Written by Scott Gerson, M.D. 2003
Ayurveda, which is a Sanskrit word meaning “knowledge of longevity”, is humankind’s oldest known preventative health care system. It is our most complete system of holistic medicine because it truly addresses an individual’s life in totality. Ayurveda is based on the law of universal interrelationships in Nature. In other words, the same laws apply to the human biology as to the rest of the universe. So the elements, energies, and laws which regulate Nature also exist in human beings.
Ayurveda considers the individual to be made up of four aspects: body (kaya), mind (manas), senses (indriyas), and consciousness (atman). In addition, every four-fold individual is has an intimate connection with the universal spirit (paramatman). Ayurveda teaches that health arises naturally and effortlessly when these four aspects of the individual are all in harmony. The state of health is the normal condition and treatments are directed at restoring this normal condition through appropriate and individualized programs of diet, herbs, exercise, meditation, massage, cleansing, etc. That is why Ayurveda is defined as prakritisthapan, or reestablishing nature. This short article will highlight some of the basic concepts of Ayurveda beginning with the five subtle elements.
The Five Subtle Elements
Ayurveda recognizes that there is a connection between the individual and the universe. In a view which is not at all different from that of modern physics and chemistry, Ayurveda teaches that there are fundamentalprinciples or qualities of matter which are shared by both human beings and the rest of the natural world, both animate and inanimate. These principles are known as the panchamahabhutas, or five subtle elements. The five subtle elements include:
- Space or Akasha
- Air or Vayu
- Fire or Tejas
- Water or Apa
- Earth or Prithvi
These elements are not to be understood in a purely literal manner. These five elements are to be understood in a material sense as well as a subtle sense. By earth we are to understand not only the terrain of our planet or the iron in our red blood cells and spleen, but also the quality of steadfastness of mind, strength of one’s moral fiber, one’s slow and quiet undeterred advancement towards a goal, and the resistance to the manifestations of others. By water we mean to imply the cohesive aspects of reality which flows into and holds things together, perfectly and simply witnessed in the ubiquitous H20 molecule. And the other elements too were intended by the ancient vaidyas (physicians) to communicate the essential universal principle inherent in a particular element. By fire we mean the universal force in nature that produces heat and radiates light; it is our passion to pursue despite obstacles and delays; it is what burns away the cloak of ignorance (avidya) and allows the Truth to shine with brilliance.
Fire removes doubt from the mother-substance of human heart and replaces it with joy. Air is that transparent, rarefied, kinetic force which sets the universe in motion; it moves the blood through the vessels, wastes from the body, thoughts through the mind; it moves the birds to warmer climates in winter, it moves the planets around their suns. Space is the subtlest of all elements which is everywhere and touches everything; in the mind it is the vessel which receives all impressions, in the heart space accepts love; space is receptivity and non-resistance to what is true.
According to Ayurveda all individuals are made up of unique proportions of these five elements.In addition, not only are human beings composed of these elements, but so are all plants, animals, oils, spices, teas, minerals, foods, and everything you might imagine. Thus these Five Subtle Elements (Pancha Mahabhutas) form the basis for all things found in the material creation, from a grain of sand to the complex physiology of every human being. So through a knowledge of which elements in a particular person is excessive or deficient, we can know which substances in the natural world can be useful for bringing us back into balance. For centuries, this theory of the five subtle elements has provided a powerful holistic tool for integrating the examination of the myriad of factors which affect health.
The Three Doshas
The five elements can be seen to exist in the material universe at all scales both organic and inorganic, from peas to planets. When they enter into the biology of a living organism, man for example, they acquire a biological form. This means that the five elements are coded into three biological forces which govern all life processes. These three forces are known as the three doshas, or simply the tridosha. The tridosha regulates every physiological and psychological process in the living organism. The interplay among them determines the qualities and conditions of the individual. A harmonious state of the three doshas creates balance and health; an imbalance, which might be an excess (vrddhi) or deficiency (ksaya), manifests as a sign or symptom of disease.
The three doshas are known as Vata, Pitta , and Kapha.
You can think of these three doshas as fundamental biological energies which regulate all the life processes of an individual. And as we will discuss later, although all individuals are made up of these same three energies, we all have them in unique proportions. The doshas obtain their qualities by virtue of their elemental composition as we can see in the simple diagram below.
Each of the three doshas is composed of two elements as shown here:
Elements Composing The Tridosha
Thus, Vata is composed of space and air, Pitta of fire and water, and Kapha of water and earth.
