Tridoṣvijnānam is the 'Science of Pathogenesis' or it can also be referred as the 'Triumvirate of Constitutional Pathology'. Understanding the origin and growth of disease is required to understand the disease progression, degree of impact and duration. This is important especially when it is related to the working and maintenance of life currents (in the psychosomatic constitution) of a man.
Terminology was distorted during the last two thousand years and received a further setback during the following period where analytical study of individual organs, tissues and cells was the focus of medical science. But the recent evolution of microbiology, progress of knowledge of nutrition and metabolism, theory of integrative functioning of endocrine glands, vegetative nervous system and studies of allergy and immunity has revived clinical interests in the study of constitutional concepts of both the human body and his holistic personality.
This study investigates the cause of disease, its prevention and cure, both in the humans as well as the environment surrounding it. The study of the nature and cause of disease is progressing along the lines of an integrated physical, chemical, bacteriological, experimental and clinical methods today. Holistic study also includes the study of economic and social conditions. The best clinicians are learning and teaching how to utilize laboratories as well as the study and treatment of the patient. Careful physicians believe the judgement of an intelligent and experienced clinician for the condition of the patient and community as the primary consideration an be augmented (but not replaced) by a synthetic clinical opinion.
It will be certainly interesting and instructive to study the Tridoṣa doctrine at this juncture of the revival of the constitutional concept of medicine. The Tridoṣa concept of Ayurveda is the earliest constitutional concept. Its origin is traced to the Ṝgveda but it was systematized and evolved as a scientific concept at a later date (known as the golden period of Ayurveda).
- 1 The Triumvirate
- 2 The Origin of inquiry into Pathogenetics
- 3 Inquiry must be Adequate and Scientific
- 4 What is Science?
- 5 The Totality of Knowledge
- 6 The Need for Analysis
- 7 Specific Biological Terms
- 8 The Characteristics of the Golden Age
- 9 From Metaphysics to Science
- 10 Biocatalysis
- 11 The Story Of Life
- 12 Creative Evolution
- 13 Vital or Motivating Organization
- 14 The Triumvirate of Organizations
- 15 Matrix or Material organization
- 15.1 Beginning of Evolution
- 15.2 Evolution Mythologically
- 15.3 Stream of Life
- 15.4 Modern Anatomy and Physiology Perspective
- 15.5 Complexity and Inter-dependability of Human Organs
- 15.6 Results of Complexity in Human Structure
- 15.7 Practical Therapeutics
- 15.8 Significance of Water in Sustenance
- 15.9 Significance of Temperature in Sustenance
- 15.10 Role of Psycho Somatic Organization
- 15.11 As per Other Philosophers
- 15.12 Significance of Vāta
- 15.13 Functions of Vāta
- 15.14 Abnormalities of Vāta
- 15.15 Evolution of Science of Physiology
- 16 The Three States of Life functioning in Men
- 17 The Study of Environment
- 18 The Study of Constitution
- 19 Prakṛiti or Constitution in Ayurveda
- 20 Body Habitus
- 21 Characteristics of Different Habitus
- 22 Significance of Nomenclature
- 23 Functions of the Base Nomenclature
- 24 The Nature and Functions of the Body Triumvirate
- 25 The General Concept of the Triumvirate
- 26 Physiological Concepts of Triumvirate
- 27 Pathological Concepts of Triumvirate
- 28 Clinical Manifestations and their Interpretation in Physical Qualities
- 29 VIII Imbalance Condition Due to Increase or Decrease
- 29.1 What is Imbalance Condition
- 29.2 Causes of Imbalance Condition
- 29.3 Causes of Imbalance as per Caraka
- 29.4 Effect due to Climatic Changes
- 29.5 Variation due to Mind Conduct
- 29.6 Instability due to Sense Objects
- 29.7 Imbalance due to Vitia
- 29.8 Causes of Imbalance as per Śuśruta
- 29.9 Causes of Imbalance as per Vagbhatta
- 30 IX Vitiation process
- 31 Conclusion
- 32 References
The Tridoṣa pathogenesis consists of the three determinants of pathogenetic and pathognomonic phenomena comprising what is generally referred to as Constitutional Pathology. These determinants, when in a normal and a well-balanced condition, work for the fundamental functionaries of the physiological state of the living organism. Harmonious working of these three functionaries is when a person is in good health and their discordance indicates the presence of a disease.
It implies the physiology and pathology of each and every form of life from the amoeba to man. Thus pathology becomes physiological in outlook enabling one to study disease conditions from the physiological point of view. The pathological processes are so coordinated with the vital physiological processes that they can be interpreted in a common terminology.
The Origin of inquiry into Pathogenetics
It is quite apparent to imply that every inquiry into the nature of phenomena starts from the nature's quality of opposition to the fullest and happy flow and expression of the current life throughout. Pain and suffering, death and disease, fear and frustration arouse the spirit of inquiry and investigation into the man. The philosophers of the Sankhya school started their research in accordance with the nature of life instigated by the presence of suffering.
Due to the affliction from the threefold misery, study was initiated for the removal of all the kinds of physical sufferings. Caraka Samhitā also ascribes to the emergence of the disease among men along with the fulfillment of the purpose of their lives, the effort of the sage-scholars in acquiring the right knowledge of disease and its correlated remedial measures.
Health is the supreme foundation for the virtue, wealth, enjoyment and salvation. Diseases are the destroyers of a healthy good being. Hence for the impediment of the humanity, its remedy was inevitable. Hence the scholars sat in the meditation. It was then correctly inferred by the single-minded devotion towards the whole science of life. Hence it is thus distressed and goaded by the pain and suffering afflicted through physical and mental state which let to the efforts of inquiry. This investigation probed further into details which bore fruit of the three-fold determinants of all the physiological and pathological processes of life.
Inquiry must be Adequate and Scientific
Just the efforts whether the inquiry is merely sincere and intense are not enough in guaranteeing the accurateness of the results conferred. The method adopted must also be sound, adequate, rational and consistent with the fundamental principals of the physical and biological laws of the universe. The first such positive scientific efforts were made by the Sānkhya intellectuals. They emphasized the necessity of scientific knowledge. There are verses in Caraka Samhita which are the patronizing maxim of the guiding principles of all the investigations. These verses emphasize that the whole suffering which cleaves to the mind and body has ignorance in its base, thence conversely whole health and well being is founded in clear scientific knowledge.
What is Science?
From the various definitions and explanations given of the science it becomes clear that science is a method. It can be deduced in three different ways as follows:
* Any department of systematized knowledge.
* A branch of study concerned with observation and classification of facts based especially on the establishment of verifiable general laws.
* Accumulated knowledge systematized and formulated with reference to the discovery of general truths or the operation of general laws.
These are some of the dictionary meanings of the word 'Science'.
In practical life and in the usage of common parlance too, we understand by scientific thought, speech or action, a systematic process of evolution wherein each succeeding part is derived from its preceding part by the inevitable compulsion of logic. It is further maintained at any time or place, given the attendant circumstances. Hence, Science is the critical systematic knowledge based on generalizations. It is an investigation into the nature of facts, facts not selected randomly but in their comprehensive entirety.
Method of Conclusion
The scientist systematizes the data, records the observations and draws conclusions therefrom which ultimately assume the form of a formula or a universal truth. He proceeds rationally and logically through all his investigations. It is the cumulative product of both the processes of analysis and synthesis, the knowledge of individual ideas and things against the background of universal laws and concepts.
Karl Pearson in his 'Grammar of Science' states, "The man who classifies facts of any kind whatever, who sees their mutual relations and describes their sequences is applying the scientific method and is a man of science."
The Totality of Knowledge
It is necessary again to remember that the totality of knowledge of things was aimed by these ancient scientific sophists. The understanding of any part merely in creation without the knowledge of the whole and the inter-relations of the parts was inadequate and liable to lead to the wrong conclusions. The knowledge of the whole cannot be accrued from the knowledge of merely a part.
The total concept led them to a comprehensive and synthetic method of the study. The knowledge of the past was acquired but with special consideration and reference to the relation it bore to the present and the future. The knowledge of the parts was co-ordinated and placed in the proper perspective of the whole. Then they studied the nature of the whole in its entirety. This concept led us to the study of man as a whole, i. e as a complete unit.
The Study of A Man
Man was studied as a whole personality which is the dynamic organization within the individual of those psycho-physical systems that determine his unique adjustment to his environment. This led to the study of his constitution which includes the aggregate of inherited characteristics, modified by the environment, determine the man's reaction to environmental factors.
The Study of the Universe for the Discovery of all the Sources
The whole series of causes and sources of pain and suffering extending over the whole universe is included in the investigation:
- Totality of Man-cum environment
- Totality of environmental factors which become sources of pain or disease.
- Totality of methods of investigation which covered all the aspects of time and space.
- Totality of things that were used as medication.
According to the Sānkhya view, all the misery can be classified into three kinds:
- Internal = This is includes the miseries of the body and mind.
- External = This includes the miseries of the physical world.
- Spiritual = This includes the miseries from the supernatural sources.
Śuśruta further sub-divides these three categories into seven which is described in details in the later section on the Etiological factors. Thus everything in the universe which can cause pain or suffering to man is properly investigated. It is an all-comprehensive classification.
Comprehensive Method of Investigation
This method of investigation evolved a system which encompassed all the possible states of time and space. Time whether present, past or future and space whether near or remote as well as things visible or invisible normal or abnormal, were all made possible of study by this system of investigation. These are the methods of investigation and there is no other left, which constitute the means by which all things are examined.
Medication Substances in the World
The therapeutic science has left no natural element unused to decipher it's medicinal properties. There is no substance left in the world which was not checked for it's therapeutic usage as medicine. Thus to understand man and the subject of medical science, one has to understand not only the whole man but also the environment which begot and which sustains him and which can be the cause of disease. It can also be the source of medicaments. Hence, this whole environment therefore consists of the universe surrounding him.
The Need for Analysis
To achieve the comprehensive and complete therapeutic knowledge, a very varied and extensive field of the study is required for its attainment. It also comprised some of the methods of simplifying the study by classification of the analytic method. This step became very inevitable. This orderly arrangement and systematization gave some basic formula for the generalization and a progressive field for research. The analytical process was carried on till the common measure of the classification was achieved.
Specific Biological Terms
Combination of Proto-Elements
As the physical body forms a part of the biological living organism, the physical formula has to be co-ordinated and incorporated into this triumvirate of the biological organizations to evolve a specific biological formula of the triad of Vāta, Pitta and Kapha. The five categories of the physical matters are integrated into three. It is merged by the method of earth and water being grouped into one and air and ether being combined together into another group. Due to this condition, all the five physical proto-elements evident in the living organism will be transformed into the biological forces of Vāta, Pitta and Kapha. It can be deduced that the air and ether are being combined into Vāta, fire turned into Pitta and water and earth combined into Kapha.
