History of Indian Medicine (and Ayurveda)

by Shree Gulabkunverba Ayurvedic Society | 1949 | 162,724 words | ISBN-13: 9788176370813

The History of Indian medicine and Ayurveda (i.e., the science of life) represents the introductory pages of the Charaka Samhita composed of six large sections dealing with every facet of Medicine in ancient India in a Socio-Historical context. Caraka is regarded as one of the pioneers in the field of scientific healthcare. As an important final a...

Chapter 7 - The Nature and Functions of the Body Triumvirate

Vata, Pitta and Kapha are the names of the three organizations of the body known as the “Triumvirate”. Their individual nature, function and mode of operation have been till now discussed in a general way.

Now we shall try to review them in greater detail from physiological, pathological, clinical and therapeutic points of view.

The General Nature and Concept of the Triumvirate

The three organizations of the triumvirate are the very warp and woof of the texture of life. The triumvirate is considered the sole support of the body.

Its physiological or pathological condition is the root cause of existence or dissolution of the body Sushruta significantlyremarks:

[Suśrutasaṃhitā Sūtrasthāna 21.3]

“It is Vata, Pitta and Slesma alone that bring the body into being. This body is upborne by them in their normal or healthy state established in the lower, the middle and the upper regions of the body respectively, even as a hut is upheld by three poles. Therefore are these called the three poles or supports”.

Thus these three organizations, though viewed individually for the purpose of a clear grasp of their peculiar nature and functions, must yet be appreciated in their united and integrated whole as mutually checking and balancing forces in the body. Their sanagenic influence is due to their integrated mode of functioning.

Caraka says that when the triumvirate is in its normal or physiological condition, the man enjoys perfect health; and when it is in the abnormal or pathological state the man suffers from disease.

[Carakasaṃhitā Sūtrasthāna 12.13]

“To be correct, it is all the three-Vata, Pitta and Kapha, in their normal condition that combine to make a man whole of his senses, possessed of strength, good complexion and ease and assured of great longevity, even as the triad of Dharma, Artha and Kama, when properly cherished, secure for him the highest good both here and in the other world (The same three) if rendered morbid, bring upon the man great tribulation”.

[Carakasaṃhitā Vimānasthāna 1.5]

“And the vitia are three: Vata, Pitta and Kapha. When normal they cause the proper functioning of the body, when they have become abnormal they certainly afflict the body by causing disorders of various types”.

Caraka further states that the triumvirate is ever present in the body either in physiological state or the pathological state:

[Carakasaṃhitā Sūtrasthāna 18.48]

“Vata, Pitta and Kapha, reside either in their normal or pathological state in the bodies of all creatures Hence the learned physician should desire to recognise them”.

The importance of the triumvirate in supporting the body is well brought home by Sushruta in the following simile.

[Suśrutasaṃhitā Sūtrasthāna 21.8]

“Just as the moon, sun and wind uphold the world by their action of release, absorption and dissemination respectively, even so do Kapha, Pitta and Vata act with regard to the body”.

The triumvirate is all-pervasive and circulate to every part of the body. As the vitia are circulating in the entire body, their normal or provoked condition gives rise to good or bad health respectively.

[Carakasaṃhitā Sūtrasthāna 20.9]

“Vata, Pitta and Kapha moving in the whole body produce good or ill effects on the entire system, according as they are normal or provoked”.

The function of the triumvirate is integrative though pentad of foci are described for each vitium where dominance of the function of that particular vitium is observed.

Sushruta states—

[Suśrutasaṃhitā Sūtrasthāna 15.4]

“The five-fold Vata upholds the body by its characteristic functions of throbbing, transmission filling up, separation and retention”.

The fivefold Pitta which causes pigmentation, digestion, vital essence, lustre, intelligence and heat, nourishes the body by its thermogenic function.

The fivefold Shlesma which causes the cohesion of the joints, unctuousness, growth, replenishment, strength and firmness, nourishes the body by its (colloidal) watering function”.

Vagbhata says:

[Aṣṭāṅgahṛdayasaṃhitā Sūtrasthāna 12.18]

“Thus the focal places of this generally all-pervasive vitia are to be known as also the different actions of the vitia (with ref. to these foci).”

