplate her graces and the freedom to choose the direction in which to make her 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 and the half uplifted ape into the full stature of au upright standing man with his gaze scanning the mystery of the endless vistas of space and time and the colorful horizon where the earth meets the heavens in an everlasting nuptial clasp.


Briefly told, the story of life, more marvellous than a fairy tale is this. When on this planet there appeared the covering expanse of the rolling waters and a moving atmosphere that blanketed the earth and the oceans filling the inter-spaces between the earth and the sun. the first stage in the unfoldment of life began. The sun, the parent of this planetary system, pouring out his radiant energy upon the earth and its waters though the intermediate atmosphere has given rise to the first forms of life and has sustained them in all their later stages of growth and evolution, and to this day remains the main source and sustenance of life declares the Veda. �The sun is the soul of all things in the world, the mobile as well as the immobile.� But the interplay of the solar radiations and the aquatic element of the earth and its ever-moving atmosphere has been essential for the maintenance of life in all its forms While the sun was the impregnator, the field for impregnation was 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; and it is the field and scope for the vital dynamics of life unfolded gradually into cognition, conation, intellection and spiritual fulfilment.


Whether life is an exotic visitor waiting to make its entry on this planet till such a favourable moment when the optimal condition for its play was evolved, or is a peculiar offspring of such an accidental condition incidental in the history of stellar and planetary evolution or whether as described by the ancient Sankhya seers, 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 Purusa who is the unchanging witness of Nature, it is not given to man to say with certitude.




Whatever be the oigin 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, �What are the fundamental phenomena which distinguish living things? Their distinctive feature is perhaps organization, and in the higher members this organization becomes more and more distinct. This greater complexity of organi�zations runs parallel with increasing range and power of adaptation, attained by the setting apart of special structures (organs) for the performance of definite functions. "The peculiar characteristic of life is its power to organize. Its internal conditions both as regards 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, became the special concern of the physician whose business it was to keep it a going concern and in perfect condition for as long as it was possible.


It was at this time when the physician occupied the exalted place, when medicine and metaphysics were equally the domain of the Vaidya - the man of knowledge, that the Ayurvedic classics came to be written by men who were admittedly the wisest of the age Hippocrates says that the nearest thing to divinity is the physician who is also a philosopher. If this is so, who can deny that men like Atreya and Dhanvantari are as near-gods as any that mortality can breed?


It is to these physician-philosophers of the golden age of India that we owe the concept of life as embodied in the Caraka and the Susruta, a complete and integrated concept which is so broad-based that in its main outline it must hold good for all time. It is true that the perception of these sages could not 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 operandiof its threefold organization and the means adopted to preserve and prolong its existence and functioning, is as supreme today in its validity as when it was first promulgated.


II The Story Of Life


The Meaning of Life


The authors of Ayurveda, �The science of life�, intended by Ayurveda much more than mere skill of treatment or diagnosis of a disease condition. It meant for them the total concept of life which includes both man and his environment. The well-being of man, the aggregate of body, mind and soul, cannot be confined to mere physical health, but extends to that total sense of enjoyment of physical, mental and spiritual satisfaction and enrichment born as a result of wholesome and mutually beneficial interactions between the individual and his environment, social, physical and 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 and to the spiritual ideal upheld by it. Such well being alone is real and true of man in his entirety and such is the object of the �Science of Life.� Caraka therefor declares

�That is named the science of life wherein are laid down the good and the bad life, the happy and the unhappy life, and what is wholesome and what is unwholesome in relation to life and also measure of life.� (Car Sutra 1, 41)

Having Visualised this total picture of life, we shall now discuss and analyze the two parts of it individually, viz., 1. The universe that forms the environment and which has given rise to life, and 2 The individual organization, its composition and structure and mode of functioning and its progressive evolution from ameba 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 and is perhaps confined to this planet of ours, where conditions favourable to its emergence, existence and growth began to obtain some millions of years ago. Science also expects life to disappear with the disappearance of these circumstances which disappearance is a certainty according to it in a few million more years.

