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1.2 Basic Concepts in Ayurveda

Ayurvedic theory conceptualizes the human body in terms of pancha mahabhutas (five elements), three doshas (biological forces that maintain and regulate the body), its seven dhatus (tissues), malas (waste products), and its agni (the fiery energy that fuels digestion and metabolism) and describes the impact of these substances and energies on the body’s srotas (metabolic pathways) and on the functioning of its organs. Ayurveda also posits that all the various forms of matter that exist in the universe are made up of the same five elements that constitute the body. In substances that body ingests, such as foods and herbs, these elements are said to manifest in the substance’s rasa (taste), gunas (qualities), virya (potency), and vipaka (the taste that arises after digestion and metabolism). Information explained under the Basic concepts of Ayurveda were compiled from Charaka Samhita and Ashtanaga Hrudaya. [4–5]

Ayurveda explains that life comprises sarira (the physical body), indriya (the senses), sattva (the mind), and atma (the soul or conscious elements). This understanding of life is rooted in the laws of nature. According to Ayurveda, one of the most important principles that govern natural phenomena is the connection between the macrocosm and the microcosm. This principle holds that human life is a microcosm that exists in a state of constant interplay with the cosmos (the macrocosm).

1.2.1 Panchamahabhutas (Five Elements)

Ayurveda proposes that the interdependence of the individual human being and all matter in the external universe stems from the precept that everything in nature consists of the same five elements, or pancha mahabhutas (five basic elements): air, fire, earth, ether, and water.In Ayurvedic terms, health is defined as a state in which both the quantities and the qualities of these five basic elements are in perfect balance. Panchamahabootas are considered as basic building block of the universe. The concept of panchamahabootas helps to understand physiology, pathology and pharmacokinetics.These are the minutest elements which constitute living and nonliving matters. Any living body is an outcome of the interplay of the panchamahaboota in a specific manner.According to panchamahaboota theory,manifestation of the entire physical universe including human body is made possible by the combined attributes of Panachamahabootas which are listed below.

Aakasha (Space): Akashamahaboota is the first expression of consciousness and is the space without which matter cannot exist. The main sense attribute to Akasha mahaboot is Sound. Nonresistance is its chief property. It is present in hollow cavities within body and empty areas of cosmos, transmit sound, non resistant to anything, frictionless or smooth,subtle, soft and abundant. Any diet, food or herbs with the similar properties will increase Akashamahaboota in the body.

Vayu (Air): Vayumahabootas evolved from Aakashamahabootas. The main sense attribute to Vayu mahabootas is Touch. As it evolves from Aakasha mahaboota, it also inherits attribute of sound. Mobility is its chief property.Properties of Vayumahaboota include light,dry, subtle, mobile, transparent, and rough. It is responsible for movement and dryness in the body. Any diet exercise and food which has simialr properties will increase Vayumahaboota in the body.

Agni (Heat): Agnimahabootas evolved from Vayumahaboota. The main sense attribute to Agni mahabootas is Vision. It also inherits sense attributes of Sound and Touch from Akasha and Vayu mahabootas. Hot is its chief property. Properties of Agniumahaboota include hot, sharp, intense, dry and light. Any food,exercise, herbs with the similar property will increase Agnimahaboota.

Aapa (Water): Aapa mahaboota evolved from Agni mahaboota. The main sense attribute to Aapa mahaboot is Taste. It also inherits sense attributes of Sound Touch and Vision from Akasha Vayu and Agni mahabootas. Liquidity is the chief property. Properties of Aapmahaboota include moist, cohesive, sticky, cool, soft and oily. Any food and herbs with the similar property will in increase Aap mahaboota.

Prithvi (Earth): Pritvi mahaboota evolved from Aapa mahaboota. The main sense attribute to Pritvi mahaboot is Smell. It also inherits sense attributes of Sound Touch Vision and Taste from Akasha Vayu Agni and Aapa mahabootas. Roughness is the chief property.Properties of Prithvi mahaboota include solid,dense, stable, heavy, hard, dull and slow. Any food, exercise and herbs which have similar property will increase Pritvi mahaboota.

1.2.2 Doshas (Biologicial Energies)

There are two kinds of doshas: somatic( vata , pitta , and kapha ) and psychological ( rajas and tamas ). The somatic and psychological doshas constitute an axis that facilitates the seamless integration of cross-talk between the mind and the body’s neurological, endocrine,and immunological systems. Whenever one of these doshas undergoes changes, the others become deranged. Each one has certain, gunas (qualities) and karmas (functions) and needs to be present in the body in a specific pramana (quantity) to bring health.

The central concept of Ayurvedic Medicine is the tridoshic theory. This theory proposes that there are three doshas, or biological energies, that govern all of the body’s biomotor,metabolic, and physiological activities. Doshas determine longevity at the cellular level and maintain homeostasis in the body. Every living species contains a unique combination of all three doshas ( vata , pitta , and kapha ). While all the five elements (air, fire, earth, ether, and water) are present in each of these dynamic physiological forces, the two elements that dominate its makeup define its nature. For example, the vata dosha is dominated by akasha (ether) and vayu (air); pitta dosha, by tejas (fire) and aap (water);and kapha doshas, by aap and prithvi (earth).

