An Ayurvedic Overview by Scott Gerson, MD, PhD (Ayu), Director of The Gerson Institute of Ayurvedic Medicine
Overview
Ayurveda, translated as “the science of longevity” is the ancient Indian system of holistic health care. The word Ayurveda is derived from the two Sanskrit roots ayu (life) and vid (knowledge) which succinctly describes the essence of this ancient Indian system of medicine.
Ayurveda is a rational approach to total wholeness which insight-fully utilizes the everyday daily routines of our lives for creating and maintaining health. The classical texts of Ayurveda, some of which have survived to the present day, are encyclopedic in their detail and date back 3000 years, though the oral tradition is shrouded in the midst of an even more distant time. In these texts, insights are given regarding what a human being truly is, what defines health, how illness manifests, and how it can be reversed and prevented. The approach of ayurvedic medicine is strikingly more life and health-oriented than disease and treatment-oriented. It offers humanity a holistic and total view of life and delineates the place of the human race within the entire cosmos.
The concepts of Ayurveda arose from the detailed observations made by the first Ayurvedic philosopher-physicians. These early sages had a deep interest in the relationship between human beings and the universe and in particular how these relationships created health and long life as well as disease. One of the most fascinating aspects of Ayurveda is its wide diversity of healing and preventive measures including: individualized lifestyle regimens, individualized diets, yoga, meditation, herbal medicines, gemstones, amulets, jyotish (Vedic astrology), aromas, colors, elaborate detoxification procedures, and even surgery in treating patients. The knowledge contained in the ancient Ayurvedic writings are exhaustive in scope and detail. We find a description of the initial stages of human embryonic developments inside the womb whose accuracy equals the modern medical understanding. We learn of eight stages of any disease from its pre-symptomatic inception to its ultimate manifestation. Ayurveda also places great emphasis on the timing and manner of the collection of medicinal plants. Other sections discuss in minute detail prosthetic surgery to replace limbs, cosmetic surgery on nose and on other parts of the body, cesarean operations, setting of compound fractures, treatment of 72 different ophthalmic diseases and even brain surgery techniques. Clearly the extensive knowledge and insight in ayurvedic medicine is very rich indeed. But from whence did this knowledge arise; what is the source of Ayurvedic wisdom?
Central to the Ayurvedic worldview is the realization that the world we see and experience with our senses is the consequence of a hidden, subtler aspect of Nature not perceivable by the senses. Woven deeply into the very fabric of reality are the tattvas, or elements, which create both the tangible and intangible dimensions of reality. Ayurveda acknowledges the interconnectedness of these dimensions and bases its system of medicine on this understanding. Today scientists continue to seek the common origin of matter and energy, the conscious and subconscious. Therefore Ayurveda is not a primitive, unscientific system, but rather a more complete medical system based on a fuller understanding of reality. Ayurvedic sages achieved this through a combination of empirical reasoning supported by experimental evidence and yogic contemplative methods which provided a direct experience of the depths of reality. Ayurveda could be considered to be what modern philosophers call a teleological worldview (from Greek telos, purpose, and logos, science). A teleological school of thought is one that holds all things to be designed for or directed toward a final result. Stated another way, that there is an inherent purpose or final cause for all that exists. Modern science is travelling a different road to eventually, perhaps, reach the same truth.
It’s important as we begin our exploration of Ayurvedic science to consider the instruments and methods used to discover such an advanced knowledge. Certainly, the instruments did not include CAT scanners or liquid chromatography columns. And the methods were not purely objective scientific methods but rather would have been a highly-developed combination of observation, intuition, and experience. Ayurveda, like all ancient Indian knowledge, reached its insights through the pramanas, or methods of obtaining knowledge. In Ayurveda there are five methods namely:
Pratyaksha (direct sensory perception)
Anumana (deductive reasoning)
Upamana (comparison)
Apta-vakya (authoritative and final testimony, considered to be the four Vedas)
Yukti (reason supported by experimental evidence)
Of note is that Ayurveda encompasses both a priori and a posteriori knowledge in contrast to Western medicine which is based solely on the latter. A posteriori knowledge is knowledge obtained through or after investigation or experience; a priori knowledge is knowledge which is independent of experience. An example of the former would be “Some mothers have daughters”; an example of the latter would be “All daughters are women”. A priori knowledge is said to be knowledge obtainable without even getting out of bed—its truth is inherently known in the human mind without any further investigation.
In the centuries that followed, a comprehensive conceptual and clinical approach was conceived. An Ayurvedic physician utilizes his knowledge and observation skills to not only understand patterns of energetic imbalance but also to determine the physical and mental constitutional make-up of the individual. The latter information allows the physician to comprehend inherent strengths, weaknesses and predispositions. Central to the Ayurvedic approach to health is the concept of a unique state of balance for every individual. This unique and individualized state of doshic balance is simply the relative proportion of the three primary biological energies which represents perfect balance for a given individual. Ayurvedic physicians are trained in the use of diet, culinary spices, yoga postures, breathing techniques, massage, meditation and a vast natural plant-based pharmacopoeia to establish and maintain that state of balance in the individual. Furthermore, Ayurveda not only treats persons who are ill but emphasizes the concepts of preventive health care and health promotion. Swasthasthya (the healthy) swasthya (health) rakshanam (protect) aturasya (diseased) vikar (diseases) prashamanam (alleviate, cure) cha, is a famous sloka recited by all Ayurvedic medical students which summarizes the goal of Ayurveda: “To heal the diseases of the diseased and maintain the health of the healthy”. The purpose of Ayurveda is to enable each person, with the guidance of an Ayurvedic physician if necessary, to realize his or her own unique strategy for a long, healthy and happy life.