From a purely common sense point of view, it becomes diffi�cult to understand that out of innumerable solar systems whirling about in space, whose volume is to be counted only in light years, that a tiny speck of a planet like ours should be the chosen or fortu�itous haven or cradle of this mysterious phenomenon called life, while organization entitles it to the name of organic life. Such life-activity naturally Involves a continuous maintenance of its body structure by means of periodic replenishment of the wear and tear, a constant supply of energy for maintaing the optimal temperature and tension and an unfailing mechanism for correlation of the distinctive functions of each limb of its complex structure so as to help the organism to react as a whole both in its Internal and external movements. Such threefold organization is the sine qua non of all organisms however small or great.


All life or every organism is engaged continually in converting the matter of the outside world into a new pattern and texture that it may subserve the purpose of life. This transformation of matter into its own field of extension is the distinctive function of life. A recent writer Jerome Alexandar in his �Life, its nature and origin�� declares that the distinguishing nature of life is bio-catalysis i.e. its power to bring about chemical change in bodies without practically undergoing any change itself. This bio-catalytic action is what enables life to maintain and extend its field of play in an alien world of matter. Life is conti�nually annexing matter by its catalytic activity and extending its dominion over space-time. Life viewed from this point, is a catalytic struggle with the environment, a process of annexation into its expan�ding boundaries of the non-responsive and even hostile forces of the material world. This is a view which fully accords with that of the Sankhya school of philosophy on which Ayurveda is based. The infinite number of Purusas, known as bions in mordern biological language 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 play of life i.e. perpetual unfoldment of sensations, images and pain-pleasure conditions. But the Purusas remain unaffected and ever the same. Matter is like a danseuse who desires her charms to be witnessed by these bions called Purusas


"The spirit, seated composed like a spectator perceives Nature.�


Thus life's play involves a recasting of matter into new patterns to suit file purpose of these bions while they themselves remain unchanged witnesses of varying life phenomena. The activity of these bions is indeed best illustrated by this process of bio-catalysis.


This biocatalytic process involves the threefold organization calculated to subserve the vital purposes of material upkeep and growth, maintenance of thermal and metabolic processes and the co-ordination of the internal and external movements suitably to the changes of environment. Without these threefold functions no organism can subsist. All processes of assimilation and dissimilation so essential to the upkeep of its structure and tone are rooted in such organizations.


It is therefore now our purpose to see how Ayurveda describes and fits into its general outline of life-processes this three-fold pheno�menon of organization. Caraka lays down the distinction between organic and inorganic life 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." (Car Sutra 1, 48)


The sentient organism involves a complex organization of structural, metabolic and kinetic processes. It also involves a mind or a co-ordinating principle however elementary or intricate it be. Such an organization, Ayurveda holds, to be universally obtaining in all 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 forms of life.


Though life is mysterious and undefinable as a whole, the phenomena which signify the existence of life are evident for purposes of observation and study. All these phenomena viz., ingestion, assimi�lation, respiration, movement, growth, creative evolution, reproduction, death and last but not the least, the power of organization distinguish * the animate from the inanimate.


Creative Evolution


Life has been observed, ever since its first appearance, to be endeavouring and struggling to create and preserve such optimal environmental conditions for itself as would help its evolutionary purposiveness.


No doubt it reserves a margin for some variations in time and space Besides, life has developed its own organization of existence, growth, perpetuation and expression so as to accord with such probable environmental variations, of course within certain limits, and has built up protective devices and technique for its survival and evolution. In the plant life we see the sap being encased in a hard case of bark-crust to protect it from the external heat and cold as well as from hostile incursions. Plant life is an example dominantly of the survival-technique of life�s organization. In spite of the great size and strength developed, that form was not conducive to the varied richness of life-processes struggling for expression. Hence, life took a different direction for the release of those processes and devised subtler and more malleable patterns endowed with movement, agility and resourcefulness, for the preservation of its life and for overcoming hostile forces either by resistance or by accommodation. This is the animal pattern from the smallest animal to the complex organism of man with the mind- principle fully dominant and suggestive of a yet higher and more subtle element in life waiting to be released for its full assertion.


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 type of life, the more subtle and distinct become these organizations. These organizations become more and more complex as evolution advances and form separate structures and special organs for the performance of definite functions.