Evolution of Terminology
A specific terminology was evolved for this triumvirate of biological categories, which is significant both of static existence as well as dynamic force viz. Kapha; it signifies aqueous proto-elements of the physical formula. It also signifies the evolutionary process of the biological formula. Thus the whole word gives the sense of the organization of fluid matrix wherein the biological process of the evolution of the life is carried out. This synonym is even more significant of the biological process of the cohesion denoting it to be the colloidal matrix or milieu for the vital play. Pitta is derived from the word 'heat' which is significant of the function of heat. Vāta is derived from the word 'to move' and is suggestive of dynamic or functional process.
Inception of Medicine Science
Thus these sophists were forced to analyse and classify the elements of the phenomenal universe and their direct and indirect products and their various modes and forms of combination in bringing about the substances, dualities and actions that the physical sciences and medicine particularly have to deal with as their subjects. It also includes the biological organizations into which they were transformed by the effect of the vital forces. This endeavor to analyse, re-group, classify and denominate the physical and biological facts and laws heralded the inheritance of the medicine into the stage of a science.
The Characteristics of the Golden Age
The base theory of Ayurveda is the theory of the triumvirate of Vāta, Pitta and Kapha. It is the product of an age which is universally acclaimed to be the most brilliant in the longest annals of man. This age which was marked by the most intense intellectual activity in the East as well as in the West, particularly in India and Greece, not only laid the foundations of thought on which the world has continued to build but has to its credit the achievements which are still the crowning glory in art, literature, philosophy and medicine.
The age in which Greece had intellectual giants like Plato, Aristotle Pythagoras and Hippocrates, India had great philosophers who were the seers of Upaniṣads and Ayurveda. This was the best time for philosophical growth with the supreme pursuit. Due to these philosopher's anticipation, the people came to know the ultimate concepts of life. The arts and the sciences were actively cultivated, but they played a subservient role to philosophy.
This meant that specialization was probed but the final verdict was not only of the the specialist but also of the general overseer, the philosopher, who alone was in a position to assess the value of the contributions made by the specialists. The result was the development of a co-ordinated outlook which was based not only on the studies of the parts but also the studies of them as forming the whole. It was this synthetic or integrated outlook which has given us the Tridoṣa concept of Ayurveda.
This view is based on the concept that any manifestation of life must involve the coming together of the three factors of the spirit, the mind, the body, the tripod on which the world is based. This coming together or assemblage of spirit, mind and the Sankhya classifies the universe into three categories:
- The phenomenal physical world
- The subtle or imperceptible world
- The principle of spirit that underlies the manifold vital forms and activities
From Metaphysics to Science
The medical propounders accounted the classification of things as held by both the Sankhya and the Vaisesika schools. The Vaisesika school enlisted the totality of things under the categories of substance, quality, action, generality, particularity and co-existence. From purely metaphysical methods, Ayurveda was passed on to the physical and expert mental methods that involved the physical categories and terms such as substance, quality and action.
As per Atreya Philosophy
Atreya reduces the universe to nine substances. These combine to form the two main groups of things inanimate and animate. All the physical substances are reduced to the five categories of proto-elements and each proto-element is ascribed certain specific qualities, the total number of all the qualities coming to twenty in number. Thus the body-substance, environmental factors necessary for life-process, causative or curative factors of diseases all these were reduced to a specific number of qualities whose use or avoidance could be prescribed in an arithmetical ratio. As a result of the analytical process, they arrived at the conclusion that each substance or thing consisted of an aggregate of five inter-related stems each possessing quite different and specific qualities.
Significance of Proto-Elements in Metaphysics
These systems were termed as proto-elements. Then the quality of each proto-element was determined and the manifestation of that particular quality of its specific grade or intensity in a substance is depended upon the relative proportion of the proto-elements in that particular substance. This formula of proto-elements served the purpose in dealing with the physical idealities. But the biological entities had two more factors to reckon with; mind and spirit. Both of these are utilized and transformed by the physical matter to suit life's purposes. Both these are dynamic forces and cannot be observed by the physical means. They are known by the effects they produce on the body and their nature is the object of inferential knowledge.
Growth of Organic Existence
The combination of physical and vital forces in the biological world gave rise to the individuality of organic existence which needs special organizations to maintain the harmonious and co-ordinated working of both the physical and vital systems of an organism. The organization of bodily constituents is a mark of all the living creatures. This was the benchmark which differs it especially from inanimate things.
Composition of Biological Functions
Time phenomena of the physical matter cannot be adequately explained by the consequence of the biological world which is characterized by the organization. One is of static existence while the other is of dynamic creative process. Hence the need to evolve the formula of biological functions was inevitable. All the living organisms need below mentioned minimum triple organization for their life processes:
- The organization of fluid-balance of the body - It is also denoted as water-balance system. A specific fluid matrix is essential for the comprehensive expression of life phenomena. This organization has to maintain the specific consistency and structure of the fluid matrix under the stresses of varying environmental factors.
- The organization of Thermal balance - Specific heat is necessary to digest and assimilate material from the environmental world and convert it into one's own body part and also maintain the optimal heat of the body for full expression of life phenomena.
- The Organization of Vital balance - Vital force is an essential part for the purpose of creative evolution, progress, power of organization. Such other vital processes characterize life and differentiate animate from inanimate things.
History of Solar System
It would seem from the opinion of science that life is alien altogether to the physical forces of the universe and can choose its habitation and its field of play and growth within very narrow limits of elemental geography. At a particular stage in the history of our universe or solar system, the earth developed its present elemental geography, temperature, contents of solid, liquid and gaseous matter, mountains, earthy crust, oceans and atmosphere of air. That was the benchmark hour in the history as the initiation of life took place from therein. Ever since then the unfoldment of life has undergone various stages of evolution in vegetable, animalculum, animals and humans. Till the human stage, the urge of life has been an inner compulsion, blind, powerful and contemplative. Only the urge has been there instinctive just like the powerful drive of the powder behind the lead in the bullet.
In the present era, man is surprised and self-contemplative. The psyche in him demands the self-indulgence of a reflecting mirror of thought which contemplates the graces and freedom to choose the direction to make the next step. i.e from a mere green grass of moss and a speck of protoplasm has grown through the states of a floating jelly, the creeping reptile, the soaring bird, the unwieldy dinosaur, the half uplifted ape into the full stature of an upright standing man scanning the mystery of the endless vistas of space and time.
Evolution of Life
The first stage of evolution of life began when there appeared the covering expanse of the rolling waters and moving atmosphere that blanketed the planet. These oceans were filling the inter-spaces between the earth and the sun. The sun, foundation of this planetary system, pour out it's radiant energy upon the earth and its waters though the intermediate atmosphere. This process gave rise to the primary forms of life and sustained them in all their later stages of growth and evolution.
Sun remains to be the main source of evolution and sustenance of life till date. The sun is the soul of all living beings in the world immaterial of their mobility. But the interplay of the solar radiations and the aquatic elements of the earth along with its kinetic atmosphere has been essential for the maintenance of life in all its forms. The sun impregnated the waters of the ocean. It alone could receive the seed, and clothe it with the habiliment of life, with the form and structure needed for abiding and growth. It is the field and scope for the vital dynamics of life unfolded gradually into cognition, conation, intellection and spiritual fulfillment.
Whether life is like an exotic visitor waiting to make its entry on this planet till the favorable circumstance when the optimal condition for its play are evolved, or is a peculiar offspring of such an accidental condition incidental in the history of stellar and planetary evolution; is still a controversial point. There is a third opinion put forth by the ancient Sankhya seers that at the beginning of each cycle of time, the primordial principle of matter gets impelled into evolutionary activity of gradual unfoldment by a peculiar change in the eternal propinquity of the Puruṣa, who is the unchanging witness of nature. This power was not in the hands of man is the certainty.
Whatever be the origin of life whether extrinsic or intrinsic to matter, the distinguishing mark of all the forms of life has been the power of organization. Lovatt Evans in his work on "Starling's principles of human physiology" writes on what are the fundamental phenomena which distinguishes living things. Their distinctive feature is perhaps this organization and in the higher cadre members of this organization it becomes more and more distinct. This greater complexity of organizations run parallel with the increasing range and power of adaptation. It is attained by setting apart the special organs for the performance of definite functions.
Characteristic of Life
The peculiar characteristic of life is its power to organize. Its internal conditions are with regards to the structure and function so as to cope with its external conditions. Such body which we know as life, was studied both in its constituents and as a whole. The individual study of the parts gave rise to several special branches of study such as metaphysics, psychology and the physical or natural sciences, while the attempt to study the living conglomerate as a whole identity became the special concern of the physician who kept it going on in the perfect condition as long as it was possible.
Importance of Philosopher Physicians
During the time of Caraka, the physician occupied the exalted place, when medicine and metaphysics were equal domains of the Vaidya. The Ayurvedic classics were written by men who were admittedly the wisest of the age. Hippocrates says that a man, who was the combination of physician and also a philosopher, was considered to be very divine. He was accounted next to God. Hence the sages like Atreya and Dhanvantari also had a very divine post in their times.
We owe these physician-philosophers, of the golden age of the country, the concept of life as embodied in the Caraka and the Śuśruta, a complete and integrated concept. This concept is so broad-based that in its main outline it must hold good for all times. It is true that the perception of these sages couldn't claim the advantage of the elaborations due to mechanical devices that are possible today. But their integrated and total vision of the organism along with the modus operandi of its threefold organization and the means adopted to preserve and prolong its existence and functioning, is as supreme today in its validity as it was when it was first promulgated.
The Story Of Life
The Meaning of Life
The authors of Ayurveda, projects it to be much more than mere skill of treatment or diagnosis of a diseased condition. It is entitled to be comprehensive concept of life which includes both man and his connected environment. The well-being of man and the aggregate of body, mind and soul cannot be confined to mere physical health but it extends to the complete sense of physical, mental and spiritual satisfaction. An enrichment was born as a result of wholesome and mutually beneficial interactions between the individual and his environment immaterial of it being social, physical or spiritual.
Man as a biological entity needs to adjust to the physical environment and as a social and spiritual entity needs to adjust and react wholesomely to the society in which he lives. It also needs to upheld the spiritual ideal owned by it. Such well being is the real and true identity of man in his entirety. This is the main purport of the 'Science of Life'. Caraka therefore declares:
Science of life is such wherein are laid down the principles of good and the bad life, the happy and the unhappy life and what is wholesome and what is unwholesome in relation to life and measures of life.
Having visualized this total picture of life, we shall now analyze the two parts of it individually:
- The universe that forms the environment and which has given rise to life
- The individual organization, its composition, structure, mode of functioning and its progressive evolution from amoeba to man
Life and the Triumvirate of Organizations
It is the belief of science with the evidence at its disposal that life is an incident in the history of the universe. It is perhaps confined to only our planet where conditions favorable to its emergence, existence and growth began to surface some millions of years ago. Science also expects life to disappear with the disappearance of these evolutionary circumstances. The vanishing or disappearance of life on the planet is a certainty according to it in a few million more years.
