Ayurveda the divine science of life -8

Ayurveda the divine science of life

7.11 ALCOHOL, COFFEE AND TEA

Although the ancient texts of A

-

yurveda speak of the

dangers of alcohol, much of what is written seems to

indicate that alcohol has many benefits. All of these references

to alcoholic beverages are to certain kinds of

wine or beer that have been naturally fermented. Wine

(madya) prepared from grapes, consumed in moderate

amounts and taken with meals, is considered to be

dı-pana (‘stimulant to digestion’). Beer (sura - ) prepared

from rice is considered to be guru (‘heavy’) in nature,

and balya (‘strength-promoting’), stanyajanana

(‘galactagogue’) and br.mhan.a (‘nourishing’) in

action, useful in the treatment of oedema, haemorrhoids,

abdominal bloating, malabsorption syndromes

and dysuria. Yavasura - , or beer prepared from barley

(the dominant form of beer in the West), is said to be

guru (‘heavy’) and ru- ks.a (‘dry’) in nature, inhibits

digestion, promotes bloating, and aggravates all three

dos.as.

Alcohol is generally avoided in paittika complaints

because the nature of addiction involves a dysfunction

of the discriminative faculties (i.e. pitta), but also

because alcohol is us.n.

a (‘hot’) in nature. Naturally

fermented alcohol is predominant in madhura

(‘sweet’) and amla (‘sour’) rasa, and is us.n.

a (‘hot’),

laghu (‘light’), and snigdha (‘heavy’) in quality, consumed

with meals in small amounts to treat va-ttika

and kaphaja conditions. Distilled alcohol (e.g. scotch,

bourbon, vodka) has a kat.u (‘pungent’) rasa, and is

us.n.

a (‘hot’), laghu (‘light’), and ru-ks.a (‘dry’) in

quality, used to control kaphaja conditions and coldness

in small amounts.

Neither coffee nor tea is mentioned in the ancient

texts of A

-

yurveda, despite the fact that these are

both exceptionally popular beverages in modern

India, often consumed with large amounts of sugar,

boiled milk and aromatic spices. Taken in small

amounts and infrequently, neither of these beverages

poses any prominent risk to health, although

both va-ttika and paittika conditions can be aggravated

by their regular usage. In kaphaja conditions

both coffee and tea may have some minimal benefit

(taken without sugar), as the stimulatory effect of

the methylxanthines counters the lethargic nature

of kaphaja and enhances mental clarity.

Unfortunately both coffee and tea inhibit digestive

function when taken on a chronic basis. Taken

before meals, coffee and tea effectively inhibit the

appetite by enhancing the breakdown of glycogen

into glucose, temporarily elevating blood sugar levels.

If taken after meals, however, coffee and tea

work to enhance stomach emptying, strongly induce

gall bladder secretion and thus mass peristalsis, such

that food is moved quickly through the gut without

first having undergone adequate digestion. The

methylxanthines in coffee and tea artificially induce

a state of nervous excitation called the ‘fight or

flight’ response, and in large doses can promote

nervous irritability, anxiety and tachycardia. I generally

find that most patients feel healthier and have

more energy when they avoid coffee and tea,

although discontinuing coffee can promote a few

days of headaches from rebound vasodilation of the

cerebral arteries.

7.12 SUMMARY OF DIETARY

GUIDELINES AND tridos.as

The following tables summarise what foods will typically

pacify (reduce) or aggravate (increase) the

affected dos.a. For specific dietary and lifestyle guidelines

for each dos.a please consult Appendix 3.

PART 1: Theory and practice of A

-

90 yurveda

Pacifies va¯ta Aggravates va-ta

Oils and fats: animal fats (free-range), Canola, refined oils, margarine, trans-fatty acids

olive oil, coconut oil, ghr. ta, butter and hydrogenated fats

Cane sugar juice (in small amounts)

Cooked fruits such as apple sauce, baked Unripe fruit, raw fruit, dried fruit, cranberries,

pears, stewed prunes, with spicy herbs sour citrus

(ginger, cinnamon, cardamom, clove)

Steamed vegetables, baked vegetables, Raw vegetables, field mushrooms

especially squash and root vegetables

(except potatoes)

Oats, basmati rice, quinoa, amaranth Granola, corn, millet, rice cakes, manna bread,

flour, pastries

Legumes (with spicy herbs and fat): natto, Most legumes: soy, lentils, split peas, kidneys,

miso, tofu, adzuki, mung beans garbanzo, pinto

Seeds and nuts (in small amounts): Seeds or nuts in excess

sesame, pumpkin, almond, brazil,

pecan, coconut

Eggs, poultry, shellfish, beef, pork, No meat contraindicated

goat, lamb, goat’s cheese, whole dairy

(in moderation, always warm, with spices)

TABLE 7.1 Va¯ta dos.a.

Pacifies pitta Aggravates pitta

Coconut oil, ghr. ta, cold-pressed vegetable Mustard, canola, refined oils, margarine,

oils, fish fats (in moderation) trans-fatty acids and hydrogenated fats

Cane sugar juice, jaggery, maple syrup Honey, white sugar (to excess)

(in moderation)

Raw fruits, especially in hot weather; Sour and acidic fruits, including sour oranges,

raspberry, plum, pear, blueberry, grape, lemon, lime; papaya or strawberries to excess

apple, melon

Raw and steamed vegetables, broccoli, Raw onion, chilies, tomatoes, eggplant

chard, celery, salad greens, cucumber, (aubergine), peppers, daikon radish

green beans, peas, cauliflower, cilantro,

sprouted beans and seeds

Oats, basmati rice, quinoa, amaranth, Refined flour products

khuskhus, whole wheat pasta, whole wheat

chapatti, pumpernickel, manna bread

Most legumes in moderation Legumes to excess

Seeds and nuts: pumpkin, coconut, Seeds or nuts to excess

almond, melon, brazil, cashew, filbert

Eggs, poultry, cold-water fish, rabbit, Pork, beef, tropical fish, shellfish, yogurt

game, goat, mutton

TABLE 7.2 Pitta dos.a.

Food and drink 91

ENDNOTES

15 A - yurveda generally abhors the ingestion of fungi, which is typical

of other fungiphobic cultures such as many of the First

Nations of North America. In contrast, the experiences of

fungiphilic cultures found in Europe and China have shown that

fungi have many beneficial and medicinal effects. Most fungi are

avoided in kaphaja or a - ma conditions, but some, such as Reishi,

Maitake and Shitake, may be helpful in such states.

16 In regard to rice, the ancient A

-

yurvedic commentators preferred

certain varieties over others, such as raktasa-li (red rice) and

s.

as.tika (60 day rice). Further, these traditional rices did not

undergo extensive milling and retained all or a portion of their

inner husk, which is rich in bran and anti-oxidant compounds.

