Ayurvedic Concepts Of Disease
Definition Of Health
The Five Elements
The Ayurvedic definition of health is that state in which the structure and function of a particular individual is operating optimally and the individual is in a state of physical, mental, and spiritual equilibrium. Both Charaka and Vagbhata elegantly describe the Ayurvedic state of health:
· All three doshas are in equilibrium with regard to the individual prakriti
· All seven tissues, dhatus, are in the proper state of strength and integrity
· The digestive fires, agnis, are balanced resulting in proper appetite, digestion, and assimilation
· The waste materials, malas, are being produced and eliminated in a regular manner
· The sense organs, indriyani, are functioning normally and the mind is undisturbed
· The individual is experiencing happiness and contentment
Disease manifests as the opposite of some or all of the criteria for health listed above. It is a state of dysequilibrium of the doshas, dhatus, agnis, and malas; the individual is out of harmony both internally and with relation to the environment and experiences unpleasant sensations and misery in some form (duhkya).
Ayurveda asserts the truth of the principle 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 naturally move is our prakriti or our unique and natural 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. There is an inherent tendency in Nature to move from vikriti to prakriti and systems of medicine are merely strategies to assist this gentle, yet inexorable, self-healing progression.
Yet despite the powerful natural inclination towards health, we nevertheless observe many individuals acquiring illnesses of many different types. We have already stated that it is a disturbance in the doshas which leads to the manifestation of disease. In other words we can regard the doshas as the agent of disease. But what causes the doshas to become disturbed? These factors are said to be the ultimate cause of disease.
Ayurveda recognizes the closely intertwined relationship between describing the pathological process in a person and assessing the disease state. Ayurvedic medicine demands an extensive and precise examination of the disease process and of the individual in whom it is manifesting. There are in fact no short cuts to take to arrive at a correct diagnosis. No computerized diagnostic tools or technological imaging techniques can ever produce an accurate picture of the disease process. In order to reach an understanding of both the nature of the disease as well as the disease process in the individual, Ayurveda has evolved a unique simultaneous approach to diagnosis and pathology. This method is known as rogi-roga pariksha.
Ayurveda is indeed the only medical system which describes an elaborate strategy for assessing both the patient (rogi) and the disease (roga). In contrast, allopathic medicine focuses intently on only the disease. Patients in modern hospitals are even often identified only by their particular disease as exemplified by the common query on morning rounds: "How's the gastric ulcer doing in Room 584?". The Ayurvedic physician never regards his patient as some form of "disease entity" and always keeps in view the complete human being. In every patient there is a human being; in every disease condition there is also health. For in actual reality even when a person has a disease of some kind, he or she has certainly not lost his or her entire health. Aspects of health always remain with a person along side the disease state. This important reservoir of health is the foundation of his eventual recovery according to the principle of svabhavoparamavada--the tendency for the body to eliminate the root of a disease and to heal itself when properly supported.
In Ayurveda, attention is paid to the nature and directly observable attributes of the disease process itself and to the pattern of doshic disturbance in the individual. Understanding the disturbance, or "vitiation" of the individual's normal doshic is the essence of Ayurvedic diagnosis and forms the basis for the therapeutic approach.
As has been stated above, in addition to assessing the doshic vitiation, the physician also must understand the tissues affected, the srotas involved, the patient's social circumstances, the emotional tendencies, personality traits, and the general state of the patient's health and life. Clearly, this information gathering demands an extensive interrogation and physical examination which Ayurveda teaches as a two-part approach:
* 1) Diagnosis of the patient (rogipareeksha), and * 2) Diagnosis of the disease (rogapareeksha)
It must be understood that although the physician may gather information separately regarding the individual and the disease, in reality their is no distinction between the two; the disease cannot exist outside of the individual.
Rogipareeksha: Diagnosis of the Patient
The first of these, rogipareeksha, is the true strength of Ayurvedic diagnosis. It includes the physician's judgement regarding the patient as a whole, his temperment, discipline, habits, digestive capacity, intelligence, hereditary traits, emotional set, finances, support system, desire to heal, and of course his constitutional type. Charaka also described a ten-fold methodology for this aspect of Ayurvedic diagnosis which is still in use today precisely as outlined below:
Ten-fold Ayurvedic Diagnosis of the Patient (Rogipareeksha)
1. Constitution (Prakriti). Constitution includes the inherited physical and mental characteristics of an individual. These characteristics are assessed through the physician's knowledge of the tridosa and the triguna. Recall that prakriti represents the proportion of the three doshas and three gunas which is the original proportion for a given individual. It is that very proportion which manifests in the physical and psychological features of the person.