Chronology of Ayurveda
Ayurveda, the oldest system of medicine in the world, traces its roots to the Vedic period in ancient India (2000-1500 BCE). The Rig Veda, the oldest of the four books known collectively as simply “the Veda” (“the Knowledge”) is the oldest surviving book of any Indo-European language (l900 BCE); in it are verses on the nature of health, disease and healing, descriptions of special elixirs, and references to bhisaj, meaning both remedy and physician. The Atharva Veda, the last of the four books (1200 BC) consisting of 731 hymns, cites the brain as a critical organ, describes plants to counter various infectious diseases, and even describes the antibiotic properties of an aushadi (medicinal substance) strikingly similar to a lichen. Ayurveda is considered an “upaveda” or supporting text of this fourth and last Veda.
The Atreya Samhita is the oldest purely medical book in the world; it survives from Takashila University which was operating as early as 800 BC. Six students of Atreya are known, all of whom are believed to have composed their own treatises: Agnivesa, Bhela, Jatukarna, Harita, Ksirapani, and Parasara. Only the works of Agnivesa and Bhela survive today. This work, the Agnivesa-tantra, was revised by the physician Charaka in 200 AD, whose work was partially lost and in turn reconstituted by Drdhabala around 400 AD. It is his edition which is studied today as the famous Charaka Samhita at all Ayurvedic colleges and is Ayurveda’s major work on internal medicine. It enlists eight branches/divisions of ayurveda: Kayachikitsa (Internal Medicine), Shalakya Tantra (surgery and treatment of head and neck, Ophthalmology and Otolaryngology), Shalya Tantra (Surgery), Agada Tantra (Toxicology), Bhuta Vidya (Psychiatry), Kaumarabhritya (Pediatrics), Rasayana (science of rejuvenation or anti-aging), and Vajikarana (the science of fertility).
Also around 200 AD a surgical text based on the teachings of Dhanvantari called the Sushruta Samhita appeared. This text describes operative techniques for rhinoplasty (plastic surgery) tumor removal, and other highly developed surgical procedures. Later an anonymous author added a supplement to it entitled Uttara-tantra (“later-work”) but perhaps to preserve the appearance of continuity of the treatise, called himself Sushruta also. This entire text was then revised by Nagarjuna and came to us as the modern day Sushruta Samhita. Questions remain as to Nagarjuna’s true identity but most scholars think he lived in the second century AD.
By 400 AD, Ayurvedic works were translated into Chinese. The famous Bower manuscript written on birch-bark discovered in Xinjiang, China and dated to around that time, provides medicinal formulas and references them in ways which somewhat supports the above chronology. However, the early chronology of Ayurveda from its ancient origins up to 500 AD still remains in serious doubt and it is not possible to determine the early timeline with any real certainty.
In the 6th century AD Vagbhata wrote both the Ashtanga Sangraha and Astanga Hrdyaya samhita (“The Heart of Medicine”) both extremely useful clarifications of earlier material in both Caraka and Susruta samhitas. The Ashtanga Samgraha contains the first references in Ayurvedic literature to astrological information and noted the influence of various naksatras (lunar phases) with disease prognosis.
Also by 600 AD, Chinese scholars were studying medicine in India at Nalanda University including the famous Tang Dynasty Chinese monk I-Ching who authored his eponymous poetic philosophical work. Indian thought, as well as influencing Chinese spirituality and philosophy through Buddhism, influenced Chinese medicine and herbology through Ayurveda. An excellent still much referenced text on Ayurvedic diagnosis was the Madhava Nidana, authored around 700 AD. In 800 AD, Ayurvedic works were translated into Arabic. The two Islamic physicians Avicenna and Razi Serapion, who helped form the European tradition of medicine, were strongly influenced by Ayurveda.
The Sarngadhara Samhita, composed by Sarngadhara in 1226 AD, marks the first description of diagnostic pulse interpretation (nadi-pariksha) in Ayurvedic literature and also discusses gemstone- and metal-containing medicines.
The Mughal dynasty (1500-1700 AD) that ruled India for two centuries saw a brief benevolent attitude towards Ayurveda (under Akbar and his son Jahangir), followed by a long period of violence and suppression against all things Hindu, including Ayurveda.
In 1558 the last of the classic Ayurvedic texts was written by Bhava Misra entitled the Bhava-prakasha. Concurrently in Europe, Paracelsus, the “father of modern Western medicine”, advanced a system of medicine which borrowed heavily from Ayurveda. Many precious Ayurvedic texts were irretrievably destroyed and Ayurveda remained suppressed and dormant for several generations including under the period of British rule.. Then with the arising of the Indian nationalist movement in the late 19th century, Ayurvedic medicine experienced a renaissance which has continued until the present day. Despite repeated attempts to eradicate it, Ayurveda remains the longest unbroken medical tradition in the world.
Ayurvedic Definition of Health
We have already traced the Sanskrit origins of the word “ayurveda” and have defined it as "the science of life." But the Vedic texts expand on these definitions to offer us a more complete understanding. A classic definition of ayurveda is found in the chapter called Sutrasthana in the Charaka Samhita, the earliest Ayurvedic text:
ayurhitahitamvyadhe nidaanamshamanam thathaa vidyate
yatra vidhwadhihi tatra ayurveda uchyate.