Vata dosha has the mobility and quickness of space and air; Pitta dosha the metabolic qualities of fire and water; Kapha dosha the stability and solidity of water and earth. Interestingly, the Sanskrit entomology of the word dosha gives it the meaning of “blemish, that which darkens”.
This alerts us to the fact that when in balance these forces are life-supporting but when unbalanced they are the agents of disease and misery.
The Nature of Disease
Ayurveda understands that health and well-being are the natural state of the human being and that health can be preserved by maintaining the unique proportion of the doshas for each individual. If the doshas become excessive or deficient, they lose their health-supporting qualities and become the agents of disease. Although not the case for absolutely every human disease, the overwhelming majority of diseases have their origin in sub-optimal digestive processes. Each of the three doshas has a specific portion of the gastrointestinal tract where it is most likely to accumulate if given a chance. For Vata, its the terminal portion of the colon; for Pitta, the small intestines and liver, and for Kapha, the stomach. Once they begin to accumulate in their respective regions, the doshas tend to become aggravated and altered as they continue to amass. They then begin to move throughout the body and lodge themselves in structures and organs predisposed to disease. There they create stagnation and obstruction.
Eventually an abnormal admixture of the disturbed (vitiated) doshas and tissues and wastes (dushyas) occurs giving rise to the prodromata (purvarupa) of disease. Prodromata are the nonspecific early signs of a specific disease. Finally, when the channels which bring nutrients to and remove wastes from that particular area become significantly obstructed, the cardinal symptoms of disease appear.
The Ayurvedic understanding of the pathogenesis of disease differs significantly from that of allopathic medicine in that Ayurveda attaches much more importance to the disease-resisting condition of the body than to the so-called causitive organisms. Since disease is initiated by vitiated doshas moving from the gastrointestinal tract (kostha) to the peripheral tissues of the body, the treatment of disease involves measures for moving those doshas back into the kostha, where they can then be eliminated through various purificatory procedures.
Although an exhaustive description of diagnostic methods in Ayurveda is beyond the scope of this short article, let us look at the principle procedures. According to Ayurveda, every manifestation in the human body has a cause which can be referenced to the energetic balance of the individual. If you feel tired after a good night’s sleep, or notice a burning sensation in the vagina, or observe your urine to be darker than usual, or have a metallic taste in your mouth, have bags under the eyes, remain bloated after dinner, find a pimple on your back, and so on and so forth—these are all signs and symptoms of the underlying doshas (energies) making themselves known. It is the duty of the physician—as well as the patient—to be a keen observer of the myriad of seemingly unrelated phenomena and to understand the energetic imbalance which is being expressed. Ayurveda has several useful methods of diagnosis.
Although not actually incorporated into Ayurveda until the 12th century, Ayurvedic pulse diagnosis has evolved to become a very important method for determining the inherited doshic composition or constitutional type (prakriti) of an individual, as well as current doshic imbalance.
In the hands of experienced vaidyas (wise physicians), the pulse can also reveal the nature of the disease, the tissues affected, the prognosis, the time required for cure, or the time of death. The pulse is generally taken in the seated or semi-reclining position, not directly after eating, exercise, bathing, sex, or if particularly hungry, thirsty, or emotionally distraught. The left or right radial artery located at the wrist is the most common pulse used. Although much experience and sensitivity are required for pulses to be evaluated fully, most well-trained Ayurvedic physicians can determine the quick, light, zigzagging vatika pulse, the strong, bounding, and fullpaittika pulse, and the slow, wide, softer kaphika pulse.
Examination of the Tongue
A normal tongue should be pink, moist (but not too moist), with a very thin clear or white coating, and smooth surfaces. A dry or rough tongue with a bluish hue and scalloped edges indicates a vata excess; a tongue which appears more red, especially near the tip, is dry towards the root, and has a yellowish hue indicates a pittaexcess; a tongue with a thick white coating which is wet and somewhat slimy is the tongue of kapha excess. The tongue can also give expression to organs which have been affected by the doshic imbalances. Ridges along the sides of the tongue may relate to toxicity of the colon, the tip of the tongue to the circulatory system, and the back of the tongue to the kidneys and water-relating structures.