2. Doshic Vititation (Vikriti). This refers to the degree to which an individual has deviated from the original proportion of the three doshas (prakriti). This can be assessed by close observation of the dhatus, upadhatus, malas, function, structure, intellect, and emotions of the individual.
3. Quality of the Tissues (Sara). This aspect of the patient examination assesses the quality of the seven dhatus and the mind. We usually grade the quality of each tissue as pravara (excellent), mahdyama (medium), or avara (inferior). Pravara status implies overall excellent immune status, recuperative capacity, and good prognosis; avara status implies poor immunity and general vitality and a poorer prognosis. Sara pariksha also includes assessment of the degree of sattvic quality in the mind. It presence is indicated by brightness of the intellect, mental calm, and capacity for discrimination; its absence is recognized by rajasic or tamasic qualities of the mind.
4. Compactness of the Body (Samhanana). This is the solidity and overall physique of the body frame. A more compact body usually indicates better immunity and healing capacity than a very soft and flaccid body habitus.
5. General Stature and Physical Proportionality (Pramana). This term really refers to the ratio of the height to the outstretched arms (which should be the same), and several other scriptural measurements said to indicate a well-proportioned body. The well-proportioned frame is said to have superior health capacity and better prognosis.
6. Physical Strength (Vyayama Shakti). This factor means the capacity of the individual to be physically exerted and is measured by assessing the powers of endurance. The exercise endurance is a good measure of certain metabolic measures which create strength and stamina. These include the ability of the heart rate and blood pressure to increase appropriately, the ability to generate sympathetic nervous activity, the ability to secrete insulin, cortisol, and other hormones, the ability to up-regulate the respiratory rate. All of these functions are tested by the patient's exercise capacity.
7. Adaptability (Satmya). This is a measure of the capacity of an individual to adjust to both physically and mentally unsettling conditions and to maintain homeostasis in the face of these factors. This is a very unique diagnostic concept which we find only in Ayurveda. It includes a wide range of psychoneuroimmunological assessments but can be simplified for clinical measurements to the following data.
8. Emotional Balance (Sattva). This feature specifically refers to the mental steadfastness: the ability to tolerate and withstand distractions such as pain and physical or mental discomfort and still proceed with one's duties. It also includes the immediate reaction which one has toward unexpectedly altered circumstances and strange situations. The capacity to remain even-minded and calm is a sign of emotional balance and a strong and healthy buddhi (intellect).
9. Digestive Capacity (Ahara Shakti). This is an assessment of the capacity to ingest, digest, and assimilate food. One way of assessing this is by virtue of the appetite and how strong and sharp (sudden onset) it is. The actual quantity of food consumed is another feature of this assessment. The time period between consuming a meal and the next onset of hunger is a measure of agnibala, or the strength of the agni. The more optimum the ahara Shakti of a patient the faster will be the recovery from imbalance and disease.
10. Rate of Aging (Vaya). This is the comparison of the person's actual chronological age with one's apparent age. If one appears to be younger than one's chronological age, this is a sign of positive health; and the converse holds true. Parameters such as long and short term memory, skin texture and luster, strength of the voice, posture, quality of movements, gait, quality of the hair, and daily activities are the measures of vaya. The antedote to premature aging is rasayana cikitsa,or anti-aging therapies. Rogapareeksha: Diagnosis of the Disease
The diagnosis of the disease, rogapareeksha, is aimed toward assessing the nature of the disease and is divided into three main activities:
1. Prasna (Interrogation). Obtaining the history of present illness, pertinent positives and negatives of the past medical history, and a very complete and accurate review of systems.
2. Panchendriya pariksha (Physical examination using the five senses). Complete physical examination; Ayurveda divides the body into the sadangas, or six major regions, for this purpose and includes the head, neck, chest, abdomen, and the upper and lower extremities. This includes assessment of the srotas (channels) and dhatus (tissues) throughout the entire body. The physical examination includes darshana ( inspection) and sparshana (palpation).
