In critical
circumstances d uring the course of a chronic illness, palliative treatment of the
Branch is the first necessity , while the Root is not addressed initially so as to
forego taxing the delicate vitality of the patient. Another important principle of treatment is that of Y in-Y ang rec onciliation,
i.e. to reduce conditions of exc ess and to build up conditions of deficiency . In
practice usually this is done dire ctly to the Or gan, Meridian, Su bstance or to the
pathogenic factor present. In all situations, once there is a positive progression towards balance,
attention will once again shift to prevention by strengthening the  body’ s ability to
self-regulate and adapt to its env ironment; thereby avoiding future maladies. This
philosophy is expressed in a Chinese proverb: “W aiting to treat illness after they
manifest is like waiting to dig a well after one is thirsty ." In Chin ese med ical therapy acupuncture-moxibustion, Interna l Medicine
(therapeutic use of medicinal substances), dietetics, massage and remedial
exercises are utilized as the pr inciple modalities. All these modalities share a
common theoret ical foundation and if required, can be applied in combination. Sur gery is used sometimes when all else fails. The venerated physician Hua T uo
who live d in the Eastern Han Dynasty (25-220 A.D.) is cred ited for his great
sur gical skill and promoted the use of Indian hemp anesthesia. It was unfortunate,
however , that after the era of Hua T uo, sur gery was lar gely neglected until
modern times. Diet and  the usage of medicinal substances from plant, animal and mineral
kingdoms depended upon the or ganizational models of Y in-Y ang and the Five
Element theories. Specifically , substances were classified by temperature, i.e. cold, coo l, warm  and hot; by taste, which is broken down into sour , bitter , sweet,
pungent and salty; by direction of action, which indicates whet her the substancehas a n a scending, descending, fl oating or sinking tendency; and by the Or gan and
Meridian they af fect. In Intern al Medicine and pharmacology the four divisions of a medicinal
substance’ s tem perature relate to the thermal ef fect it has upon the body . For
example, skullcap root and chrysanthemum flowers are known to be cold in
nature a nd therefore useful in t reating fevers; while cinnamon bark and ginger
root being hot, w arm the body w hen chilled. In terms of Y in and Y ang theory the
hot and warm temperatures are Y ang  in nature, while cold and cool temperatures
are Y in. The five tastes are each representative of one of the Five Elements as
follows, W ood.sour , Fire:bitter , Earth:sweet, Metal:pungent and W atensalty . In
addition, some substances are classified as being bland or lacking in flavor . These
are grouped with the sweet taste. In general sweet, bland and pungent are
considered to be Y ang in ef fect; while sour , bitter and salty have a Y in ef fect. Specifically the tastes are associated with certain actions and ef fects on the Qi. Sourness has an astringent actio n; it arrests dischar ge, promotes digestion
and has an overall concentrating  ef fect on the Qi. Hawthorne berries and lemons
are examples of plants with a sour taste. Bitterness is considered to be eliminative, anti-inflammatory and
detoxifying in action, with the  ef fect of dischar ging Qi dow nward. Mugwort
leaves, rhubarb root and cascara bark may be cited as examples of bitter taste. Sweetness and those substances that are bland in taste have a nourishing,
harmonizing an d tonic action, while tending to slow down the flow of Qi. Licorice root and dates are predominately of the sweet taste. Pungency or spiciness have bot h a stimulating and dispersing action that
raises and quickens the pace of Qi. Ginger root, prepared aconite root and
peppers are noted for their pungent taste. Saltiness has a softening and moistening action, with the ef fect of
dissolving Qi that has become congealed as, for example, in hard abdominal
masses. Most forms of seaweed typically possess a salty taste. T o understand a substance comprehensively both temperature and taste
must be  taken into account toge ther . For example, if two plants  are both hot but
possess dif ferent flavors (such as pungent and bitter), their actions will be
dif ferent in the body . Also substances are recognized to have particular af finities
to ce rtain specific Or gans and M eridians; these associations ar e usually derived
from empirical experience.Generally the direction of action is in harmony with a substance’ s taste and
temperature acco rding to their re lationship with Y in or Y ang. This is summarized
below:
The ascending and descending tendencies refer explicitly to a substance’ s
ef fect on  redirec ting the Qi eith er upwards or downwards. Floating has the main
