The conventional western medicine views the body from a structural perspective, whereas ayurveda, the ancient medical system of India, understands the human body from the perspective of functions/tridoshas (vata, pitta and kapha). These different viewpoints of ayurveda and western medicine have resulted not only in the use of different terminologies and metaphors to explain the human system but also in their different approaches to health and illness. This article focuses on the distinctive approach of ayurveda to health and disease and the science behind it.
If one looks at the health scenario in India, one finds that in the not too distant past (precolonial India), Indians were leading a healthy lifestyle and were health literate. The then prevalent medical systems like ayurveda were handling effectively, ailments, surgical cases (like cataract, removal of urinary stones, otoplasty and rhinoplasty) and even some medical emergencies (like snake bites). They had even practised innoculation till the British banned it around AD 1802/1803. But, starting with colonization and the subsequent meteoric ascent of western medicine and its widespread popularity, all indigenous systems of medicine were swept into near oblivion. Now, an increasingly chemical-weary population has begun turning towards alternative approaches during illness not only in India but the world over. The wheel has thus come a full circle. The growing interest in ayurveda has prompted a relook at this ancient medical science of India.
Ayurveda is a highly systematized medical system resting on proven theories and thousands of years of documented clinical observations with unbroken and successfully continuing clinical practices. Despite these, proper recognition and appreciation have been denied for ayurveda. One of the major criticisms is its use of a language seen to be archaic and of terms that do not relate to the modern scientific terminologies that one is familiar with. This, coupled with the fact that ayurveda’s concepts and approaches to health and diseases are very different from those of western medicine, has made one wonder whether ayurveda is yet another mystery of India.
Biomedical model / western medicine
The model adopted by western medicine is a structural one with atom as its fundamental unit. This model has a clear structural hierarchy with atom in the lowest level forming the building block of the entire human body. Atoms make molecules, which in turn form cells and then tissues, organs, organ systems and finally the entire organism (human body). The human body is understood in terms of different systems like skeletal, endocrine, reproductive, circulatory, etc. Since this approach is based on structures and reduces everything to the fundamental unit of matter, it is generally referred to as a reductionistic viewpoint. This model looks at illness as being caused by the deranged behaviours of the molecules and organs in the body. Reductionism is breaking down of a complex system into smaller, more manageable parts and then studying these separately. It has been a tremendously useful and successful method of studying the human body and has led biologists to unravel the human genome and the neurobiologists to uncover in minute details, the working of the nerve cells in the brain. This approach places emphasis on obtaining measurable structural information using technologies and has fine-tuned the various diagnostic tools to obtain such information.
Ayurvedic model
In ayurveda, an organism is not considered a system of organs, but a system of relationships which define the functions. Ayurveda’s understanding of the functioning of the human body, therefore, is different from that of biomedicine. It is based on tridoshas – vata, pitta and kapha. These words in Sanskrit, the language of ayurveda, refer to functions like movement, transformation, and support and growth, respectively. Ayurveda refers to these as ‘doshas’, which literally means ‘that which can become vitiated’. This is apt because in a disease it is ultimately the functions which become impaired.
A function results from the collective efforts of many parameters in the body ranging from structures (gross and subtle), biochemistry, measurable activities such as electrical and magnetic, and non-measurable activities such as mental and emotional, to many other physiological parameters. For example, let us look at functioning of the heart. Heart in any other shape will not function in the same way, making structure a very important component of function. It is well known that the electrical activity of the sino-atrial node, heart’s natural electrical pacemaker, is a crucial component for the proper functioning of heart.
It is also now well established that mental and emotional activities affect heart’s functioning. All functions are expressed through the physical medium of the structures. A function, therefore, is an emergent property of many parameters. It characterises the whole system, where all the various components work together to yield a function. A functional model will, therefore, be an inclusive model, taking into account all parameters, which contribute to a function. It will be a reflection of the whole system, where all the various components working together result in a function.