3. Ashtavidha pariksha (Specialized "Eight-fold" Ayurvedic examination). This is given below in table form: Ayurvedic Eight-fold Examination to Assess Disease (Rogapariksha)
1. Examination of the complexion
2. Examination of the eyes
3. Examination of the speech and voice
4. Examination of the tongue
5. Examination of the skin
6. Examination of the stool
7. Examination of the urine
8. Examination of the pulses
These three activities are applied to assess the nature of disease using the following rational and orderly approach. First one identifies the cause(s) of the disease (Nidana). Next, one evaluates the stage of progression of the disease or pathogenesis (Samprapti). This is followed by careful observation of any very early signs of disease (Purvarupa) and the overt symptoms of the manifest disease condition (Rupa). Finally, we derive additional information about the disease from how it responds to theraputic interventions which are administered, i.e. response to treatment (Upashaya). Nidana (Etiology or Cause of Disease)
One of the fundamental truths of the Ayurvedic philosophy is proclaimed in the classical idea of loka-purusha samya. This very important concept teaches that the universe (loka) and the individual human being (purusha) are under the same laws and in fact exist on a continuum which reaches from the realm of the universal to that of the smallest form of creation. The individual living being, whether it be a man or an ant, is a miniature replica of the universe. This concept is beautifully and succinctly captured in the famous sutra "as above, so below". It is important to reflect on the full implications of this universal truth and to realize that the microcosm (man) and macrocosm (universe) are in a never-ending interaction with each other. This interaction operates under the law of samanya-vishesa or like-increases-like. The constantly changing conditions both in Nature and in the individual create a dynamic harmony between the two--a state which we recognize as health. When there is more deviation that can be tolerated between the individual and Nature (the universe) that harmony is lost and a disease state can arise.
The universe and the individual being interact through the eternally shifting interplay of three factors which exist in both realm and form a bridge between loka and purusha. These three factors are:
· Buddhi (intellect)
· Indriyartha (sense objects)
· Kala (natural rhythms)
The healthy state of all three of these factors is called samayoga (balanced). However buddhi, indriyartha, and kala can also become imbalanced as atiyoga (excessive), ayoga (deficient), or mithyayoga (distorted). These deviations of buddhi, indriyartha, and kala from their normal balanced state are considered in Ayurveda to be the fundamental cause of disease. It is these disharmonies which lead to the vitiation of the doshas, accumulation of ama, weakening of agni, and the entire cascade of the Kriyakala. We give specific names to each of these fundamental causes of disease:
· Prajnaparadha
· Asatmyendriyartha samyoga
· Kalaparinama
They are defined as follows:
Prajnaparadha literally means a "blasphemy,or mistake, of the intellect". Improper use of the intellect which results in a wrong understanding of some kind is an example of prajnaparadha. Another form of this disease factor is a volitional transgression against what an individual knows to be correct and true. Whether volitional or non-volitional, prajnaparadha leads to fallacious information, wrong conclusions, and hazzardous actions. When an intelligent and educated person indulges in an unhealthy habit or abuse, it is always a consequence of prajnaparadha.
Asatmyendriyartha samyoga literally means an "inappropriate association of the sense organs with certain sense objects". This is a fascinating concept with wide implications for creating health and preventing disease. This concept views the sense organs as having a direct connection with the highest levels of the mind. An unwholesome (excessive, deficient, or distorted) perceived stimulus produces an unwholesome effect in the mind which in turn causes stress and a vulnerability to disease. The unwholesome perception disturbs the sattvic quality of the mind and creates a rajasic or tamasic state. This mental state, in turn, can promote aggravation of the doshas, transforming an initially mental phenomenon into a somatic manifestation.
Kala parinama is defined as "being out of harmony with the rhythms and cycles of Nature". Ayurveda recognizes several important cycles on the macroscopic scale which have corresponding effects on the human being. If an individual does not become aware of these cycles and modify his life accordingly, that discordance will lead to a disease state. The diurnal rhythms discovered by modern physiologists, the female menstrual cycle, the male and female sexual peaks, the seasonal variations in immune status, the sleep cycle, the daily changes in breathing patterns are all examples of chronobiological rhythms which were intuitively known to the ancient vaidyas.