This verse takes us to a deeper level of understanding what ayurveda is:
“Ayurveda is the science of health and disease that which deals with good, bad, happy and unhappy life, it’s promoters and non-promoters, measurement and nature." --Charaka Samhita, Sutrasthana, 1, 42-43.
Thus, Ayurveda provides us with a complete understanding of what is life-promoting and what is not, not just for the physical body, but also our mind, heart, senses and spirit. This includes descriptions of the kind of diet, lifestyle and behavior that is optimal for well-being, the ideal environment, and the herbal preparations that are good or bad for each of these aspects of health. There is great detail given on each of these modalities--what to eat, when to eat and how to eat are a part of dietary recommendations, for example. The texts also include recommendations for nurturing relationships and living as part of the human community.
If an individual does not have this knowledge or has the knowledge but does not implement the knowledge, then, say the texts, the person becomes susceptible to imbalance and disorders. But even before one can utilize specific knowledge for an optimal life, we first have to understand more completely what exactly is “life’?
Ayu explained
(Scale demonstration and human composition list)
What is the full definition of ayu or life according to the teachings of Ayurveda? Sharirendriya sattwa atma samyogo ayuhu, explains one verse. Sharir means physical body; indriya means senses. Sattwa refers to the combination of mind and heart, atma means soul or spirit and samyogo means joined.. When all of these--body, senses, heart, mind and spirit--are in proper balance and function in a harmonious, coordinated manner, that is true life--"the living body." Health is defined as cohesiveness and harmony of body (shrira), senses (indriyas) mind-heart (sattwa) and Spirit (atman). Vitality and balance in each of these sheaths must be fostered if the individual is to create and maintain health. Ayurveda offers a holistic approach based upon the understanding that no single physical or mental agent by itself causes disease or creates health.
Let’s explore what Ayurveda has to say about each of these components and we will then emerge with a fuller understanding of what is meant by “life”.
Atman: The Soul
Through deeply developed and focused powers of observation and reasoning the ancient sages understood that there exists a supreme, inconceivable creative intelligence directing the creation at both the largest and the most infinitesimal scales throughout the universe. Looking both outside into Nature and deep inside the mind, they saw that the creation in all its manifestations moves together in an intricate interdependence and perfect synchrony. They saw from their perspective of higher consciousness that every aspect of life acted in coordination with every other part of life for the greater good of the whole. Every object in the world is an intelligent assemblage of many and varied smaller components. A tree is made of fibers; every fiber is made of a precise arrangement of molecules; the molecules from specific atoms and so on. This, they reasoned, could only occur if every individual part was connected to or infused with that great universal intelligence. Further explorations revealed that this parcel of universal intelligence exists in all forms of life and all human beings and silently governs all mental, sensory, and physical activities and processes. The universal intelligence they called param atman—the pure absolute consciousness of the universe permeating all living, non-living, material, non-material realms. The parcel of this universal intelligence within each of us—that intangible, attribute-less director guiding us towards our destiny—they called jiva atman or individual soul. The jiva atman, they understood, arose from the param atmam and had no separate existence except in relation to its source. The relationship between the individual soul and the universal soul is the same as the relationship between an individual wave and the ocean. Just as the vast ocean does not cease being the ocean when it rises up into an individual wave, Consciousness retains its universal quality when it differentiates into unique expressions of human consciousness. Every jiva atman, or individual soul, no matter how different it appears from all other jiva atmans, is in truth the eternal, universal param atman.
Based on their realizations and observations about the evolutionary cycles of all life, in which every individual ultimately merges back into its Universal Source, the ancient Ayurvedic sages saw the true meaning and purpose of Human life which is unique to human beings only: the potential to consciously reconnect with that Source while still living.
The path an individual takes in order to achieve this ultimate goal is different for each of us and is defined by how each jiva atman expresses its distinct set of desires and inclinations. These tendencies and situations guide the soul towards specific experiences necessary for progressing along one’s path. For some it might be The Way of the Scientist, for other The Way of the Office Worker, for another The Way of the Politician, and for some The Way of the Mother. In any case life does not exist without the soul or atman.
Manas: The Mind
The next aspect of life we will examine is manas or mind. If the jivatman, or soul, is always guiding us toward our ultimate destiny of health, wholeness and realization why then, the ancient Ayurvedic sages observed, do we often make choices which are harmful to our physical and emotional well-being? Why do we, fully knowing the ill-effects of certain foods and drinks, sometimes find we are completely unable to control our urges to consume them? Why are some people naturally and effortlessly disciplined and others wildly impulsive? Where does depression, anxiety, lust, greed, anger, and the other negative emotions come from? Ayurveda answers that all health and disease, happiness and misery, harmony and disharmony originates in the mind. Though the soul is the director of life, quietly urging one towards their destiny, it is the mind which controls the senses and the body and determines whether these two are used for life’s refinement or ruin. The mind ultimately orchestrates all of life and determines the quality of one’s conscious connection with the universal creative intelligence.
The quality of the connection with the universal consciousness is directly proportional to the quality of mind. To describe what the ancient Ayurvedic sages saw as the three qualities of mind, we must first look at the three operating tendencies which they observed to be present in all of Nature. These three tendencies are called the trigunas. The Sanskrit word guna actually means “a single strand within a twine” but may also mean “a part, subdivision, quality, or tendency”.