These three innate physiologic forces govern the entire life process from conception and growth through decay and death. While the doshas pervade the entire body, there are particular organs/body parts where they primarily reside. For example, vata is located mainly in the large intestine, pelvic region,thighs, ears, bones and the organ of touch(skin); pitta in the small intestine, stomach,blood, eyes, skin, sweat glands, lymph, and body nourishing fluid; and kapha in the chest,larynx, head, pharynx or esophagus or pancreas,all joints, the stomach, body nourishing fluid,body fat, nose, and tongue.

Vata governs all types of movement in the body and thereby governs all life functions. Its specific functions include controlling respiration and speech, maintaining co-ordination between body and mind, excreting waste products from the body, transporting body elements,and regulating intestinal movements. Pitta controls all types of digestions, metabolism,and transformational actions in the body.Its particular functions include maintenance of body temperature, softness of the body and luster of the skin, visual acuity, taste,appetite, thirst, intellect, and courage. Kapha is responsible for anabolism and the stability and strength of the body. This general role encompasses maintaining stability of joints,unctuousness of body, and the ability of mind and body to tolerate stress.

Each dosha has its own characteristics,anatomic, physiologic, and psychologic properties. Vata is dry, light, cold, rough, subtle,and mobile. Pitta is oily, sharp, hot, light,spreading, liquid, pungent, and fleshy smelling.Kapha is wet, cold, heavy, dull, sticky, soft,dense, and static.

Each of the doshas is divided into five types. The five types of vata are:

Prana vata: Situated in the head; moves around in the chest and larynx. It is represented by the functional units of the respiratory center and governs the sensory and motor organs,mind, intellect, and consciousness. Prana vata also regulates inhalation, swallowing, sneezing,and expectoration.

Udana vata: Situated in the chest. It moves around in the nose, umbilicus, throat,and trachea. It maintains the act of speech and governs energy, enthusiasm, color of the skin/complexion, and memory.

Vyana vata: Situated in the heart. It moves all over the body. It controls walking, flexion,extension of limbs, blinking, and yawning.

Samana vata: Situated near digestive fire(stomach and small intestine). It moves around the abdominal cavity. It controls digestion and absorption and assimilation of nutrients.

Apana vata: Situated in the anal canal. It moves around in the area of urinary bladder,genitals, thighs, and pelvis. It controls excretion of urine and feces, ejaculation of semen, the flow of menstrual fluids, and delivery of infants.

The five types of pitta are:

Pachaka pitta: Situated in stomach and large intestine. It governs digestion and assimilation of food and nourishes the other types of pitta.

Ranjaka pitta: Situated in liver, spleen,stomach, and small intestine. It governs the synthesis of hemoglobin and imparts red color to the blood.

Sadhaka pitta: Situated in the heart. It helps individuals to achieve their desires by maintaining mental activity and intellect.

Alochaka pitta: Situated in the eyes. It is responsible for vision.

Bharajaka pitta: Situated in the skin; it maintains a healthy, lustrous complexion.

The five types of kapha are:

Avalambaka kapha: Situated in the chest;it nourishes other types of kapha.

Kledaka kapha: Situated in the stomach; it is represented mainly by mucus secretion in the gastrointestinal tract, and it helps moisten food.

Bodhaka kapha: Situated in the tongue;enhances sense of taste.

Tarpaka kapha: Situated in the head. It nourishes all the sensory organs.

Shleshaka kapha: Situated in the joints. It helps in maintain joint stability.

During different seasons of the year, the doshas undergo certain changes. For example,at the end of summer, vata tends to become aggravated, increasing beyond the level required to maintain the proper balance of the doshas.This typically happens to pitta during autumn,and to kapha during spring. Failure to harmonize dietary and lifestyle practices with the seasons,as well as improper eating habits and an unhealthy lifestyle, may also lead to aggravation of the doshas and eventually manifest as symptoms of disease. Please see below for the factors that cause each of the doshas to increase.

1.2.2.1 Increase of the Doshas: Causative Factors

Vata Excessive consumption of bitter,astringent, and pungent tastes; overconsumption of cold, dry, and light food; intake of food at improper time, intake of less nutritive food, and fasting; suppression of natural urges; late bedtimes; loud conversations; excessive physical exercise; overexposure to erratic motion due to traveling in a vehicle for long time; rainy weather.

Pitta Excessive consumption of salty,pungent, and sour tastes; overconsumption of alcoholic beverages and hot, spicy, oily fried foods; excessive sorrow, fear, anger, leading to reduced intake of food and lack of sleep;overexposure to the sun and fire.

Kapha Excessive intake of sweet, sour and salty tastes; overconsumption of oily,cold, heavy, sweet, and sticky food; sedentary lifestyles and sleep during day time; excessive intake of meat, heavy, or unctuous food, and milk; overeating.

If a dosha that has increased due to these factors continues to accumulate, the aggravation progresses to a more severe state, known as provocation. Doshas can also decrease to a point below their optimal level. The following section outlines the signs and symptoms of increased (aggravated), provoked (agitated),and decreased (depleted) doshas.

1.2.2.2 Signs and Symptoms of Dosha Imbalances

Increased vata Emaciation, black discoloration of skin, craving for heat, tremors, flatulence, constipation, loss of power of body and organs, sleeplessness, talkativeness, dizziness,sorrow, hoarseness of voice, and dry skin.

Provoked vata Prolapse of organ, ptosis,dilatation of organs, throbbing pain, numbness,tiredness, pain, cutting pain, retention due to obstruction, body ache, muscle contractions,rounding of an organ, shivering, dehydration,abnormal movements in limbs, dryness,sponginess, atrophy, pulsation, feeling of covering, rigidity, astringent taste in the mouth,and appearance of blue or crimson discoloration of skin.

