Chapter 5 - The Study of Constitution

The outstanding fact of life is that no two individuals are exactly alike either in appearance or physical and mental aptitudes, abilities and gifts. This is because each person occupies a point in space-time different from that of every one else. This endows on each person at the very moment of his coming into being, a peculiar group of qualities and tendencies through the ‘genes’ Each person thus enters into life with a peculiar viewpoint, mode of reaction to environment and susceptibility to physical and psychic influences. That is why we find that though people live in a common environment no two of them react in identical fashion.

The great physician Osler says,

“No two persons react equally to incursion of injury. No two persons suffering from the same disease run exactly similar clinical courses”.

All this emphasizes the supreme importance of the knowledge of individual constitution in medicine.

It is difficult to say at the present stage of human knowledge, how and what factors go into the making of this unique bundle of tendencies and qualities, why certain ancestral and race traits get to be recessive in one child and dominant in another. But that such is the case is evident from the investigations of Mendel and other scientists who have tried to reduce the subject into a biological law.

Classification of Types

If one is over-scrupulous in statement there are as many types as there are individuals. But that is unhelpful in reducing the subject to some approximate formula. Therefore some biologists and medical scientists have classified these types, racewile, groupwise regionwise and in some other ways. But the inadequacy of these classifications becomes evident from the medical clinician’s point of view when individuals of the same race, group or region show divergent reactions and degrees of tolerance to common disease-factors. Hence a totally biological classification and grouping alone is entitled to the clinician’s credence and appreciation.

In the ancient pathology of India and to an approximate degree in that of ancient Greece, such a biological view and classification do obtain. In India or constitution has been broadly classified into three groups allowing of innumerable minor groupings according to the varied combinations of these three main categories. This classification was done both from the physiological and pathological points of view, in the light of the triumvirate of biological organizations. This classification became the guiding spirit of the clinician and the patient in the maintenance of positive health and in prophylactic as well as curative measures of disease. It was also the beacon light in the realm of diagnostics and practical therapeutics

In the daily regimen of diet and behaviour meant for balancing and correcting the predisposing factors of disease, this constitutional perspective was considered of supreme significance.

Caraka says,

[Carakasaṃhitā Sūtrasthāna 7.41]

“A practice of things antagonistic in effect to one’s predisposing factors, is recommended in the wholesome living”

This contains the beginnings of the science of immunity in its active aspect where the individual is enabled to react powerfully with all his vital power of resistance.

The term “constitution” is used in physiology nearly in the same sense as in' sociology wherein it is defined as the fundamental law according to which the government of a state is organized and the relations of individuals with society as a whole are regulated. This regulation is accomplished by the legislature, the administration and the judiciary, all of them co operating with and dependent on each other. Thus it is with the integrated physiology. The millions of body-cells, the nervous system, the heart, the lungs and the intestines, all act in a coalition-government and mutually impel and check and balance and produce an integrated and harmonised result that is life and good health. Ayurveda depicts this integrated function in terms of the triumvirate of biological organizations and their mutual interaction.

Prakriti or Constitution in Ayurveda

Constitution is called Prakriti in Ayurveda. It is the sum total of the crystallized results of all the influences of time and space on individual human life. It is easy to see that since no two individuals can occupy the same point in this time space world, no two individuals are identical in all respects. It is now for us to understand the various factors that constitute this time-space in order to ascertain and define its variable influences on constitutions, as also the multiple of its types.

‘Space’ connotes the geographical and climatic conditions of the region of the individuals residence and all the characteristics of the social and physical environment of the man, while “time” refers to the age of the individual, the seasonal characteristics and the sum total of the influences from the inception of the man commencing from the moment of impregnation of the mother’s ovum or even much earlier. The germ-cell contains the tendencies developed through all previous Incarnations and thus is traced ultimately to the very beginning of time.

It is common knowledge now that the fetus undergoes all. the evolutionary metamorphoses of its biological ancestry in the uterus before it emerges as a full-fledged human. Thus the whole experience of the species is in the germ-cell. This is known as (śūkra-śoṇita-prakṛti)—genes. The peculiar influence inherited from both the parents and the combination of the formative forces, such as climate, season and environment, obtaining at the time of impregnation—all these, go to shape the constitutional destiny of the individual. The inheritance of previous incarnations, being subtle, is psychic, but they in turn have their influence on the somatic reactions. Thus at birth, a whole world of influences has already been at work in giving the individual a definite predisposition, a definite pattern of tendencies set in motion, which determines his, or her degree of tolerance and resistance to external and internal disease factors. The varying effects of climate on the gravida and her habits and tendencies and social and seasonal environment are bound to have profound consequences (kāla-garbhāśaya-prakṛti) and (mātura-āhāravihāra-prakṛti). Thus at the very moment of birth, the individual is a complex being, a bundle of tendencies bearing the seal of destiny, with of course, a margin for freedom of will and action.

Constitution is an inherited or genotypical condition, that cannot be altered fundamentally and is a life-long concern and of supreme significance in determining the conditions of health and disease in man.

This is well expressed m the following verses of Caraka and Sushruta.

[Carakasaṃhitā Sūtrasthāna 7.39-40]

“From the moment of coception some men are equi-balanced as regards the three vitia—Vata, Pitta and Kapha, and some have a predominance of Vata, some, of Pitta and some of Kapha.

[Carakasaṃhitā Sūtrasthāna 7.39-40]

“Of them the first alone enjoy perfect health while the rest are ever liable to disease. Their body-habitus is named according to the continual predominance of a particular vitium in the body”.

[Suśrutasaṃhitā Śārīrasthāna 4.63]

“These are the symptoms of the heriditary disposition or constitution formed by the predominant vital habitus formed at the time of the fertilization of the ovum by the sperm”.