Completely milled rice, and certainly parboiled rice, which unfortunately

makes up a large part of the rice now consumed in India

and the rest of the world, is a pale comparison of the healthgiving

food mentioned in A

-

yurveda.

17 Even now, vegetarianism in India is not a strict veganism: fresh

and fermented unpasteurised dairy products are a major component

of the vegetarian diet.

18 Honey manufactured from the nectar of several species of

Rhodendron and other members of the Ericaceae contains

grayanotoxins that can cause dose dependent symptoms of toxicity

such as acute salivation, vomiting, paralysis, and hypertension

(Lampe 1988 JAMA 259(13): 2009).

19 It is interesting to note that heated honey is used in traditional

Chinese medicine, such as stir-frying it with Gan cao (Glycyrrhiza

uralensis) to modify the activity of Licorice, to ‘strengthen the

middle’, and enhance digestion. Despite the idea that heated

honey is never taken internally, the Madanapala nighan.t.u

indicates that heated honey can be taken with water in diseases

caused by a - ma, presumably to enhance agni.

Pacifies kapha Aggravates kapha

Mustard oil Most fats and oils; canola, refined oils, margarine,

trans-fatty acids and hydrogenated fats

Honey Sweet or sweetened foods

Dried fruit, apple, cranberry, Raw vegetables in excess, field mushrooms

grapefruit, lemon, lime, papaya

Raw vegetables (in moderation): sprouted Flour products, white rice, yeasted flour

beans and seeds, spicy salad greens; products, pasta, wheat, rye, spelt

steamed vegetables

Brown rice, quinoa, amaranth, millet, kasha, Peanuts, black gram

barley, popped grains, granola, rice cakes

Most legumes, with spicy herbs Most seeds and nuts

A few seeds: pumpkin, melon Most animal products, fatty meats, especially

to excess

Poultry, wild game, goat, fish, mutton Dairy products

TABLE 7.3 Kapha dos.a.

93

PART 1

Chapter 8

PATHOLOGY AND DISEASE

8.1 Vikara: DISEASE IN A¯YURVEDA

From an A-yurvedic perspective health is defined as the

equilibrium between the dos.as, dha¯tus and malas.

When there is a disruption to this equilibrium the result

is vikara or ‘disease’. Vikara can be seen to have several

different synonyms, each of which details an

aspect of disease, including:

1. Vya¯dhi: ‘pain’, literally referring to the sensation

of a pricking pain, but can be thought of as the

experience of pain.

2. Pa¯pa: ‘evil’ or ‘sin’, referring to the desires and

ignorance of the aham. ka¯ra (‘ego’) that

perpetuates the illusion of individuality, of being

separate from the Whole. Such an orientation

creates a downward spiral into dissolution and

promotes disease.

3. A - ma: ‘undigested food’, referring to toxins and

waste products that impair metabolic activities.

4. Ba¯dha: ‘trouble’, referring to the hindrance and

obstacles that disease brings to spiritual progress.

5. Dukha: ‘sorrow’ or ‘work’, referring to the

sadness and extra effort that disease brings.

The etymology of the modern English word ‘disease’

suggests that the ‘ease’ by which life is lived becomes

hindered or blocked in some way. While disease can be

at the least an inconvenience, it often strikes at the core

of our being, challenging basic assumptions, attitudes

and behaviours, and as such has profound lessons to

teach, providing opportunities for an expanded awareness

of life and death. Disease and dying are powerful

teachers, and in this respect should be honoured,

embraced and understood, and given our complete

attention and concern.

OBJECTIVES

● To understand the concept of disease.

● To understand the causes of disease.

● To understand the manifestation of disease.

94 PART 1: Theory and practice of A-yurveda

Although A-yurvedic medicine considers the nature

of vikara as being profound and important, others

might argue that some disease is a meaningless, random

event. In many cases it seems as though a disease

is unrelated to factors of personal responsibility, such as

influenza or the plague that appear to affect people

indiscriminately. According to A-yurvedic medicine

there is no disease that is a random event: it is solidly

built on the foundation of previous actions, some of

which may be beyond our ability to fully comprehend,

especially if we insist upon finding a single causative

factor. Thus, rather than simply attributing an epidemic

to a viral or bacterial pathogen, A- yurvedic medicine

always considers co-factors such as diet, lifestyle

and the environment. Thus, in the case of epidemic disease

an A-yurvedic physician would analyse individual

factors such agni and ojas, and then regard the time of

season and the health of the surrounding ecology.

Treatments would be given to control the disease in a

symptomatic way, but ultimately the treatment is

directed towards strengthening agni and nourishing

ojas, and making any modifications to the environment

as seems necessary.

In the Western medical model, and even in the later

teachings of A - yurveda, a great deal of emphasis is

placed upon the differentiation of disease states. While

this is a practical approach, it is a process that

inevitably leads to the fragmentation of knowledge. To

some extent this process is complete in A-yurvedic medicine,

because as a classical science the number of

basic diseases has not been added to for centuries. In

contrast, the number of diseases described in modern

medicine is ever-increasing, despite being hampered by

a comparatively limited materia medica. Modern medicine

has thus become increasingly specialised, such

that it is rare nowadays to find a medical doctor who

has skills in a variety of specialties, such as gastroenterology,

obstetrics and infectious disease. In comparison,

A-yurvedic physicians traditionally worked with all

kinds of diseases, in both genders, with the young and

old, and even treated domesticated animals such as

horses and cows. A-yurvedic physicians profess to practice

the ‘knowledge’ (veda) of ‘life’ (a¯yus), and thus

specialise in understanding the manifestation of this

life principle and the individual living bodies that arise

from it. From an A-yurvedic perspective there are quite

possibly as many diseases as there are people that experience

them, because each state of illness arises from

unique physical, emotional, mental and spiritual factors.

These factors are then assessed according to relativistic

theories such as tridos.a and agnis.omiya

(agni and ojas). The advantage that A - yurveda has

over the fragmented science of pathology is that disease

can be understood as a manifestation of relatively

simple principles, regarding the body as a whole, and

attempting to understand the flux manifested in

the dos.as. As the As. t.a¯ñga Hr.

daya states, ‘. . . the

physician who knows not the name of the disease, but

recognises and understands the influence of the

dos.as, need never be embarrassed’.

8.2 Pañcavidha ka¯ran.

a: THE FIVE

CAUSES OF DISEASE

A -

yurveda clearly states that all disease is made manifest

through the increase and vitiation of the dos.as.