But the fundamental principle of organizations which main tain the integration of the individual remains the same for all living organisms, whether minute or large. Even in unicellular life, all the fundamental phenomena of life are carried out in the same pattern though there is no differentiation in appearance or structure of the tiny speck of protoplasm These fundamental phenomena are carried out by the following three integrative organizations of life.


I Vital or motivating organization

This is the master organi�zation which initiates and directs all activities and maintains the specificity of all vital processes which characterize living organisms.


5.            �Physical or material organization

It is that which maintains the specificity of fluid matrix of protoplasm wherein life-phenomena are played.


6.            �Thermal or metabolic organization

It is that which maintains specificity of heat by carrying out anabolic and catabolic processes.

III. The Triumvirate of Organizations


The miraculous story of life�s evolution or unfoldment is recorded by biologists and need not occupy us here beyond the recognition of the fact that the process of such evolution has always necessitated the pursuit of the technique of the threefold system of organizations viz, (1) the structural or material pattern, (2) the maintenance-device of the thermal optimum for metabolic functions and adjustment to environmental temperature, and (3) a 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. Let us now consider the full significance of the nature and texture of each of the three devices or organizations that have made for the survival and progressive growth of life.


I The Matrix or Material organization


There is common ground between science and religion on the question of the primeval abode of life. The aqueous element has been known to be the first resort of life. 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 the waters were there in the beginning. (Brihad 5-5) From water, God created all living things on the earth. It is the faith of all religions that life spirit dwelt and moved on the dark primeval waters. In Hindu mythology, the creative force Visnu, lay for ages on the milky ocean, till one day it bestirred itself into a creative mood. In so many ways, the eye of intuition and revelation and that of science as well, have regarded water as the origin and the abode of life. (Narayana Upanisad 1-1)

The matrix of the material pattern that life requires for its abiding and play is provided by water and by none else of the elements of this universe. That is the medium best suited for the vibrant throb of life and for the transmission of its impulses. The body of man and of all plant and animal life is the material ocean on which floats the immaterial spirit of life. This fluid matrix can be poured into vessels of various shapes and its consistency increased or lessened. And life has attempted all those shapes, patterns and the densities needed for its consummate expression and for the release of the dormant spiritual force and the latest product of such life�s enterprise is Man.


Like a spider that has woven its web and has retired into its centre, so has life woven around itself the web of the human organism with its automatic devices of circulation and respiration, its autonomous nervous system and a part of the mind mechanically ope�rating its gears and clutches, leaving the higher life at the centre to contemplate and design its course of further evolution. Thus, there is a whole complex system distributed in its outline under this three�fold divisions of body-organization with the sole purpose of maintain ing a uniform and unchanging environment for life, an environment that contains in itself its power of accommodation and adjustment to exogenous as well as endogenous interferences. (Homeostasis of Cannon). This leaves the higher mind of man free to reflect and weave out his patterns of thought for spiritual fulfilment and for his creative imagery in art, literature and science, all calculated to expand 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 parts, and changes in any one are bound to affect the rest. But for purposes of their specific knowledge the nature of each of these is to be referred to in terms of quantity or form, the degree of intensity and degree of tempo respectively.


Modern anatomy and physiology have to their credit a long and persistent career of investigation and study of the human orga�nism in all its complexity and minuteness and they have tracked down the secrets of the human structure and function to the microscopic cells and even beyond. It has, with great diligence, experimented on lower animals and ascertained with approximating certainty the probable human reactions under given circumst&nces and to given stimuli, this is an essential part of the equipment needed to understand the details of human dynamics but it is by no means all and exhaustive. Man is more and greater than the mere sum total of his body-organizations or cells. In R G. Hoskins words �Medicine is now in a transitional phase. The ineptitude of regarding a man as a mere collection of interesting organs is becoming increasingly clear. The personality of their prossessor is more important than his organs no matter what fascinating pathological condition or secretory versatility they may disclose.�' There is, in the first place, an as yet inadequately understood factor of the psyche whose influence on the soma is gaining increasing recognition daily. There seem to be still greater factors as yet not understood, but whose workings are only dimly suspected and observed in crucial moments and special exigencies. Though their intrinsic nature and technique of functioning may defy our present powers of comprehension, yet their net effects are obvious to the discriminative eye. A good part of it is perhaps clear to the mind that is able to observe and appraise these influences from a view�point internal to the human organism, whole to the clinician these are accessible through intelligent catechistic methods. This presupposes an extensive or inclusive and not an exclusive view of the structure and function of the individual parts of the body. The excellence or other- wise 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 and adaptive principle to which all the body-functions and life-purposes con�verge and from which emanate the subtle and vital vibrations that uphold and preserve life both in health and disease. In a word, this presupposes a comprehensive or integrated concept of physiology, the doctrine of vitalism as against that of mechanism. For man is more than a machine; and over and above the psycho-somatic organization, there subsists presiding principle which is instinct with awareness and a wisdom beyond the conscious mind.