Decreased vata Slow movements, slow,diminished speech, laziness, diminished functioning of sense organs, unconsciousness,and disease due to increased kapha.

Increased pitta Yellow coloration of skin, feces, urine, and eyes; increased appetite,thirst, anger, affection for cold; reduced sleep;unconsciousness; loss of power; and weakness of organs.

Provoked pitta Burning sensation, redness,rise in body temperature, suppuration, sweating,discharge, secretion, gangrene, coma, sour and pungent taste in the mouth, discoloration of skin except in white or black skin.

Decreased pitta Reduced body temperature,diminished digestive power, and loss of luster of skin.

Increased kapha Anorexia, excessive salivation, laziness, heaviness, pallor, reduced body temperature, tiredness, cough, breathlessness,excessive sleep, dullness, drowsiness, weakness in joints.

Provoked kapha Unctuousness of body and stools, hardness, thickening, obstruction,wetness, heaviness, edema, itching, indigestion,coldness, excessive sleep, salty or sweet taste in mouth, pallor, chronicity of diseases.

Decreased kapha Dizziness, feeling of emptiness in stomach, palpitations, weakness in joints, dryness of skin, burning sensation,excessive thirst, weakness and reduced sleep.

Thorough understanding of each dosha’s primary locations, functions, and the symptoms associated with its increase and decrease is crucial for understanding the causes and effects of diseases.

Health and disease are a direct reflection of the balance/imbalance of the doshas in the body and mind. Proper diet, exercise, and a harmonious lifestyle promote balance among the doshas. Restoring and maintaining the proper balance of the three doshas with respect to their quantity (pramana), quality (guna), and functions (karmas) leads to health.

1.2.3 Prakriti (Constitution)

In Ayurvedic Medicine, constitutional phenotypes, or psychobiological tendencies,are referred to as prakriti. This term equates to the innate balance of the combination of mental and physical qualities that is unique to each individual. This distinctive constellation of qualities is determined at conception and correlates with the patterns of gene expression that shape the individual’s physical, psychological and emotional, and structural characteristics; physiological functioning; metabolic tendencies; personality;and disease susceptibility (immunity). An individual’s prakriti reflects his or her baseline characteristics. It determines an individual’s capacity for transformation at the physical,mental, and emotional levels and influences how that individual interacts with external and internal stimuli, all of which affect the aging process [6] . The idea that there is a delicate balance between biophysiological forces(doshas) and constitution (prakriti) is central to Ayurveda’s understanding of health and disease. Ayurvedic theory ascribes prakriti to the preponderance doshas at the time of an individual’s conception, while also factoring in external influences such as the environment inside the mother’s womb and the dietary and lifestyle habits of both parents. As described in classical Ayurvedic texts, these features of prakriti point to its genetic origin and to its dependence on the interplay between innate characteristics and external factors.

There are seven types of prakriti: vata , pitta , kapha , vata-pitta , pitta-kapha , vata kapha , and sama .

Three Basic Types of Prakriti: Characteristic Features

Vata prakriti Dry, rough skin and nails;cracks in soles of the feet and palms; production of cracking noise in joints during movement;thin or emaciated body; prominence of tendons and veins; irregular teeth; loss of hair and beard; dry, rough hair with split ends; dry eyes.

Pitta prakriti Medium build; feeling of excessive heat; early appearance of grey hair and wrinkles, baldness; numerous black moles;foul body odor; coppery color of nails, whites of eyes, tongue, palate, limbs, palms, and soles of feet; enthusiasm; bloodshot eyes.

Kapha prakriti Large, compact physique;soft, smooth, unctuous skin; big eyes with plenty of eyelashes; whitish tinge in the eye; curly dark hair; prominent forehead, chest; and arms.

Mixed Prakritis The mixed prakritis combine the characteristic features of the different doshas that govern them. While the vata-pitta, pitta-kapha, and vata-kapha prakritis combine the characteristics of two doshas, the sama prakriti possesses the features of all three doshas in equal proportions.

The Importance of Understanding Prakriti Effective Ayurvedic treatment requires a firm grasp of the patient’s prakriti, including its susceptibility to certain diseases. For example, a person with kapha prakriti is particularly vulnerable to kapha-type diseases,such as ailments of the respiratory tract.Hence the clinician should advise this person to consistently avoid any factors that can aggravate kapha.

Factors Responsible for Determining Prakriti These include the following: The quality of sperm and ovum; the season when conception occurred; diet and lifestyle of mother and father at the time of conception; lifestyle and diet of the mother during the pregnancy;nature of the elements that constitute the fetus.

Researchers continue to evaluate whether the various prakritis can be grouped according to anthropometric measurements and biochemical variables like serum cholesterol, blood sugar,and blood types [7] . Studies have also looked into variations in whole genome expression among the different prakriti types.

The Psychic Components of Prakriti An individual’s prakriti encompasses not only the body’s physical aspects but also the characteristics of his or her mind. Ayurveda proposes that three fundamental attributes (gunas) exist in everything in the universe, including our body and mind: sattva (purity), rajas (motion/action),and tamas (inertia). Rajas and tamas represent opposing influences on the mind that, like the doshas, can cause disturbances when they are present in excess. Sattva is the state of perfect balance. The gunas that predominate at the time of an individual’s conception determine the nature of his or her manas (mind).