Generally speaking, there are five basic factors that

affect the dos.as:

1. Asa¯tmyeñdriya¯ rtha: the improper correlation

of sense objects (stimuli) with the jña¯na

indriya¯s (‘sense organs’)

2. Prajñapara¯dha: crimes against wisdom

3. Ka¯la and de´sa: seasonal, climatic, ecological and

geological factors

4. Karma: the cause and effect relationship of

thoughts and actions generated through the

repetitive cycles of birth, life and death

5. A - ma: toxins and retained waste products, derived

endogenously or exogenously.

8.3 Asa¯tmyeñdriya¯rtha: SENSE AND

SENSE OBJECTS IN DISEASE

As the first causes of disease, asa¯tmyeñdriya¯rtha is

divided into three separate categories relating to the

use of one’s senses.

Atiyoga

The first misuse of the senses is atiyoga, in which one

or more of the five senses (i.e. nose, tongue, eye, skin or

ear) are over-used or over-stimulated:

Smell: to expose oneself to excessively heavy, sharp or

pungent fragrances and perfumes.

Taste: to over-indulge while eating, or eating too

much of one particular food item.

Pathology and disease 95

Sight: to stare excessively at a certain object, or at

bright objects.

Touch: to expose oneself to extreme temperatures, or

engage in excessive and indulgent forms of tactile

stimuli on a chronic basis.

Hearing: to listen to loud or stimulating sounds.

Hı-na¯yoga

Hı-na¯yoga is the under-usage of the senses, something

that is perhaps not all that common in our comparatively

over-stimulated society. A good example would be

a form of asceticism that deprives certain kinds of sensory

experience, or chronically emphasising one kind

of sensory experience over another. We have been

given all five senses to use for our spiritual development

and to ignore any one of them is to deprive ourselves

of true spiritual growth. Remember that each of the

pañcabhu-tas are manifest in the tanma¯tra¯s, and

each of these stimulates a specific jña¯na indriya.

It is only through understanding the subtle nature of

sense that we gain true insight into the nature of reality.

Examples of under-usage are:

Smell: the avoidance of otherwise pleasing fragrances

or odours.

Taste: excessive fasting, or eating an unvaried diet.

Sight: to not move the eyes around, change one’s

focus or remain in darkness for long periods of time.

Touch: to avoid physical affection and touch.

Hearing: to avoid the sound of voices or music.

Mithya¯yoga

Mithya¯yoga is the distorted or unnatural usage of the

senses, either the over-use or under-use for an end that

is destructive to oneself or another being. In many

respects the insatiable desires of the Western world for

certain commodities deprives those that produce them

from living complete and whole lives. One example

might be our craving for sugar that results in vast

tracks of monocultured sugar cane, produced with

herbicides and pesticides that have replaced traditional

crops in developing countries. The social repercussions

of such desires change social and cultural patterns in

these countries, where traditional sustainable values

are discarded for the fragmentation of industrialisation.

Mithya¯yoga would also indicate the pleasure

taken in harming or torturing another individual, or

the pleasure taken in watching such acts (even in the

form of the so-called ‘horror movie’). Examples of distorted

usage are:

Smell: to expose oneself to toxic, putrid and otherwise

harmful odours.

Taste: to not follow appropriate dietary guidelines, to

consume spoilt, foul or toxic foods.

Sight: to strain the eyes by focusing on tiny or distant

objects, to watch lewd, horrifying and violent acts.

Touch: to touch broken and uneven surfaces or

unclean objects, to cause physical pain.

Hearing: to listen to the sound of someone screaming

or moaning in pain, to expose oneself to harsh and

fearful sounds.

8.4 Prajñapara¯dha: CRIMES AGAINST

WISDOM

The second cause of disease according to A-yurveda is

prajñapara¯dha (lit. ‘crimes against wisdom’). These are

acts performed by a person with body, mind or speech

whose comprehension, intelligence, intent or memory is

deranged in some fashion. There are 12 aspects:

1. Forced expulsion or suppression

of natural urges

Such activities generally upset the flow of va¯ta in the

body and cause its vitiation. A-yurveda lists 13 bodily

urges that should not be suppressed, as follows, which

also describes the result of their suppression:

(a) Sleep: insomnia, exhaustion, headaches, depletes

ojas

(b) Crying: eye diseases, throat diseases, disrupts

pra¯n. a

(c) Sneezing: headache, trigeminal neuralgia, respiratory

disorders

(d) Breathing: dyspnoea, cough, depletes ojas

(e) Belching: cough, hiccough, dyspnoea, palpitations

(f) Yawning: tremors, numbness, convulsions,

disrupts pra¯n. a

(g) Vomiting: nausea, oedema, fever, skin diseases

(h) Eating: low appetite, malabsorption, hypoglycaemia,

mental/emotional irritation

(i) Drinking: thirst, dehydration, constipation,

fatigue, urinary disorders

(j) Urination: urinary disorders, lower backache,

headache

96 PART 1: Theory and practice of A-yurveda

(k) Ejaculation: prostatic hypertrophy, incontinence,

insomnia, mental/emotional frustration

(l) Defecation: constipation, abdominal pain, bloating,

dysuria, poor appetite, autotoxicity, spasm

(m) Flatulence: constipation, abdominal pain, bloating,

dysuria, joint pain.

2. Indulgence in violence

This refers to, as well as overt physical violence, any

harm wished upon another being, or actions by which

we injure another being in any sense. When we take

out our anger, rage or frustration on another being we

generate unwholesome karma and perpetuate the

cycle of violence. We should instead look to why it is

we are experiencing these feelings and find appropriate

ways to vent their expression, and find peaceful solutions

to problems in which violence or aggression

seems like the only answer.

3. Over-indulgence in sexual activity

This point refers specifically to men, who are considered

to have a finite sexual capacity that fluctuates according

to age and seasonal influences (see Ch. 4). It also refers,

however, to excessive sexual activity to the extent that it

becomes indulgent, interfering with dharma (‘duties

and obligations’) and artha (‘generation of wealth and

abundance’). In ancient India sexuality was never

viewed as inherently ‘bad’ or ‘dirty’ as it was in the West,

but rather, as a natural and celebrated form of human

expression. Some A-yurvedic texts such as the As.t.

a¯ñga

Hr.daya even contain rather ‘steamy’ passages that deal

with sexuality, but later texts such as the Bha¯vapraka¯sa

have a fairly rigid and patriarchal approach.20 Although

kama (‘pleasure’) is an essentially positive and worthy

pursuit, like all indulgent acts sensuality and sexuality

are thought to contain illusory elements that can blind

us to deeper insights, and thus confuse our actions such

that sexuality becomes an end in and of itself.

4. Postponement of healing a disease

When any disease manifests, A-yurveda considers this

to be a clarion call from our higher self to attend to the

maintenance of health and equilibrium. By not

acknowledging illness or taking the appropriate measures

to treat it, illness and disease worsen, and lead to

an increasingly poor prognosis.