The tridoshas actually represent a set of parameters, which are physico-chemical and functional in nature. For example, vata represents dryness, lightness, weightlessness, coldness, roughness, minuteness and movement. Pitta refers to parameters like slight unctuousness, penetrating, heat producing, lightness, bad smell, causing movement and liquidity. Kapha indicates unctuousness, producing coldness, heavy, sluggish, smoothness, shining, firm/static. These parameters express through the structures and give them their functionality.
It is interesting to note that vata, pitta and kapha cover not only the physiological but also the psychological functions. It is important to note that in this functional model, there is no hierarchy, i.e. there is no building at the macroscopic level and also at subtler levels like cells and molecules. The three ‘doshas’ exist in fine balance indicating homeostasis. A change in one will cause changes in the other two. For example, when vata increases, certain functions and parameters in kapha and pitta will change and vice versa. If the vata parameter dryness increases, this will reduce the unctuous property of both pitta and kapha and affect the functions associated with them. Similarly, changes in other parameters of one dosha will cause increase or decrease of parameters in the other two doshas, resulting in some impaired functions.
Disease results when the doshas/functions are out of balance and ayurvedic treatment involves bringing the doshas back to balance. The model adopted by ayurveda is thus a model dealing with nonlinear relationships. Doshas, thus, represent a different perspective of the body and provides a conceptual framework different from that of biomedicine.
The core idea of tridoshas underpins all ayurvedic understanding of human body and treatment of diseases. Ayurveda’s view of life as a complex interrelationship of vata, pitta and kapha and not merely a structure made of atoms and molecules is unique and gives it its distinctness in dealing with human body in a holistic way. It is interesting to note that while biomedicine’s paradigm is based on classical Newtonian physics and lies outside quantum concepts, ayurveda’s concepts are seen to resonate with some of the concepts of quantum physics, in particular, the quantum physical worldview.
From theory to practice
Diagnosis: Since the central tenet of its theory is that illness results from imbalance of ‘doshas’, identification of the dosha/doshas gone out of balance in a disease plays an important role in diagnosis in ayurveda. Other factors such as ‘prakruti’ (person’s physical and mental constitution), age, occupation, season, region in which the patient lives, etc. also play an important role in diagnosis. All clinical symptoms have been classified under the three doshas. For example, consider swelling. If it is air-filled and associated with pain, then vata is affected.
If the swelling is reddish with burning sensation, then pitta is associated. On the other hand, if it is a pitting oedema and associated with no/dull pain, then kapha is impaired. A combination of these would indicate the derangement of more than one dosha. All clinical symptoms ranging from cold, cough, fever, diarrhoea to swelling and skin disorders have been classified under vata, pitta and kapha.
The clinical symptoms can thus be directly linked to the dosha/doshas (read functions), which have gone out of balance, which in turn can be directly related to the known causative factors (such as diet and lifestyle activities – physical and mental) responsible for this imbalance. For example, let us take the disease osteoarthritis.
According to ayurveda, in this disease vata is deranged and hence it is a vata disorder. The vata parameter ‘dryness’ has increased causing a reduction in the lubrication (a function of kapha) between the joints. The reason for this increase in vata could be the patient’s prakruti (vata predominant) or age of the patient (vata predominates after the age of 60 years) or diet and activities which had increased vata. All these are assessed leading to a proper diagnosis and appropriate treatment is then given. Diet and lifestyle changes are always part of any ayurvedic treatment. On the other hand, biomedicine’s diagnosis places emphasis on structural changes (gross and subtle) and the various diagnostic tools are also designed and fine-tuned to observe these changes, which need not be the causative factors of the disease. It may reflect only symptoms of the disease. It is pertinent at this point to note that ayurveda identifies the etiology (causative factors) for all the diseases.
