Ayurvedic Concepts of Disease Process

Health is order; disease is disorder. Within the body, there is constant interaction between order and disorder. Those who are wise are aware of the presence of disorder in their body and they set about to re-establish order. They understand that order is inherent in disorder and that a return to health is thus possible.
The internal environment of the body is constantly reacting to the external environment. Disorder occurs when these two are out of balance. To change the internal environment in order to bring it into balance with the external environment, one must understand how the disease process occurs within the psychosomatic being. Ayurveda provides explanations of disease that make it possible to restore order and health from disorder and disease.

In Ayurveda, the concept of health is fundamental to the understanding of disease. Dis means “deprived of” and ease means “comfort”. Therefore, before discussing disease, we must understand the meaning of comfort or health. A state of health exists when: the digestive fire (agni) is in a balanced condition; the bodily humors (vata-pitta-kapha) are in equilibrium; the three waste products (urine, fecess and sweat) are produced at normal levels and are in balance; the sense are functioning normally; and the body, mind and consciousness are harmoniously working as one.

When the balance of any of these systems is disturbed, the disease process begins. Because a balance of the above-mentioned elements and functions is responsible for natural resistance and immunity, even contagious disease cannot affect the person who is in good health. Thus, imbalances of the body and mind are responsible for physical and psychological pain and misery.

Disease Classification

According to Ayurveda, disease may be classified according to its origin; psychological, spiritual or disease. Disease is also classified according to the site of manifestation; heart, lungs, liver and so forth. The disease process may begin in the stomach or in the intestines, but manifest in the heart or lungs. Thus, disease symptoms may appear in a site other than the locus of origin. Disease are also classified according to the causative factors and bodily dosha; vata-pitta-kapha

Disease Proneness

The individual constitution determines disease-proneness. For example, people of kapha constitution have a definite tendency towards kapha disease. They may experience repeated attacks of tonsillitis, sinusitis, bronchitis and congestion in the lungs. Similarly individuals of pitta constitution are susceptible to gallbladder, bile and liver disorders, hyperacidity, peptic ulcer, gastric and inflammatory disease. Pitta type also suffer from skin disorders such as hives and rash. Vata people are very susceptible to gas, lower back pain, arthritis sciatica, paralysis and neuralgia. Vata disease have their origin in the large intestine; pitta disease in the small intestine; and kapha disorders in the stomach. Imbalanced humors in these areas will create certain signs and symptoms.

The imbalance causing the disease may originate in the consciousness in the form of some negative awareness and it may then manifest in the mind, where the seed of the disease may lie in the deeper subconscious in the form of anger, fear or attachment.

These emotions will manifest through the mind into the body. Repressed fear will create derangement of vata; anger, excess pitta and envy, greed and attachment, aggravated kapha. These imbalances of the tridosha affect natural body resistance (the immune system -agni) and thus the body becomes susceptible to disease.
Sometimes, the imbalance causing the disease-process may first occur in the body and then manifest in the mind and consciousness. Food, living habits and environments with attributes similar to those of the dosha (humor) will be antagonistic to the bodily tissues. They will create an imbalance that is first manifested on the physical level, and later affects the mind through a disturbance in the tridosha. For instance, disturbed vata creates fear, depression and nervousness; excess pitta in the body will cause anger, hate and jealousy; aggravated kapha creates possessiveness, greed and attachment. Thus, there is a direct connection between diet, habits, environment and emotional disorder.

Impairment of the bodily humors, vata-pitta-kapha, creates toxins (ama) that are circulated throughout the body. During this circulation, toxins accumulate in the weak areas of the body. If the joint is a weak area, for example, disease will manifest there. What creates these toxins and bodily weaknesses?

Key to Health or Disease – ‘Agni’.

Agni is the biological fire that governs metabolism. It is similar in its function to pitta and can be considered an integral part of the pitta system in the body, functioning as a catalytic agent in digestion and metabolism. Pitta contains heat-energy which help digestion. This heat-energy is agni. Pitta and agni are essentially the same with this subtle difference: pitta is the container and agni is the content.

Pitta manifests in the stomach as the gastric fire, agni. Agni is acidic in nature and its action breaks down food and stimulates digestion. Agni is also subtly related to the movement of vata because bodily air enkindles bodily fire. In every tissues and cell, agni is present and necessary for maintaining the nutrition of the tissues and the maintenance of the auto-immune mechanism. Agni destroys micro-organisms, foreign bacteria and toxins in the stomach and small and large intestines. In this way, it protects the flora in these organs.