ef fect of dispersing the Qi outward to dispel external Pernicious Influences. Sinking has a co ncentrating ef fe ct on the Qi, moving it inward and downwards;
this being specifically useful in promoting mental tranquillity . In the most general
sense, su bstances are used therapeutically to counteract the nature of the illness. Thus Y i n sympt om patterns are treated with substances that h ave a Y ang taste,
temperature and direction of action, and vice versa for Y ang diseases. Historically the configuration of a plant or mineral has also be en used in
Chinese medicin e to determine its appropriate use. Configuratio n refers to shape,
texture, color , moisture and its n atural environmental origins. A  good example of
this con cept is the ginseng root  that is shaped similar to the h uman body , with
head, arms and legs. This plant  is native to cold, mountainous  regions of north
China a nd Kore a. It has a long growth cycle that takes about 7 years to reach
maturity . Ginseng is said to be an excellent tonic that nourishe s and warms the
whole body , and also promotes longevity . In fact, the Chinese characters for
ginseng (or ren shen in pinyin) literally mean “man root". A unique feature of Internal Medicine is the highly evolved art of
formulation. A physician is not only required to know the individual substances,
but also the strategies of treatment and most importantly the complex ways in
which medicina l substances combine and interact therapeutic ally . Specifically
there are 8 gen eral strategies of treatment and around 20 types of formula
categories to select from. The traditional strategies of treatment in Internal Medicine include:
sweating, vomiting, clearing, d raining, harmonizing, warming, reducing, and
tonifying. Each strategy focuses on dif ferent key causes to ill health, principally:
sweating is utilized to dispel invading Pernicious Influenc es; vomiting is
ef fective in excess toxic conditions in the upper digestive tract; clearing refers to
loosening and de-congesting the Blood, Qi or Fluids; draining is useful to pur gethe lar ge intestine of accumulation; harmonizing denotes restoring balance
amongst the malfunctioning Or gans; warming dispels coldness and strengthens
the Y an g; reducing refers to lowering the body’ s temperature when there is
excess heat; and lastly , tonifyin g is used to build up the defici ent conditions of
Y in, Y ang, Blood or Qi. The form ula categories are extensions of these treatment strategies and
broadly or ganiz e the formulas according to their clinical pr esentation. Each
formula or prescription will normally contain four classes of ingredients arranged
in a hierarchica l fashion, being referred to as the chief, deputy , assistant and
envoy . The chief is the principal ingredient, specific to the patient’ s pattern or
illness and thus indispensable to the formula. The deputy either acts to strengthen
the principal ingredient’ s ef fect or serves as the main ingredient directed against a
co-existing pattern. The assistant helps to reinforce the ef fect of the chief and
deputy i ngredients or treats secondary manifestations of the disease pattern, or
contains ingredi ents that check the toxic side ef fects of the oth er ingredients in
the formula. The envoy direc ts the above to their appropriate site and/or
harmonizes the various actions of the other ingredients. Not all formula s contain the f ull hierarchy of ingredients, while others
contain a number of ingredient s in each class within the hierarchy . There are
hundreds of formulas of both classical and modern origins in use today . Ideally
each formula is tailored to meet the needs of a particular patient’ s condition,
although pre-made standardized formulas are now readily available. These
combinations of  medicines have a syner getic ef fect that is dif ferent from the sum
total of its ingredients. The medicines are administered in a wide variety of
forms: decoction, pills, powders, plasters, medicinal wines and syrups. Acupuncture and  massage therapy are considered more of a Y an g, external
form of therapy . The focus of these therapies is to remove blockages (especially
of Qi) in the M eridian System  so that Y in-Y ang, Substances and Or gans can
communicate an d function harmoniously . This idea is express ed in the axiom
found in  the Inner Classic:  “Where there is communication there is no pain;
where th ere is pain, communication is obstructed.” “Pain” here includes both
somatic and emotional suf ferin g. Acupuncture is not only ef fe ctive for painful
syndromes, but  also for all sort of illnesses like chronic indigestion or
gastrointestinal ulcers; menstrual problems; musculoskeletal co mplaints such as
lower b ack pain and tendinitis; mental depression and emotional disorders;
hearing loss; asthma; viral illne sses, such as chronic fatigue syndrome and viral