The three universal gunas are Sattva, Rajas, and Tamas.
Sattva is defined as balance, order, or purity, clarity and is associated with the creative impulse of Nature.
Rajas is translated as activating, desiring, dynamic, and preserving. It is the tendency found in Nature to build and maintain what has been created.
Tamas is literally translated as “darkness” or “obscurity”. It also means the tendency towards inactivity, entropy, lethargy, inertia, negativity, dullness, and destruction.
All of creation contains of all three forces. For any category of creation to exist, a force to initiate the process is required (sattva guna). Then each new creation needs a force to develop and maintain it (rajas guna) and another force to limit or retard the process in the state already produced and eventually dissolve it, so that it may form the basis for new creations. Every particle of creation contains all three gunas but the variations in equilibrium manifest all the variety in creation including matter, mind, body and spirit.
So what do these three universal qualities or tendencies have to do with our mind? Well, these same gunas which govern all of existence also govern our mind. As it manifests in the human mind, Sattva expresses itself as happiness, stillness, contentment, brightness, comprehension, and creative intelligence. It is also the source of our inspiration and attraction to the truth and subtle aspects of life.
Rajas in the human mind is what gives us desire. It propels us into motion and generates human activities of all kinds. Rajas overcomes stillness and the tendency to do nothing and both motivates and initiates action. It is the ultimate cause of not only of achievement in the world but also of pain and suffering.
Tamas is the mental constituent responsible for inaction and inertia. In material objects it resists motion and change. Tamas guna manifests in people as what slows and limits our activities but also as ignorance, lethargy, insensitivity, and indifference. Tamas is also recognized in individuals by the presence of coarseness, the absence of empathy, and by negligence toward oneself and others.
As is clear from the brief descriptions above, each guna can manifest in positive or negative aspects. The presence of all three gunas is required for life however they do not exist in the mind in exactly equal proportion. The ancient sages observed that, in normal healthy circumstances, there is a “disproportionate equilibrium” among the three gunas which maintains human life and keeps it moving in a positive, evolutionary procession. And what is this healthy human proportion of the three gunas? Well, like all wisdom, it is identical to the balance found amongst the gunas in life. Life is essentially creative. It resists the incessant pull of entropy which pulls everything toward dissolution and instead organizes itself into stable cells, tissues, and structures. Behind this process is a single Creative Intelligence. This influences the human mind to be also primarily creative or sattvic, with sufficient rajas and tamas to bring thoughts and desires into manifestation. But in order to remain in its natural healthy state, the mind must maintain its primarily sattvic quality.
The sattvic mind promotes the evolution, maturity, and happiness of the individual because the mind maintains its quiet, clear connection with its source, atman, whose nature is peaceful, all-knowing, and endlessly loving.
When rajas dominates, however, the mind becomes too active and unsteady. Though its has knowledge of the beneficial and creative, it will impulsively follow desires and ideas which are not beneficial. When tamas dominates, ignorance and darkness cloud the mind and our connection to the universal source is forgotten as the mind spirals down a destructive set of poor choices and actions.
What determines the sattvic, rajasic, or tamasic quality of the mind? Stimuli of three types affect the gunas. The first is the content of the mind itself—the thoughts and emotions which we generate and give attention. The second stimuli is the body—what we choose to eat and drink, how we exercise and sleep all affect the gunas. And the third stimuli which affects the gunas of the mind is what we take in through the five senses—which is the next component of Life which we will now describe.
Indriyas: The Five Senses
The indriyas are the bridge between the inner and the outer; between the mind within and the physical body and environment, without. The five senses gather information from the outer world and relay them to the mind in the form of sound; touch, pressure and temperature; light, color and form; taste and smell. Life depends on the senses and their capacity to discriminate between life-promoting and harmful sensations. One will lead to growth and evolution, the other toward pain, disintegration, and disease. In fact, together with a distortion of one’s intelligence, called pragya aparadha, the improper association of the senses with their respective sense objects is one of the primary causes of disease in humankind. The original Sanskrit term for this wrong use of the senses was asatmyendriyartha samyoga. Inappropriate use of the senses can be of three types. Sensory stimuli can be excessive, as in music which is too loud, staring at a computer screen for too long, being exposed to noxious odors for extended periods of time, or even talking too much. Insufficient use of the senses is the second form of misuse, as in living indoors in isolation for extended periods of time. And thirdly, the senses can be used in a morally wrong or emotionally upsetting manner, as when children (or adults) watch hours of physically or emotionally violent television, listen to sexually provocative music, or gossip and speak ill of others. All of these three forms of association of the sense organs with inappropriate sense objects causes harm to the sense organs and damage, disconnects the mind and body, and weakens Life itself.
The quality of the mind determines the caliber of sensory function and discrimination. A rajasic mind will seek out sensory input which overly-stimulates the senses, such as loud music, action-packed or violent movies, and excessively spicy foods. A tamasic mind dulls and damages the receptive capacity of the senses which then transmit distorted information about the body and environment. Only a sattvic mind chooses sensory nourishment which supports and strengthens life, promotes health and happiness, and a strong vital body..