Longevity depends upon agni. Intelligence, understanding, perception and comprehension are also the functions of agni. The color of the skin is maintained by agni, and the enzyme system and metabolism totally depend upon agni. As long as agni is functioning properly, the processes of breaking down food and absorbing and assimilating it into the body will operate smoothly.

When agni becomes impaired because of an imbalance in the tridosha, the metabolism is drastically affected. The body’s resistance and immune system are impaired. Food components remain undigested and unabsorbed. They accumulate in the large intestine turning into a heterogeneous, foul-smelling, sticky substance. This material, which is called ama, clogs the intestines and other channels, such as capillaries ad blood vessels. It eventually undergoes many chemical changes which create toxins. These toxins are absorbed into the blood and enter the general circulation. They eventually accumulate in the weaker parts of the body, where they create contraction, clogging, stagnation and weakness of the organs and reduce the immune mechanism of the respective tissues. Finally, a disease condition manifests in the affected organs and is identified as arthritis, diabetes, heart disease and so on.

The root of all disease is ama. There are many cause for the development of ama. For example, whenever incompatible foods are ingested, agni will be directly affected as a result of the toxins or ama, created from these poorly digested foods. If the tongue is coated with a white film, this symptom indicates that ama exists in the large intestine, small intestine or stomach, depending upon which part of the tongue is coated.
Ama develops when agni’s function is retarded; however, overactive agni is also deterimental. When agni becomes hyperactive, the digestive process burns away, through overcombustion, the normal biological nutrients in the food and emaciation results. This condition also lowers the body’s immunity.

Repressed Emotions

Toxins are also created by emotional factors. Repressed anger, for example, completely changes the flora of the gallbladder, bile duct and small intestine and aggravates pitta, causing inflamed patches on the mucous membranes of the stomach and small intestine. In a similar manner, fear and anxiety alter the flora of the large intestine. As a result, the belly becomes bloated with gas, which accumulates in pockets of the large intestine causing pain. Often this pain is mistaken for heart or liver problems. Because of the illeffects of repression, it is recommended that neither the emotions nor ay bodily urge, such as coughing, sneezing and passing gas, should be repressed.

Repressed emotions create an imbalance of vata which in turn affects agni, the body’s auto-immune response. When agni is low, an abnormal immune reaction may occur. This reaction may cause allergies to certain substance, such as pollen, dust and flower scents. Because allergies are closely related to the immune responses of the body, individuals who are born with an abnormal immune reaction often suffer from allergies. For examples, a person born with a pitta constitution will be naturally sensitive to hot, spicy foods which aggravate pitta. In the same way, repressed pitta emotions such as hate and anger also may increase the hypersensitivity to those foods that aggravate pitta.

People with kapha constitutions are very sensitive to foods that aggravate kapha. In such individuals, kaphagenic foods such as dairy products produce disturbance like cough, cold, congestion and wheezing. Individuals who repress kapha emotions such as attachment and greed will have allergic reactions to kapha foods.
Ayurveda recommends that emotions be observed with detachment and then allowed to dissipate. When emotions are repressed, that repression will cause disturbances in the mind and eventually in the functioning of the body.

The Three Malas

Imbalances in other bodily systems, such as the waste systems, also may result in disease. The body produces three waste products, or malas: fecess, which are solid; and urine and sweat, which are liquid. The production and elimination of these is absolutely vital to health. Urine and feces are formed during the digestive process in the large intestine, where assimilation, absorption discrimination between essential and nonessential substances take place. Feces are carried to the rectum for evacuation; urine is carried to the kidneys for filtration and then stored in the bladder for elimination; and sweat is eliminated through the pores of the skin.

Though they are considered bodily waste products, the urine and feces are not strictly waste. They are, in fact, to some extent essential to the physiological functioning of their respective organs. For example, faces supply nutrition through intestinal tissues; many nutrients remain in the feces after digestion. Later, after these are absorbed, the feces are eliminated.

Feces also give strength to the large intestine and maintain its tone. If a person has no feces, the intestine will collapse. A person who suffers from constipation lives longer than one who suffers from diarrhea. If diarrhea continues for fifteen days, death will follow. However, one can experience prolonged constipation and live, though it will cause problems in the bodily systems. Constipation creates distention and discomfort, flatulence and pains in the body, headache and bad breath.