Base of Functioning in Organisms
From a common point of view, it becomes more difficult to understand that out of innumerable solar systems whirling about in space, which solar system has the volume which can be counted in light years. A tiny speck of a planet was chosen to cradle this mysterious phenomenon of life, while organization entitles it under the name of the organic life. Such life-activity involves a continuous maintenance of it's body structure by the means of periodic replenishment of it's wear and tear, a constant supply of energy for maintaining the optimal temperature and tension and an unfailing mechanism for correlation of the distinctive functions of each limb of its complex structure. This aids in helping the organism to react as a whole both in its internal and external movements. Such threefold organization is the sine qua non of all the organisms immaterial of their size.
Complete structure of life or every organism is engaged continuously in converting the matter of the outside world into a new pattern and texture that it may serve the purpose of life. This transformation of matter into its own field of extension is the distinctive function of life. A recent writer named Jerome Alexandar in his book 'Life, its nature and origin' declares that the distinguishing nature of life is bio-catalysis. Bio-catalysis is the power to bring about chemical change in bodies without practically undergoing any change within itself. This bio-catalytic action is the one responsible for enabling life to maintain and extend its field in the alien world of matter.
Life is continually annexing matter by it's catalytic activity and extending it's dominion over space-time. Life, viewed from this point, is a catalytic struggle with the environment. This struggle is a process of annexation into its expanding boundaries of the non-responsive and ever hostile forces of the material world. This is a view which fully accords with that of the Sankhya school of philosophy, base of Ayurveda. The infinite number of Puruṣas, known as bions in the modern biological languages are caught up in the meshes of matter. In the presence of these bions, matter undergoes changes in order to give these life-units their objective of life. It is the perpetual unfoldment of sensations, images and pain-pleasure conditions. But the Puruṣas remain unaffected. Matter which holds these bions are called Puruṣas.
Segmentation of Bio-catalytic Process
The spirit or soul perceives 'Nature'. Thus life acts in involving a recasting of matter into new patterns to suit the base purpose of these bions, while they themselves remain unchanged witnesses of the varying life phenomena. The activity of these bions is indeed best illustrated by the process of bio-catalysis. This bio-catalytic processes involve the threefold organization calculated to sub-serve the vital purposes of material. They are:
- Progress and growth
- Maintenance of thermal and metabolic processes
- Co-ordination of the internal and external movements suitable to the changes of environment
Without these threefold functions no organism can survive. All the processes of assimilation and dissimilation so essential to keep the ongoing progress of its structure and tone are rooted into such organizations. It is therefore very evident to analyze the description by Ayurveda. It is important to know whether it fits into its general outline of life-processes of this three-fold phenomenon of organization or not.
Ayurvedic Spectrum of Bio-catalytic ProcessCaraka lays down the distinction between organic and inorganic life denoting thus:
'The thing that is endowed with the sensory organization is organic or sentient and that which is not endowed thus is inorganic or non-sentient.'
The sentient organism involves a complex organization of structural, metabolic and kinetic processes. It also involves either mind or a co-ordinating principle however elementary or intricate it may be. Ayurveda holds such an organization to be universally obtained in all the forms of life, from the most rudimentary to the most complex. Thus its physiology and pathology is uniformly applied in the broadest outline to all the forms of life.
Though life is mysterious and undefinable, the phenomena which signifies the existence of life are evident for the purpose of observation and study. All the phenomena which distinguishes the animate from inanimate are ingestion, assimilation, respiration, movement, growth, creative evolution, reproduction and potency of each organization.
Life has been endeavoring and struggling to create and preserve optimal environmental conditions for itself which would help its evolutionary purpose. It corresponds to certain modifications in the process as per variations in time and space. Besides, it has also developed its own organization of existence, growth, perpetuation and expression so that it can accord to such probable environmental variations. The variations definitely happens within certain limits. It has also created protective measures and techniques for its survival and evolution.
Evolution in Plant and Animal Life
In the plant life, we observe that the sap is encased in a hard case of bark-crust to protect it from the external heat, cold as well as hostile incursions. Plant life is an excellent example of the survival-techniques of life's organization. In spite of the big size and strength developed from within, this form was not conducive of the varied richness of life-processes struggling for expression. Hence a subtler and more malleable patterns endowed with movement, agility and resourcefulness for the preservation of its life and even for overcoming hostile forces either by resistance or by accommodation was developed. This gave rise to evolution of animal life.
The animal pattern of survival was considered to be more advanced. The cadre of animal evolution included every being from the smallest animal to the complex organism of man with the mind-principle fully dominant. The process of such evolution is the direct result of the integrative organization which every living organism possesses and is able to evolve. The higher the complexity of life, the more subtle and distinct becomes these organizations.
These organizations become more and more complex as evolution advances and form separate structures. There are special organs for the performance of these definite functions. But the fundamental principle of organization which maintains the integration of the individual remains the same for all living organisms, whether minute or large. Even in the unicellular life, all the fundamental phenomena of life are carried out in the same pattern though there is no difference in appearance or structure of protoplasm.
Vital or Motivating Organization
This is the master organization which initiates and directs all the activities and maintains the specificity of all the vital processes which characterize living organisms. They can be classified into two parts:
- Physical or material organization- It is the system which maintains the specificity of fluid matrix of protoplasm wherein life-phenomena are played.
- Thermal or metabolic organization - It is the system which maintains specificity of heat by carrying out anabolic and catabolic processes.
The Triumvirate of Organizations
The miraculous story of life's evolution or unfoldment is recorded by biologists. The process of such evolution has always necessitated the pursuit of the technique of the threefold system of organizations viz:
- The structural or material pattern
- The maintenance-device of the thermal optimum for metabolic functions and adjustment to environmental temperature
- Kinetic or motivating organization of the entire structure for purposes of growth, perpetuation and enterprise
Without these forms of its dynamics, life could not have achieved its survival and progress. Nature and texture of each of the three organizations have played a significant role in survival and progressive growth of life.
Matrix or Material organization
Beginning of Evolution
There is common ground between science and religion on the question of the primeval abode of life. The aqueous elements were the first one to get evolved. Both vegetable as well as animal life-forms have been born and have dwelt in water before they grew into amphibious and terrestrial species. The seers of the Veda declare that there was existence of only clear waters in the beginning. God created all the living things on the earth from water. It is the faith of all the religions that life spirit dwelt and moved on the dark primeval waters.
In the mythology, it is believed that Lord Viṣṇu, while lying on the milky ocean, bestirred himself into a creative mood. This is how the creation of living beings on the Earth took place. Even the science supports this theory of evolution to be the origin and abode of life.
Stream of Life
The matrix of the material pattern that life requires for its abiding is provided by only the water element of this universe. That is the medium best suited for the vibrant throb of life and transmission of its impulses. Human, plant and animal life is run by the immaterial spirit of life. This fluid matrix can be poured into the vessels of various shapes and its consistency is increased or lessened. Life has attempted all those shapes, patterns and the densities needed for its consummate expression and release of the dormant spiritual force. The last output of life's enterprise is Man.
Like a spider that has woven its web and retired to its center, so has life woven around itself the web of the human organisms with its automatic systems like circulatory, respiration, nervous system and mind which mechanically operates centering the higher life as it's goal in the course of further evolution. Thus, there is a whole complex system distributed in its outline under this threefold divisions of body-organization with the sole purpose of maintaining a uniform and unchanging environment for life. This environment contains in itself its power of accommodation and adjustment to exogenous as well as endogenous interferences.
This leaves the spiritual mind of man free to reflect and weave out his patterns of thought for spiritual fulfillment and creative imagery in art, literature and science. All these creative skills expands the scope and variety of life expression. It is obvious that all the three aspects being component of an indivisible whole are vitally inter-related as integral part and change in any one is bound to affect the rest. But for the purpose of their knowledge in specific, the nature of each of these is referred to in the terms of quantity or form, the degree of intensity and degree of tempo respectively.
Modern Anatomy and Physiology Perspective
Modern anatomy and physiology have credited a long and persistent series of investigations and study of the human constitution in its complexity and minuteness. They have tracked down the secrets of human structure and function to the microscopic cells and even beyond. With utmost diligence it was experimented on animals and ascertained with almost full approximating certainty. It is very essential to understand a comprehensive human dynamics for the probable reactions and effects under the given circumstances to achieve a specific stimuli. Man is the most tangible structure made by an aggregate of mere cells. In R G. Hoskins book, it has been said that Medicine is now in a transitional phase.
The ineptitude of regarding man as constitution of different interesting organs working differently for a united goal of living is becoming increasingly clear. The personality of their nature is more important than his organs; no matter whatever fascinating pathological conditions or versatility they may disclose. The influence of soma on body is an another misunderstood factor of psyche which is gaining increasing recognition daily. There seem to be more factors yet not understood, but whose workings are only suspected and observed in crucial moments and special exigencies. Though the intrinsic nature and technique of functioning may defy our present powers of comprehension, yet their net effects are obvious to the discriminative eye.
Complexity and Inter-dependability of Human Organs
Positive side of this theory is that it clears the mind that is able to observe and appraise these influences from an internal viewpoint of the human organisms. For the clinicians, this information is accessible through the intelligent inquiring methods. This phenomena presupposes an extensive and exclusive view of the structure and function of the individual parts of the body. Otherwise the excellence of each part is vitally related to that of every other part and the body as a whole.
There is an intelligent and highly sensitive adaptive principle to which all the body-functions and life-purposes converge. From this there emanates the subtle and vital vibrations that uphold and preserve life both in health and disease. This pre-supposes a comprehensive or integrated concept of physiology, the doctrine of vitality against the phenomena of mechanism. Man is more than a machine. Over and above the psycho-somatic organization there subsists presiding principle which is instinct with awareness and wisdom beyond the conscious mind.
At the first instant it sounds that the doctrine of vitality was a superfluity intruding into a realm where it was not allowed. But on comprehensive consideration it is seen that without the recognition of this element, there is a void and inadequacy, a scattered and disintegrated jumble that is belied by the fact of the universal subjective experience of men of an integrated and compact unity of personality. This points out to the the ancients, Caraka and Śuśruta of India and to Hippocrates of Greece and Galen of Rome. But this by any means is not suggestive of the same path being followed by both the countries. Apart from it nevertheless of their inspiration which was derived from a common viewpoint of regarding man as a whole and in the vital inter-relation of his various organs of the extensive or inclusive nature of the functions of each of them in health and in disease.
Results of Complexity in Human Structure
These analytical results should be cast again into the mould of the synthetic or the integrative view of man. Instead of the data being priced, their ultimate net values ought to be worked out and cherished. The inter-relation of each limb and part of the body has inevitable repercussions on the total well-being of the psycho-somatic whole which is man and vice versa. With this motto in mind, the natural corollary is to set about discovering the main springs of human well-being and reactions, the sources of living, action along with resisting disease and rebuilding of loss.