It may sound at first thought as if this doctrine of vitalism were a superfluity intruding into a realm where it were best not to allow it. But on fuller consideration it would be seen that without a 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. It is here that the beckoning hand of time points to the ancients, to Caraka and Susruta of India and to Hippo�crates of Greece and Galen of Rome. This is not to suggest that India and Greece have followed the same path. Far from it as we shall see Nevertheless their inspiration was derived from a common viewpoint of regarding man as a whole and in the vital inter-relation of his various organs and of the extensive or inclusive nature of the functions of each of them in health and in disease.


These analytical results should be cast again into the mould of the synthetic or the integrative view of man. Instead of the data themselves being priced, their ultimate net values ought to be worked out and cherished. The affection or otherwise 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. Once this is kept in mind, the natural corollary is to set about discovering the main springs of human well-being and reactions, the sources of living, action and growth as also of resisting disease and rebuilding of loss. Once the main springs of life and action are dis�covered, 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 com�ponents 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.


In the ancient medical thought of India, as we may find from Caraka, Susruta and other works, this 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 these main planks of life were all important. It was not mere theory. In practical therapeutics too, it was almost everything.

As we have already seen, they had grasped by observation and long study of human behaviour and reactions in health and disease, and also by general inference based on the understanding of the unity and uniformity of principles governing the cosmos as a whole and in its several parts, that man like the world around him was governed by a triumvirate of forces and elements well organized. The action of the sun, the waters and the vital air were the proto-types to them of the aqueous, thermal and kinetic organizations of the human body.


Water, as we have seen, was regarded as the source and 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 a god and a religion grew about it. (Thales of Greece and the Seers of India). Holiness and purity were acquired through bathing and sipping, and water had to be poured as witness to gifts or vows made.


The counterpart in the body of the water in nature was the body-fluid, the colloidal fluid known as protoplasm. Of the triumvirate that governed the body this was the first essential. In a word this provided the very 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 and salt, and it constantly fluctuates to adjust to and counter internal as well as 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, the water bound in the colloidal system of protoplasm, the free water between the cells and fibres as well as the stored water in any water-depot of the body.


Temperature is an essential factor in the maintenance of this natural and uniform pattern and in providing it the scope for vital play, the body therefore is found to possess that mechanism of internal combustion, its heat-generating or thermal mechanism distributed and concentrated as the case may be, in the entire body.


This is a radical aspect and not an exclusive or limited function and quality of any one limb or part of the organism. In the distribution of the function, it may be concentrated here and diffuse there 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 the metabolic process. The internal thermal balance is sustained by the anabolic and catabolic processes taking place constantly in the body. Though this thermal element is diffused in the entire body it has also its regions or points of focus. These foci are important to the clinician, for the pathogenic and restorative processes are centred round these points of foci in particular and the entire system in a general way. 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 Vata, the three factors of the triumvirate that governs the psycho-somatic organism, are apportioned each its pentad of foci in the body. These, as has been already stated, have special clinical significance and are guides and aids in practical diagnostics and therapeutics.


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 the supreme and 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 are all the more complicated. Yet again, where the psyche is dominant and charges the body with the impulses of hope, despair, anticipation and fear and the desire for efficiency, for triumph over opposition and for the ]oy of achievement, the dynamic organization involving such kinesthetic force must be subtle, many-sided, self-suffi�cient and creative This the body-mind does possess and is known as Vata or Vayu, meaning to move or convey.


The Kapha and the Pitta are relatively static and need at every point of their existence and functioning the co-ordinated impulse and motivation of Vata.