The urinary system removes the water, salt and nitrogenous wastes of the body. Urine is formed in the large intestine. This wastes product helps to maintain the normal concentration of water electrolytes within the body fluids. The functioning of this mala depends upon the water intake, diet environmental temperature, mental state and physical condition of the individual. The color of the urine depends upon the diet. If the patient has a fever, which is a pitta disorder, the urine will becomes darkish yellow or brownish. Jaundice, which is also a pitta disorder, causes dark yellow urine. Bile pigmentation may give the urine a greenish color. Excess pitta may create high acidity in the urine. The substances that stimulate urination, such as tea, coffee and alcohol, also aggravate pitta.
If the body retains water, the urine will be scanty and this water will accumulate in the tissues. This condition, in turn, will affect the blood and increase the blood pressure. So, balanced urine production is important for the maintenance of blood pressure and volume.

Ayurvedic texts states that human urine is a natural laxative that detoxifies poisons in the system and helps absorption in the large intestine as well as the elimination of feces. If one takes a cup of urine (passed in midstream) every morning it will help to cleanse and detoxify the large intestine.
Perspiration is a by-product of fatty tissue. Sweating is necessary to regulate the body temperature. Sweat keeps the skin soft, maintains the flora of the pores of the skin and also maintains skin elasticity and tone.
Excessive sweating is a disorder that can create fungal infection and reduces the natural resistance of the skin. Insufficient sweating will also reduce the resistance of the skin and it will cause the skin to become rough and scaly, creating dandruff.

There is a special relationship between the skin and the kidneys since the excretion of watery wastes is primarily the function of these two organs. Thus, perspiration is indirectly related to the formation of urine. Like urine, perspiration is related to pitta. In summer people perspire profusely, but their urination is reduced because waste products are eliminated through perspiration. In winter, many people perspire less and urinate more.
Excessive urination may cause too little perspiration production and excessive perspiring may result in a scanty volume of urine. Thus, it is necessary that the production of perspiration and urine be in balance. Diabetes, psoriasis, dermatitis and ascites (dropsy) are examples of disease resulting from an imbalance of perspiration and urine in the body.Excessive perspiration reduced body temperature and creates dehydration. In the same way, too much urination also creates dehydration and also will cause coldness of the hands and feet.

The Seven Dhatus

The human body consists of seven basic and vital tissues called dhatus. The Sanskrit word dhatu means ‘‘constructing element’’. These seven are responsible of the entire structure of the body. The dhatus maintain the functions of the different organs, systems and vital parts of the body. They play a very important role in the development and nourishment of the body. The dhatus are also part of the biological protective mechanism. With the help of agni, they are responsible for the immune mechanism. When one dhatu is defective, it affects the successive dhatu, as each dhatu receives its nourishment from the previous dhatu. The following are the seven most important dhatus in serial order:

1. Rasa (plasma) contains nutrients from digested food and nourishes all the tissues, organs and systems.
2. Rakha (blood) govern oxygenation in all tissues and vital organs and maintains life.
3. Mamsa (muscles) covers the delicate vital organs, performs the movements of the joints and maintains the physical strength of the body.
4. Meda (fat) maintains the lubrication and oiliness of all the tissues.
5. Asthi (bone) gives support to the body structure.
6. Majja (marrow and nerves) fills up the bony spaces and carries motor and sensory impulses.
7. Shukra and Artav (reproductive tissues) contains the ingredient of all tissues and are responsible for reproduction.

The seven dhatus are understood in a natural, biological, serial order of manifestation. The post-digestion of food, called ‘nutrient plasma’, ahara rasa, contains the nutrition for all the dhatus. This ‘nutrient plasma’ is transformed and nourished with the help of heat, called dhatu agni, of each respective dhatu. Rasa is transformed into rakta, which is further manifested into mamsa, meda, etc. This transformation results from three basic actions: irrigation (nutrients are carried to the seven dhatus through the blood vessels); selectivity (each dhatu extracts the nutrients it requires in order to perform its physiological functions); and direct transformation (as the nutritional substances pass through each dhatu, the food for the formation of each subsequent dhatu is produced). These three process – irrigation, selectivity and transformation – operate simultaneously in the formation of the seven dhatus. The dhatus are nourished and transformed in order to maintain the normal physiological functions of the different tissues, organs and systems.

Dr. Vasant Lad (Ayurvedacharya)

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