1.2.4 Dhatus (Tissues)

Dhatus are seven basic tissues in the body: rasa (plasma/lymph), rakta (blood), mamsa (muscle), meda (adipose tissue), asthi (bone,or osseous tissue), majja (bone marrow/nerve tissue), and shukra (reproductive tissue). The term dhatu means “that which assists the body or which serves as building block of the body”.These seven dhatus and several updhatus (secondary tissues) make up the physical bulk of the body and occur in particular proportions in various organs of the body. Any changes in these proportions and in their proper equilibrium can lead to disease. As long as the production and nourishment of the seven dhatus proceeds normally, health is maintained.

The following list describes the main functions of each dhatu:

Rasa (plasma/lymph) — nourishes all the other tissues.

Rakta (blood) — gives vital energy to all bodily functions.

Mamsa (muscle tissue) — covers all the other tissues.

Meda (adipose tissue) — lubricates all the tissues.

Asthi (bone tissue) — supports the body.

Majja (bone marrow/nerve tissue) — f ills bones.

Shukra (reproductive tissue) — reproduction.

1.2.4.1 Dhatu Imbalances: Signs and Symptoms

The following section lists the signs and symptoms that arise in each of the seven dhatus when there is an increase or a decrease in that dhatu.

Rasa Dhatu

Increase: Discomfort in chest area, and excessive salivation.

Decrease: Chest pain, tremors, numbness,excessive thirst, dryness of body, tiredness,drowsiness, intolerance to sound.

Rakta Dhatu

Increase: Skin rash, splenomegaly, abscesses,dermatitis. Gout, excessive bleeding, tumors,thickening of gums, jaundice, discoloration of skin, loss of digestive power, unconsciousness, redness of eyes, skin, and urine, craving for blood, enlarged veins.

Decrease: Liking for sour and cold food,varicose veins, dry skin, loss of luster of skin.

Mamsa Dhatu

Increase: Cervical tumors; enlarged cervical and other lymph glands; enlarged thyroid and abdomen; hypertrophy of cervical muscles, thighs, neck, lips, phallus, arms;buttocks appear big and muscular.

Decrease: Emaciation of buttocks, neck,abdomen, lips, chest, calves; dryness and pain in the organs; drowsiness; joint pains; weakness of organs; varicosity of blood vessels.

Meda Dhatu

Increase: Mental confusion, breathlessness on little exercise, flabby buttocks, breasts, abdomen and back, oily skin, cough, breathlessness, foul body odor.

Decrease: Joint pain, drowsiness, weakness,emaciation, reduced abdomen, numbness in lower back, splenomegaly, numbness of joints.Dryness of body, affection for oil, and flesh.

Asti Dhatu

Increase: Excessive bone growth and extra teeth.

Decrease: Loss of body hair, scalp hair,beard nails, loss of teeth, tiredness, weakness of joints, pain in bones, breaking of teeth and nails, dryness of body.

Majja Dhatu

Increase: Heaviness of eyes and body, nonhealing ulcers over joints.

Decrease: Weak, light bones, disease of bone due to aggravated vata, reduced semen,joint pains, and numbness.

Shukra Dhatu

Increase: Formation of stones of semen,excess semen, increased sexual desire.

Decrease: Weakness, dryness of mouth,paleness, tiredness, lethargy, impotency,absence of ejaculation of semen, pain in testes and penis, reduced sexual power, premature scanty, blood-stained ejaculation of semen.

1.2.4.2 Formation of the Dhatus

Rasa dhatu is formed directly from ahara rasa (the nutrient portion of food obtained from the digestive process). The rasa dhatwagni (the metabolic fire within that tissue) further processes the rasa tissue, producing the plasma and lymph that circulate throughout body as well as components of its successor tissue, rakta dhatu . The metabolic fire within those components ( rakta dhatwagni ) then complete the transformation of rasa into blood. The formation of the other tissues proceeds step-by step from the initial creation of rasa (the first tissue) to the production of rakta (the second one) and continues on until the last one (shukra) is generated.

During the formation of dhatus, upadhatus(secondary tissues) and malas (waste products) are produced. Table 1–2 shows the secondary tissues and waste products associated with the various dhatus.

1.2.4.3 The Impact of Dosha Imbalances on the Dhatus

Doshas imbalances are usually reflected in the dhatus that they govern, where they can lead to dosha-specific diseases. For example,pitta diseases typically involve the blood; vata diseases, the bone; and kapha diseases, the plasma. That said, a doshas can enter into any tissue and cause various diseases.

1.2.5 Ojas (Essence of Dhatu)

The ultimate essence of all the dhatus is known as ojas . As the body’s source of biological strength, vitality, and immunity,ojas determines a person’s vigor and resistance against disease. The word ojas means “shining,bright, or full of luster”. While it is present throughout the body, its main seat is the heart.In terms of its qualities, ojas is described as white with yellowish and reddish tinge, cold,oily, soft, smooth, steady, sweet, heavy, viscid,and clear.

Ayurvedic texts refer to two kinds of ojas:

Para ojas — Located in the heart it consists of eight drops. Its loss leads immediately to death.

Apara ojas — Circulates all over the body. Its volume is approximately that of a fist (10~15 mL).

All the activities of all cells, tissues, and organs depend on ojas. If ojas is diminished or absent, the tissue won’t function properly.Increased ojas makes a person happier, stronger, and more energetic.

Table 1–2 Upadhatus and Malas Produced during Dhatu Formation

Disorders of Ojas Injury, overexertion,and psychological disturbances such as anger,sorrow, fear, and worry can all lead to disorders of ojas. These include the following:

Ojo visramsa — Displacement of Ojas from its own site. Symptoms include pain, dull complexion, dislocation of joints, inactivity, and disturbance of doshas.