�Pitta is lame and so is Kapha and so also the body-elements and the excretions. These, like a cloud, go wherever the Vata (wind) carries them.��


Claude Bernard states that �vital force directs phenomena which it does not produce, and physical agencies produce (in living things) phenomena which they cannot direct. This apt remark of that great physiologist has much similarity with the statement of Kapila the propounder of the school of Sankhya.


�(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 (1e the spirit and the Nature) is like that of a lame man with a blind man. The creation is brought about by that (union).


All life is dependent on Vata, for, it is the up-bearer, impeller, sustainer and operator of life It is known as the Tantra-Yantra- Dhara. In a chapter, classic in its pattern and expression, Caraka describes the nature and functions of Vayu both in the cosmic as well as its biological aspects. It is the lord of the supreme principles of life. The salutary as well as the pathologic aspects of the Vata principle are described by the royal sage Varyovida in eloquent - terms thus


�The Vata is the upholder of both, structure and function (in the body). It is the very self of the five forms of Vata in the body viz, Prana, Udana, Samana, Vyana and Apana. It is the impeller of upward and downward movements, the controller and conductor of the mind, the inspiritor of all the senses; the conveyer of all the sense stimuli, the marshaller of the body-elements; the synthesizing principle in the body; the impeller of speech; the cause of feeling and audition; the source of the auditory and tactile senses; the origin of all excitement and animation; the stimulator of the gastric fire; the desiccator of the morbid vitia; the eliminator of excrement and deobstruent of the gross and subtle body-channels, the modeller of the fetal form; the 'sustaining principle of life' all these are the functions of the normal Vata in the body.


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 uterus, 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.�� (Car. Sutra 12-8)


It is necessary at this stage to remind ourselves that the science of physiology has passed through several stages of evolution. It was first a static view of the individual and of specific functions of the various organs and tissues of the body. Later it was realised that there was an integrative control through the nervous system and the psychic influences and that these parts could not be regarded as functioning separately. Yet again the endocrine secretions opened up newer processes of physiologic and metabolic conditions, having integrative chemical control on the body and new light was thrown on the cellular structure and function. We now know that no one part of limb or gland or cell of the body can be viewed unrelated to the rest of the psycho-somatic whole. One kind of secretion is balanced by another and the glands, the tissues, cells and all the other elements are inter�related 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 must never be ignored. This triumvirate of Kapha, Pitta and Vata form the general outline of that constitutional pattern or scheme, and all constructive, integrative, assimilative, recuperative and eliminative processes are to be understood in terms of the nature and working of these three principles as an integrated whole. They are all inclusive and complete in their com�prehension 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 condition; hence life develops within itself such active organization as can enable the body to adjust immediately and adapt to the variation in the external relation. Moreover life evolves a special protective and survival technique to counteract the inimical environmental incursions.


The Three States of Life functioning in Men


We know all animate life to exist and grow in three different forms, the stationary life of plants, the mobile but instinctive and more or less passive and reflex life of the animal and the discursive, active and creative life of the human. The human body evolved as it is from the most rudimentary life, contains the vital processes of all these three types of life. It contains parts and organs that grow, abide and function like the plants, absorbing food, turning it into energy and discharging the waste products and automa�tically maintaining the basic body-life uninterfered and unaided by the higher aspect of the mind generally. From birth to death the heart, the stomach and the intestines, the liver and other glands go on functioning in their own autonomous nature without constant active impulsion or inhibition from the mind. Nature has managed to keep generally this basic body-mechanism beyond the ordinary mans reach and control.


Then there is the reflex life of man wherein the limb and sense organs execute purposive or protective movements in response to the external stimuli and in defence of the body-life against extraneous incursions and interferences. Much of the normal man's physical activity and mental and emotional impulses are reflexes and therefore a passive reaction to the external world of stimuli in multi- famous forms. This is the part of animal life in man.


Above these two forms of life stands the real human life i.e. the purposive, creative and self-conscious propulsion of the higher mind. It is in the function of the higher mind and the translation into action by deliberate effort that man rises to and asserts his essential humanity. This is the life of the psyche bringing up into play will, determination and discrimination.