Sharira: The Body
Finally we come to the fourth and last fundamental component of Life: the physical body. Unlike western medicine whose focus is almost exclusively on the body, Ayurveda does not consider it to be more important than the subtler parts of human life described already. However Ayurveda considers the body to be the vehicle through which these subtle parts of life have their connections with each other. Viewed in this way, the body is an evolutionary miracle of inconceivable complexity which supports the limitless possibilities of human Life. We can understand this wonderful instrument from many points of view. The Western view sees the body as a material object composed of smaller and smaller objects: organs, tissues, cells, molecules, atoms, subatomic particles, and so forth.
Ayurveda does not deny the validity of this view of the body but also has a more comprehensive perspective. It places less emphasis on the purely material components of the body’s structure and focuses more on the underlying principles which order and govern its function. Ayurvedic physicians observed that the same laws that orchestrate processes within the human body also regulate Life everywhere in the Universe.
The conceptual model that Ayurveda uses to understand the principles of how Nature functions is called the theory of the Five Great Elements or Panchamahabhutas. One must fully penetrate and comprehensively understand the five elements in order to be an Ayurvedic physician. It is the key to understanding the vital interrelationship between mankind and Nature and is the basis of all of Ayurveda’s diagnostic and therapeutic methods. The panchamahabhutas are an important subject to discuss here. However, since they arise from the Tanmatras, we need to first discuss this often miscomprehended aspect of the creation.
Tanmatras: The Five Subtle Elements
The Tanmatras, the subtle elements, evolve out of the ego (ahamkara) due to the interaction of the gunas. Tamas energized by liberated rajas of ahamkara overcomes sattva and the resulting preponderance of tamas gives rise to the tanmatras. The tanmatras are a step in the de-volution of Spirit towards material forms. The tanmatras are “subtle matter”, vibratory; they are instinct with potential energy. They are not known by nor do they affect or are perceived by the sense organs; they have only the potentiality to do so. They are called in English sound, touch, form, taste, and smell. They have to “material-ize” into the definite paramanus (atoms) of the bhutas (elements) before they can affect the senses. The tanmatras are the inner vital cosmic principles, the causal rudiments, which evolve forth the grosser pancha mahabhutas which can be known by the five human sense organs.
The tanmatras—shabda, sparsha, rupa, rasa, ghanda—are the intangible powers that are behind the sensations of hearing, touching, seeing, tasting and smelling. These are the subtle energies which are behind all material elements and objects, which in turn elicit reactions from our sense organs.
The Panchamahabhutas: The Five Gross Elements
The five tanmatras—hearing, touching, seeing, tasting and smelling, through a peculiar kind of permutation and combination, become the cause of the five gross elements—earth, water, fire, air, and ether. This process of permutation and combination is called panchikarana, a odd term which implies a quintuplication of the tanmatras to construct the five gross elements.
Let us describe how this occurs. All the gross elements contain ½ of its corresponding (dominant) tanmatra and the other ½ consists of 1/8 part of the other four (non-dominant) tanmantras. This process of combining the tanmatras is called panchikarana or quintuplication, by which the physical elements are formed.
For example, the gross element Space consists of:
1/2 shabda tanmatra (subtle space),1/8 sparsha tanmatra (subtle air),1/8 rupa tanmatra (subtle fire),1/8 rasa tanmatra (subtle water), 1/8 ghanda tanmatra (subtle earth).Since the gross Space element consists of more of its dominant tanmatra (shabda) than any other tanmatra, it will naturally exhibit more characteristics of the shabda tanmatra. The other 1/8 portions of air, fire, water and earth though present are recessive. Although recessive, however, to a certain extent these other tanmatras exert an effect which might not be perceivable to our perception.
As a simple example, this explains the basis of Ayurveda’s understanding of the different qualities of water which come from rivers, streams, rain, snow, lakes, mountains, etc. In these examples tanmatras other than rasa manifest in differing degrees creating qualitative differences on the gross level.
The Tridosha
Thus Ayurveda is both radically non-materialist and non-reductionist in its underlying philosophy. It is this non-materialistic and holistic view of reality achieved by the first Ayurvedic priest-physicians that gave rise to the Ayurvedic understanding of what we human beings truly are. It also followed logically that any practical and comprehensive approach to health would require a system which included the dynamics of body, mind and spirit. The spirit is deemed to be beyond treatment which leaves the target of Ayurveda as the mind body complex. But what connects these two aspects of the human being which would allow for a rational, coordinated treatment?
Ayurveda views a human being as constructed and governed by 3 underlying biological forces known as the doshas. Their names are Vata, Pitta and Kapha.
Vata is responsible for all movements, physical as well as subtle (thoughts). Movements include those gross movements of the arms and legs, the flow of blood through the vessels, nerve conduction, the movements of air in and out of the lungs, the constant tiny fluxes of sodium and potassium through millions of cell membranes as well as the movement of thoughts and ideas through the mind.
Pitta is responsible for the metabolic functions of digestion, absorption and assimilation (again both physical and mental), heat and acid production, and the capacity to focus and fully engage the mind and its perceptual apparatus at the highest level.
Kapha is responsible for the physical structure and stability of the body and creates various physical substances such as secretions, synovial fluids, lymph, as well as various solid organs and substances. At the cellular level it is what manifests as cellular ground substances and the intercellular “glue” (today known as integrins) which binds cells together.
