The theory of three faults (tridoṣa-siddhānta)

Ayurveda applies the theory of five physical elements to the whole living body, whether doṣa, guṇa, dhātu, or mala.^[1] The body, similar to that of the external objects, is a conglomeration of five elements and is sustained by a three-fold function:

1. the disintegrating function,
2. the integrating function,
3. the regulating function or the nerve function.

In Āyurveda each one of these functions is ascribed mainly to three primal constituents of the body generally called tridoṣa. They are vāta, pitta, and kapha.^[2] Kapha integrates, pitta disintegrates and vāta controls.^[3] In fact the very existence of life is determined by these three functions attributed to the three doṣas. Suśruta is of opinion that the human body is sustained by these three basic elements;like a dwelling house is supported by the supporting stays.^[4] These three doṣas have two aspects called natural (prakṛti) and morbid (vaikṛti). Pitta in its natural state, promotes digestion and metabolism and causes disease in the morbid state. Kapha props up strength in the form of ojas in the normal condition and in the morbid state it takes the form of excreta and causes diseases. Vāta is responsible for all the activities of the body in its natural state and causes disease and death in morbid condition.^[5]

In the Atharva Veda there is a reference of three kinds of diseases, the airy, (vātaja), the dry (sūkṣma), and the wet (abhraja).^[6] Similarly, in the Chandogyopanisad earth, water, and fire are told as principles world of contruction. In many of the Upaniṣads vayu is regarded as the principle of life.^[7] Yāska states that sleṣma originates from semen (retas) and from śleṣma the seven dhātus originate in a successive manner.^[8] Suśruta also refers to some early conception that the body is physical (bhautika), and the three elements that constitute body are air, water and fire.^[9] All this show that before the systematization of Ātreyatantra there had been a continuous efforts to explain the physiological functions of the body. However, what we see in Carakasaṃhitā is the earliest systematized form of the tridoṣasiddhānta and there it is construed as a biological adaptation of the pañcabhūta-siddhānta.

The three factors namely, vāta, pitta, and kapha are counted as constituents responsible for both sustaining and degenerating the body. They are called dhātus because their equilibrium, form the foundation of the body. They are called doṣas since they form the intrinsic cause of diseases.^[10]

It is to be noted, in this connection that the qualities of the body are briefly divided into two called pure (prasāda) and impure (mala). Of them, the malas refer to those which are undesirably accumilated in the orifices of the body seeking egress; the constituents of the body like blood which are often turned into pus; the vitiated vāta, pitta, and kapha and other entities which tend to weaken or destroy the body. Other entities which sustain and purify the body are called (prasāda). Depending on the variation of substance the prasādadhātu is classified into seven called saptadhātus.^[11] The waste products like urine, (malas) sweat which makes the body foul are also called dhatus so long as they are in their proper measure and serve to sustain the body.^[12]

The digested food is transformed into two, namely essence (prasāda or rasa) and waste products (kiṭṭa or mala).^[13] Kiṭṭa nourishes sweat, urine, stool, vata, pitta, kapha, and the execreta of the ear, eye, nose, mouth hair follicles, genital organs and also hair of the head, beard, small hair of the body, and nails. Similarly the essence of the food nourishes the rasa, rakta, maṃsa, medas majja, asthi, sukra, ojas and the material constituents of the sense organs, that is, the five physical elements.In brief it is the prasād dhātus, and maladhātus that constitute the body and determine the integrity of the body.All of them together can be called the constant internal environment in modern physiology.^[14] When the prasād dhātus, and mala dhātus continue in their proper measure they do not pollute or weaken the body or produce diseases. They all in their proper measure co-operate together in sustaining the body^[15] and in that sense all are called dhātus. Still, vāyu, pitta, and kaph are regarded as the most important, or they are recognized as the root of all growth and decay of the body, health and disease. Suśruta attributes the same status of vāta, pitta and śleṣma to blood also because its impurities play a vital role in producing disturbance to wounds and so has got a special importance in surgery. Thus, he says that the three doṣas, together with blood (śonita) determine the origin, preservation, and dissolution of the living being.^[16] Augmentation (vṛddhi), normalcy (sāmya), and diminution (kṣaya) are the three characteristics of the three doṣas.^[17] So health is being conceived as the equilibrium, resulting from the co-ordinated normal functions of the dhātus. The loss of this equilibrium due to their disturbed or abnormal function is called disease.^[18]