Once the main springs of life and action are discovered, understood and assessed properly in their values, the rest follows easily and naturally. In the light of this radical knowledge of man, the data gathered assiduously about the various individual components of the body, big and small, get reoriented and yield a richer wealth of wisdom pertaining to the body as a whole as well as of its parts.
As per the ancient medical thoughts from Caraka, Śuśruta and other works, knowledge and observation of the main springs of human life and action and the full appraisement of the functional values of life-expression, the full and detailed classification of the varied signs and symptoms, visible and expressed psychically and somatically of life were all important. It was not mere theory. In practical therapeutics also it has lot of weightage.
Through observation and prolonged study of human behavior and reactions in health and disease and also by general inference based on the understanding of the unity and uniformity of the principles governing the cosmos as a whole; man was governed by a triumvirate of forces and elements well organised. The action of the sun, water and air were the proto-types to them of the aqueous, thermal and kinetic organizations respectively of the human body.
Significance of Water in Sustenance
Water was regarded as the prime source as sustainer of life, the daily purifier and refresher and the elixir of life. Water was held so sacred by most ancient races that it became was worshiped as god and a religion grew about it. Holiness and purity were acquired through bathing and sipping water. Even water was poured from the hands as the oblation to God and vows made.
The counter-part in the body of the water in the nature was the body-fluid, the colloidal fluid known as protoplasm. Among the triumvirate that governs the body this factor was the first essential. This provided the field for governance and was the substantial structure for the state itself. This is the material organization of the kingdom. This vital fluid forming the vehicle of the life-spirit contains proteins, fats, carbo-hydrates, vitamin, salt and it constantly fluctuates to adjust and counter internal as well as the external disturbances.
This integrative organization regulates constantly the physical and chemical structure of the body-fluid as well as its circulation. It maintains the proper balance between the fluids in the various parts of the body viz:
- Water in the colloidal system of protoplasm
- Water between the cells and fibres
- Stored water in any water-depot of the body
Significance of Temperature in Sustenance
Temperature is an essential factor in the maintenance of this natural and uniform pattern. It is very important in providing life, the scope for vital play. The body is found to possess the mechanism of internal combustion. It has heat-generating thermal mechanism distributed in the entire body. This is a radical aspect and not an exclusive function or peculiarity of any one limb or part of the organism.
It might be possible that this phenomena of body thermal mechanism would be more at some place and very less at other. But in its total aspect it balances the thermal production and output to maintain the thermal constant of the whole body. This bio-combustion process is termed as the metabolic process. The internal thermal balance is sustained by the anabolic and catabolic processes constantly taking place in the body. Though this thermal element is diffused in the entire body, it also has its regions or points of focus.
These foci are important to the clinicians because the pathogenic and restorative processes are centered around these points of foci in particular and the entire system in general. These general foci are distributed in the body so as to meet the exigencies and functions of each structural system of the body. The kapha, pitta as well as vāta, the three factors of the triumvirate that governs the psycho-somatic organism, are each apportioned with its pentad of foci in the body. These have special clinical significance and are guides and aids in the practical diagnostics and therapeutics.
Role of Psycho Somatic Organization
We now come to the last and the most important factor of the triumvirate, the factor closest allied to the life-principle and which is supreme; vital function of the psycho somatic organization. Life is never static. Even in its most rudimentary states even simple existence presupposes an internal dynamics, where action, aspiration and adaptation to environment are involved. The dynamics of it are very complicated.
Wherever the psyche is dominant it charges the body with the impulses of hope, despair, anticipation, fear, desire for efficiency, triumph over opposition and the joy of achievement. The dynamic organization involving such kinesthetic force must be subtle, self-sufficient and creative. This attribute is possessed collectively by the body and mind which is known as vāta or vāyu. Here it means to move or convey. The kapha and the pitta are relatively static. At every single point of their existence and functioning they need the co-ordination of vāta. Pitta and kapha exhibit at the places wherever the vāta carries them.
As per Other Philosophers
Claude Bernard states that vital force directs phenomena which it does not produce. Physical agencies produce the phenomena in living things which they cannot direct. This apt remark has much similarity with the statement of Kapila, the propounder of the school of Sankhya. He suggests that the union of the spirit with the nature is for the contemplation of the Nature. The union of the Nature with the spirit is for liberation. The union of both 'the spirit and the Nature' is like that of a lame man with a blind man. The creation is brought about by the last union.
Significance of Vāta
Life is dependent on vāta because it is the impeller, sustainer and operator of life. It is known as the Tantra-Yantra-Dhara. In a chapter, classic in its pattern and expression of thoughts, Caraka describes the nature and functions of Vāyu both in the cosmic as well as its biological aspects. It is the master of the supreme principles of life. The salutary as well as the pathological aspects of the vāta principle are described by the royal sage Varyovida in the eloquent terms.
The vāta is the upholder of both, structure and function in the body. It is the very self of the five forms of vāta in the body:
Functions of Vāta
Normal function of vāta includes the following activities:
- Impeller of upward and downward movements
- Controller and conductor of the mind
- Spirit of all the senses
- Conveyer of all the sense stimuli
- Protector of the body-elements
- Synthesizing principle in the body
- Impeller of speech
- Cause of feeling and audition
- Source of the auditory and tactile senses
- Origin of all the excitement and animation
- Stimulator of the gastric fire
- Desiccator of the morbid vitia
- Eliminator of excrement
- Obstruction of the gross and subtle body-channels
- Maker of the fetal form
- Sustaining principle of life
Abnormalities of Vāta
When the vāta becomes abnormal in the body, it afflicts the organism with diverse kinds of disorders, tending to impair its strength, complexion, well-being and life. It depresses the mind; impairs all the senses, destroys the fetus in uterus, produces deformity in it or unduly prolongs the period of gestation. It also results in giving rise to fear, grief, stupefaction, depression of the spirits. Hence in this manner any abnormality in vāta causes delirium and obstructs the vital functions of the body.
Evolution of Science of Physiology
The science of physiology has passed through the several stages of evolution. It was first a static view of an individual of specific functions of various organs and tissues of the body. Later it was realized that there was an integrative control through the nervous system and psychic influences. These parts can not be considered to be functioning separately. Yet the endocrine secretions opened up newer processes of physiologic as well as metabolic conditions. This had an integrative chemical control over the body. This phenomena highlighted the cellular structure and function.
Not even one internal part of the limb or gland or cell of the body can be viewed. One kind of secretion is balanced by another and the glands, the tissues, cells and all the other elements are interrelated and controlled by the fulcrum of personality on which the whole organism is fixed. Thus physiology is a total and integrated life-process and though viewed analytically for study-purposes, the comprehensive constitutional view should not be ignored.
The triumvirate of kapha, pitta and vāta form the general outline of that constitutional pattern or scheme. Hence the phenomena like constructive, integrative, assimilation, recuperative and elimination processes are to be understood in terms of their basic nature. They should be studied by their working of these three principles individually as well as the inter-connectivity of these three among each other. They are all inclusive and complete in their comprehension of the body-mind processes as a whole.
Time and space factors vary every moment and hence it is not possible to maintain optimal environmental conditions. Hence, the life develops within itself such active organization which enables the body to adjust immediately as per the changing circumstances. It is an adept to the variation in the external relation. Moreover life also evolves a special protective and survival technique to counteract the inimical environmental incursions.
The Three States of Life functioning in Men
We know that for every animate life to exist and grow, it requires three different forms, the stationary life of plants, mobile but passive and reflex life of the animals and the discursive, active and creative life of the humans. The human body evolved from the most rudimentary life contains the vital processes of all these three types of life.
Human Life Functioning as per the Surrounding Flora
Human body also contains the parts and organs that grow, abide and function like the plants. It absorbs food, turn it into energy and discharge the waste products thereby automatically maintaining the basic structure non-interfered and unaided by the higher aspect of the mind on general.
Human Life Functioning as per the Surrounding Fauna
Right from the evolution of life the heart, stomach, intestines, liver and other glands keep on functioning in their own autonomous nature without constant active impulsion or inhibition from the mind. Nature has managed to keep this basic body-mechanism beyond every man's reach and control. There is a reflex life of the man wherein the limb and sense organs execute protective movements in the response to the external stimuli. It is the defense mechanism of the body which is inbuilt against extraneous incursions and interferences. Many of the man's normal physical activities and mental and emotional impulses are the reflexes. Therefore a passive reaction is projected to the external world of stimuli. The reflex organization controlled by the central nervous system represents the next higher stage of man's evolution as an animal which reacts suitably to the environment and acts and learns by adjusting to external stimuli. This is the animal aspect of man.
Functioning of Human Life as per Brain
Above these two forms of life, stands the real human life i.e. the purport, creativity and self-conscious propulsion of the higher mind. Man can asset his essential humanity due to the functioning of mind which executes the essential actions and commands. This is the significant purport of psyche performing will, determination and discrimination.
The basic survival functions work beyond the control of the individual as they are autonomous set of organizations. Thus man's survival is assured against his will. This autonomous nervous system includes the functioning of the heart, liver, intestine and such other vital organs. These organs have an independent functioning of their own and continue to work even outside the human body if given suitable environment. Thus they represent the most primary unicellular life-forms which forms the unit of life. It is a passive activity in response to the environment. The full psychic life where the creative forces of his imagination and reason come into play and launch man's life upon the vast option of creative activity, discovering new factors and shaping the environment to this inner impulses. It is the fullest expression of man on the human platform.
Diagnosis based on this Phenomena
Thus a human being is effected and expresses himself in all these three aspects of his life immaterial of him being healthy or diseased. For the people concerned with man's pathological manifestations, the varied changes and symptoms which are displayed in these three aspects are very important for the diagnosis and treatment. The most sensitive part of a person is psyche. Hence internal symptoms such as malaise, mental images and status, dreams, desires and impulses form the base for evaluating the situation. These factors are accessible to the physician only through close questioning and conversation with the patient. It forms a base of certain degree of observation, introspection and intelligence on the patient's part. In the absence of these factors, the proper appraisement of a diseased condition in its early state is difficult. Thus the psychic disturbances serve as the earliest symptoms that can guide the physician in the diagnosis of a disease condition.
The next stage of diagnosis is referred to be the vegetative aspect of our body-organization. Since these functions are mainly independent of the mind and central nervous system, they evince individual and automatic reactions to the disease affection and try to make suitable adjustments in it. This can manifest in various forms like instinctive inclinations for or against certain tastes, things, diet, heat and cold in order to correct the decrease or increase of a particular structure or function in the body. These two groups of symptoms, whether psychic modifications or instinctive inclinations, are very predominant symptoms which are helpful in the early diagnosis of the disturbed health. Ayurveda has always emphasized on the study of premonitory symptoms which forms an important category in the pentad of diagnostic methods.