Examination of the Urine
Ayurveda has developed a sophisticated, if not unusual set of diagnostic methods involving the urine. The urine is a major route of excretion of excess pitta dosha. The physician will often question the patient as to the quantity, color, turbidity, frequency, foaminess, and sensations associated with the urine. In addition to visual examination, Ayurvedic physicians will place a single drop of sesame oil into a glass beaker containing the patient’s morning urine. It is then observed if the oil drop sinks or floats, stays together or breaks up, moves to the east, west, etc., or forms a recognizable shape (i.e., half-moon, foot, etc). This gives important information about the condition or disease to the knowledgeable vaidya..
In addition to these methods of diagnosis, Ayurvedic physicians also examine the entire body, much like a general internist would. Then he also includes the following considerations in his evaluation: the general appearance, the complexion, the eyes, the stool, the skin luster, the voice, the speech pattern, the nails, and the emotional status of the individual. The wise physician always remembers that in this universe everything is interlinked and interconnected; our individual health is often impacted by the rhythms and conditions of our immediate surroundings and the larger environment as well. Therefore, Ayurvedic physicians also consider factors such as one’s place of residence, job, exposure to pollution, family or ancestral history, and even astrological signs in completing their evaluation.
Modern Ayurveda utilizes many therapeutic tools to achieve health. The preeminent of these therapies ismeditation. Meditation is the fundamental therapeutic strategy because it promotes the flow of intelligence from the universal source to the individual. Properly and regularly enjoyed, meditation brings balance to the mind which promotes a compassionate heart, a strong will and a refinement of discrimination. One develops disinterest for unhealthy cravings and desires and interest in a useful and peaceful life.
A second approach to health in Ayurveda are the concepts of dinacharya and ritucharya. These are simple daily and seasonal routines to be followed to promote hygiene, beauty, and health. Historically, these hygienic themes actually preceded meditation and yoga in Ayurveda. These regimens involve the timing and measure of our eating, sleeping, and other behaviors to put us “in synch” with the natural rhythms of our environment. Agitation and disease result when one becomes “out of synch” with these natural rhythms. Centuries ago the ancient Ayurvedic sages recognized, through meditation, these natural rhythms in their own consciousness and saw that their physiologies were under the same laws as the rest of the universe. They then revealed to mankind practices and preparations to maintain harmony between Man and the universe.
Thirdly, Ayurveda emphasizes a system of dietary recommendations. Foods are classified into groups based on taste and other primary qualities and diets are given to individuals according to their constitutional body typewith additional consideration given to the season of the year. Although in Western medicine the concept of constitutional typing is very new and only superficially understood, Ayurveda has accumulated a great body of detailed knowledge about this over many centuries.
A fourth approach in Ayurveda is its purification and cleansing therapies known as panchakarma. Panchakarma involves a series of massages and other physical therapies which remove impurities from the body’s various tissues and channels. According to Ayurvedic medical theory, one of the earliest stages of disease involves the accumulation of toxins in different areas of the body. These therapies loosen and eliminate these toxins and create a clean internal environment.
A fifth area of health promotion is through the use of specific herbal and mineral preparations, carefully gathered and prepared according to Ayurvedic tradition. The earliest reference to the use of medicinal herbs was in the Rigveda probably composed between 1500 and 1000 B.C. A little later, in the Atharvaveda, the descriptions of the use of medicinal plants becomes more detailed. As Ayurveda emerged fully in the first century B.C., these botanicals came to range from simple spices used as food supplements to sophisticated herbal/mineral preparations requiring much time and specialized knowledge.
There are many additional treatment strategies in Ayurveda including aromas, oils, exercise, yoga, massage of vital (marma) points, color therapy, use of gemstones, chanting and even prayer. One is reminded of a famous anecdote from Ayurvedic lore. Jivaka was a candidate for admission into the medical faculty at Taxila, the most prestigious institution of ancient India. Along with other worthy candidates he appeared before the “dean” who happened to be Atreya, the greatest of Ayurvedic vaidyas. All the candidates were then told to go to a nearby forest and collect as many plants as they could find which had no therapeutic use. Only after several days did Jivaka return empty-handed, stating “I could not find any plant, or any thing, which does not have medicinal value”. Among the candidates he alone was selected for admission to the faculty. In fact Ayurveda teaches us that everything in our environment affects us in some way and therefore has healing potential! It provides us with guidelines to interact with our environment in the most healthy, fulfilling way possible.
Scott Gerson, M.D.
Medical Director, National Institute Of Ayurvedic Medicine
Clinical Assistant Professor, New York Medical College
Department of Family and Community Medicine
845-278-8700 for further information