The special feature of the definition of health and disease given by Caraka is that it keeps harmony with the causation theory of evolution which he followed in his description of world construction. Thus disease is only a change of the dhātus and not a new creation. But this is in no way admissible in the Nyāya-Vaiśeṣika thought, for their causation theory suggests that each and every effect is different from the cause. Referring to this, Dasgupta cites Vivaraṇasiddhāntacintāmaṇi of Narasiṃha Kavirāja and states that the Naiyāyikas, however, hold that disease is a separate entity which is produced by dośa, but which is not itself a doṣa. (dravyatve sati doṣabhinna doṣajanyatvaṃ rogatvaṃ).^[19]

From the time of conception itself, in certain individuals, all the three doṣas are in equilibrium; some are predominated by vāta, some by pitta and some by kapha. According to Cakrapāṇi, there are also people dominated by two doṣas, that is by vātapitta, vātakapha, and pittakapha. Normally the first category, by nature, maintains normal health while those belonging to the other categories are always susceptible to bodily diseases. This is due to imbalance of the doṣas brought about by the domination of one or the other of the doṣas.^[20]

When vāta, pitta and kapha become deficient or excess in quantity (prakupita) they become doṣas and they afflict the body with different types of diseases.^[21] Based on the comparative strength of the various components of the doṣas and the relative strength and proportions of each doṣa among themselves, innumerable combinations are formed and so the diseases proceeding from them are also innumerable. Caraka points out that there are sixty-two such commonly manifested combinations.^[22]

We know that the doṣa are mutually contradictory in character. Normally, when two contradictory elements combine, they generally get destroyed as in the case of fire and water. Cakrapāṇi, pointing out this example, suggests that there is the possibility for the question as to how the doṣas with contradictory character can combine and then he himself settles the query. He says that mutual contradiction is to be determined by their own action and not merely by citing other illustrations. Even in the cited example itself, though water and fire are contradictory to each other they do no obstruct the combination of the five mahābhūtas. Similarly, the sour taste is found to be caused by the domination of the combined qualities of water and fire. This would not be possible if the mutually contradictory elements do not combine together. Finally he ascertains that it is because of the presence of the specific characteristic of prabhāva, the doṣas with contradictory nature combine together. As for as the specific characteristic of prabhāva is concerned, he says that it is caused by adṛṣṭa^[23] for adṛṣṭa is capable of causing miseries.^[24]

Another thing to be noted in this connection is that when there is a disease due to the predominance of a doṣa (caused by extraneous factors) corresponding to the predominant doṣa in one's constitution from his birth, the newly collected doṣa produces morbidity in accordance with the working of the predominating doṣa of his constitution. But his original constitutional doṣa (prākṛti) is never increased or decreased due to the predominance of a doṣa by any kind of disease. They always remain the same operating in their physiological functions. The constitutional doṣa (prākṛti) and the accumulated doṣa due to extraneous factors (vaikṛti) are different. The increase and decrease of doṣas have a separate course of action in diseases and there is no interchange between the latter collections or deficiency of doṣas and constitutional doṣas.^[25] The actual fact regarding the relation of the constitutional doṣa and the accrued or deficient doṣa has been further pointed out by Cakrapāṇi. That is a doṣa will be aggravated in a system in which the corresponding constitutional doṣa is predominant and a doṣa will lose its strength to a great extend in a system in which the corresponding constitutional doṣa is not predominant.^[26]

Footnotes and references:

[1]:

“Introduction”, Rasavaiśeṣika-sūtra of Bhadantanāgarjuna., p. xii. vāta, pitta and kapha are usually referred to as wind, bile and phlegm in English. But they are not able to convey their intended meaning.

[2]:

vāyuḥ pittaṃ kaphaścoktāḥ śārīro doṣasaṃgrahaḥ, CS, Su, I. 57; Suśrutasaṃhitā of Suśruta., Su, XXI. 3; Aṣṭāṅgahṛdaya of Vāgbhaṭa., Su, I. 6; Aṣṭāṅgasaṅgraha of Vāgbhaṭa., p.7; Śārṇgadharasaṃhitā of Śārṇgadharācārya., I. V. 23.

[3]:

K. Raghavan Thirumulpad, “Basic Principles of Ayurveda”, SHI, p.13

[4]:

vātapittasleṣmāṇa eva dehasaṃbhavahetavaḥ, tairevāvyāpannairadhomadhyordhvasanniviṣṭaiḥ sarīramidaṃ dhāryate'gāramiva sthūṇābhistisṛbhirataśca tristhūṇamāhureke, Suśrutasaṃhitā of Suśruta., Su, XXI. 3

[5]:

gatiśca dvividhā dṛṣṭā prākṛtī vaikṛtī ca yā............tenaiva rogā jāyante tena caivoparudhyate. CS, Su, XVII. 115 - 118.