Ojo-vyapat — Ojas is disturbed by one or more doshas. Symptoms include emaciation,wasting, weak digestive power, exhaustion,edema of vata type, splitting pain, excessive sleep, drowsiness, dizziness, and fainting.

Ojo-kshaya — Decrease of Ojus. Weakness,exhaustion, dull complexion, dryness of skin,weak digestive fire, fear, disorders of sensory and motor system, impaired thinking, blindness,wasting of muscles, fainting, delusions, delirium,and loss of consciousness sometimes leading to death.

1.2.6 Malas (Waste Products)

The word mala means “dirty” or “unclean”and refers to excretable products of the body.The body produces two kinds of malas: ahara malas (food wastes) and dhatu malas (tissue wastes). Ahara malas comprise purisha (feces), muthra (urine), and sweda (sweat). According to Ayurveda, these waste products help maintain health as long as they are properly eliminated and normal in their quantity, qualities, and functions. Malas play a vital physiological role—their extreme depletion may lead to death. The signs and symptoms of imbalances in the malas are listed below:

Signs and symptoms of increased feces Flatulence, heaviness and pain sides of chest and abdomen.

Signs and symptoms of decreased feces Pain in cardiac region and back, intestinal pain, shifting pain due to vata in the sides of chest,backache.

Signs and symptoms of increased urine Pricking pain in urinary bladder, feeling of incomplete excretion of urine, increased urine output, frequency of micturition, flatulence.

Signs and symptoms of decreased urine Painful micturition, discoloration of urine,excessive thirst, dryness of mouth, pricking pain in urinary bladder, decreased urine output,blood in the urine.

Signs and symptoms of increased sweat Excessive sweating, bad smell to skin, itching.

Signs and symptoms of decreased sweat Loss of body hair; numbness, dry cracked skin;abnormal sensation; decreased or absent sweating.

1.2.7 Agni (Transinformatory Energy)

Agni (digestive fire) is the force responsible for digesting, absorbing and assimilating everything that the body takes in. It resides chiefly in the kostha (gastrointestinal tract) and dhatus (tissues). Any imbalance in the function of agni can leads to disease. Agni has a profound influence on the individual’s lifespan and health span. In addition to digestion and metabolism, it controls sensory perceptions,intellectual functions, and the transformation and assimilation of mental and emotional impressions. Agni fuels the production of various types of enzymes in the gastrointestinal tract and in the liver and in the tissues. The 13 different types of agni that govern digestion of food and metabolism at different levels fall into the following 3 categories:

Jatharagni — This is the primary digestive fire located in the stomach ( amashaya ) and duodenum ( grahani ) of the small intestine.

Bhutagni — These five types of agni correlate with the pancha mahabhutas (five elements). Their role is to metabolize and transform external heterogenous mahabhutas into internal homogeneous ones.

Dhatvagni — The seven dhatvagni reside in the body’s tissues. They help in assimilation and transformation of nutrient materials after processing in the liver ( bhutagnipaka ).

Weak agni undermines digestive functions,resulting in malabsorption and the accumulation of ama (digestive and metabolic toxins). Due to its central role in the body’s digestive and metabolic functions, disturbances of agni are considered the most critical factor in the development of disease. One of the core treatment principles in Ayurveda is to restore and to strengthen the patient’s agni.

When the doshas are in a state of equilibrium, agni functions normally. When there is imbalance in the functioning of doshas,the functioning of agni is impaired. These states are described below:

Vishamagni — This state stems from excess vata. It is characterized by erratic digestion that ranges from slow to normal and may also include symptoms such as abdominal distension,colicky pain, constipation, heaviness, and gurgling sounds in the intestinal tract. This type is seen in individuals with Vata-predominant body constitution.

Tikshnagni — The predominance of the pitta dosha fuels extremely sharp and strong agni that can quickly digest large frequent meals. This type of digestion may be followed by a burning sensation in the abdomen and the palate, parched lips, and a feeling of heat.This type is seen in individuals with Pittapredominant body constitution.

Mandagni — This state of agni is mainly due to influence of kapha. Agni in this state is very sluggish and sometimes unable to digest and metabolize even a small quantity of food.It also leads to heaviness in the abdomen and head, coughing, dyspnea, salivation, vomiting, and weakness of the body. This type is seen in individuals with Kapha-predominant body constitution.

Samagni — This term describes balanced agni that can properly digest a normal diet.

Before starting the treatment of any disease,all the effort should be made to balance the agni.The concept of agni and its role in digestion,metabolism, and assimilation is fundamental to the theory and practice of Ayurveda.

1.2.8 Ama (Undigested Metabolities)

Ama is the undigested, toxic, foulsmelling, viscid, sticky substance formed as result of weak digestive fire such as weak jatharagni or dhatvagni. Ama is considered as the root cause of the diseases. The undigested food is not easily absorbed and remains in the gastrointestinal tract where it stagnates and acts like a poison.

There are many factors that can cause weak digestive fire: quantity of food — excessive food intake; quality of food — intake of excessive fluids and dry, heavy, cold, contaminated food;improper administration of panchakarma (detoxification therapies); suppression of natural urges; abnormal season (aberration in the seasons).