The Study of Environment
Life and Environment
To understand the nature and functions of life, it is essential to study and appreciate the factors of environment. Indeed both the factors are one like the two different sides of a coin. To think of life apart from environment is impossible. It can be compared with the light without it's surrounding sphere of illumination. For the medical science in particular, life always run in accordance with it's environment. Every organism, especially man must be understood in the relation to his environment because all his life-functions are engrossed in a continual flux to meet the challenge or reap the benefits of the factors of the environment in the various forms of weather, geographical conditions, nature of soil and its tendencies, bacterial saturation and similar other conditions. In fact, the life of any organism depends on its reactions to the constant or changing environment. Environment is not only its prime cause of being but also responsible for its disorders and perfection. Caraka expresses this truth as a philosophical axiom and asserts that the existence of all the beings is derived from the nature of their reaction to environment.
A continuous existence of all the creatures is dependent on proper, inadequate, excessive or wrong interaction between them and their environmental factors. Their well-being and ill-being or existence and non-existence is dependent on the right degree and nature of contact with environment. Thus in the medical science, man-cum-environment is the unit of study.
Life is not a static condition but a dynamic process of continual adjustment with environment. Time and space which constitutes the environment, are perpetually varying factors of the universe which facilitate the constant vigilance, activity and modification in the reactions of the organism. Caraka therefore uses the various synonyms of life denoting it to be the constantly changing, dynamic and of progressive nature.
Disease factors of Environment
When the organism fails to adjust or adapt due to either some innate deficiency or overwhelming force of the environment, the result is diseased-condition which is the subject matter of medicine. Such environmental factors are known as exogenous disease factors. They are of the nature of space and time which include varying places and positions of things and seasonal variations as well as physical chemical and biological invasions.
The organism can be taught to adjust and prepare against such hostile forces in an extensive way. All these conducive practices of diet, behavior and seasonal regimen that are entitled to be wholesome life in the texts of Ayurveda are formed to help the organism to adjust and overcome these impediments to health from the changing environment. This is a lesson in acquiring immunity against probable antagonistic features of time and space.
Guiding factor in Adaptation
The above phenomena is true only in a general sense, because the reaction to the environment is different from one individual to another. Nobody is same in looks, tastes and degree of tolerance to heat and cold. Consequently the degrees of their individual adjustment and adaptive reaction must also be different. While trying to bring about similar results, varying methods and degrees of efforts have to be pursued.
It leads to the query to the foundation on which this difference is based. It also intrigues regarding the guide in determining the different degree and quality. It is essential to know the differences in reaction towards a common environment. The answers to these queries lead us to the fundamentals of the medical science i. e individual constitution. Complete adjustment of the individual with his environment is possible only on the basis of the appreciation of facts of his individual constitution. It can be successfully accomplished only by considering the environment and constitution together as a whole. This brings about a harmony between man and environment, which is the sole aim and justification of medicine.
The Study of Constitution
A peculiar fact about life is that no two individuals are exactly alike by any means either it be in appearance or physical and mental aptitudes, abilities and god gifts. This is because each person occupies a point in space time, different from every one else. This endows peculiar tendencies through genes on each individual at the very moment of his birth. Each person thus enters the life with a peculiar viewpoint, mode of reaction to environment and susceptibility to physical and psychic influences. That is why we find that though people live in a common environment, each one reacts in a very distinguishable pattern.
The great physician Osier denotes that each person reacts differently to the incursion of injury. People, though suffering from the same disease, have a different mode of treatment administered to get cured. All this emphasizes the supreme importance of the knowledge of individual constitution in medicine. It is difficult to say even after the knowledge of advanced stages of body constitution that how and what factors are responsible for forming this unique tendencies and qualities. It is challenging to perceive why certain ancestral and hereditary traits become recessive in one child and dominant in another. This is evident from the investigations of Mendel and other scientists who tried to perceive this subject into a biological law.
Classification of Diseases
It is not over-scrupulous to say that the number of diseases is equal to the number of individuals. But this does not help in reducing the subject to some approximate formula. Therefore it has been classified on the basis of their race, group, region and some other ways by some biologists and medical scientists. The inadequacy of these classifications become evident from the medical clinicians point of view when individuals of the same race, group or region show diverse reactions and degrees of tolerance to common disease-factors. Hence a biological classification and grouping is entitled to the clinician's credence and appreciation.
In the ancient Indian and Greece pathology, such biological views and classifications were observed. They can be classified into three groups allowing innumerable minor groups according to the varied combinations of these three main categories. This classification was done both from the physiological and pathological points of view, highlighting the triumvirate of biological organizations. This classification became the guideline for the clinician and patient for maintaining good and positive health. It accelerated prophylactic as well as curative measures of the disease. It gave an immense insight into the realms of diagnostics as well as the practical therapeutics.
Inter-Dependability of Constitution
In the daily regimen of diet and behavior meant for balancing and correcting the predisposing factors of disease, this constitutional perspective was considered to be of supreme significance. Caraka delineates it for using the things antagonistic in effect to one's predisposing factors. It is recommended to lead wholesome living. This becomes the foundational cause of the science of immunity in its active aspect where the individual is enabled to react powerfully with all his vitality and 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 state is organized and the relations of individuals with the society as a whole are regulated. The legal regulation is accomplished successfully by the internal dependability and co-operation amongst the legislature, administration and judiciary. Thus it is the integrated physiology. Millions of body-cells, nervous system, heart, lungs and intestines, all act in a coalition-government and mutually impel, check, balance and produce an integrated and harmonized result. This is called as life and good health. Ayurveda depicts this integrated function in terms of the triumvirate of biological organizations and mutual interaction.
Prakṛiti or Constitution in Ayurveda
Constitution is called Prakṛiti in Ayurveda. It is the sum total of the crystallized results of all the influences of time and space on the individual human life. It is easy to deduce since no two individuals can occupy the same point in this time space world that no two individuals are identical in all respects. Hence there are many responsible factors for understanding different causes that constitute this time-space in order to ascertain and define its variable influences on constitutions and its multiple 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 qualities and tendencies based on all the previous incarnations and thus is traced ultimately to the very beginning of time.
Prakṛiti Evolution in Foetus
Fetus undergoes all the evolutionary metamorphosis 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 are termed as genes. The peculiar influence inherited from both the parents and the combination of the formative forces, such as climate, season, environment at the time of impregnation; all these factors shape the constitutional destiny of the individual. The inheritance of previous incarnations being subtle, are more of psychic qualities; but they in turn have their influence on the somatic reactions also. Thus at the time of birth, a lot many factors influence in giving the individual a definite predisposition, pattern of tendencies set in motion, which determines his or her degree of tolerance and resistance to all the external and internal disease factors. The varying effects of climate on the gravida, her habits, tendencies and social and seasonal environment are bound to have profound consequences. Thus from the very moment of birth, an individual is a complex being. It is a bundle of tendencies bearing the seal of destiny with a margin for freedom of will and action.
Determining Body Habitus
Constitution is an inherited or geno-typical condition, that cannot be altered fundamentally. Evaluating conditions of health and disease is a life-long concern of supreme significance in man. This is expressed by Caraka and Śuśruta denoting that from the moment of conception some men are equi-balanced with regards to the three vitia; vāta, pitta and kapha. Some people have a predominance of either vāta, pitta or kapha. People having equi-balance of these three enjoy perfect health while the rest are liable to diseased condition.
The body-habitus of a person is determined as per the continual predominance of a particular vitiura in the body. These are the symptoms of the hereditary disposition or constitution molded by the predominant vital habitus formed at the time of the fertilization of the ovum by the sperm. Any part of the healthy seed is vitiated by the nature and action of the vitia during that particular time. After germination, that part of the germ-cell determines the future constitutional type of the person. 
Types of Persons as per Body Habitus
Generally the constitutional condition does not change, nor increase or diminish except at the end of life. Thus the importance of knowledge of constitution is established both in physiology as well as pathology. Caraka propounds that there are three main classes of persons. They are:
- Atala - It denotes the person having vāta habitus.
- Pittala - It delineates the person having pitta habitus.
- Sleśmala - It denotes the person having Sleśma habitus.
The above mentioned classification is the base of constitution for each and every person falling into the category where any one of the vitia is predominant in the biological constitution. There are various degrees of combinations of these vitia. They can be in combined form of two or three also sometimes in a hyper or hypo pathological condition.
When the symptoms associated with the characteristic of each of these vitia are known, the degree of their combination can be inferred. Laying out the general outline of these three main categories of constitution, Caraka declares that in the clinical investigation of these three types of constitution there are very specific display of their characteristic traits and qualities.
Characteristics of Different Habitus
Let us get into the explanation of the characteristics of habitus. The fetal body develops its habitus from the nature of the mother's diet and behavior along with the nature of the proto-elemental combinations. Among these factors, whichever elements are predominant, will influence the nature of the fetus. This exhibits the vitial susceptibility right from the evolution of their fetal life. Some people exhibit different types of habitus depending on the dominant characteristic while some are possessed of vitial equipoise.
Peculiarities of Kapha Habitus
The kapha is unctuous, smooth, soft, sweet, firm, dense, slow, stable, heavy, cold, viscid and clear. Kapha, being unctuous, those of kapha habitus have glossy limbs. It being smooth in texture the people with predominant kapha qualities have smooth limbs. Due to its softness, person with kapha tendency has delicate and clear body. The sweet quality of kapha leads to profusion of semen, desire for the sex-act and children. On account of its firmness they have firm, well-knit and stable bodies. It's denseness leads to the plump and round in shape of all their limbs. Owing to its slowness, they are sluggish in their actions and speech. It's stability leads to their sulky undertakings, change of moods and pathological condition. Due to its heaviness, they have firm, large and stable gait. It's tepidness makes their hunger, thirst, heat and perspiration meager. The viscosity of kapha leads to their well-knit joints. The clear look of kapha exhibits clear looks, mellow complexion and voice. Hence we can deduce from all these qualities that a person of predominant kapha are possessed of strength, wealth, knowledge, vitality, gentleness and long life.
Characteristics of Pitta Habitus
Pitta is hot, acute, fluid, acid, pungent and raw-meatish in smell. Owing to its heat, people of pitta habitus are intolerant of the heat. Pitta is very hot in the mouth. Hence the person of pitta habitus has delicate and clear bodies. They have profuse moles, freckles, spots and pimples on the body. Excessive hunger and thirst leads to early wrinkles, grey hair and baldness. They are generally possessed of scanty, soft and tawny hair on the head, face and body. It's decree of acuteness leads to different ratio of keenness in valor. Their acute digestive fire leads them to taking excessive quantity of food and drink. They are generally the constant eaters. They are subject to incapacity to bear sufferings. Owing to its fluidity they have flabby and soft joints and flesh. They profusely discharge 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 off-springs. Hence due to the combination of such qualities, the person of pitta habitus are of moderate strength and life-span. They even are of moderate knowledge, experience, wealth and means.