Life has so managed to construct man that the basic survival functions are placed normally beyond the control of the individual himself and are an autonomous set of organizations. Thus mans survival is assured even as against himself This organization is known as the autonomous or vegetative nervous systems including as it does the functioning of the heart, the liver, the intestines and such other vital organs. These organs have an independent functioning of their own and continue to work, given suitable environment, even outside the human body. Thus they represent In man the most primary life-forms of unicellular life, which is the unit of life. 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 environment, and acts and learns by adjusting to external stimuli. This is the animal aspect of man. 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 ocean of creative activity, discovering new factors and shaping the environment to this inner impulses, is the fullest expression of man on the human plane.


Thus a human being is effected and expresses himself in all these three aspects of his life while in health as well as in disease. For us who are concerned with man�s pathological manifestations, the varied changes and symptoms that are manifested in these three aspects of man are very important for purposes of diagnosis and treatment. The most sensitive apparatus in him being the psyche in him, such internal symptoms as malaise, mental images and modes, dreams, desires and impulses form the material on which to base our appraisement of a situation. These factors are accessible to the physician only through close questioning and conversation with the patient and presuppose a certain degree of observation, intros�pection and intelligence on the part of the patient himself. In the absence of these factors, the proper appraisement of a disease 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 referable to the vegetative aspect of our body-organization. Since these functions are mainly independent of the mind and the central nervous system, they evince individual and automatic reactions to disease affection and try to make suitable adjustments with it.� This will be manifest in the form of instinctive inclinations for or against certain tastes, things, articles of 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, psychic modifications and instinctive inclinations are really the prodromal or premonitory symptoms helpful in early diagnosis of the disturbance of health. The study of premonitory symptoms has been given a great importance in Ayurveda and forms an important category in the pentad of diagnostic methods.


IV The Study of Environment


Life and Environment


The understanding of the nature and function of life involves the study and the appreciation of the factor of environment. Indeed the two are one, like the two sides of a coin. To think of life apart from an environment is as impossible as to think of light without its surrounding sphere of illumination.

For the medical science particularly, life goes always with its environment Every organism and specially man must be understood always in relation to his environment, for all his life-functions are engrossed in a continual flux to meet the challenge or reap the benefit of the factors of environment in the various forms of weather, geographical conditions, nature of soil, social tendencies, bacterial saturation and similar other conditions. In fact the play of life of any organism consists in its reactions to a given or changing environment. Environment is its prime cause of being, as also of its disorders and perfection. Caraka expresses this truth as a philosophical axiom, that the existence of all beings is derived from the nature of their reaction to environment.


'�The continued existence or otherwise of all creatures is dependent on the proper, inadequate, excessive or wrong interaction between them and their environmental factors. For well-being and ill-being or existence and non-existence are dependent on the right degree and nature of contact with environment." (Car. Sutra 11-44)


Thus in the medical science �Man-cum-environment" is the unit of study.

As we have noted, life is not a static condition but a dynamic process of continual adjustment with environment. Time and space which constitute the environment, are perpetually varying factors of the universe which necessitate the constant vigilance, activity and modification in the reactions of the organism. Caraka therefore uses the various synonyms of life such as ___ and _______ denoting the constant changingg, dynamic and progressive nature of life.


Disease factors of Environment


When the organism has failed to adjust or adapt owing either to some innate deficiency or to the overwhelming force of the environment, the resultant is disease-condition which is the subject matter of medicine. Such environmental factors are known as exoge�nous 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.


In a great measure the organism can be taught to adjust to and prepare against such hostile forces. All these wholesome practices of diet and behaviour and seasonal regimen that are entitled �whole�some life' in the texts of Ayurveda are calculated to help the organism to adjust to and overcome these impediments to health from 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, for we find that reaction to environment is so 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 adjust�ment and adaptive reaction must be different and in helping 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 adjust�ment 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 environment and constitution together that we can accomplish the complete and successful harmonization 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 envir�onment 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 physic�an 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 indi�vidual 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". (Car Satra 7, 39-40)


��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�. (Susruta Sarira 4-63)


�There any part of the healthy seed (germ-cell) 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". (Commentary by Dalhana on the above verse).


"The constitutional condition does not get changed, nor incre�ased nor diminished generally except at the end of life�. (Susruta Sarira 4-78)

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. (Car. Vimana 8)


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


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 forgeting 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 behaviour in the maintenance of health and in his fight against diseases.