Pentad of foci of each of the vitia has great diagnostic importance as the signs of discondance of the vitia are manifested first and certainly in their respective pentad of foci.

Thus it helps to diagnose the disease in its earliest stage.

Caraka states:

[Carakasaṃhitā Cikitsāsthāna 19.121]

“The Vata necessarily gets increased in its own habitat consequent upon the decrease of Kapha”.

Moreover the general line of treatment shall have to be modified when it is to be practically applied to disease conditions originating in or affecting dominantly the particular pentad of foci.

Vagbhata says:

[Aṣṭāṅgasaṃgraha Sūtrasthāna 23]

“Therefore special line of therapeutics has to be pursued to suit the special site of affection”.

Physiological Vata (prakṛtibhūta-vāta)

Vata we know as the vital, mobile and motivating principle of all life functions Its pervasion is throughout the body, for no part or cell of the body can function without its motivation. Its function is to cause all movement including that of the conveying of sense-impressions and thought and emotional impulses. Thus all neuromuscular activity, voluntary as well as involuntary is at its bidding and all sense functions that form the very basis of life-play are the functions of Vata. All the life-functions including the daily metabolic processes of maintaining the proportion and tone of body-elements belong to Vata. It is indeed the very life-principle, the overlord of the body. That is why Atreya calls it and the all controller of the body.

The Actions of the Organizations of Normal Vata as described by Caraka

[Carakasaṃhitā Sūtrasthāna 12.8]

  1. vāyustantrayantradharaḥ—The Vāta is the upholder of both, structure and function (in the body).
  2. prāṇodānasamānavyānāpānātmā—It is the very self of the five forms of Vāta in the body viz., Prāna, Udāna, Samāna, Vyāna and Apāna.
  3. pravartakaśceṣṭānāmuccāvacānāṃ—It is the impeller of upward and downward movements.
  4. niyantā ca manasaḥ—The controller and conductor of the mind.
  5. sarvendriyāṇāmudyojakaḥ—The inspiritor of all the senses.
  6. sarvendriyārthānāmabhivoḍhā—The convener of all the sense-stimuli.
  7. sarvaśarīradhātuvyūhakaraḥ—The marshaller of the body elements.
  8. sandhānakaraḥ śarīrasya—The synthesizing principle in the body.
  9. pravartako vācaḥ—The impeller of speech.
  10. prakṛtiḥ sparśaśabdayoḥ—The cause of feeling and audition.
  11. śrotrasparśanayormūlaṃ—The source of the auditory and tactile senses.
  12. harṣotsāhayoryoniḥ—The origin of all excitation and animation.
  13. samīraṇo'gneḥ—The stimulator of the gastric fire.
  14. doṣasaṃśoṣaṇaḥ—The desiccator of the morbid vitia.
  15. kṣeptā bahirmalānāṃ—The eliminator of excrement.
  16. sthūlāṇusrotasāṃ bhettā—The deobstruent of the gross and subtle body-channels.
  17. kartā garbhākṛtīnām—The modeller of the fetal form.
  18. āyuṣo'nuvrṛttipratyayabhūto bhavatyakupitaḥ—The sustaining principle of life.

Caraka describes the functions of in short as follows:

[Carakasaṃhitā Sūtrasthāna 18.49]

“Actions of the normal Vata are animation, inspiration and expiration (respiratory movement), body movement, regular circulation of body-elements and regular elimination of excretions”.

And finally he makes an aphoristic statement all-comprehensive of the function of Vata.

[Carakasaṃhitā Sūtrasthāna 17.118]

“All the life-activities of the body are performed by the normal Vata which is said to be the life of living beings”.

Sushruta describes the function of Vata as under:

[Suśrutasaṃhitā Śū. 15.4]

“The fivefold Vata upholds the body by its characteristic functions of throbbing, transmission, filling up, separation and retention”

Vata is given the supreme importance in the series of the triumvirate

Caraka says—

[Carakasaṃhitā Cikitsāsthāna 28.3]

Vayu is life and vitality, Vayu is the supporter of all embodied beings, Vayu is verily the whole universe, and Vayu is the lord of all. Thus is Vayu extolled”

Sushruta describes Vata or Vayu in highly eulogistic words.