1.2.9 Srotas (Circulatory Channels)

Srotas are channels of circulation, where nutrients and other essential materials and energies are assimilated, transformed, and transported to and from the body’s organs and tissues. Within these hollow structures, body elements are produced, nourished, transformed into other body elements and catabolized, and metabolic wastes are carried out of the cells for elimination by the body’s excretory organs.The structure and functions of the srotas are deemed normal as long as the doshas, agni, and the dhatus are functioning normally. When damaged or impaired, however, srotas serve as a base for the production of a lesion or manifestation of disease. This typically occurs when a vitiated dosha spreads throughout the network of channels and comes into contact with a defective srotas. The disturbed dosha may then settle there, creating the conditions for the development of a disease. The various causes of defective srotas include the following:

Kulaja (heredity) — the cause of an impairment that’s linked to the genetic makeup of a person’s mother or father.

Jataja (teratogenicity) — improper diet and lifestyle of a pregnant women that produces a defect in the system.

Aharaja (dietary causes) — irregularities in diet and daily regimen that cause imbalances in the doshas, dhatus, or other aspects of a person’s constitution, setting the stage for disease.

Agantuja (external causes) — factors such as excessive heat or cold or toxins that produce imbalances in the doshas or dhatus or other aspects of the person’s constitution, leading to diseases.

Shesha doshaja (remnant causes) —improper management of an existing disease that causes relapse of that diseases or new diseases.

The classical Ayurvedic text, the Charaka Samhita , describes the body’s major systems in terms of 13 srotas: Pranavaha srotas (respiratory system), Annavaha srotas (digestive system up to small intestine), Udakavaha srotas (water metabolism system), Rasavaha srotas (body nourishing fluid system), Rakthavaha srotas (cardiovascular system), Mamsavaha srotas (muscular system), Medovaha srotas (fatty tissue system), Asthivaha srotas (bony tissue and skeletal system), Majjavaha srotas (bone marrow/nervous system), Sukravaha srotas (reproductive system), Mutravaha srotas (urinary system), Purishavaha srotas (defecation system), and Swedavaha srotas (perspiratory system).

In another foundational Ayurvedic text written later, the revered physician Sushruta delineated 11 srotas, excluding the asthi vaha srotas and majja vaha srotas and introducing a system called the artava vaha srotas (channels for transporting nutrients to the female reproductive tissues).

Ayurveda also recognizes two other srotas: Manovaha srotas (system of mind), Stanyavaha srotas (lactation system).

1.2.10 Manas (Mind)

According to Ayurveda, mind is considered as the controller of the sense faculties. Ayurveda explains that mind plays a major role in the knowledge of happiness and unhappiness etc.and it is Atindriya-Trans-sensual. It has been considered as the controller of sense faculties.Mind is part of a person, consisting of thoughts,feelings and the function of willing.

There are three qulaities of Mind explained in Ayurveda: Satva-state of balance, harmony and stability; Raja-Incharge of activity; Tamasleads to inertia.

Satva Guna makes mind more conscious.Our eternal Self could be discovered by pure Satva.

Raja and Tamas cause disharmony,agitation and delusion in mind. Raja makes the difference in perception of the mind as it perceives false ideas of the external world and makes the impression like real. This may temporarily cause happiness for some time but lose the inner peace in longer run. Desires and emotional upsets are caused by Raja. Rajas is in charge of activity of mind. Ignorance comes from Tamas. Adequate balance of these three Guna is very much essential as Satva makes balance in the energy of Raja, while stability with Tamas. According to Ayurveda, brain and heart are the seat or location of mind.

Peace of mind, sensory satisfaction and positive mind play a major role in healthy life.Disturbances in the balance of quality of mind cause various dosorders in the functioning of mind which can lead to various psychological and physiological disorders. According to Ayurveda, body, and mind are connected.

1.2.11 Ayurvedic Treatment Approaches

Ayurveda defines health as a state in which an individual sustains the balance between the 3 doshas, the 7 dhatus, the 3 malas, and the 13 agnis that is ideal for his or her constitution.In this state, the person experiences total biological equilibrium along with sensorial,mental and emotional, and spiritual well being. Ayurvedic teachings help individuals achieve this healthy balance by providing comprehensive guidance on lifestyle, diet,exercise, and personal and social behavior, as well as detailing daily, nightly, and seasonal routines that are specifically designed for their unique constitution. Ayurveda also promotes health through the use of various types of rejuvenating ( rasayana ) herbs and therapies and detoxification therapies (panchakarma).

These treatment approaches are based on a holistic understanding of the various factors that cause imbalances of the doshas, dhatus,and malas. According to Ayurveda, the primary cause of all disease is a lack of harmony between the individual and his or her environment.Thus malfunctions of kala (time), such as unseasonable weather, and improper use of budhi (the intellect) or indriyartha (objects of five sense organs) can be considered causes of disease.

The Ayurvedic approach to diagnosis is a two-fold process: examination of the patient and examination of the disease. Examination of patient helps the clinician determine and understand the prognosis of the disease and to decide how to manage it. This part of the diagnostic process entails an assessment of 10 aspects of the patient: constitution, imbalance,quality of tissues, compactness of the body,anthropometric data (e.g., weight, height,etc.), adaptability, mental stamina, digestive power, physical strength, age and rate of aging.This assessment provides the clinician with a general picture of the patient’s constitution and the status of his or her health and vitality. The second part of the diagnostic process is carried out in order to identify the patient’s present disease. This threefold process includes the following: patient interview (to determine the chief complaint and obtain a health history),general examination (observation of the patient’s pulse, tongue, voice, skin, eyes, urine, stool,general appearance, etc.), systematic examination of the whole body, including the channels.