Dhatu (vug)

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 elimina�tion, though not forming a part of the regular body-elements, does exist in the body enjoying perfect health and is probably rende�ring 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 triumvi�rate 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:

1. 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 (clean matter) 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 up�holder of body. (vide Caraka Sutra. 28, 4)


(2) The other meaning of mala as given in Caraka, (Sarira 6-17) 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."(Car Vim 5, 9)


�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�. (Car. Sutra. 20, 9)


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 � (Car. Cik 15-9)


�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.� (Caraka Cik. 15-10)


�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� (Car Cik. 15-11)������������


(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 characte�rized by morbid accumulations of Kapha and Pitta� (Car Sutra 2, 8)


Those should be prescribed for purgation when the morbid matter has accumulated in the colon � (Car Sutra 2, 10)


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.�� (Car Vim 3, 170-171)


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 (Car Satra 12,13) 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". (Sar Pu. 5 24).


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�� (Susruta Sutra 21-3)


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�. (Car Sutra. 12,13)


��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" (Car Vim. 1, 5)


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." ( Car Sutra, 18, 48)


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". (Susruta Sutra. 21-8)


The triumvirate is all-pervasive and circulate to every part of the body. As the vitia are circulating in the entire body, their nor�mal 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.� (Car. Sutra 20-9)


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�. (Susruta Sut 15, 4)


Vagbhata says, �Thus the focal places of this generally all-pervasive vitia are to be known as also the different actions of the vitia (with ref. to these foci)


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.�� (Car Cik. 19, 121)


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�. (Asfc. Sang Sutra, 23)


Physiological Vata

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 fun�ction (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.(Car Sutra 12, 8)


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�. (Car. Sutra. 18-49)

And finally lie makes an aphoristic statement all-compre�hensive 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� (Car. Sutra, 17,118)


Susruta describes the function of Vata as under:

"The fivefold 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 embo�died beings, Vayu is verily the whole universe, and Vayu is the lord of all Thus is Vayu extolled.� (Car. Cik 28, 3)

Susruta describes Vata or Vayu in 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 dis�solution of all beings". (Susruta Nid. 1, 5-6)


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) �. (Sarn Pu. 5,25)


Physiological Pitta

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 inter�nal 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 pigmenting 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" (Sus. Sutra 21-10)


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."


Physiological Kapha


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- lessness.�


�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.

Caraka Sutra 12 - 13, 18 - 48, 20 - 9

Vimana 1 - 5

Susruta Sutra. 21 � 3

Disease conditions produced by the pathological behaviour of each member of the triumvirate:


Pathological Vata


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 diag�nosed as a Pitta-disorder� (Car. Sutra 20, 15) ,���������� Pathological Kapha


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��. (Car. Sutra 12, 12)


Moreover the following conditions will occur when the function of Kapha organization is deranged�����������

"Whitness, 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." (Car Sutra 20,18)


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 recognised 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". (Car. Sutra 1,59-61)


All pathological conditions are grouped under two headings.

17.          �Imbalance condition due to increase or decrease

18.          �Vitiation condition


Imbalance 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.


Vitiation 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 marvellous 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 wellbeing is the harmonious or concordant interaction". (Car. Sutra. 1, 54-55)


Homologous environmental factors maintain health, any varia�tion 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 norma�lity 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." (Car Sar 1-109)


�Owing to the perception of things, in a manner that is contrary to their real state of existence, there result wrongful speech and conduct��, (commentary on the above verse by Cakrapani)


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 behaviour 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, mode�ration 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.� (C�r Sutra. 7, 41)


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." (Car. sarira 6, 10)


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)

(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." Sus Sutra 15, 32-33)


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.�' (Ast Hrd. Sutra 11,42)


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.� (Sus Sutra 15-44)


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 unfavourable 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 endeavour 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 (Car Nid 1, 6)

(1) Etiology

(2) Premonitory symptoms

(3) Signs and symptoms

(4) Homologatory signs

(5) Pathogenesis


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, predo�minant morbid humor, mode of classification, minutia and period of exacerbation� (Car Nid. 1, 12/1)


The very word (Samprapti) is indicative of all-comp�rehensiveness 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� (Sus. Sutra 21,36)