[Suśrutasaṃhitā Nidānasthāna 1.5-6]

“Vayu is praised as the seif born and worshipful one. As it is free, eternal and all-pervasive, it is the soul of all beings and worshipped by all the world. It is the cause of the creation, subsistence and dissolution of all beings”.

The supreme status of Vata may be also attributed to its being the propeller and director of the movement of the other two members of the triumvirate.

[Śā. Pu. 5.25]

“Pitta is lame, Kapha is lame and lame too are the excretions and the body-elements. These, like a cloud, go wherever they are carried by Vayu (wind or Vāta)”.

Physiological Pitta (prakṛtibhūta-pitta)

Pitta is indeed the thermal element or element of fire. The integrative organization of it does the following functions in the body Caraka states—

[Carakasaṃhitā Sūtrasthāna 12.11]

“It is Agni (Fire) alone that is immanent in the Pitta’

Sushruta, in reply to a pertinent question raised by the pupil whether Pitta is dififerent from fire-element or whether Pitta and fire-element are one and the same, declares:

[Suśrutasaṃhitā Sūtrasthāna 21.9]

“There is known to be no fire other than Pitta (in the body)”

This, as has already been stated, is the organization of the thermal balance of the body. It is the total thermal function or process going on in the body including all the secretions internal or external that go to build up the metabolic process and maintenance of the thermal optimum necessary for the preservation and growth of all life-processes

It has also the further function of giving coloration or of pigmenting the body-elements such as redness in the blood, flesh and marrow and the pigmentation of the excretions like feces and urine.

[Suśrutasaṃhitā Sūtrasthāna 21.10]

“The Pitta of the liver and the spleen is known as the pigmenting aspect of the thermal organization (Pitta). It is said to cause the red pigmentation of the nutrient fluid”

The actions of normal Pitta are described as follows:—

[Carakasaṃhitā Sūtrasthāna 12.11]

“It is Agni (fire) alone that, located in the Pitta, gives rise to good and evil consequences according as it is in a normal or abnormal condition. These consequences are digestion and indigestion; vision and loss of vision; the normality and abnormality of temperature, the healthy and diseased look, intrepidity and fear, anger and delight, confusion and lucidity and such other pairs of opposite qualities”.

[Carakasaṃhitā Sūtrasthāna 17.116]

“It is by the heat of Pitta that digestion takes place in men, and when that very Pitta is in a provoked condition, is causes various diseases”

[Carakasaṃhitā Sūtrasthāna 18.50]

“Actions of the normal Pitta are power of vision, digestive fire, body-heat, hunger, thirst, softness of body, lustre, clarity of mind and intelligence”.

Sushruta describes the function of Pitta organization as under:—

[Suśrutasaṃhitā Sūtrasthāna 15.2]

“The fivefold Pitta which is causative of pigmentation, digestion, vital essence, lustre, intelligence and heat nourishes (the body) by its thermogenic function”

Physiological Kapha (prakṛtibhūta-kapha)

Caraka calls Shlesma, the colloidal water in the body as Soma (soma eva śarīre śleṣmāntargata). It is already described as the fluid matrix for the play of life. It is the living fluid or the protoplasm in which all the operations of life are made possible, it really serves as the stage for life.

Shleshma holds the joints together, does all cohesive, nutritive, developing and stabilizing functions. It promotes the well-being of the body by its watering activity. It thus supplies the living waters for the roots of life. In its physiological aspect it is the strength and stamina of man but becomes an impurity fit to be eliminated when it is vitiated.

[Carakasaṃhitā Sūtrasthāna 12.12]

“It is Soma (the water-element) alone, located in the Kapha of the body, that gives rise to good and evil consequences”

[Carakasaṃhitā Sūtrasthāna 17.117]

“The normal Kapha constitutes the body-strength while the morbidised Kapha becomes a vitiated element. It is said to be the vital essence of the body when normal, while it is described to be the source of ailment when morbid”.