5. Inappropriate treatments

A -

yurveda suggests that we should seek the most

appropriate form of treatment for any imbalance or

disease, one that seeks to resolve the fundamental issue

rather than suppressing the symptoms. Many treatments

employed by modern medicine are orientated

towards symptom management instead of prevention

and cure, and are thus regarded as a prajñapara¯dha

(‘crime against wisdom’).

6. Disregard for modesty and customs

This point refers to appropriate and inappropriate

behaviours in specific social contexts. A-yurveda counsels

us to be respectful of majority opinions and practices,

which creates trust and faith in our actions.

Being mindful of social customs integrates us within

the social dynamic and removes restrictions upon how

others see us, allowing us to fulfil our dharma with

the least hindrance. It also allows others to feel that

they have space to be who they are, even if you are

proposing change or reform.

7. Disrespect to the venerable and

the aged

A -

yurveda counsels us to show utmost respect and courtesy

to those who have attained significant positions of

(spiritual) influence, and honour our elders and seniors

for their life experience and practical wisdom. This does

not mean that one needs to sacrifice one’s integrity,

only create a space for the venerable that is openminded,

non-judgemental and respectful. Most traditional

cultures revolve around the decisions and

insights of their elders, whereas in our increasingly

puerile society, elders and seniors are obsolete,

sequestered away in senior centres and resorts far away

from the children and adolescents who could best benefit

from their grace, compassion and wisdom.

8. Travelling at improper times and

in improper places

A -

yurveda traditionally acknowledges certain times of

the year that are considered to be bad times to travel,

especially when the weather is poor. Travel during

autumn (vars.a) was typically avoided, and even the

wandering sannyasin (‘religious ascetic’) would temporarily

take up residence in a village or a monastery

Pathology and disease 97

until the weather improved. During vars.a, va¯ta is

already said to be in an increased state, and thus excessive

movements such as travelling will compound the

effects of this seasonal tendency and promote the vitiation

of va¯ta. Certain places such as burial grounds

and cemeteries were traditionally considered to be dangerous

places to be at certain times, such as during

a full moon, or in the middle of the night.

9. Friendship with those who commit

crimes against wisdom

A -

yurveda suggests that by maintaining friendships

with persons who have little or no moral character we

expose ourselves to negative influences that may

cause us to commit prajñapara¯dha. A-yurveda states

that these people do not need to be judged, reviled and

rejected, but that we should maintain a certain distance

that prevents us from coming under their direct

influence.

10. Abandoning good habits

Indulgent attitudes such as ‘just this once’, are behaviours

that, when taken alone, may seem harmless but

provide precedents for repeated incident. Although

these influences are often hidden until after the act

has been committed, the effect of these habits begins

to accumulate and promote imbalance, both in mind

and body. Firmness and discipline of mind and body, as

well as compassion for one’s weakness, is the only way

to address such behaviours. The satisfaction of maintaining

this kind of integrity, despite the inconvenience

that it can cause, allows for the continuous flow

of spiritual energy.

11. Negative thoughts and emotions

Although it is difficult to inhibit negative thoughts

altogether, A-yurveda suggests that we need to actively

create feelings of love, compassion and charity to

counter them, and direct these positive feelings

towards ourselves and all other living beings. We

might be inclined to think that our lives are difficult

and unfair, but if we can find even just one thing to be

thankful for we have the seed of how to change our

lives. We see that true satisfaction comes when we

turn inward, and at least feel that awesome power that

sustains each of us, which truly loves us, and become

grounded in this. We cease comparing ourselves to

others, developing externalised criteria for happiness:

we love ourselves so completely that it becomes a great

romance, a profound love. This is the sattvic power of

aham. ka¯ra, recognised by the Buddha in the

Anguttara nika¯ya, who, in his journey for enlightenment,

found that ‘in whatever quarter of heaven

I searched, none could I find whom I loved as dearly as

myself ’. This great love affair is recognised as a facet of

all living beings, and is thus honoured, respected and

shared because it is good and leads to happiness. The

heart is opened and we become a well-spring of our

own divine beauty. Eventually this, too, is seen as

a kind of subtle self-deception, however, and we know

that even positive thoughts can cloud the intelligence.

True wisdom is manifest only in the equanimity and

freedom of buddhi (‘pure awareness’).

12. Over, under or perverted usage

of the body, mind and speech

This point has been covered under sadvr.tta in

Chapter 4. A-yurveda states that all thoughts, words

and actions generate karma, and at some point in the

future these actions will come back to haunt us. If we

are lucky, these bad events happen soon after the act

has been perpetrated, and we see a cause and effect

relationship and an immediate opportunity to remove

an obstruction. If we are unlucky this ripening may

manifest at some distant point in the future, even in

another life, where a cause and effect relationship is

difficult to perceive and may provoke an unskilful

response.

8.5 Parin. a¯ma: SEASONAL AND

CLIMATIC FACTORS IN DISEASE

The third cause of disease, called parin. a¯ma, relates to

periods (ka¯la) of seasonal and climatic changes and

distortions. Like asa¯tmyeñdriya¯rtha, these factors

can be understood to be of three types: atiyoga

(‘excess’), hı¯na¯yoga (‘deficient’) and mithya¯yoga

(‘distorted’). Atiyoga ka¯la relates to excessively hot

weather or extended periods of rain, which can affect

both pitta and va¯ta. Hı¯na¯yoga refers to excessively

cold or dry weather, which affects kapha and va¯ta.

Mithya¯yoga refers to unseasonable weather, particularly

in the transitional periods between seasons

(r.

tusandhi), and can aggravate any of the three

dos.as. Parin.a¯ma however also indicates an ecological

98 PART 1: Theory and practice of A-yurveda

perspective upon disease: that excess, deficiencies and

distortions in the natural environment create disease

in humans and other living creatures. This suggests

that the human relationship with the natural environment

should be respectfully maintained and cultivated.

8.6 Karma AND DISEASE

The fourth cause of disease is the ripening of unwholesome

karmic fruits, which manifest only when the

conditions are right for them to do so. In some respects

it is a highly esoteric subject but one that cannot be

avoided, especially when we confront the issue of disease.

If disease is indeed a manifestation totally or in

part due to karmic influences then the opportunity to

see disease and death as a healing journey cannot be

over-estimated. According to jyotis., or Vedic astrology,

specific karmic influences can be seen in an

astrological chart by the position of ´Sani (‘Saturn’),

Ra¯hu (‘lunar north node’) and Ketu (‘lunar south

node’). Specific regimens such as the repetition of

mantra, the performance of good works (karma

yoga), asking a deity for assistance (bhakti yoga), the

wearing of certain colours, precious metals and gem

stones, and avoiding negative thoughts can all be

utilised to negate the effects of unwholesome karma,

but nothing may stop its effects entirely.