Ayurveda’s approach to restoring the balance of doshas, dhatus, malas, and agnis draws on the principle of samanya and vishesha (similarity and dissimilarity). According to this principle, materials that are similar to various constituents of the body strengthen those constituents and dissimilar materials deplete them. Based on this principle, Ayurveda recommends dietary, lifestyle, behavioral,and psychological interventions with qualities that are either similar or different from the qualities of the patient’s dosha, dhatus, or other constituents, depending on whether they are depleted or present in excess. The entire approach is individualized to restore balance to the body and mind of each patient.

Ayurvedic Medicine encompasses three main categories of interventions: daivavyapashraya (divine therapy), yukthivyapashraya (rational therapy), and sattvavajaya (psychotherapy).Divine therapy includes chanting, offering oblations and prayers, and wearing stones with special properties. Psychotherapy aims to support the mind, and rational therapy strives to restore balance by recommending strategies based on tridoshic theory and on the state of the patient’s agni and other indications of his or her health status. The rational therapy comprises two parts: samshodhana (purificatory therapy) and samshamana (curative treatment). The purificatory therapy aims to clean the channels of the body to facilitate absorption of nutrients and herbs. It is practiced in two forms: external purification such as oleation, fomentation,and massage to liquefy the impurities and push them to gross channels from where they get easily excreted using internal purificatory therapies; internal purifications (panchakarma),which consists of vamana (emesis), virechana (purgation), anuvasana vasti (oil enema), asthapana vasti (decoction enema), and nasya (nasal cleansing). When a disease is present,purificatory therapy is followed by specific curative treatment. This typically consists of herbs and diet and lifestyle practices that are appropriate for the patient’s constitution and the state of his or her dosha, dhatus, malas, and agni.

The classical texts of Ayurveda contain detailed explanations of how to achieve its twin goals of protecting the health of healthy persons and managing disease in persons suffering from disease. In addition to recommending daily and seasonal routines, practices that promote physical and emotional balance, and a code of proper conduct, these texts stress the importance of traya upastamba — the three pillars of health.

1.2.12 Traya Upastamaba (Three Supportive Pillars)

Ayurveda identifies three supportive pillars/values for the maintenance of life and health: Ahara (food), Nidra (sleep), and Brahmacharya (positive lifestyle).

1.2.12.1 Ahara (Food)

The adequate growth and maintenance of body depend on a healthy and balanced diet. Ayurveda provides detailed advice about wholesome food and describes a wide variety of foods and drinks and methods of preparation,as well as a code of discipline that should be followed while eating, and factors that need to be considered when cooking food.

In Ayurveda, ingredients used for food and drinks have been classified into the following 12 groups: Sukadhanya (corn with bristles), Samidhanya (pulses), Mamsa (meat), Saka (vegetables), Phala (fruits), Harita (vegetables eaten raw), Madya (wines), Ambu (water), Gorasa (milk and milk products), Iksuvikara (products of sugarcane), Kritanna (cooked food preparations), and Aharayogin (other supplies used for cooking food such as oil, spices, salts).

According to Ayurvedic wisdom, one’s diet should be easily digestible, simple, small in quantity, and sattvik (balanced). One must always give thought to agni (digestive power) before consuming food. When taking food,one should fill half of the stomach with solid food, one fourth with liquids, and leave the rest of the stomach empty. This will promote easy digestion of food. One must consume food containing different rasas (tastes) so that all the doshas will be balanced. One must pay attention to the quality and quantity of the food. The proper choices may vary from person to person.When planning and eating meals, individuals must also consider the potential effects on their constitution of the combination of foods, the method of preparing and eating the food, and their emotional state during the meal.

The following factors play a significant role in determining the makeup of a balanced diet: Matra (quantity), Kala (time of the day or season), Kriya (mode of preparation or cooking), Bhumi (habitat or place or climate), Deha (constitution of person who will consume the diet), and Desa (body and environment).

Ayurvedic Medicine also considers the issues surrounding dietary incompatibility. It advises against eating foods that present any of the following issues: combinations of foods with biological qualities that conflict with one another, foods that are incompatible with your constitution, foods that are incompatible with the place or time of consumption.

All of the factors outlined above can be used to determine the wholesomeness or unwholesomeness of various foods. In addition,Ayurveda identifies eight other factors that should be considered: Prakriti (nature of food articles), Karana (method of processing), Samyoga (combinations), Rasi (quantity), Desa (habitat or climate), Kala (time), Upyoga samstha (rules for governing intake of food),and Upyokta (wholesomeness of the individual who is taking food).

Other important considerations include the impact on processing/cooking food. The qualities of food may be transformed in ways that can either enhance or degrade the food’s wholesomeness by activities such as diluting, applying heat, cleaning, churning, storing,maturing, and flavoring.

Ayurveda also lays out 10 rules for governing the intake of food: One should eat warm food. One should consume unctuous food. One should take food in the proper quantity. One should wait to consume a meal until the previous meal is digested. One should avoid food with contradictory properties. One should eat in the proper place and use the appropriate utensils. One should not eat too hurriedly. One should not eat too slowly. One should avoid talking or laughing while eating and focus solely on the food. One should take food in the prescribed manner, with due regard for oneself.

Individuals are also advised to give thought to the effects that various foods may have their constitution in terms of their weight.For instance, foods classified as brahmana samanya have properties like heaviness,unctuousness, and coldness that can lead to increase in tissue and body weight. Foods called langana samanya , on the other hand, tend to reduce tissue and body weight.