[Carakasaṃhitā Sūtrasthāna 18.51]

“Actions of the normal Kapha are causing viscousness, cohesion, firmness, heaviness, potency, strength, forgiveness, fortitude and greed-lessness”

[Suśrutasaṃhitā Sūtrasthāna 15.4]

“The five-fold Shleshma which is causative of the cohesion of the joints, unctuousness, growth, replenishment, strength and firmness, nourishes (the body) by its (colloidal) watering function.”

These very physiological organizations when they become dis organized and vitiated behave pathologically in the body.

We need not repeat the whole references as they are already quoted in previous pages. We shall give only the reference of chapter and verse.

[Carakasaṃhitā Sūtrasthāna 12.13.—18.48.—20.9.]

[Carakasaṃhitā Vimāna 1.5.]

[Suśrutasaṃhitā Sūtrasthāna 21.3.]

Disease conditions produced by the pathological behaviour of each member of the triumvirate:—

Pathological Vata (vikṛtibhūta-vāta)

Caraka describes the following disease condition produced when Vata behaves pathologically:

[Carakasaṃhitā Sūtrasthāna 12.8]

“When however, the Va ta becomes abnormal in the body, it afflicts the organism with diverse kinds of disorders, tending to impair its strength, complexion, well-being and life, it depresses the mind; impairs all the senses; destroys the fetus in utero, produces deformity in it, or unduly prolongs the period of gestation gives rise to fear, grief, stupefaction, depression of the spirits and delirium and obstructs the vital functions”

He further states that abnormal functioning of Vata is the root cause in the following disease-conditions:—

[Carakasaṃhitā Sūtrasthāna 20.12]

“They are.—subluxation, dislocation, dilatation, contraction, taxation, depression, excitation, attraction, tremor, circular movement, motion, pricking pain, aching pain and movement, as also coarseness, harshness, clearness, porousness, dusky-redness, astringent taste, dysgeusia, dehydration, aching pains, numbness, contractions, rigidity, tameness, etc. These are the effects produced on the body by the actions of Vata. The condition accompanied with any of these signs or symptoms should be diagnosed as a Vata-disorder”.

And later on Caraka mentions some conditions that can be produced by Vata when it becomes located in particular regions or organs

[Carakasaṃhitā Cikitsāsthāna 18.20-23]

“Contraction, stiffness of joints, aching pain in bones and joints horripilation, garrulotisness, spasticity of the hands, back and head; lameness of hands and feet, hunch back; atrophy of the limbs, insomnia, destraction of fertility, fetus and menses; tremors, anesthesia and paralyses of limbs, ticks of muscles of the head, nose, eyes, shoulder, girdle and neck, splitting pain, pricking pain, agony convulsions, delusions and fatigue—such are the general symptoms which the provoked Vata manifests on account of the differences in the etiological factors and in the seats of affection, it produces the specific characteristics in each disease”.

Pathological Pitta (vikṛtibhūta-pitta)

Caraka describes the physiological as well as pathological conditions caused by Pitta in the following dyads:

[Carakasaṃhitā Sūtrasthāna 12.11]

“It is Agni (Fire) alone that located in the Pitta, gives rise to good and evil consequences according as it is in a normal or abnormal condition. These consequences are digestion and indigestion, vision and loss of vision, the normality and abnormality of temperature, the, healthy and diseased look, intrepidity and fear, anger and delight, cofusion and lucidity, and such other pairs of opposite qualities”.

Pathological functioning of Pitta will lead to the following conditions:

[Carakasaṃhitā Sūtrasthāna 20.15]

“Burning, heat, suppuration, perspiration, softening, sloughing, itching, discharge, redness and the emanation of smell, color and taste are the effects produced on the body by the action of Pittas Conditions accompained with any of these symptoms should be diagnosed as a Pitta-disorder”

Pathological Kapha (vikṛtibhūta-kapha)

Caraka attributes the following conditions of health and disease to the physiological and pathological behaviour respectively of the Kapha.

[Carakasaṃhitā Sūtrasthāna 12.12]

“It is Soma (the water-element) alone, located in the Kapha of the body, that gives rise to good and evil consequences, according as it is in normal or abnormal condition. These are: compactness and flabbiness, plumpness and emaciation, zest and lassitude, virility and impotence, knowledge and ignorance, understanding and stupefaction and such other pairs of opposite qualities”.