[6]:

Atharvaveda, I, 12, 3.

[7]:

HIPS, Vol.II, p.333.

[8]:

śleṣmā retasaḥ saṃbhavati, śleṣmaṇo raso rasācchoṇitaṃ...tadidaṃ yonau retaḥ sriktaṃ puruṣaḥ saṃbhavati., “Pariśiṣṭa”, Nirukta, p. 148;Cf. CS, Cikitsa - sthāna, XV. 16.

[9]:

prakṛtimiha narāṇāṃ bhautikīṃ kecidāhuḥ pavanadahanatoyaiḥ kīrtitāstāstu tisraḥ, Suśrutasaṃhitā of Suśruta., Śārīra - sthāna, IV. 70.

[10]:

śarīradhārakavastūni. tadyathā. kaphaḥ. vātaḥ. pittaḥ. śrīradūṣaṇāddoṣāḥ malinīkaraṇānmalāḥ dhārṇāddhātavaste syurvātapittakaphāstrayaḥ, Śabdakalpadrumaṃ, Vol. II, p. 790; vikṛtāvikṛtā dehaṃ ghnanti te vartayanti ca, Aṣṭāṅgahṛdaya of Vāgbhaṭa., Su, I. 7; Aṣṭāṅgasaṅgraha of Vāgbhaṭa., p. 7.

[11]:

CS, Śārīra-sthāna, VI. 17; rasāsṛṅmāṃsamedāstimajjāśukṛāṇi dhātavaḥ. Aṣṭāṅgahṛdaya of Vāgbhaṭa., Su, I. 13; Aṣṭāṅgasaṅgraha of Vāgbhaṭa., p. 10; Śārṇgadharasaṃhitā of Śārṇgadharācārya., I. V. II

[12]:

HIPS, Vol. II, p. 325.

[13]:

tatrāhāraprasādākhyo rasaḥ kiṭṭaṃ ca malākhyamabhinivartate CS, Su, XXIII. 4.

[14]:

LC, p. IVI.

[15]:

kittāt... samadhātordhātusāmyamanuvartayataḥ. Ibid.

[16]:

ta eva ca vyāpnnāḥ pralayahetavaḥ. tadebhireva śoṇitacaturthaiḥ saṃbhava-sthiti-pralayeṣvapyavirahitaṃ sarīraṃ bhavati. Suśrutasaṃhitā of Suśruta., Su, XXI, 3; See also Dalhaṇa on ibid.

[17]:

doṣāprakṛtivaiṣamyaṃ niyataṃ vṛddhilakṣaṇaṃ, doṣāṇāṃ prakṛtirhānirvṛddhiścaivaṃ parīkṣyate. CS, Su, XVIII. 53. doṣāṇāṃ vṛddhisāmyakṣayalakṣaṇāni, Cakrapāṇi on CS, Su, XVII. 62.

[18]:

vikāro dhātuvaiṣamyaṃ sāmyaṃ prakṛtirucyate sukhasaṃñjaka-mārogyaṃ, vikāro dukhameva ca. CS, Su, IX - 4; rogastu doṣvaiṣamyaṃ doṣasāmyamarogatā, Aṣṭāṅgasaṅgraha of Vāgbhaṭa., p. 14; Aṣṭāṅgahṛdaya of Vāgbhaṭa., Su, I. 20.

[19]:

see foot-notes, HIPS, Vol. II, p. 329.

[20]:

CS, Su, VII. 39-40. see also Cakrapāṇi on ibid.

[21]:

vātapitta śleṣmaṇastu khalu sārīrā doṣāḥ. teṣāmapi ca vikārāḥ jvarātisāraśopha śoṣaśvāsa mehakuṣṭādayaḥ. CS, Vimāna - sthāna, VI. 5.

[22]:

CS, Su, XVII. 6.

[23]:

adṛṣṭa refers to merit (dharma) and demerit (adharma) see Nyāyakandaī, Praśastapādabhāṣya., p. 28.

[24]:

See Cakrapāṇi on CS, Su, XVII. 62.

[25]:

prkṛtisamānarogotpatau na prakṛtibhūtasya vṛddhiḥ, kiṃ tarhi hetvantarajanitasya vātadestatra vikarakaritvaṃ prakṛitibḥūtastu doṣastatatropadarśako bhavati......, Cakrapāṇi on Ibid., VII. 39-40.

[26]:

samānaṃ hi prakṛtiṃ prāpya doṣaḥ pravṛddhabalo bhavati, asamānaṃ tu prāpya tathā tathā balavān na syāt, Cakrapāṇi on Ibid., XVII. 62.