Peculiarities of Vāta Habitus
Vāta is a dry, light, unsteady, abundant, swift, cold, rough and clear. Because of its dryness, those of vāta habitus are of dry and small bodies. They are of long-drawn, dry, low, broken, hollow and hoarse voice. They are ever wakeful. Owing to its lightness, they are of light and inconstant gait, behavior, diet and speech. Due to its unsteadiness, person of this habitat are restless in their joints, eyes, brows/jaws, tongues, heads, shoulders, hands and feet. Due to its abundant nature, people of this habitus are more talkative and have prominent veins and tendons. Its swiftness leads to their quick undertakings and variation of moods. They are subject to various pathological changes. They are quickly affected by fear, likes and dislikes. Their ability to quickness in grasping and forgetting things is remarkable. Because of its cold quality, they are intolerant towards cold. They are very much susceptible to suffer from cold, shivering and stiffness. It's roughness promotes rough hair on the head, face and body. They have rough nails, teeth, mouth, hands and feet. The characteristic of its clearness produces cracked limbs. Their joints always make noise as they walk. Due to the combination of such qualities, persons having vāta habitus are generally of less strength, short life-span, scanty offspring and means of meagre wealth.
Characteristics of Combined Habitus
In a combined habitus, the qualities of the habitus which are combined are displayed together. If vāta is compounded with pitta, then there is a display of the qualities of both the habitus in an individual. Similar reactions are exhibited if there is a combination of vāta and kapha and pitta and kapha. It is possible that each peculiarity of both the habitus might not be displayed but overall there is an exhibition of atleast few characteristics of both the habitus.
There is a possibility of the aggravated forms of vāta, kapha and pitta altogether. In this case the distinctive qualities of the three are displayed in the patient. There might not be a display of all the characteristics at one and the same time but overall atleast few symptoms of all the three habitus are being displayed.
Distinctiveness of Equipoise Habitus
Those, having a maintained equilibrium of all the three vitium in their body, are endowed with every good qualities of each habitus. It can be concluded from the peculiar characteristics of each habitus. The perfect equilibrium of this vitia is the foundation for the perfect health in an individual.
Significance of Nomenclature
The highly logical spirit of that age impelled them to be very accurate and meticulous in all the matters, especially in definitions and nomenclature. Having understood the triumvirate of vitia in details it becomes easy to determine it for the total psycho-somatic texture of a man. It is also necessary to develop a more detailed information about the nature and mode of operation of this triumvirate of vitia. This leads to the justification of their nomenclature. Let us get into the details of study of man's behavior in the maintenance of health and his fight against diseases.
Method of Nomenclature
The living organism includes the unicellular protoplasm, the tiny speck of non-differential protoplasm, as well as the man with his highly differentiated organs, tissues and cells. The cell is a functional and structural unit of life. Many lower forms of lives consists only of a single cell as an entire body. Moreover man, a highly evolved creature structure-wise, commences the life at unicellular stage, namely the fertilized ovum. The fundamental phenomena of the life are identical with each living organism.
In unicellular life, structure is hardly visible or definable but the life-phenomena are same as those observed in the higher forms of life. Though the material form of existence is too insignificant to be noticeable, it is made of dynamic systems manifesting ceaseless activities. These dynamic systems fully sustain life and carry out life-functions effectively.
There are three primary organizations. As they are the fundamental physiological systems sustaining life in co-ordination with the insignificant speck of protoplasm, they get a significant name. The origin of their word comes from the root 'vr' which means to support or sustain'. In higher life this protoplasm greatly increases in proportion and gets differentiated into various forms in order to carry out the special functions assigned to them. In human structure, we find several different kinds of tissues or body-elements evolved which plays a significant role in the maintenance of the physical body. This differentiation and specialization of tissues is to augment the power of primary triumvirate of the organizations. Hence in man, the three primary organizations, vāta, pitta and kapha, as well as the specialized tissues of the physical body are evolved for the special functions. They both are given equal importance and included in the category of the upholders or the sustainer of life.
Types of Nomenclature
Thus in order to use a specific terminology for the nomenclature the words dhātu and mala are generally used in the following sense:
- Doṣa - The triumvirate of body-organizations or the triad of vitia
- Dhātu - The body-elements
- Mala - The waste or toxic matter
Dhātu is also called as vug. The human body lives on the food which it ingests everyday. It assimilates some nutritive portion out of the food ingested and throws out the rest. Among the primitive unicellular life, this process occurs immediately. But in man, having a complex structure of tissues and systems, the process of separating the useful from the unuseful material takes place in one part and the process of assimilation happens at another part. The elimination process is executed by some other parts.
According to its needs and capacity, the body absorbs a portion of the useful nutrients. The process of elimination takes some time in the complex machinery of the human body. The matter separated for elimination is surely not harmful, infact sometimes it is useful. This waste matter meant for ultimate elimination, though not forming a part of the regular body-elements, does exist in the body. Hence it is also included in the category of general way though it is usually given the significant name of waste matter in particular. Thus the word Dhātu includes the below mentioned in its category:
- The primary three functional organizations, i.e. the triumvirate which is the primary organization in each and every unit of life.
- 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.
- The waste or excretory material, healthful in action.
The word 'Doṣa; is derived from 'Drup' to vitiate or pollute, to become impure, to be bad or corrupted. All the Dhātus may become vitiated in the whole body or a local part of the body. The factors which arises the condition of vitiation in the whole body are the triumvirate of organizations. This generalized or vitiating nature is the most common in this organization because they are all-persuasive and constant in the action which maintains the perfect effectiveness of the whole body in ever changing environmental factors.
Thus the word doṣa is used for the three biological organizations of the triumvirate. 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 it's toxic matter. They are often termed as doṣa. The predominant quality of doṣa is to pollute. From the definitions of Doṣa, Dhātu and Mala, it can be deduced that the term 'Doṣa' is used 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 the other parts of the body.
The word 'Mala' is used in two senses.
- The end-products of the digestive process which is excreted by the body. The end product of the digestive process is again further classified in two parts. The first part which is assimilated in the body and which becomes a part of the body elements is called Prasād while the other part which does not assimilate and gets converted into some secretory and excretory products. These excretory products serve as some auxiliary purpose in the body-functions and then gets eliminated from the body. This is called as mala or unclean matter. But this matter being the normal physiological function, is included under the term Dhātu or upholder of the body.
- All the morbid matter which is harmful to the body. There are different kinds of morbid material which are existent in the body which can be determined in various manners. The first one is the excretory matter issuing outwards from the orifices of the body in various forms. The second one is the over-mature body-elements. The third one consists of irritated vāta, pitta and kapha. The last variant of mala includes rest of the things residing in the body tending to injure it.
Thus healthy mala is un-assimilated portion of the food ingested, existing in the healthy body while harmful mala is the harmful matter of any kind existing in body harming it.
As per Samgadhara
Samgadhara summarizes the three aspects of these vitia in a terse thus:
"Vāta, pitta and kapha are called vitia because they vitiate the body. They are called the body-elements or supports because they uphold the body and they are also known as waste or toxic matter because they pollute the body.
Functions of the Base Nomenclature
Each of the Dhātus of the body, the triumvirate organization, body-tissues and the excretory and secretory matter, become vitiated in disease condition. But the main role as vitiator is played by the triumvirate organization. Once they get vitiated, they spread their vitiating effects to all the other body-parts and channels because pervade all over the body.
The vitiated body-channels spread it to other body-channels and the vitiated body-elements to other physical elements likewise. Vāta, pitta and kapha move in the whole body hence they produce good and ill effects on the entire system depending on their normal or aggravated condition. The body secretions pertaining to the functions of each of the triumvirate organization are given the same term like vāta, pitta and kapha to the physiological triumvirate of the organizations.
Just after the ingestion, food prepared from the sis categories of tastes first gets converted into sweet taste during digestion and leads to the formation of kapha or mucus-like fluid of frothy appearance. In the further digestion, the food becomes acidic. In the last stage of excretion it accelerates the secretion of limpid bile. Thus the food after reaching the large intestine, gets dehydrated by the body-heat. It gets converted into fecal lumps there after. These lumps are of pungent taste which leads to the increase of vāta.
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 Doṣa in general and vāta, pitta and kapha in particular. These, drugs should be used as emetics by the physician in a way which is not harmful to the body in gastro-genic disorders characterized by morbid accumulations of kapha and pitta. Heavy doses should be prescribed only for purgation when the morbid matter has accumulated in the colon.
Enema used to clear the whole digestive track, if given when the morbid matter has been fully digested, will immediately increase the vitality and digestive powers and produce apyrexia, good cheer and appetite. Laxation will eliminate pitta or kapha, while enema will eliminate all the three kinds of morbid matters lodged in the colon. Hence vāta, pitta and kapha are used in their excretory aspect.
In order to avoid ambiguity in sense, each thing is given a specific designation with the view of its preponderant or special tendency towards a form or function. These vitia are also called because they are considered to be the first things to be modified by diet, behavior, other environmental factors, 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 to 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. They are specially designated as vitia owing to their condemnable vice. But these vitia, when they are in their normal non-vitiated state, support, enliven and rear the other elements of the body. They are the prime source of health and happiness.
In non-vitiated state they form the pillars of life and become the base functional elements. In their balanced state, they are the Dhātus, but for convenience of the exposition and uniformity of application they are called vitia even in their benevolent or sanagenic state. In their morbified state they are known as pathogenic. While dealing primarily with the pathogenic factors and their various manifestations, they are known by their pathological state and refer to their physiological status too by the same term prefixed by its non-morbid quality. Thus the unvitiated vitium; is called the vitium in its normal state and the vitiated one as the morbid vitium. Etymologically, it is interesting to analyze that the Greek prefix 'dys' used for dysfunction, dysuria, dyspepsia etc, is akin to Sanskrit 'dus' meaning to be bad, corrupted, spoiled or vitiated.
The Nature and Functions of the Body Triumvirate
Vāta, 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 discussed in a general way till now. It has to be studied in the various aspects of the manifestation. They can be analyzed from different points of view delineated below:
The General Concept of the Triumvirate
The three organizations of the triumvirate are the base essentials to lead a life. Its physiological or pathological condition is the root cause of existence or dissolution of the body. Śuśruta significantly remarks that vāta, pitta and śleśma can bring the body into being. This body is borne by them in their normal or healthy state established in the lower, middle and upper regions of the body respectively. Therefore these are called as the three support system.
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 syngeneic influence is due to their integrated mode of functioning. The importance of the triumvirate in supporting the body is well brought home by Śuśruta in the 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 vāta act with regard to the body.
The triumvirate is all-pervasive which circulates to each part of the body. As the vitia are circulating in the entire body, their normal or provoked condition gives rise to good or bad health respectively. Vāta, pitta and kapha moving in the whole body produce good or ill effects on the entire system, according as they are normal or provoked. The function of the triumvirate is integrative though pentad of focus are described for each vitium where dominance of the function of that particular vitium is observed.
Concept as per Caraka
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. All the three vāta, pitta and kapha in their normal condition make a man with complete senses, possessed of strength, good complexion and great longevity. If one pursues the triad of dharma, artha and kāma properly, one can secure the most beneficiary effects both here and the other world. The same three if rendered morbid, bring upon the man great tribulation.