Moreover the following conditions will occur when the function of Kapha organization is deranged

[Carakasaṃhitā Sūtrasthāna 20.18]

“Whitness, coldness, itching, fixity, heaviness, unctuousness, numbness, humidity, excretory secretion, obstruction, sweetness and chromcity are the effects produced in the body by the action of Kapha. The condition accompanied with any of the above symptoms should be diagnosed as a Kapha-disorder”

Clinical Manifestations and their Interpretation in Physical Qualities

When one of the triumvirate is deranged or thrown off its norm, it invariably affects the balance of the other organizations and thus sets in motion the triad of vitia operating in disease-conditions with one or two of them in a relatively pre-ponderant condition. When two vitia are provoked and act in combination, the condition is called (saṃsarga) or bi-discordance. When all the three are provoked and combine together to produce the disease, the condition is called (sannipāna) or tridiscordance. Such discordance of the triumvirate will give rise to clinical manifestation of physical signs which will be observed either in the whole body or in is parts viz., body-elements, secretions or excretions, in the form of exaggerated, diminished or deranged physical qualities

The clinical investigation of a disease-aspect was thus always in terms of qualities augmented or diminished by the effect of the vitium, and the determination of the treatment was for the specific quality aspect of the vitium or the vitia concerned. Thus the equation between the nature and degree of the symptom and the drug called for, was the main feature of clinical investigations. The pathological processes were recognised by the effects associated with the vitia in their operation on the psycho-somatic whole.

In psychic disorders the immediate intermediary and terminal results produced on the psyche by the various processes of each of the triumvirate in health and disease were observed minutely and correlated with the particular phase of the vitium as well as with the secondary changes in the physical body,

The psychic symptoms included changes in character, behaviour, proclivities, inclination, urges, dreams etc.

In somatic disorders similar examination was made of the physical body All body-tissues and systems were physically examined (sārataḥ parīkṣā); also all the secretions and excretions of the body were thoroughly examined. The results obtained by all these examinations were correlated with the particular phase of the vitium or vitia and were also coordinated with the secondary psychic changes.

The final results of all these examinations were reduced to and interpreted in quality-equation for simplification of the methods of physical examination and of practical therapeutics.

What the main physical qualities observed in the body signifying the presence or dominance of each of the triumvirate are and what the principles of practical therapeutics should be to counteract the over-dominance of that vitium are briefly but clearly described in the following three verses by Caraka.

[Carakasaṃhitā Sūtrasthāna 1.59-61]

“Vata is dry, cold, light, subtle, unstable, clear and rough; it is quieted by substances of antagonistic qualities.

Pitta is slightly unctuous, hot, acute, fluid, acid, mobile and pnngent; it is readily quieted by substances of antagonistic qualities.

Kapha is heavy, cold, soft, unctuous, sweet, stable and viscid; it is quieted by substances of antagonistic qualities”.

All pathological conditions are grouped under two headings.

  1. Imbalance condition (vaiṣamya) due to increase or decrease (vṛddhikṣaya),
  2. Vitiation condition (doṣaprakopa).

Imbalance Condition (vaiṣamya)

This is brought about by simple process of increase or decrease either in the function or the structure of the body. It is a minor pathological condition of hyper or hypo state, being merely deviation from the normal constant of the body-function or structure.

It will however cause some disturbance in the mutually well balanced state between the various functional and structural systems of the body. This disturbance of the equilibrium or balanced state is the imbalance condition.

Vitiation Condition (doṣaprakopa)

This is the real or major pathological condition brought about by the vitial reaction or vitiation process. The triumvirate of organizations having passed beyond the imbalance stage, become disorganized and turn into irritants and tend to vitiate the whole or part of the body functions or structures.

How constitutional factors of the individual resist the incursion of harmful factors in the body, how one, two, or all three vitia get provoked, irritated or inflamed, or get vitiated by endogenous or exogenous factors, how they overpower the whole body when all of them get highly provoked, how when not so highly provoked they circulate in the body and get located in susceptible parts, how the Constitution of local part reacts to and, legists these irritant vitia and what are the terminations of this struggle between the body and the noxious factors, make the most marvellous story of biological activities in Man

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