8.7 A¯ ma AND DISEASE

The fifth and final cause of disease is a¯ma, the metabolic

and psychological residue that impairs the function

of the body, mind and senses. By disrupting the

flow of energy in the body, a - ma promotes the vitiation

of va¯ta, the dos.a most associated with the disease

process. A - ma is easily recognised by kaphaja symptoms

such as lethargy, fatigue, a lack of enthusiasm,

mucoid congestion, weak digestion, constipation,

abdominal distension, orbital oedema, rectal itching

and a thick coating on the tongue. A¯ma can associate

with any dos.a, especially in va¯ttika conditions, in

which the patient becomes weak and thin while continuing

to display what might be considered kaphaja

symptoms. The concept of a¯ma was introduced in

Chapter 4, and is explored further in Chapters 9

and 10.

8.8 Rogama¯rgas: THE PATHWAYS

OF DISEASE

A -

yurveda recognises three pathways of disease

(rogama¯rgas), or three distinct levels in which disease

will manifest in the body. The first pathway of

disease is the ‘inner pathway’ or añtarma¯rga, consisting

of the digestive and respiratory systems. Although it

is called the ‘inner pathway’, it is actually the most

superficial level that disease can manifest in, and is

thus comparatively easy to treat. Examples of conditions

that manifest on this level include vomiting, gastritis,

abdominal bloating, constipation, diarrhoea,

piles, coughing, dyspnoea and fever. Treatments typically

consist of internal therapies such as ingestion,

inhalation and enema.

The second pathway of disease is the ba¯hya

rogayana, or ‘outer pathway’, consisting of the circulatory,

lymphatic and integumentary systems. The

outer pathway of disease is a little more difficult to

treat, as conditions within this pathway can be considered

to be conditions of the inner pathway that have

been driven deeper, from the gastric and respiratory

mucosa into the blood, lymph and skin. Examples of

conditions on this level include eczema, acne, boils, psoriasis,

granuloma, warts, swollen lymph nodes, oedema

and arterial disease. Treatments for the ba¯hya

rogayana typically consist of internal therapies in

combination with external therapies such as svedana

(‘diaphoresis’).

The third pathway of disease is the madhyama

rogama¯rga or ‘middle pathway’, consisting of deeper,

harder to reach tissues such as the nervous and

endocrine systems, the kidneys, heart, bones and muscles.

It is the deepest level in which a disease can manifest,

and also represents the most difficult kind of

disease to treat. It is called the ‘middle pathway’

because it is sandwiched between the other two levels,

making accessibility difficult. Examples of conditions

on this level include paralysis, mental disorders,

seizures, wasting, osteoporosis, rheumatoid arthritis,

renal failure and heart disease. Typically, a combination

of both internal and topical therapies will be

required.

Pathology and disease 99

8.9 Vya¯dhya¯vastha¯: THE

PATHOGENESIS OF THE DISEASE

As we have learned in the previous sections, the dos.as

are responsible for all negative changes in the body,

not as causal agents per se, but as mediators of internal

and external influences. In Chapter 2 we learned

how to identify the dos.as according to their laks.an. as

(‘symptoms’) and how they undergo caya (‘increase’)

and kopa (‘vitiation’). In truth, this process is only

a simplified description of vya¯dhya¯vastha¯ (‘pathogenesis’),

in which three separate categories are recognised:

1. S.

atkriya¯ka¯las: sixfold progression of dos.a

increase, vitiation and disease manifestation

2. Vegavastha¯ and avegavastha¯: exacerbatory

and remissive symptoms

3. Dos.apa¯ka avastha¯: the digestion and removal

of a¯ma.

S.

atkriya¯ka¯las

The first classification of vya¯dhya¯vastha¯ describes

a sixfold process of pathogenesis, in which the dos.as go

through progressive stages called the s.

atkriya¯ka¯las:

1. Caya (‘accumulation’): the dos.a(s) undergo

caya (‘increase’) in their stha¯nas (lit. ‘seat’ or

‘location’): va¯ta in the antra (‘colon’) and vasti

(‘urinary bladder’); pitta in the a¯ma¯´saya

(‘stomach and duodenum’) and yakrit (‘liver’);

and kapha in the hr.daya (‘heart’) and

phuphphusa (‘lungs’).

2. Prakopa (‘aggravation’): the dos.a(s) undergo

further increase within their respective sites

(stha¯na) and begin to manifest as amorphous

health issues, as a sense of physical uneasiness

that is indiscernible but definitely noticeable.

3. Prasa¯ra (‘migration’): the increased dos.a(s)

now begin to migrate from their respective

stha¯ nas into other locations of the body,

settling in weak areas of the body.

4. Stha¯nasam. ´sraya (‘localisation’): the dos.a(s)

now settle into weakened dha¯tus, and begin to

alter their function.

5. Vyakti (‘manifestation’): the dos.a(s) now begin

to manifest discernible signs and symptoms, mostly

in the acute stage. At this stage the disease can be

classified, and the specific characteristic of the

dos.as can be identified.

6. Bheda (‘fruition’): the nature of the condition

becomes chronic and the debilitating effects of the

disease become manifest. The person afflicted

with the disease becomes weakened and

treatment becomes progressively more difficult.

Vegavastha¯ and avegavastha¯

The second classification of vya¯dhya¯vastha¯ is vegavastha

¯, the stage ‘during the attack’ (acute symptoms),

and avegavastha¯, the stage ‘between the

attack’ (chronic or remissive symptoms). The knowledge

of these states allows the practitioner to establish

a clear line of treatment. During vegavastha¯ the

treatment consists of balancing the dos.as (´samana),

while during avegavastha¯ the treatment is focused on

removing the cause of the disease (´sodhana),

strengthening digestion (dı-panapa¯cana) or attending

to rejuvenation (rasa¯yana).

Dos.apa¯ka avastha¯

The third classification of vya¯dhya¯vastha¯ is dos.apa¯-

ka avastha¯. The term paka means ‘digestion’, and it

is at this stage that a¯ma becomes separated from the

dos.as and dha¯tus and is digested. The dos.as also

begin to normalise and move to the kos.t.

ha (lit. ‘digestive

tract’, but referring to all aspects of elimination).

Outer surface Antarmarga

Bahya rogayana Madhyama rogamarga

Inner surface

Figure 8.1 The rogama- rgas.

100 PART 1: Theory and practice of A-yurveda

Dos.apa¯ka avastha¯ is noted by such symptoms as a

normalisation of body temperature, lightness of the

body, renewed sensory perception, increased strength

and an improvement in mental and emotional clarity.

Such symptoms indicate a good prognosis, and it is

usually at this stage that therapies such as pañca

karma are most favourable (see Ch. 11). Although

they can bear some resemblance to one another,

dos.apa¯ka avastha¯ must be clearly separated from

avegavastha¯, and vice versa.