Other properties such as taste can have a profound impact on an individual’s dosha,dhatus, malas and agni. Ayurveda delineates a total of six tastes. Table 1–3 shows the effects of the six taste on the three doshas.

Table1–3 The Effects of the 6 Tastes on the 3 Doshas

1.2.12.2 Nidra (Sleep)

Proper sleep endows the individual with happiness, nourishment, strength, vitality,knowledge, and longevity. Improper sleep,untimely sleep, and excessive sleep cause various imbalances in the body. Ayurveda has described in detail the mechanisms of sleep and its qualities. It advises against sleep during the daytime in a season other than summer.Sleeping during the daytime in all seasons is recommended for only those people who are exhausted by singing; study; alcoholic drinks;sexual acts; elimination therapy; carrying heavy loads; walking long distances; suffering from wasting diseases, thirst, diarrhea, colic pain, dyspnea, hiccups, or psychosis; and for those who are very old or very young, weak, or emaciated, as well as for those injured by a fall or an assault; exhausted by a long journey in a vehicle or by anger, grief, or fear; and for those who are accustomed to daytime sleep.

1.2.12.3 Bramacharya (Positive Lifestyle)

Ayurveda teaches that living a long and healthy life requires practicing restraint in regard to sex and worldly pleasures.

Classical literature in Ayurveda also includes extensive discussion on the two other aspects of good conduct that promote health and happiness: Sadvritta (mental and social health), Swasthavrtta (healthy lifestyle).

1.2.13 Swasthavrtta (Healthy Lifestyle Practice)

Ayurveda proposes that swasthavritta (a healthy regimen) is the key to a balanced life.This regimen spans three categories of routines.The ancient Ayurvedic literature gives detailed instructions on how each of these should be conducted: Dinacharya (daily routine), Ratricharya (night routine), and Ritucharya (seasonal routine).

1.2.13.1 Dinacharya

Ayurvedic instructions for a balanced daily routine are as follows: One should get up from bed before sunrise. He or she should attend to natural calls and should wash his face, hands,and excretory orifices properly with clean water. The individual should clean the mouth and teeth. The teeth should be cleaned with the help of fresh wooden stick with astringent,bitter or pungent taste (top portion is crushed) without damaging gums. After this, one should clean his tongue using tongue cleaner made of gold, copper, or silver, which should be about 10~15 cm long. Eyes should be cleaned with cold water. After drying the eyes, one must apply anajana (collyrium) to promote good vision. One should use nasal drops (anu tailam can be used) daily to protect the sensory organs and organs above the shoulder. Gargling with oil or decoction is beneficial for the strength of jaws and teeth and to protect the sensory organs. One must also put the oil drops in the ears to prevent the diseases due to vitiated vata and to protect the ears. One who applies oil on his head regularly won’t suffer from headache,baldness, early greying of hair, and hair loss. It also helps to protect all the sensory organs. One must apply oil all over the body and massage the body to protect the body and to have healthy skin and happiness. One must engage in daily exercise to achieve body stability and physical and biological strength. One must pay attention to his own strength to decide on the intensity of the exercise. After exercise, one should take a bath. A bath should be taken twice a day and an attempt should be made to clean all of the body. Beard and nails should be cut thrice a fortnight. One should wear clean cloths and use natural perfumes and garlands. One should wear gems and ornaments to have a charming effect and happiness. One should use footwear while walking to protect the feet from attacks of reptiles, thorns, etc. One should eat in proper quantity, paying attention to agni. (The previous section includes detailed explanations about food.) One should engage in smoking the cigars that are made up of plant powders.It helps create a feeling of lightness in the chest and head and promotes the liquification of kapha.

1.2.13.2 Ritucharya

The regimen of life in different seasons is described in this section of the text. This regimen will help the body to overcome the seasonal challenges and prevent the diseases that occur due to seasonal changes. According to the time factor, the whole year is divided into two parts: uttarayana, or adanakala (northward movement of sun and its act of dehydration),which bring about three seasons (late winter,spring, and summer), and dakshinayana , or visargakala (southward movement of sun) and its act of hydration that give rise to the other three seasons (rainy season, autumn, and early winter). The changes in the body that happen during these times influence the doshas, dhatus, agni, and malas. The practices explained in this section of the text mainly aim to preserve the equilibrium of these biological energies.

1.2.13.3 Ratricharya

Conduct during night is explained in this section. Ayurveda explains different types of sleep and measures to induce good sleep. Proper sleep endows the individual with happiness,nourishment, strength, virility, knowledge, and longevity. Improper sleep causes emaciation,weakness, ignorance, and even early death.Ayurveda recommends avoiding day sleep, and advises that only certain people can indulge in day sleep (please refer the previous section about sleep). Certain measures are explained to induce good sleep. Massage; bath; intake of soup of domestic marshy, aquatic animals, rice with curd,milk, unctuous substances, and alcohol; smell of fragrance; calming the mind; application of soothing ointment to the eyes, head and face;and a comfortable bed and home will help induce good sleep. Food should be taken as early as possible during night. One shouldn’t go to sleep immediately after a meal at night. Food should be light and easily digestible. Intake of curd during night is prohibited; it may affect digestion and metabolism. uehb3XpOnGuj2LZLDMPOPl67AloeSGCOOQcRi+MqtmGClvLU2zPXPF0g8ErNzWux

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