Doshas in the Theory of Indian Medicine

H.H. Sir Bhagvat Singh Jee

|| Index || Chapter 1 || Chapter 2 || Chapter 3 || Chapter 4 || Chapter 5 || Chapter 6 || Chapter 7 || Chapter 8 || Chapter 9 || Chapter 10 || Chapter 11 || Concluding Remarks || Bibliography

INDIAN Medical Science attributes all morbid phenomena to the disordered condition of the three principal humours in the body, called Doshas, viz., wind, bile and phlegm. These fluids pervade the whole microcosm of man. So long as these are in their normal condition the body remains healthy. If they be deranged they subject it to all sorts of disorders. The three humours fill the whole body which they support; yet the principal seat of wind (VATA) is between the feet and the umbilicus ; of bile (PITTA), between the umbilicus and the heart; and of phlegm (KAFA), between the heart and the vertex.

Wind (Vata)

Wind predominates in old age, bile in middle age, and phlegm in childhood. Evening is the time for the predominance of wind, and noon and morning for the prevalence of bile and phlegm respectively. Similarly, the influence ​of wind is great after the food in the stomach is digested; when the action of the stomach is half done, or when the food is in a semi-digested state, bile gets the ascendency, and phlegm holds sway in the commencement of the process of digestion.

When wind predominates, digestion becomes irregular ; when bile is abundant, it is accelerated ; under the controlling influence of phlegm, digestion becomes weak. For perfect digestion the three humours must be in their proper proportion. If wind is predominant the bowels become costive ; when bile is in excess they become loose ; when phlegm predominates, the bowels remain in their normal condition. A proper equilibrium of the three alone keeps the body healthy.

Sometimes defect in the humours is congenital. In that case bilious diathesis is considered better than windy, and phlegmatic better than either, though, on the whole, any disorder in the humoral functions is undesirable. The cardinal humours, VATA, PITTA and KAFA, are expressed in English by wind, bile, and phlegm respectively ; but they convey more meaning than their English equivalents are capable of expressing, as will appear from a short description of each.

Every movement of the body depends, according ​to the Hindu theory, on VATA, which alone possesses motive power. It is susceptible of taking on qualities by contact, but it is naturally dry, light, cool, sharp, fine and motive. It is of five kinds, distinguished from one another according to the functions they perform in the organism. Their names are Udana, Prana, Samana, Apana and Vyana.

• Udana is situated in the neck, above the sternum. It is by this wind that one can speak, sing, and utter sounds. When it becomes defective, it produces diseases in the parts above the clavicles.
• Prana is situated in the chest and passes through the mouth and nose, and is the means of respiration and performing deglutition. When it is deranged it produces hiccough, asthma, etc.
• Samana is in the stomach, in the neighbourhood of the gastric fire. It converts the food introduced into the digestive canal into a nourishing juice, and separates the juice from the refuse which is to be rejected from the body. When vitiated it causes dyspepsia, diarrhoea and colic.
• Apana is located in the hypogastrium. Its function is to expel faeces, urine, semen, menstrual fluid and the foetus. When vitiated it causes ​constipation, diseases of the rectum, urethra, bladder and seminal disorders.
• Vyana pervades the whole body, and energises it by conveying the fluids over the different parts. It produces the flow of sweat and blood, and the various movements of the body are all dependent on it. Any derangement of it gives rise to all sorts of bodily complaints. "If all the five kinds of wind are diseased the body perishes." Some writers recognise five more vital airs, and call them Naga, Koorma, Krikala, Devadatta, and Dhananjaya, their respective functions being eructation, nictation, sternutation, yawning and inflation of a corpse.

Pitta (bile)

PITTA is naturally hot, liquid, yellow, bitter, but acid when vitiated, light and oily. It produces animal heat, and is of five kinds.