The unique and distinctive movements observed in the human physiology such as locomotion, respiration, circulation, peristalsis, and thought are actually governed by specific subdoshas of Vata. Similarly, subtypes of Pitta (e.g. digestion, skin metabolism, vision, liver function, mental discrimination) and Kapha (e.g. gastric secretions, joint fluids, lubrication, glandular secretions, taste) are also observed to account for their respective metabolic processes and physical substances. The homeostasis of these three universal biological forces determines health and disease. When these forces act harmoniously, the result is a continuous adaptation to the environment and maintenance of health. If the early stages of a dysfunction or disease state begins to appear, because we know that Vata, Pitta and Kapha are related to specific aspects of physical and mental structure and function, the symptoms manifested will indicate which of dosha(s) has become imbalanced. Based on observations of these doshic-related dysfunctions, Ayurveda provides mankind with a detailed and rational description of the categories of human suffering, or illnesses. Disease of the body or mind are chiefly seen to be a consequence of a state of doshic imbalance; ultimately both body and mind have a common doshic origin. Ayurveda not only repairs the illusory split which has been erroneously constructed between mind and body but completes the triad by including Spirit in its paradigm of diagnosis and healing although admits that it is unnecessary to treat it and beyond human manipulation. Ayurveda employs other diagnostic observations which take into account the state of individual tissues, the precise stage of the disease process, one’s environment, one’s daily routine, diet, relationships, socio-economic circumstance, one’s mental state, and one’s karmic influences which are used in conjunction with doshic information. Together this framework provides an accurate and precise diagnostic framework.
Constitution
Each of us is born with a unique proportion of the three doshas entering into our physical and mental make-up. In Ayurvedic medicine, determining an individual’s constitution is the required initial step in applying any therapeutic measures. This logical categorization of the varieties of human beings, views every individual as comprised of Vata, Pitta and Kapha in a unique proportion. Although each of the three doshas (independent variables) can occur in an infinite variety of degrees, in clinical practice we recognize in three degrees: weakly present (1), moderate (2), or strongly present (3). The mathematical formula to calculate the number of common human constitutions is a factorial written as 3 x 3 x 3, meaning there are 27 hypothetical combinations (i.e. V2P3K1, V3P1K3, V2P2K2, V1P1K1, V1P3K2, etc.).
With study and continuous observation of oneself and others, it is easy to become familiar with the 27 different human constitutions. However we must remember that, although this schema includes only three degrees or strengths of each dosha, there are in reality many more degrees. Also remember that although one dosha may greatly dominate, all individuals are aggregates of all three doshas (i.e. a Vata-dominant individual--V3P1K1--or a Pitta-dominant individual--V1P3K1). In the beginning it is useful to recognize the chief qualities and characteristics of the three classical constitutions: Vata, Pitta, and Kapha.
By and large, an individual of a Vata prakriti is thin, are always cold, tend to have dry skin, sensitive digestion, and hard dark bowel movements; they think quickly, show great enthusiasm, see relationships and connections among things, and are creative and creators. However, they can seem anxious for no apparent reason, are easily distracted, are usually not overly assertive, and can be impulsive and nervous.
Persons who are predominantly Pitta prakriti are focused and intense, have a wiry physical build, have a strong digestion, can have several freckles or birthmarks, have normal or loose bowel movements, and tend to become hot easily. They are very responsible, great leaders, lucid speakers and teachers. However, their fire element can manifest inflammation and acidity both physically and mentally; they can be easily irritated, are prone to yelling and foul language, are famously impatient, and tend to develop skin conditions especially rashes, inflammatory types of acne, eczema and psoriasis.
The Kapha-dominant person is more naturally connected to others than the other two types. They are more complacent and slow-paced than either Vata or Pitta. Kapha prakriti can be recognized by their generally larger physical build, their grace and coordination despite being heavier, and their seemingly constant pleasant happy demeanor. They tend to act slowly and only after long periods of consideration, they can have slower metabolisms and digestion, and are prone to inertia, lethargy, and attachment to material goods.
The concept of constitution (prakriti) is central to Ayurveda. The constitutional determination provides insight into the deeper workings of an individual. . It is the energetic template upon which the mind and body are constructed. With this template in mind, it is possible to know the foods, spices, herbal medicines, emotions, thoughts, climates, colors, sounds, forms of exercise, and so on that move toward either balance or imbalance for a particular individual and that promote healing or further aggravation of conditions or frank diseases which may be present. Furthermore, since the general disease tendencies of the different constitutions is known, it is possible to construct specific preventive lifestyles for people of different constitutions which can follow a cogent, perennial approach utilizing Nature’s full scope and bounty.
Holistic Diagnosis
Ayurveda recognizes underlying natural law of svabhavoparamavada, which states that every living being has an inherent tendency to move in the direction of self-healing and balance. The balance toward which we humans naturally move is our prakriti or our unique proportion of Vata, Pitta, and Kapha inherited by us at birth. The disease state is known as vikriti, which represents a deviation from that natural proportion of the doshas. According to Ayurveda, if one lives a natural, simple, and clean life there will always be more momentum in the direction of health than towards disease. Systems of medicine are merely strategies to assist this gentle, yet inexorable, self-healing progression.