Caraka states that the vāta necessarily gets increased in its own habitat consequently upon the decrease of Kapha. Moreover the general line of treatment should be modified when it is to be practically applied to the diseased condition originating or affecting dominantly the particular pentad of foci.
The vitia are abnormal because they certainly afflict the body by causing disorders of the various types. Caraka further states that the triumvirate is always present in the body either in physiological state or the pathological state. Hence the learned physician should learn to understand and analyze their actions and results.
Concept as per Śuśruta
Śuśruta states that the five-fold vāta upholds the body by its characteristic functions of throbbing, transmission, separation and retention. The five-fold pitta which causes pigmentation, digestion, vital essence, luster, intelligence and heat, nourishes the body by its thermogenic function. The five-fold śleśma which causes the cohesion of the joints, unctuousness, growth, replenishment, strength and firmness, nourishes the body by its colloidal watering function.
Concept as per Vāgbhatta
Vāgbhatta says that the focal places of this generally all-pervasive vitia are to be known by the different actions of the vitia. Pentad of foci of each of the vitia has great diagnostic importance as the signs of discordance of the vitia are manifested first and certainty in their respective pentad of foci. Thus it helps to diagnose the disease in its very early stage. He also adds, that due to this reason a special branch of therapeutics has to be pursued to suit the special site of affection.
Physiological Concepts of Triumvirate
Physiological Consequences of Vāta
Vāta is known as the vital, mobile and motivating principle of all the life functions. Its pervasion is throughout the body, because no part or cell of the body can function without the aid of vāta. The primary function of vāta is to cause all the movements including that of the conveying of the sense impressions and thought and emotional impulses. Thus all the neuro-muscular activity, voluntary as well as involuntary happens due to the activity of vāta. They are the sense functions that form the foundation of all the activities of life.
The supreme status of vāta may be also attributed to its being the propeller and director of the movement of the other two members of the triumvirate in which pitta and kapha are lame. Even the excretory and body elements are the same. These go wherever they are carried by vāyu, wind or vāta.
Actions of Vāta in Human Body
All the life-functions including the daily metabolic processes of maintaining the proportion and tone of the body-elements belongs to vāta. It is the fundamental life-principle of the body. That is why Atreya describes it as the controller of the functions outside and within the entire body:
- The vāta is the upholder of both, structure and function in the body.
- There are five forms of vāta in the body viz., prāna, udāna, samāna, vyāna and apāna.
- It is the impeller of upward and downward movements.
- It controls and conduct the mind.
- It inspires and works all the senses and convenes all the sense-stimuli.
- It is the main protector of all the body elements.
- Vāta is the synthesizing principle in the body.
- It is the impeller of speech.
- It is the main cause of feeling and audition.
- It acts as the source of the auditory as well as tactile senses.
- It is the origin of all the excitation and animation.
- It is the stimulator of the gastric fire in beings.
- It performs as the desiccator of the morbid vitia.
- Vāta is an eliminator of excretory material from the body.
- It is the deobstruent of the gross and subtle body-channels.
- It is the main constituent which helps in modelling the fetal form.
- It is the sustaining principle of life.
Functions of Vāta as per Caraka
Caraka describes the functions of vāta to be animation, inspiration, expiration, body movement, circulation of body elements and elimination of excretory wastes. All the life-activities of the body are performed by the normal vāta which is said to be the life of living beings. Vāta is given the supreme importance in the series of the triumvirate. Caraka says that vāyu is life and vitality, supporter of all the embodied beings, whole universe and the lord of all. 
Functions of Vāta as per ŚuśrutaŚuśruta describes the function of vāta as the five-fold system of the body which upholds the body by its characteristic functions of throbbing, transmission, filling up, separation and retention. Śuśruta describes vāta in a highly eulogistic words.
Vāyu is praised as the self born and worshipful one. As it is free, eternal and all-pervasive, it is the soul of all beings and worshiped by all the world. It is the cause of the creation, subsistence and dissolution of all beings.
Physiological Consequences of Pitta
Pitta is indeed the thermal element or element of fire. Caraka states that pitta is form of Agni in the body. Śuśruta, 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 that there is no other kind of fire existent in the body other than pitta. It regulates the thermal balance of the body. Pitta is the total thermal process occurring in the body which includes all the secretions internal as well as external. It establishes all the metabolic processes and maintain the temperature which is optimum necessary for the preservation and growth of all the life-processes.
It gives coloration and pigmentation of the body-elements such as redness in the blood, flesh and marrow and the pigmentation of the excretions like feces and urine. Pitta of liver and spleen is known as the pigmentation factors of pitta. It also causes the red pigmentation of the nutrient fluid.
The integrative organization of pitta does the following functions in the body: It is Agni which is located in the pitta that gives rise to good and evil consequences according to it's normal or abnormal condition. These consequences are:
- Digestion and indigestion
- Vision and loss of vision
- Normal and abnormal temperature
- Healthy and diseased outlook
- Intrepidity and fear
- Anger and delight
- Confusion and lucidity
- Softness and hardness of body
- Lustre and dullness of the skin
- Intelligence of mind
Hence pitta is the root cause of such pairs of opposite qualities.
Qualities of Pitta as per Śuśruta
Śuśruta describes the function of pitta organization to be five-fold which is causative of pigmentation, digestion, vital essence, lustre, intelligence and heat. It nourishes the body by its thermogenic function.
Physiological Consequences of Kapha
Caraka calls śleśma, the colloidal water in the body, as soma. It is described as the fluid matrix for the vital functioning of life. It is the living fluid or the protoplasm in which all the operations of life are possible. Śleśma holds the joints together and does all the cohesive, nutritive, developing and stabilizing functions. It promotes the well-being of the body by its watering activity. It thus supplies the water to the roots of life.
In its physiological aspect it is the strength and stamina of man but becomes an impurity which is excreted from the body when vitiated. Soma, located as the kapha of the body, gives rise to good and evil consequences. The normal kapha constitutes the body-strength when it becomes morbid it transforms into a vitiated element. Functions of the normal kapha are causing viscosity, cohesion, firmness, heaviness, potency, strength, forgiveness, fortitude and greed. The five-fold śleśma nourishes the body by its colloidal watering function.
These physiological organizations when dis-organize and vitiates behave pathologically in the body. It is quoted in many difference reference books of Caraka and Śuśruta. These are the physiological diseases conditions which occur due to the disturbance of the triumvirate.
Pathological Concepts of Triumvirate
Caraka describes the many disease conditions when vāta behaves pathologically. Abnormalities of vāta afflicts the organism with diverse kinds of disorders, impair its strength, complexion, well-being and life. It depresses the mind, diminish all the senses, damages the fetus in uterus and produces deformity in it. It unduly prolongs the period of gestation, gives rise to fear, grief, stupefaction, depression of the spirits. It creates delirium and obstructs the vital functions. It can be concluded that the abnormal functioning of vāta is the root cause in the following disease conditions:
- Pricking and aching pain
- Astringent taste
These are the effects produced on the body by the actions of vāta. The condition accompanied with any of these signs or symptoms should be diagnosed as a vāta disorder. Caraka also mentions some conditions that can be produced by vāta when it becomes located in particular regions or organs.
Conditions accompanied with any of these below mentioned symptoms should be diagnosed as the malady created due to the pitta-disorder in the body. They are:
- Emanation of smell, color and taste
Soma, located in the kapha, gives rise to good and evil consequences in the body according to it's normal or abnormal condition. Caraka attributes the following conditions of health and disease to the pathological behavior of the kapha. They are:
- Compactness and flabbiness
- Plumpness and emaciation
- Zest and lassitude
- Virility and impotence
- Knowledge and ignorance
- Understanding and stupefaction
- Excretory secretion
The condition accompanied with any of the above symptoms should be diagnosed as a kapha-disorder.
Clinical Manifestations and their Interpretation in Physical Qualities
Significance of Clinical Investigations
The clinical investigation of a disease-aspect was always in the terms of qualities augmented or diminished by the effects of vitium. It helps in determining the treatment 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 was the main aspect of the clinical investigation. The pathological processes were recognized by the effects associated with the vitia in their operation on the psycho-somatic whole.
Reasons for the Clinical Investigation
When one of the triumvirate gets deranged, it invariably affects the balance of the other organizations. This creates a disturbance in the well-balanced triad of vitia operation. This gives rise to a diseased condition in which one or two of them are in a relatively aggravated 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 tri-discordance. Such discordance of the triumvirate will give rise to clinical manifestation of physical signs which will be observed either in the whole body or certain parts viz. body-elements, secretions or excretions. It is also displayed in the exaggerated, diminished or deranged form of physical qualities.
Mode of Clinical Observations
In the somatic disorders all the body-tissues and systems were clinically examined. All the secretions and excretions of the body were also thoroughly investigated. The results obtained by all these examinations were correlated with the particular phase of the vitium or vitia. These results were also coordinated with the secondary psychic changes.
The final results of all these examinations were reduced and interpreted in quality equation for simplifying methods of physical examination and practical therapeutics. The main physical qualities observed in the body signifies the presence or dominance of each of the triumvirate. Evaluation of the principles of practical therapeutics, determines the dominance of a particular vitium.
Clinical Inferences of Vitia
Vāta is dry, cold, light, subtle, unstable, clear and rough. The imbalance created due to vāta can be stabilized by the drugs or medicines having antagonistic qualities. Pitta is slightly unctuous, hot, acute, fluid, acid, mobile and pungent. The disease condition which arise due to pitta can be neutralized by the drugs or medicines of antacid qualities. Kapha is heavy, cold, soft, unctuous, sweet, stable and viscid. The disparity in body created by the imbalance in kapha can be cured with the medicines having antiphlogistic effects.
VIII Imbalance Condition Due to Increase or Decrease
What is Imbalance Condition
Condition of imbalance is brought about by a 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 from the normal constant of the body-function or structure. It however causes 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 termed as the imbalance condition.
Causes of Imbalance Condition
Imbalance condition brought about by the increase or decrease of the functional or structural system either in tempo or quantum is a simple pathological process mainly concerned with the particular system affected. From the point of view of maintenance of a perfect health it is very important. It generally results from the errors of personal hygiene regimen. It can certainly be rectified and prevented by careful observation 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 due to some faults either in the natural environment of man or some errors in the observance of the personal regimen.
Causes of Imbalance as per Caraka
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 mind are both considered to be the abodes of diseases and well-being. Right and harmonious interaction of both these factors is the cause of well-being.
Effect due to Climatic Changes
Homologous environmental factors maintain healthy condition while any variation disturbs the balance constant. The first factor is the 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:
- If the climatic variations are not happening in a natural or normal way but becomes too intense or weak or perverted and the reserve power of the man's constitution cannot cope with such variations then the balance of human body-constants cannot be stabilized. In this condition imbalance occurs.
- The condition of imbalance may occur even with normal natural climatic environment if the body vitality has been lowered by age, disease or any other factor.