• Pachaka — its situation is between the stomach and the small intestines (Pakvashaya), which are the seat of the fire of digestion. It assists digestion and imparts heat to the whole body and separates the nourishing juice (Rasa) and dejecta. Native writers do not seem to be unanimous in their opinion about the nature of the "fire of digestion." In the opinion of some, this bile and the bodily fire are identical ; others think ​differently. The author of the "Rasa-pradipa" describes this fire as an exceedingly minute heating substance situated in the middle of the navel. It communicates heat to the bile and digests the food received in the stomach. In the largest animal it is no larger than a barley corn ; in smaller animals it is as small as a sesamum seed, while in worms and insects it is as minute as the point of a hair.
• Ranjaka remains in the liver and the spleen, and imparts redness to the essential juice, which then becomes blood.
• Sadhaka is in the heart. It sharpens the memory, the intelligence, and the understanding.
• Alochaka has its seat in the eyes, and supports the power of vision.
• Bhrajaka is situated in the skin, to which it gives brightness and a healthy colour. It absorbs applications made to the skin, and improves the complexion.

Kafa (phlegm)

Kafa is white, heavy, oleaginous, viscid, cooling and sweet, but becomes salt when defective. It is of the following five sorts, according to the locality in which it is situated :

• Kledana is in the stomach. It moistens the ​food, and strengthens the different organs of the body.
• Avalambana is situated in the heart, the shoulder-joints, and the trik (sterno-clavicular joints).
• Rasana is in the throat and the tongue, which it keeps moist, and by means of it we discriminate the tastes of different kinds of food.
• Snehana is in the head, arid refreshes the organs of sense by keeping them moist.
• Shleshana is situated in the joints, which it lubricates and keeps ready to perform their actions.

Signs of imbalance

It is easy to find out from certain signs as to which of the humours is in excess in a particular individual. For instance, a person constitutionally subject to excessive wind is generally dark, lean, has dry and scanty hair, is susceptible to cold, garrulous, jealous, impatient, in the habit of keeping awake, walks fast, is not very fond of women, and has few children. He often dreams of flying or climbing. Vagbhata says that the dog, the hare, the camel, the vulture, the rat, the cow and the owl, are by nature subject to wind hunoour.

A person with bilious temperament is fair, lean, red-eyed, prematurely gray, timid, intelligent, ​irritable, enterprising, proud, loving self-praise, kind-hearted ; a huge eater, often feeling thirsty and hungry, fond of scents and flowers, sweet, bitter, astringent and cold food, and spirits dis- tilled from molasses ; has good memory, and dreams of fire and lightning. The tiger, the monkey, the cat, the wolf and the spider, are said to be bilious by nature.

A phlegmatic person has a fair complexion, long and black hair, broad chest ; likes bitter, astringent and hot diet ; is strong and forbearing, true to his word, courteous, pious, and intelligent, but slow in work ; is fond of vocal and instrumental music as well as lecherous, takes delight in physical exercise and is constant in love. He often dreams of rivers and ponds. The eagle, the swan, the lion, the horse and the ox, are said to have phlegmatic constitutions.

Wind is engendered by fasting, watching, jumping, severe exercise, and excessive indulgence in sexual intercourse ; bile by very hot, dry and bitter food, and intoxicating drinks, as well as by anger and excess in venery ; and phlegm by want of sleep, sleeping in the day-time and eating without appetite.

Dhatus

Besides the three humours described above, ​seven more essential parts or supporters of the body are enumerated, and are called Dhatus, or the constituent parts. They are Rasa (lymph-chyle), Rakta (blood), Mansa (flesh), Medas (fat), Asthi (bone), Majja (marrow) and Shukra (semen). Their respective functions are to cause pleasure by circulation, to energise, to plaster, to lubricate, to support, to fill the cavity of the bones, and to propagate.