8.10 Dvividha roga: THE TWO KINDS

OF DISEASE

A -

yurveda identifies two basic pathological processes:

that which is a ‘primary manifestation’ (sva¯tantra),

and that which is a ‘secondary manifestation’ or

a sequela (paratantra). Sva¯tantra diseases are easily

identified, and have specific causes and easily recognisable

symptoms and signs. In contrast, paratantra

diseases are opposite in nature and do not have specific

causes, nor do they manifest in predictable or easily

discernible ways. Paratantra diseases are the sequelae

(secondary conditions) of sva¯tantra diseases, and

thus their treatment is dependent upon the removal

of the primary condition. If during treatment, however,

the sequelae of the primary disease remain

unchanged, then specific treatment is also given to

them. In cases where the signs and symptoms of the

sequelae are worse than the primary disease, they are

given preference in a treatment regimen.

ENDNOTE

20 Most historians agree that ancient India has fairly strong matriarchal

roots, but in response to successive invasions by Arabs,

Persians and Europeans during the medieval period India

became an increasingly patriarchial society, in which women

and sexuality became increasingly limited in their expression.

India is only now reclaiming its heritage in this regard, such as

the efforts made by the government in the state of Kerala to promote

economic and societal prosperity by ensuring literacy

among women.

101

9.1 Nida¯na: CLINICAL ASSESSMENT

In Chapter 8 we learned that vikara (‘disease’) and its

various synonyms are classified according to the concept

of nida¯na, which means ‘causes’. Nida¯na is the

model of aetiology and pathology in A¯yurvedic medicine,

and under this practice the signs and symptoms

of a patient are classified according to specific criteria,

assessed by a thorough examination of the case history

(da´savidha parı¯ks.a¯), physical observation

(pratyaks.a), and specialised assessment techniques

(as.ta¯stha¯na parı¯ks.a¯). Chapter 9 details the components

of da´savidha parı¯ks.

a¯, or the ‘ten methods of

assessment’ used to analyse the case history, whereas

Chapter 10 details the as.t.

a¯stha¯na parı¯ks.a¯, eight specialised

assessment techniques, including pulse and

tongue diagnosis.

9.2 Trividha parı¯ks.

a¯: THREE SOURCES

OF KNOWLEDGE

Before we can even begin to study the patient, Caraka

tells us that we must consider three basic sources of

knowledge when gathering the evidence to support any

kind of therapeutic regimen. These are a¯ptopade´sa,

pratyaks.a and anuma¯na.

A¯

ptopade´sa

A¯

ptopade´sa is derived from the term ‘aptas’, referring

to persons whose memory and comprehension are

sound and complete. Specifically, Caraka tells us that

a¯ptopade´sa refers to wise teachings that help us

understand the nature of health and disease, such as

OBJECTIVES

● To review the clinical methodology of

A -

yurveda.

● To review case history techniques in

A -

yurveda.

PART 1

Chapter 9

CLINICAL METHODOLOGY AND

CASE HISTORY

102 PART 1: Theory and practice of A-yurveda

A¯

yurveda. In context with nida¯na however, a¯ptopade

´sa means ‘interrogation’, referring to questions

asked of the patient, family and friends to determine

the case history.

Pratyaks.a

Pratyaks.a means ‘direct observation’, or the use of

one’s own senses and mind to observe the patient. This

includes techniques such as visual observation, auscultation,

percussion, palpation and odour. When the

patient complains of digestive disorders, for example,

this may include observing the abdomen for distension,

protuberances or discolorations, listening to

the abdomen for borborygmi (intestinal gurgling), tapping

the abdomen to determine the nature of the

abdominal distension, gently pressing upon the different

areas of the abdomen to determine the presence of

any swellings or masses, and smelling the patient’s

breath.

Anuma¯na

Anuma¯na are factors in the patient’s health that cannot

be observed directly. For example, if a patient complains

of a bad taste in their mouth this cannot be

observed or experienced directly. Instead, an A¯yurvedic

physician must rely upon the ‘case history’

(a¯ptopade´sa) by asking the patient questions, and

by utilising specialised techniques of ‘inference’

(anuma¯na). For example, Caraka mentions that flies

are more often attracted to a person who has a sweet

taste in his or her mouth, which generally speaking

denotes an increase of kapha. Similarly, Caraka states

that the determination of raktapitta, a haemorrhagic

disease caused by pitta, can be tested by having a dog

taste the blood – if the dog rejects the blood then the

bleeding disease is inferred to be raktapitta. Thus

anuma¯na is any source of medical information that is

arrived at purely through inferential means, no matter

how simple, skilled or unique the techniques are.

Although anuma¯na refers specifically to those techniques

mentioned under as.t.

a¯stha¯na parı¯ks.

a¯ (see Ch.

10), one could consider certain medical tests as a kind

of anuma¯na since these tests do not describe

the nature of a disease, only a temporary fragment

or snapshot of the blood, urine, saliva, etc., and should

be carefully interpreted in context with the patient’s

case history and physical signs and symptoms.

Caraka states that it is of the utmost importance to

base any therapy upon these three aspects of knowledge,

first beginning with one’s own training and the

case history of the patient (a¯ptopade´sa), and then

through direct observation (pratyaks.a) and then specialised

diagnostic techniques (anuma¯na). When any

one of these three aspects in data collection is ignored,

or if one is overemphasised (as is often the case with

blood tests, pulse diagnosis, etc.), Caraka states that

the knowledge obtained is fallible. Fallibility in assessment

leads an inaccurate diagnosis and ineffective or

even harmful treatments.

9.3 CRITERIA FOR PHYSICIANS,

PATIENTS AND TREATMENT

LOCATION

Healing best occurs when the physician acts with wisdom,

when the patient maintains the best mental state

and actions conducive for healing, and when the environment

is well-suited for healing to take place. Caraka

states that the physician should be pure from both

mental as well as physical defilements, possessing all

the normal sense faculties as well as the necessary

equipment to undertake clinical assessment. The

physician should be an expert in the observation of life

and its various manifestations, and should have studied

the medical texts and committed them to memory.

The physician should also have practical experience in

the treatment of disease, and should display this skill in

assessment as well as in the analysis of the condition

and in the determination of the treatment. Physicians

are also counselled by Caraka to be sympathetic and

kind to all patients, and reside in a state of equanimity

regardless of prognosis. This later point is particularly

germane, especially with novice physicians, who have

a tendency to take the progress of their patient somewhat

personally.