Variation due to Mind Conduct
The- second factor is intelligence. This is expounded by Caraka suggesting that the misunderstanding by the intellect and wrongful conduct are to be understood as volitional transgression because they fall under the ken of the mind. Owing to the perception of things, in a manner that is contrary to their real state of existence, there results wrongful speech and conduct. Here the vital relationship subsisting between psychic and somatic life is clearly emphasized. Thus a somatic transgression has psychic repercussions and likewise psychic transgressions lead to somatic disturbances. Therefore volitional transgression of either kind leads to the disorders affecting the entire psycho-somatic unit.
Instability due to Sense Objects
The third factor is the sense-objects. These sense-objects are the modes of diet and pleasures of the senses. It involves the diet and behavior of man. The sensory organ of taste is food along with the sensory objects of sight, smell, hearing and touch which constitute pleasures of art, beauty, music and love respectively. The guiding factors for all these conducts should be moderation and agreeability to one's nature and capacity. 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 the disease.
Imbalance due to Vitia
Practical wisdom is discerned in the perception of Caraka who advises to prescribe personal regimen in accordance with the individual constitution so that a person can always maintain the absolute standard of perfect health. According to the rules of healthful living, in the case of those, who are characterized by the predominance of one vitium, the use of things antagonistic in quality to that particular vitium is beneficial. The causes of increase and decrease of the body-elements is suggested by Caraka denoting that there is an increase of the tendencies of the body-elements by access of like factors and decrease by the access of unlike factors.
Causes of Imbalance as per Śuśruta
The modes of action of these causes increase and decrease as described by its qualities, nature of substances, specific action and 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 Śuśruta denoting body to be the root-support of the vitia, body- elements and excretory substance. So there can be increase or decrease of any of them. Such changes in turn will disturb the equilibrium between various functional and structural systems of the body. This gives rise to an imbalance condition. The dośas are three viz. vāta, pitta and kapha. The dhātus are seven consisting of 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 all the consequences because of their imbalances are described in great details in the classics of Ayurveda. There are the therapeutic measures given to rectify each condition. We replenish the body-elements that have decreased and deplete those that has increased.
The optimum level of the advanced clinical science and practical therapeutics of the ancients was evident from the verses of Śuśruta. The person whose vitia, body-elements, excretory matter and body-strength have suffered diminution, craves for varieties of food because they are the sources of these diminished objects. By satisfying the yearning for the type of food which supply the deficient constituents of the body, their diminution is corrected.
Causes of Imbalance as per Vagbhatta
Vagbhata suggested that whatever type of food a person dislikes and whatever he craves for by avoiding and satisfying these respectively should be appropriate neither excess nor less respectively of the body-constituents. That this imbalance condition due to increase or decrease has great importance in the maintenance of positive and perfect health. It is evident in the 15th chapter of Sutrasthāna which is devoted to the description of the condition of vruddhi and Kṣaya by Śuśruta, ends with the masterly definition of perfect health. A person who possess the proper balance of the vitia, metabolic heat, body-elements and excretory functions, absolute clarity of the spirit, senses and mind is said to enjoy perfect health.
IX Vitiation process
When the imbalance condition of triumvirate transgresses a particular defined limit of accumulation, disorganization of the triumvirate of the organizations occurs. As a result of rupture of these kind of integrative functions, organizations, circulation and distribution of these dynamic functional principles become irregular and misdirected. During such unfavorable condition, exciting vitia gets disturbed, provoked and further vitiated. The body as a whole or some part of it may not tolerate the provoked symptoms and gets irritated. Thus the healthy sustaining organization of the body becomes an irritant and pathogenic factor for that particular moment. This stage is called as the stage of provocation of the vitia.
Difference between the Simple Pathogenesis and Vitiation Pathogenesis
Vitiation pathogenesis is the real or major pathogenesis. It is quite different from the minor pathological conditions or imbalance conditions brought about by the simple process of increase or decrease which is just due to the variation in quantity. Simple pathological condition is a quantitative change, while the vitiation process is the morbid modification of the qualities of functions of the triumvirate of organizations. It is like a qualitative change in the functions of the vitia.
The vitial pathological process is the drama of action and reaction of the triumvirate when they are converted into the pathological state from their physiological state. The hero who rules and protects the body is assailed by the malevolent exciting factors. These immediate exciting etiological factors may arise from the endogenous or exogenous sources. Just like a battle, the triumvirate marshals all its forces and equipment and destroys the enemies or nullifies their injurious influences. But if the opponent turn out to be stronger than the hero or even if the incidence of attack is too sudden, the issues will be otherwise. The triumvirate will be vitiated and it will carry out vitiation all over the body. This is the real or major pathological condition brought about by the vitiation process.
The intensity, periodicity and results of this process are determined by the strength of etiological factors, vital triumvirate, body-elements, extraneous aid received by them and the course of resistance .
Stages of Vitiation Pathogenesis as per Śuśruta
Śuśruta divides the vitiation pathogenesis process in six stages as follows:
- Stage of accumulation
- Stage of provocation
- Stage of diffusion
- Stage of location
- Stage of manifestation
- Stage of termination
Effect Of Vitiation Pathogenesis
The triumvirate of the organizations having passed beyond the stage of imbalance, becomes disorganized and turn into irritants. This tend to vitiate the whole or part of the body functions or structures. The stages of concern after this process gets initiated for the subject of biological analysis of the functions of the human body. This subject include the below mentioned topics of prime concern:
- How constitutional factors of the individual resist the incursion of harmful factors in the body?
- How one, two, or all the three vitia gets provoked, irritated, inflamed?
- What is the reaction of vitia by provocation through the endogenous or exogenous factors?
- How they overpower the whole body when all of them get highly provoked?
- How they circulate in the body and get located in susceptible part when not intensely aggravated?
- How the constitution of local part reacts?
- What are the effects of these irritant vitia?
- What are the termination causes of this struggle between the body and noxious factors?
Diseases from the Pathogenesis Condition
The following types of disease-conditions may be produced by vitiation pathogenesis:
- Acute General Disease Condition - It happens when the vitiation process spreads with full intensity and affects the entire body and in turn the body resists very poorly.
- Prolonged Disease Condition - This situation occurs when the vitiation process is strong enough to affect the whole body, but the body vitality encounters the incursion with nearly equal force. There are events of fluctuations in this process on the either side. It happens when the waxing and waning of the disease happens according to the extraneous circumstances.
- Acute Inflammation of Specific Part - When vitiation process does not affect the whole body but becomes located in some system, part, organ or tissues then it begins to spread. Then the constitution of the local tissues tries to resist which results into local inflammatory reaction. If the resistance power fights rigorously then the it will result into acute inflammation of that part.
- Chronic Inflammation - It happens when the local vitiation process progresses very slowly.
Significance of Study of Pathogenesis
This is a brief account of the interplay of triumvirate in the vitiation process that may affect the whole body or even a part of it. These are the clinical phenomena of the various disease-conditions that are produced by the vitiation pathogenesis. Having taken a bird's eye-view of the significant facts of vitiation pathogenesis and co-related disease conditions produced by them, it is essential to study the vitiation pathogenesis, stage by stage, and its intricate details regarding beginning, gradual or sudden evolution, development and final termination to have a more intimate understanding of the pathological process which guides the practical application of therapeutic measures.
The importance given by the ancient authors to complete the study of triumvirate and the physiological as well as the pathological processes becomes quite evident in the aphoristic statement of Caraka. The knowledge of disease is obtained by the study of the etiology, premonitory symptoms, signs and symptoms, homologatory signs and pathogenesis.
Thus it is considered to be one of the five methods necessary for the diagnosis of diseased condition. Moreover this fifth method is detailed and subdivided in various ways to have a thorough knowledge of pathogenesis. Pathogenesis is again classified according to number, predominant morbid humor, modes of classification, minutia and period of exacerbation. The word "Samprapti" is indicative of the all-comprehensiveness of the process of pathogenesis.
- Caraka Sutra 1, 15-17
- Caraka Sutra 1-25
- Caraka Samhita Sutra 30, 84
- Caraka Vimāna 4-5
- Caraka Sutra 11-26
- Caraka Sutra 26-12
- It has been declared in the Veda.
- Here nature refers to mother Nature.
- He was the man of Ayurvedic knowledge.
- Caraka Sutra 1, 41
- Caraka Sutra 1, 48
- Bṛhad 5-5
- Nārāyaṇa Upaniṣad 1-1
- These interferences are Homeostasis of Cannon.
- Thales of Greece and the Seers of India
- Caraka Sutra 12-8
- Caraka Sutra 11-44
- Caraka Sutra 7-41
- Caraka Sutra 7, 39-40
- Śuśruta Śarira 4-63
- It means germ-cell.
- Commentary by Dalhana on the above verse.
- Śuśruta Śarira 4-78
- Caraka Vimāna 8
- It means clean matter.
- Caraka Sutra 28, 4
- This meaning is given by Caraka in his Śarira Sthāna 6-17
- Samgadhara Samhitā 5 24
- Caraka Vimāna 5, 9
- Caraka Sutra 20, 9
- Caraka Cikitsā 15-9
- Caraka Cikitsā 15-10
- Caraka Cikitsā 15-11
- Caraka Sutra 2, 8
- Caraka Sutra 2, 10
- Caraka Vimāna 3, 170-171
- Caraka Sutra 12,13
- Śuśruta Sutra 21-3
- Śuśruta Sutra 21-8
- Caraka Sutra 20-9
- Caraka Sutra 12,13
- Caraka Cikitsā 19, 121
- Caraka Vimāna 1, 5
- Caraka Sutra 18, 48
- Śuśruta Sutra 15, 4
- With the reference to these foci.
- Astāṅga Sang Sutra, 23
- Sarn Purāṇa 5,25
- It refers to inhaling in respiratory system.
- It denotes the respiratory system.
- Caraka Sutra. 18-49
- Caraka Sutra, 17,118
- Caraka Cikitsā 28, 3
- Caraka Sutra 12, 8
- Śuśruta Nidāna 1, 5-6
- It means fire.
- Śuśruta Sutra 21-10
- It means fire.
- It is the water-element.
- Caraka Sutra 12 - 13
- Caraka Sutra 18 - 48
- Caraka sutra 20 - 9
- Caraka Vimāna 1 - 5
- Śuśruta Sutra 21 - 3
- Caraka Sutra 20, 15
- Caraka Sutra 12, 12
- Caraka Sutra 20,18
- Caraka Sutra 1, 54-55
- Caraka Śarira 1-109
- Commentary on the above verse by Cakrapani
- Caraka Sutra 7, 41
- Caraka Śarira 6, 10
- Śuśruta Sutra 15, 32-33
- Astānga Hṛdaya Sutra 11,42
- Śuśruta Sutra 15-44
- Śuśruta Sutra 21,36
- Caraka Nidāna 1, 6
- Caraka Nidāna 1, 12/1
- The Caraka Samhita published by Shree Gulabkunverba Ayurvedic Society, Jamnagar, India