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The Science of the Triumvirate of Pathogenesis or of Constitutional Pathology
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."
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�.
 "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.
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.
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.
�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.
�Therefore special line of therapeutics has to be pursued to suit the special site of affection�. (Asfc. Sang Sutra, 23)
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)
Pitta is indeed the thermal element or element of fire. The integrative organization of it does the following functions in the body.
"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."
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:
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
This is brought about by simple process of increase or decrease either in the function or the structure of the body. It is a minor pathological condition of hyper or hypo state, being merely deviation from the normal constant of the body-function or structure.
It will however cause some disturbance in the mutually well balanced state between the various functional and structural systems of the body. This disturbance of the equilibrium or balanced state is the imbalance condition.
This is the real or major pathological condition brought about by the vitial reaction or vitiation process. The triumvirate of organizations having passed beyond-the imbalance stage, become disorganized and turn into irritants and tend to vitiate the whole or part of the body functions or structures.
How constitutional factors of the individual resist the incursion of harmful factors in the body, how one, two, or all three vitia get provoked, irritated or inflamed, or get vitiated by endogenous or exogenous factors, how they overpower the whole body when all of them get highly provoked, how when not so highly provoked they circulate in the body and get located in susceptible parts, how the Constitution of local part reacts to and, legists these irritant vitia and what are the terminations of this struggle between the body and the noxious factors, make the most 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)
(2) Premonitory symptoms
(3) Signs and symptoms
(4) Homologatory signs
Thus it is considered one of the five methods necessary for the diagnosis of disease-condition.
Moreover this fifth method is detailed and subdivided in various ways to have a thorough knowledge of pathogenesis.
Pathogenesis is again classified according to number, 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)