The qualities of the patient are also important to

consider, and in ancient texts such as the Asta¯ñga

Hr. daya and the Caraka Sam. hita¯ physicians are

encouraged only to work with patients who listen to

and practice the advice given to them. It is important

that the patient has a strong will power and control

Clinical methodology and case history 103

over the senses, and is capable of accurately reporting

the details of his or her health to the attending

physician. The A¯yurvedic texts state that the physician

should reject patients who are ungrateful, rude

and impolite, those who are sceptical or afraid of the

treatment regimen, those who have no will power, or

those patients that are constantly in a hurry and too

busy to follow through with the recommendations.

Although it is the duty of physicians to be compassionate,

A¯yurveda suggests that the physicians should

not hesitate to distance themselves from bad patients,

in order to protect their honour and the honour of the

medicine.

According to Caraka the clinic or hospital should be

designed by an architect trained in vastu ´sa¯stra, the

ancient science of Indian architecture. In many

respects vastu ´sa¯stra bears some similarity to the better-

known Chinese system of feng shui. According to

vastu ´sa¯stra, the building is viewed as a body composed

of different energies that are represented by different

deities. For example, the very centre of the

house corresponds with Brahma¯, the Lord of Creation,

and is traditionally left empty (such as a courtyard) to

invite Brahma¯ into the heart of the home. Vastu

´sa¯stra states that disease can occur in someone who

lives in a house that was not built properly, and that

the location or type of disease may indicate the afflicated

part of the house.

The building should be strong and well-built in

a location free from high winds, although it should

be constructed in such a way that gentle winds can

pass through it if desired, freshening the interior

environment. The building should not be built in

mountainous places (for lack of accessibility), and

nor should it be located next to a bigger building

(which brings misfortune upon it). Dusty locations,

wet environments, or locations with foul or toxic

smells should be rejected as building sites. The attendants

that work in the clinic or hospital should be

enthusiastic, skilled and compassionate. Caraka

states that people well versed in music and poetry

should also be encouraged to participate in the healing

centre. Outside the building a herb and vegetable

garden should supply medications and food for the

clinic or hospital, and certain animals, such as a cow

and her calf, and birds such as quail and partridge,

should be kept by the facility for the benefit and

enjoyment of the patients and faculty.

9.4 Nida¯na pañcakam: THE FIVE

METHODS OF INVESTIGATION

There are five methods by which an A¯yurvedic physician

gathers clinical information to formulate a diagnosis,

called nida¯na pañcakam. They are:

1. Nida¯na: aetiology of the disease

2. Pu¯rvaru¯pa: prodromal symptoms

3. Ru¯pa: symptomology

4. Upashya and anupa´saya: trial and error

5. Sam. pra¯pti: pathology.

Nida¯na

Nida¯na as ‘aetiology’ refers to the causative factor of

disease (vikara), the basic components of which have

already been discussed in Chapter 8. Since the nida¯na

or cause of a specific disease may be the same for

another disease, such as the consumption of unwholesome

foods or lack of sleep, nida¯na alone cannot provide

enough information to diagnose a specific disease,

and thus more information is required.

Pu¯rvaru¯pa

Pu¯rvaru¯pa are the premonitory symptoms, or generalised

symptoms that appear before the appearance

of a disease. In some cases these symptoms are nonspecific,

such as fatigue in jvara (‘fever’), and do not

indicate the involvement of a specific dos.a. In other

cases, however, the pu¯rvaru¯pas are highly specific. In

the case of jvara for example, yawning is given as

a pu¯rvaru¯pa of va¯taja jvara, burning sensations in

the eyes for paittika jvara, and a loss of appetite in

kaphaja jvara. The identification of specific

pu¯rvaru¯pas may help in the early diagnosis of a disease,

assisting in the efficacy of preventative treatments

and in the differentiation of the syndrome from

other conditions.

Ru¯pa

Ru¯pa are the signs and symptoms of dos.a vitiation

that are characteristic of a particular syndrome or disease.

In the earlier Vedic literature all disease

is described as being one of two archetypal forms:

takman (jvara), a disease of ‘fever’ and ‘excess’; and

104 PART 1: Theory and practice of A-yurveda

yaks.ma (ka´sa¯ya), a disease of ‘wasting’ and ‘deficiency’.

In this respect takman represents the acute,

immediate stage of disease, whereas yaks.ma relates to

the chronic, end-stage of disease. The comparatively

later Caraka and Su´sruta sam. hita¯s expand upon this

simple dichotomy and enunciate several different diseases

(or stages) that exist between them, and over the

centuries the number of diseases gradually increased,

finally culminating in the Ma¯dhava nida¯nam (c. 7th

century CE), a text that solely specialises in pathology.

This approach of differentiating signs and symptoms

into specific diseases appears obviously similar to modern

pathology, but in actual fact diseases in A¯yurveda

are also arranged to illustrate the spectrum of different

treatments within the takman and yaks.ma

dichotomy. In describing diseases such as jvara

(‘fever’), atisa¯ra (‘diarrhoea’) and kasa (‘cough’)

A¯

yurvedic medicine orientates the practitioner to a

specific set of symptoms, as well as specific set of remedies

that can be used to treat them, e.g. Gud. u¯cı¯

(Tinospora cordifolia) for jvara, Da¯d. ima (Punica granatum)

for atisa¯ra, and Va¯saka (Adhatoda vasica) for

kasa, etc. While each disease category displays general

characteristics it also contains potentially diverse manifestations

based on the differing activities of the

dos.as, dha¯tus and malas. Thus while jvara (‘fever’)

is generally characterised by an increase in body temperature,

secondary symptoms are based on the underlying

manifestation of the dos.as, identified by the

gun. as each sign or symptom represents, for example:

● In va¯ttika jvara, the ru¯pa is noted by qualities

such as rapid temperature fluctuations (cala), dryness

of the throat and lips (ru¯ks.

a), insomnia (´sita,

laghu), dehydration (ru¯ks.

a, laghu), headache

(´sita), constipation (ru¯ks.

a), bloating (laghu,

cala), excessive yawning (laghu, cala).

● In paittika jvara, the ru¯pa is noted by qualities

such as a very high and constant temperature

(us.n.

a), diarrhoea (sara), insomnia (us.n.

a, laghu),

mucosal ulceration (us.n.a, snigdha), burning sensations

(us.n.

a), and thirst (us.n.

a).

● In kaphaja jvara, the ru¯pa is noted by qualities

such as a feeling of coldness (´sita), mild temperature

increase (´sita), lassitude (guru), stiffness

(´sita), nausea and vomiting (´sita), horripilation

(´sita), mucus congestion (snigdha, ´sita),

rhinitis (´sita, snigdha), and a lack of appetite

(´sita, guru).