Questions always arise as to whether ayurveda can manage diseases that were not known 1000s of years ago, in other words, contemporary diseases. Since it has a theory of health and disease, it can handle new diseases. This can be explained in the following way – if a person knows the theory of addition, he/she will be able to add any combination of numbers by applying the theory. In the same way, by applying its theory of health and disease, ayurveda can understand, diagnose and treat new diseases. This is also clearly mentioned in texts like Caraka Samhita, while mentioning the treatment of new diseases and those not mentioned in the text. It says: ‘In fact, diseases are of innumerable varieties depending upon their distinctive features …. Only important diseases have, however, been enumerated. Other diseases can be classified similarly according to the factors (doshas) involved in their manifestation’.
‘If a physician is not able to name a particular disease, he should not feel ashamed on that account because it is not always possible to name all types of diseases in definite terms. When aggravated, one and the same dosha may cause manifold diseases depending upon the various etiological factors and the sites of manifestation. So, a physician should try to comprehend the nature of the dosha, the site of its manifestation and etiological factors and then initiate the treatment. A physician, who so initiates the treatment after having full knowledge of these three aspects would never fail in his attempt to cure the disease’.
In any disease, ultimately some functions or the other in the body are going to be impaired and by identifying them with the doshas, ayurveda can diagnose and treat it. The advantage of this approach is that even if ayurveda lacks a priori knowledge of a new disease, this disease can be handled because it can identify the deranged functions and their causative factors. The strength of ayurveda is this simplicity in diagnosis and it should not be regarded as its weakness.
Treatment: Ayurvedic treatment involves removal of the causative factors and bringing the functions/doshas into balance. For this, ayurvedic medicines, diet and activities (mental and physical) are also understood in terms of vata, pitta and kapha. Medicines are categorized according to their action on either one or two or all the three doshas. For e.g. Rāsnādi kashāyam is a vatahara (vata reducing) medicine. Food is also categorized similarly. While items which are sweet and fatty increase kapha (i.e. certain functions and parameters in the body) and decrease pitta and vata (again certain functions and parameters in the body), those which are (chilli) hot and spicy will increase pitta predominantly and also vata and decrease kapha. Table 1 shows the relation between the tastes (rasas) and the doshas/functions. Physical activity like exercise will increase vata whereas mental activities like worrying and anger will increase vata and pitta, respectively. To put in a nutshell, everything ranging from medicines to diet to mental, physical and emotional activities are categorized and understood in terms of the changes they cause in the doshas/various functions of the body.
These classifications have occurred through centuries of experimentation, observation and clinical applications. Millenia of such careful study and documentation have produced this successful model, which offers a comprehensive and holistic paradigm with time-tested successful treatment protocols. While this approach seems strikingly simple, it is clinically very effective and gives a distinctive approach to the ayurvedic practice and results that outscore those of western medicine, specifically for the treatment of complex diseases. In the case of osteoarthritis discussed in the previous section, since vata is increased, the entire treatment will act to reduce the increased vata (particularly its dryness aspect), i.e. ‘vata reducing’ medicines, procedures (e.g. Medicated-oil application), diet and lifestyle activities. Ayurvedic treatment involving medicines, diet and lifestyle activities which restore the doshic/functional balance shows how a textual theory has been translated into a successful and viable clinical practice. Since health is a balanced state of the doshas, interconnections between various functions (doshas) in the body are known in ayurveda and the treatment is able to avoid side effects by judicious use of medicines, diet and activities.
Ayurvedic texts clearly mention that treatments should have no side effects and this is adhered to in practice as well. In biomedicine, benefits from treatment are quite often outnumbered by the side effects of the medication. More importantly, ayurveda takes health into the realm of one’s personal responsibility (empowerment of the socalled patient) by offering several methods to stay healthy and prevent diseases. Ayurvedic principles and methods of healthy living can be incorporated easily into people’s daily life, their cuisine and other day to day activities. It can thus have a pervasive influence on the daily life of people by providing optimal health by customizing and harmonizing diet and lifestyle activities. This way, people are made responsible for their health and they need not consider themselves as victims of factors beyond their control. Ayurveda, therefore, goes beyond treating diseases and is a healthcare system teaching one how to be healthy by facilitating harmonious diet and activities (svastha vrittam).
Rama Jayasundar is in the Department of NMR, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi 110 608, India.