Rasa

As has been stated above, the Rasa, which permeates the whole body by circulating through the Dhamanies, is a nutritive fluid extracted by intestinal absorption from the food which has been subjected to the action of the digestive organs. It is purely white, sweet, and cooling, and keeps a man in good spirits. When the fluid in its circulating course enters the spleen and the liver, its white colour turns to red, and it is then known by the name of "blood." Blood is formed into flesh, flesh into fat, fat into bone, bone into marrow, and marrow into semen. Rasa, when defective, becomes acrid or acid, and engenders diseases, sometimes poisoning the whole system.

Rakta

Rakta (blood), which is heavier than Rasa, also circulates in the vessels assigned to it. This theory of the motion of the blood through the ​different vessels of the body is worthy of attention, for it sets up the ancient Hindus as claimants for the honours given to William Harvey for discovering the circulation of the blood in 1628. Harvey, no doubt, was the greatest experimenter of his age, and deserves the highest credit for leaving a "glorious legacy" to modern Physiology by scientifically explaining the theory of the circulation of the blood. But it is possible for him to have received his inspiration from earlier writers, who have taught something similar, if not with so much precision.

If the ancient Hindu writers on Medicine do not make mention of the circulation of the blood as frequently and explicitly as they do of the circulation of the Rasa, it is because there is, according to them, little difference between the two except in their colour and specific gravity. Both are fluid, but Rasa is a finer liquid, which supports the body and is the very essence of existence. Blood, minus its colouring ingredients, is Rasa. It may be called Chyle, or rather Lymph-chyle, though the Hindu writers give it a wider significance than the English word is capable of bearing. The function of circulation is common to both the fluids. For Rasa, it is distinctly stated that ​from the heart it is propelled by the Vyana Vayu to circulate through the arteries and veins ; and that it nourishes the body, as water conveyed through the canal irrigates the field. This to some extent answers the description of the circulation theory.

The circulation of the blood is also mentioned by several early writers, who each and all ascribe the property of Chala (motion) to the blood. Harita, in his work called the Harita Samhita, which some believe to be older than Sushruta, refers to the circulation of the blood in describing a disease called "Panduroga" (Anaemia). He says that this disease is sometimes caused by swallowing clay, which some persons are in the habit of doing. "The clay thus eaten blocks the lumen of the several veins and stops the "circulation of the blood." The author of Bhavaprakasha, who is a century older than Harvey, quotes the following couplet bearing on the circulation of the blood : —

Dhatoonam pooranam samyak
Sparshajnanam asamshayam,
Svashwasu charad raktam
Kuryach chanyan gunan api.

"Blood, by circulating through its vessels, fills the Dhatus well, causes perception, and ​performs other functions (of nourishing and strengthening)."

Again :

Yada tu hupitam raktam
Sevate svavahas shiras,
Tadasya vividha roga
Jayante raktasambhavas.

"When defective blood circulates through its vessels it causes many blood diseases."

Similar passages can be transcribed from even earlier writers. But the above quotations are enough to satisfy a casual reader that the circulation of the blood was not unknown to the early ancient Indians.

Mansa (flesh)

Mansa (flesh) is blood digested by heat and thickened by wind. This also produces Peshi (muscle). There are five hundred muscles in the body of a male. In females there are four hundred and ninety-seven.

Medas

Medas (fat) is produced by the digestion of the flesh by the internal fire. Its principal seat is in the abdomen.

Asthi

Asthi (bone) is fat digested by the internal fire and thickened by the wind. According to Sushruta, there are 300 bones in the body. Charaka includes the cartilages of the ears, eye​lids, nose, and the larynx, and makes the number 306. Of these 120 bones are in the limbs — the arms and legs — 118 in the trunk, and 63 in the head and the neck.

Majja

Majja (marrow) is situated within the bones, and gives a shining appearance to the body.

Shukra

Shukra (semen) is formed in males by the essential parts of marrow mixed with blood. It is the support of the body and the root of pregnancy. In the female the Easa is converted once a month into menses, the analogue of semen in the male. When conception takes place, the menstrual fluid is diverted to the mammary glands and forms milk. Urine, faeces, sweat, cerumen, free extremity of the nails, hair, expectorations, tears, chassie and nasal mucus, are considered impurities of the body.