As a result of understanding these subtypes of jvara

we are inclined to use antifebrile herbs such as Gud.u¯cı¯

(Tinospora cordifolia) in combination with herbs that are

specific to the dos.a or dos.as manifest: for example,

with Harı¯takı¯ (Terminalia chebula) and saindhava in

va¯taja jvara; with U´sı¯ra (Vettivera zizanioides) and

Candana (Santalum album) for paittika jvara; and

Kan.

t.

aka¯ri (Solanum xanthocarpum) and ´Su¯n.t.

hı¯

(Zingiber officinalis) for kaphaja jvara, etc. Thus each

sign or symptom described as ru¯pa immediately

announces its complement in nature, be it any influence,

such as a herb, food, place, person, colour,

mantra etc. What remains is for the A¯yurvedic physician

to understand, analyse and integrate these relationships.

Even the most skilled A¯yurvedic practitioner,

however, may be unable to ascertain these relationships,

and based on their best understanding will formulate

a hypothesis, a method of trial and error called

upa´saya and anupa´saya.

Upa´saya and anupa´saya

The term upa´saya refers to the administration of treatments

orientated to relieve the signs and symptoms of a

given condition, and is of two types: viparı¯ta upa´saya

and viparı¯ta¯rthaka¯ri upa´saya. Viparı¯ta upa´saya is

the successful administration of medicaments that are

opposite in nature to the condition being treated, essentially

an allopathic effect (‘opposite cures opposite’). For

example, the Indian herb Pippalı¯ fruit (Piper longum)

displays qualities such as us.n.

a, ru¯ks.

a and laghu, and

these are used to counter the ´sita, snigdha and guru

nature of kaphaja diseases such as kasa (‘cough’).

Similarly, the ru¯ks.

a and ´sita gun. as of Kut.aja bark

(Holarrhena antidysenterica) are used in paittika conditions

such as atisa¯ra (‘diarrhoea’), and the us.n.

a and

guru qualities of A´svagandha¯ root (Withania somnifera)

are used to counter va¯taja diseases such as

ka´sa¯ya (‘consumption’). We could even consider the

usage of drugs such as acetaminophen in the treatment

of fever to be viparı¯ta upa´saya, although because

acetaminophen only suppresses inflammation and

does not resolve the underlying cause of the disease its

usage could be considered a prajñapara¯dha (‘crime

against wisdom’), or vya¯dhi asa¯tmya (‘unwholesome’).

The second classification of upa´saya, called

viparı¯ta¯rthaka¯ri upa´saya, is the administration of

treatments that have qualities of a similar nature to

Clinical methodology and case history 105

the condition being treated but also bring relief. For

example, an A¯yurvedic physician might use the

emetic herb Madanaphala (Randia dumetorium)

in the treatment of vomiting, usually in doses well

below those that could be considered to have a physiological

effect. Viparı¯ta¯rthaka¯ri upa´saya is an

expression of the homeopathic axiom ‘like cures like’

coined by Samuel Hahnemann, an idea similarly

found in almost every other traditional system of

medicine, including those of ancient Mesopotamia

and Egypt. Although A¯yurvedic physicians are traditionally

trained in some homeopathic treatments, in

India, as well as in ancient Mesopotamia and Egypt,

this class of treatment was more often a matter of

religious and spiritual speculation and hence officiated

by a class of skilled priests or spiritual intermediaries.

With the evolution of a secular form of

homeopathic medicine in the West, however, homeopathic

principles in A¯yurvedic medicine evolved into a

separate system of ‘Indian’ or ‘A¯ yurvedic’ homeopathy,

which is based on both A¯yurvedic and modern

homeopathic principles.

The opposite of upa´saya is anupa´saya: treatments

that promote a worsening of the signs and

symptoms of a disease. Anupa´saya can be the result

of treatments that are either similar or opposite to the

qualities of the condition being treated. When

anupa´saya occurs treatment is withdrawn immediately

and a new approach is undertaken. It is important

to distinguish anupa´saya from other clinical

events, however, such as insufficient dosage, too high

a dosage, and drug interactions.

Sam. pra¯pti

Sam. pra¯pti is the course by which a dos.a becomes vitiated

and produces a specific disease. This is unlike

vyadhavastha¯ described in Chapter 8, which is a more

general model relating to the pathogenic influence of

the dos.as. Sam. pra¯pti is divided into five parts:

1. Sa¯n.khya: Sa¯n.khya sam. pra¯pti is the enumeration

of several distinct disease states, such as jvara

(fever), chardi (vomiting) and kus.t.

ha (skin disease),

each with unique clinical features. In turn,

each disease is then classified according to the

dos.as. Jvara for example, is classified into 25 categories,

depending upon the state of the dos.as, the

duration of the condition, stress, injury, environmental

influences, etc.

2. Vı¯kalpa: Vı¯kalpa sam. pra¯pti is simply the recognition

of the quality (gun.a) of a specific symptom

and its correlation with a particular dos.a. Thus the

drava (liquid) alteration of the bowel movement in

diarrhoea indicates pitta, because drava is a gun.a

of pitta. Similarly, if the eyelids go into spasm, this

is identified as excess movement (cala), and is correlated

with va¯ta.

3. Pra¯dha¯nya: Pra¯dha¯nya sam.

pra¯pti constitutes

an analysis of which dos.a is the predominant

dos.a in the pathology or pathologies, especially

when a disease arises from the vitiation of two or

more dos.as.

4. Bala¯: Bala¯ sam. pra¯pti is an analysis of the

strength of the disease, based on an assessment of

the nida¯na, pu¯rvaru¯pas and ru¯pas. If all three

factors are clearly manifested then the disease is

said to be severe, whereas if they are only partially

manifested the disease would be classified as mild

to moderate.

5. Ka¯la: Ka¯la sam. pra¯pti is the analysis of biological,

daily and seasonal influences that indicate the influence

of the different dos.as in disease. In some cases

it can be observed that a condition manifests only at

a certain time of day. In ka¯sa (cough) for example,

if the symptoms manifest only in the morning or

the evening, then this would clearly be distinguished

as a kaphaja ka¯sa.

9.5 Da´savidha parı¯ks.

a¯: TEN METHODS

OF EXAMINATION

It is important that the practitioner gain a thorough

knowledge of the patient’s state prior to treatment, and

A¯

yurvedic tradition suggests that case history taking

should contain ten components, called da´savidha

parı¯ks.

a¯:

1. Du¯s.yam: the state of the dha¯tus

2. Ka¯lam: the staging or progression of the

condition

3. Prakr. ti: the constitution of the patient

4. Vayah.

: the age of the patient

5. Bala¯m: the strength of the patient

6. Agni: the digestive capacity of the patient

7. Sattva: the mental and emotional state of the

patient

8. Sa¯tmya: the lifestyle habits of the patient

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to   Sreeman Todd Caldecott, Elsevier’s Health Sciences and others other eminent medical scholars and doctors   for the collection)