[Suśrutasaṃhitā Śārīrasthāna 4.63, Ḍalhaṇa-ṭīkā]

“There any part of the healthy seed (germ-cell) is vitiated by the nature and action of the Vitia, i.e., Vata and the rest, that part of the germ-cell determines the future constitutional type of the person”. (Commentary by Dalhana on the above verse).

[Suśrutasaṃhitā Śārīrasthāna 4.78)]

“The constitutional condition does not get changed, nor increased nor diminished generally except at the end of life”

Thus the importance of knowledge of constitution is established both in physiology as well as pathology.

Caraka propounds that there are three main classes of persons. They are the Vatala, the Pittala and Shlesmala i.e. the one of Vata habitus, that of Pitta habitus and that of Shlesma habitus. These are the three main constitutional groups in each of whom one of the triumvirate of biological organizations is predominantly active or ronounced. There are various degrees of combinations of these vitia (doṣa) as these habituses are called, of two or three of these being jointly in a hyper or hypo condition. When the symptoms associated with and characteristic of each of these vitia are known, the degree of their combination can be inferred from them.

Laying out the general outline of three main categories of constitution, Caraka declares that in the clinical investigation of these three types of constitution the following are their characteristic traits and qualities. (Carakasaṃhitā Vimānasthāna 8)

95-(I) We shall now explain the characteristics of habitus etc. It it thus. The fetal body develops its habitus from the nature of the mother’s diet and behaviour, and the nature of the proto-elemental combinations

95-(II). Among these factors, whichever elements are predominant, will be observed to influence the nature of the fetus; therefore are men spoken of, as of such and such habitus and vitial susceptibility beginning from their fetal life.

95. Hence some are of Kapha habitus, some are of Pitta habitus and some of Vata habitus; some are of the combined habitus. Some are possessed of vitial equipoise. The characteristics of these, we shall describe here

96-(I). The Kapha is unctuous, smooth, soft, sweet, firm, dense, slow, stable, heavy, cold, viscid and clear

96-(II). Kapha, being unctuous, those of Kapha habitus have glossy limbs; on account of its smoothness they have smooth limbs; owing to its softness they have pleasant, delicate and clear bodies, owing to its softness they have pleasant, delicate and clear bodies; owing to its sweetness they have a profusion of semen, desire for the sex-act and children. On account of its firmness they have firm, well-knit and stable bodies; owing to the denseness of Kapha, they are plump and rounded in all their limbs Owing to its slowness, they are slow in their actions and speech; due to its stability, they are slow in their undertakings and in the change of moods and pathological condition; owing to its heaviness, they are of firm, large and stable gait, owing to its coldness, their hunger, thirst, heat and perspiration are meagre; owing to its viscidity, they are firm and well-knit in their joints. Similarly owing to its clearness they are of clear looks, of clear and mellow complexion and voice

96. Owing to the combination of such qualities, those of Kapha habitus are possessed of strength, wealth, knowledge, vitality, gentleness and long life.

97-(I) Pitta is hot, acute, fluid, raw-meatish in smell, acid and pungent

97-(II) Owing to its heat, those of Pitta habitus are intolerant of heat, very hot in the mouth, of delicate and clear bodies, and have profuse moles, freckles, spots and pimples on the body, excessive hunger and thirst, are subject to early wrinkles, grey hair and baldness, and are possessed generally of scanty, soft and tawny hair on the head, face and body. Owing to its acuteness, they are possessed of keen valour and acute digestive fire, are given to taking excessive quantity of food and drink, are subject to incapacity to bear suffering, and are constant eaters. Owing to its fluidity they have flabby and soft joints and flesh and profuse discharge of sweat, urine and feces. Owing to its raw meatish smell, they smell very much in their arm-pits, mouth, head and body Owing to its pungent and acid taste they have a small quantity of semen, limited sex appetite and scanty offspring

97.Owing to a combination of such qualities those of Pitta habitus are of moderate strength and life-span and of moderate knowledge, experience, wealth and means

98-(I). Vata is dry, light, unsteady, abundant, swift, cold, rough and clear.

98-(II). Owing to its dryness, those of Vata habitus are of dry, wasted and small bodies, of long-drawn, dry, low, broken, hollow and hoarse voice, and are always wakeful. Owing to its lighteness, they are light and inconstant of gait, behaviour, diet and speech. Owing to its unsteadiness, they are restless in their joints, eyes, brows/jaws, tongues, heads, shoulders, hands and feet. Due to its abundance, they are given to much talk and have prominent veins and tendons Owing to its swiftness they are quick in their undertakings and variation of moods and pathological change. They are quickly affected by fear, likes and dislikes. They are quick in grasping and in forgetting too. Owing to its cold quality, they are intolerant of cold, and are greatly liable to suffer cold, shivering and stiffness. Owing to its roughness they have rough hair on the head, face and body, rough nails, teeth, mouth, hands and feet. Owing to its clearness they have cracked limbs and their joints always make noise as they walk.

98. Owing to the combination of such qualities, those of Vata habitus are generally of small strength, short life-span, scanty offspring and means, and of meagre wealth

99.In a combined habitus the qualities are also combined.

100.Those possessed of the equipoise of triumvirate of vitia are endowed with all the good qualities described. This should one examine from the point of view of habitus

The perfect equilibrium of this vitia is the norm or perfect health.

Having now the full outline of this triumvirate of vitia that determine the total psycho-somatic texture of man, it is necessary to enter into a more detailed inquiry into the nature and mode of operation of this triumvirate of vitia (tridoṣa), and into the justification of their nomenclature.