Beneath the surface of the myriad of human illnesses, lie the doshas which show specific patterns of deviation from their normal state; this is observed by the presence of specific physical and mental signs and symptoms which progressively develop in the course of a disease and can be noted during an Ayurvedic examination. Perhaps the greatest divergence from Western conventional medical thought is that Ayurveda recognizes that diseases will manifest in people of different constitutions in different ways. Although the major symptoms may be common to all, the accompanying and seemingly unrelated conditions will vary according to one’s constitution. An individual with a predominantly Pitta constitution will experience symptoms that are different than those for Vata or Kapha, despite all being diagnosed with the same Western “disease”. Treatment must aim at correcting the deviated state of Vata, Pitta, Kapha. The goal of Ayurvedic treatment is to bring these three bio-forces back to a state of proper proportion and equipoise, which is a unique proportion for each individual.Though western medicine focuses on the disease (that is, the main outer symptoms), Ayurveda aims to bring the whole person into health. For example, a Vata person with bronchial asthma will usually also have prominent wheezing along with other symptoms such as constipation, dry skin and perhaps scant and dark urine. In contrast, a Kapha individual with the same diagnosis might have a much more prominent and mucous-producing cough, slight nausea, and edema. Ayurveda recognizes these differences and treats each person quite differently. One’s present state of health or disease occurs within his/her constitution. Since the constitution is fundamental to health and illness, an understanding of one’s Prakriti prior to treating any disease is essential. We must always seek to nourish and cultivate the terrain as well as the seed.
The Roots of Constitutional Imbalance
The categories of factors which can trigger imbalance are diet, lifestyle, disregard for seasonal rhythms, emotions, deranged ideas, seasonal influences and injuries. Because nourishment of the bodily tissues (dhatus) depends on food intake, an inappropriate diet is seen as the paramount cause of illness. Ayurveda provides us with on the one hand a quite ground-breaking and on the other a simple and rational understanding of how to eat according to both individual constitutional types and for specific types of illnesses. Other Ayurvedic treatment modalities include plant-based herbs and spices, mineral-based medicines, bodywork and physical therapies, detoxification procedures, exercise, yoga and meditation.
Recognizing Doshic Imbalance
Because imbalance of the doshas always underlies the physical signs of disease we must learn to recognize the early features of doshic imbalances.
Signs of Vata imbalance include anxiety, insomnia, restlessness, hypersensitivity, indecision, constipation, abdominal distension, dry skin, dark urine, dehydration and weight loss.
Signs of Pitta imbalance include irritability, impatience, loose stools, nausea, acid reflux, changes in vision, dizziness, skin conditions such as acne, eczema and psoriasis, inflammation, infection, and increased body heat.
Signs of Kapha imbalance include weight gain, edema, swellings, emotional attachment, lethargy, depression, stubbornness, greed, mucous congestion, and tumors.
Ayurveda, in one of its seminal contributions to medical thought, precisely describes this sequence of pathogenesis in terms of six specific stages. This has become known as the satkriyakala. Literally, this translates to "six times for action" but is also more commonly referred to as "the six stages of disease". Either translation is suitable.
The satkriyakala gives a view of the entire natural course of the disease from its early, reversible, pre-organic stages through its stage of manifestation and symptoms, to its late advanced stage with its irreversible complications. Knowledge of which stage of the satkriyakala a particular disease is in guides us toward the appropriate therapeutic intervention for that stage. The legacy left behind by this brilliant and profound set of observations into the nature of the disease process is of vital importance and practical relevance. Early identification of the incipient disease process, affords the possibility that the disease can be precluded while in one of its early stages.
First, one or more doshas begins to accumulate somewhere in the body and if not addressed soon enter the second stage where they become vitiated or aggravated. At this stage the signs and symptoms lack intensity and permanency. However if the causative factors are not removed the imbalanced doshas will increase in intensity and frequency and after filling the initial site, may spill over and begin to spread, which represents the third stage. When it reaches a vulnerable or somewhat weakened area or organ of the body, it will stagnate there and begin to mix with and disturb the structure and function of the local tissues (dhatus). When they become mixed with aggravated doshas, the dhatus are known as dushyas. This dosha-dushya sammurcchana is the actual disease process (sammurcchana means "interaction"). The interaction of the doshas and dushyas, together with the specific effect from the site or organ involved (adhisthana) is the fourth stage of disease and leads to the development first of specific prodromal features, and then may progress to the fifth stage of the main symptomatology, of a disease. Left untreated the disease will evolve its unique set of complications and reach the sixth and final stage where it is no longer curable by any means. However even at this stage a disease can still be treated and controlled—but not cured.
Due to its insight into the earliest patterns of doshic imbalance along with its recognition of constitutional types, Ayurveda excels at illness prevention and early intervention. By the time a fully developed disease is identified, the responsible doshas are critically disturbed and the required treatment will be more complicated and of longer duration. In these cases, Ayurveda also can be extremely effective in treating many diseases and differs from the convention approach because it treats not just the disease but the whole human being.
Ayurvedic Treatment
Ayurveda utilizes many therapeutic avenues including diet, herbal medicines, massage, herbalized steam baths, herbal teas, culinary spices, laxatives, herbal pastes and plasters, therapeutic enemas, as well as the time-honored techniques of Yoga, breathing exercises and of course Vedic meditation. All of these can be utilized to address an individual’s constitutional needs, their current doshic imbalance, or specific conditions. It is up to the judgment of the physician to choose from among the broad range of therapeutic options and construct a program that suits the needs, abilities, and personality of the individual. Ayurvedic treatments can be grouped into the following 4 categories:
Shodhana (Strong Detoxification): These therapies include methods of internal and external cleansing which remove both toxic metabolites and subtle impurities from the body and mind. Shodhana is one of the distinguishing features of Ayurvedic medicine and its cornerstone. Together with special herbal medicines and specific dietary regimens, there are specific purification methods which employ therapeutic vomiting procedures, enemas, bowel purgation, sweating, nasal medications, blood-letting (small amounts at affected sites), as well as other highly-specialized treatments. These treatments are only available at Ayurvedic centers with experienced supervising physicians.