Ashayas

There are six Ashayas or hollow viscera for holding phlegm, undigested food (ama), bile, wind, fasces and urine. A female has three more for holding the foetus and milk. Seven smaller viscera, for holding some of the essential parts, are called Kalas or receptacles. The human body contains 210 joints or Sandhis, of which 68 are movable and the rest are immovable. There are 68 joints in the upper and lower ​extremities — all movable — 59 in the trunk, and 80 in the head and neck. The joints are bound together by 900 Snayus (ligaments), thus distributed : 600 in the upper and lower extremities, 230 in the trunk, and 70 in the head.

There are altogether 700 vessels in the body, with sixteen larger ones called Kandaras, and twenty-four called Dhamanis. Wind, bile, blood and phlegm have each a number of vessels assigned to them. The human body also comprises sixteen Jalas or plexuses, six Koorchas (larger glands ?), four Rajjus or chordlike structures, seven Seevanis or sutures which should never be bored, fourteen bone-groups, fourteen Simantas or supporters of the groups and seven layers of skin. The names of the seven layers are : —

• Avabhasini, containing the vessels. Its thickness is one eighteenth of a barley corn. It is so called because it "shines" by the bile called Bhrajaka.
• Lohita (blood-red) is the sixteenth part of barley in thickness. It is in this layer that pimples originate.
• Shveta (white) is of a white colour, and is one-twelfth part of a barley grain in thickness. It is the seat of cutaneous eruptions. ​ Tamra (copper-coloured) is a membrane an eighth part of a grain of barley in thickness.
• Vedini (sensible) is the thickness of the fifth part of a grain of barley. Erysipelas begins in this layer.
• Lohini has the thickness of a barley corn and is the seat of tumour.
• Mansadhara (flesh-holding) is the thickness of two barley corns. It retains the muscles in their places and is the seat of boils.

These layers are distinguishable only in the region of the belly and a few other parts.

A man's body has nine orifices — two nostrils, two ears, two eyes, the mouth, the anus and the meatus urinarius. The female has three more, namely, the openings of the lactiferous ducts and the orifice of the vagina.

Vital organs

Hindu anatomy recognises certain Marmasthanas (vitals ?) in the body which are most essential to life and to sound health. They are to be carefully preserved against all injury, and are arranged in five groups according to their regions and the consequences they produce when wounded : (a) parts which if wounded cause immediate death : there are nineteen such ; (b) those which if injured cause a lingering death : there are thirty​three of this kind ; (c) such as impair the limbs if wounded : there are forty-four of these ; (d) parts which when slightly wounded produce intense pain : the number of such parts being eight ; and (e) vital parts which produce fatal results if foreign bodies located therein be extracted : of these there are three in the body. All these parts are described at length, and surgeons are particularly warned to avoid operations on these.

The science of ancient Indian Medicine is, as we have seen, based on the three morbific diatheses. These dispositions are born with man — nay, it is asserted that there is no substance in the universe which does not owe its formation to the humours in more or less proportion. The humoral pathology of the ancient ancient Indians has been in existence for ages. Diagnosis made on the principle of this theory, and medicines administered in conformity with its teachings, have, say the Hindus, worked pretty successfully in India. This theory seems to have been borrowed from the Hindus by Hippocrates (460 B.C.), the Father of Greek Medicine, and to have retained its hold on the medical schools of Europe for more than 2000 years. To discard the theory ​as thoughtless and barbarous is, urge its advocates, unjustifiable. The epithets are strongly resented by the ancient Indian physicians, who complain that their science has not been properly studied and examined by modern investigators, who have condemned it on insufficient data. They are, however, taking comfort in the hope that modern medical science, in the course of its onward march, or on reaching its goal of progress, may possibly land its votaries on the very theory which they have at present rejected.