Shamana (Gentle Balancing): These therapies aim to gradually restore balance to the disturbed doshas without disturbing the remaining doshas. This is achieved through balancing diets, carminatives spices, digestive spices, fasting, sun exposure, herbal medicines, Yoga asanas, breathing exercises, and meditation. These are gentler treatments not requiring daily supervision.
Satvavajaya (Treatment of Mental Disturbances): Includes restraining the mind from unwholesome desires, cultivation of courage, discipline, memory, concentration, discrimination.
Rasayana (Revitalization): These therapies are designed primarily for the promotion of strength and vitality, integrity of the psychophysical matrix, intelligence, immunity, preservation of youth, optimization of the mind. This category is unique to Ayurveda and is appropriate for the elderly, the convalescent and for those who are healthy but wish to further strengthen and refine mind and body. Ayurveda recognizes the capacity for human beings to evolve into higher states of physical strength, mental capability, and consciousness
.Health and Wholeness through Ayurveda
Ayurvedic physicians have by tradition engaged themselves and their patients simultaneously in the process of self-discovery and the pursuit of health. Refining one’s consciousness for realization of the ultimate truth that all things come from One Absolute Source, a consciousness in which apparent opposites of science and spirit, logic and intuition, mind and body, matter and energy are united, is an important aspect of healing. Ayurveda ultimately removes our limits and re-shapes one’s concept of life and the universe by showing us that we are truly part of a whole.
The unique effect of a specific food, yoga posture, medicinal herb, emotion, belief, or of any phenomenon in the environment or within the mind is directly known when consciousness is free, unconditioned, and unfettered.
Imagine it is the year 5000 BC. You emerge one morning from the shelter of your grass hut and survey the scene. There are no cities, no skyscrapers, no cars, telephones, no television, no noise. Unpolluted clear water gurgles from a distant stream, the morning air refreshing and clean, stretches of land fertile and untouched. In every direction there is plenty space to walk, to sit, to breath, to think, to feel, to be. Nature continually beckons with things for you to see, hear, smell, touch and taste. With the eyes of a child you take it all in without naming or preconditioned responses. The silent spaces between your thoughts are vast. Amidst this great mental quiet, you effortlessly observe your spontaneous instinctive responses to the world. You can perceive a flowing exchange of a subtle energy (prana) between you and the world. There is a connection with Nature, a kinship, a mutual recognition…
However when thoughts dominate your mind, this connection begins to fade. You spot a tiger in the distance. As the mind becomes quicker and more active, the connection is now abruptly disrupted. In its flurry of activity, the exterior mind (manas) becomes isolated from the interior mind (buddhi), from its source. Suddenly, it imagines itself to be separate from the rest of Nature (ahamkara). Thankfully this mental turbulence soon subsides and your connection with Nature is re-established and the imaginary sense of a separate self dissolves.
Imagine now that you are hurtled through time into our modern world, with its incessant clamor, pollution, stimulation, and ceaseless background din of humming computers, cellphones and automobiles. Your expansive world is suddenly narrowed down to an immediate set of worries and anxieties as you rush from one task to the next. This is our modern world-experience, our modern self-experience born from our distorted modern self-concept of separateness and limits.
To correct this misperception of ourselves, Ayurveda prescribes the mentally-refining practices of Yoga to create a greater level of awareness. Yoga here means the vast array of ancient behavioral and mental practices aimed at the refinement and quieting of the mind—not only the practice of yogic postures which have gained popularity in the past several decades. As the mind quiets and consciousness expands, one’s view clears once again. Also the effects of any category of substance or thought can be experienced and known first-hand.
An Ayurvedic physician through recommendations of dietary, herbal, physical and yogic therapies, not only prevents and cures illness but also cultivates for every patient a discovery of the natural world and their own essential nature.Ayurveda, in fact, is our guide for the encounter of the individual constitution with the rest of nature. The Ayurvedic approach is empirical: it is based on the knowledge gained through direct experience rather than on theory or pure logic. Experience is the most reliable knowledge one can have about an herb, food, massage or anything in Nature. We can say in theory that a particular plant will help cure constipation, but until we experience that this is true this remains in doubt. The fact that lab analysis in this century has revealed the biochemical basis for the much earlier Ayurvedic empiric findings is a testament to this approach. For example, we find in the Charaka Samhita that eggs, sesame seeds and panir (an unfermented cheese) are all categorized as sleep inducing foods. Centuries later, we now know that these three foods are among the highest in tryptophan content—an amino acid which indeed induces relaxation and sleep via its metabolism into serotonin and melatonin. It follows that there are detailed guidelines on selection, preparation and combination of foods for the various constitutional types and also for various types of illness. If this sounds restrictive, think about it this way: once you know your constitutional strengths and limitations you can assimilate anything if you know how to prepare it, what to eat it with and what not to eat it with. This part though it relies on the scientific knowledge of foods as developed in Ayurveda definitely requires the approach known as “Art”. The Ayurvedic ideal is to simultaneously become a scientist and an artist—the true nature of a complete human being.
To read more about Basic Ayurvedic Principles click here.