hepatitis; and so on.Acupuncture is the method of applying delicate thin needles to  pierce the
body at specific points. These n eedles were made classically of various metals
depending on their intended ef fect; gold, for example, has a tonifying ef fect,
while sil ver tend s to sedate. In modern times more durable stain less steel needles,
which have a neutral ef fect, are  most commonly used. The ef fect of needling is
also dete rmined by the method of insertion and manipulation o nce in place, the
breathing sequen ce of the patient, the intention of the practition er , as well as the
specific therapeu tic qualities of the Meridian and point selected . Needless to say ,
acupuncture is a precise technic al science as well as an art tha t requires a great
deal of skill and experience to master . Moxibustion is an application o f heat to the chosen focal point. Mugwort
(artemisia vulga ris) is the herb of choice, even though others are also used. A
small po rtion of the dried ignited herb is placed on the skin  directly or held
slightly above the surface. The patient feels warmth at the fo cal point, and in
cases w here necessary the skin may sometimes be cauterized producing a
powerful ef fect to stimulate the flow of Qi and to tonify the body’ s Y ang. Other
adjunctive techn iques such as m icro-bloodletting on the acupu ncture points, or
cupping—a type  of localized su ction technique, may also be u sed under special
conditions. Interestingly , the written form of the term for Chinese medicine, “zhong
yi", is composed  of two charact ers, the first is “zhong" 
    mea ning middle, as
in the Middle Kingdom, what we call China. The second  character “yi" 
  s tanding  for medicine is, howev er , again composed of two, a root and a phonetic
character . The root character “yu" 
    shows a jar which is used for keeping
fermented liquors (which could  be medicinal wines or cordials). The phonetic
character “yi" 
    m eans to take out arrows “shu" 
  _ from the quive r “yi" 
  r efe rring to the practice of acupuncture and possibly ancient sorcery (killing the
demons that cause disease). The written expression for “medicine” thus reflects
the nature of the therapeutic approaches that medicine embraces. Therapeutic massage is widely practiced for all manner of illne sses, and is
especially preferred over acupuncture for treating children. T echniques of
massage include  manually activating the points and Meridians, kneading and
rubbing the soft tissues, manipulating the joints, bonesetting and massaging the
viscera. In the field of reme dial exercise both ritualized calisthenics andbreathing techni ques such as Qi Gong and T ai Qi Quan are used  to promote self-
healing and to prevent disease. In the modern e ra many impressive new procedures have been developed,
some in  conjunction with modern medicine, such as acupuncture anesthesia,
which is  useful in some types of  sur gery . New medicines using a combination of
western and oriental pharmaceutical substances and techniques have also been
introduced. Another important d evelopment has been the theory and practice of
various acupuncture microsystems. One such is auricular acupuncture, through
which the whole body can be t reated via the ear alone. Qi Gong, a method of
directing the Qi in the body via the breath, has also grown popular for self-
healing in conditions such as cancer , arthritis and chronic painful disorders. Often a practitioner specializ es in one field of therapeutics, like
acupuncture or massage, or in a branch of medicine, such as pediatrics or
gynecology . Nev ertheless, the higher vision of educating and in spiring everyone
to live in harmony with nature has always been an important goal of Chinese
medical practitioners.P A R T  T W O
A Y U R V E D A1
O r i g i n s  a n d  D e v e l o p m e n t
T he  w ord “A yurved a,” which comes from the V edas, the ancient sacred I  books
of the Aryans, m eans “the Lore of Life.” A yurveda, whose or igins go back at
least fiv e thousa nd years, began as an appendix to the youngest of the V edas, the
Atharva V eda. Most of the V edic healing lore occurs in the Atharva V eda,  which
is basic ally a manual of magic (see illustration 8). After its incantational
medicine evolve d into empirical medicine, the most important  of all A yurvedic
texts, the Charaka Samhita,  appear ed, possibly between the 8th and 10th
centuries B.C. A yurveda’ s most famous sur gical text, the Sushruta Samhita,  was
also com piled a round this time. While these texts may have had single authors
they are more likely to be compilations of material from many sources. A yurvedic medi cine was already extensively developed by the time of
Gautama Buddh a, and the Budd ha supported both the study an d the practice of
medicine. Since  the days of Charaka and Sushruta, A yurvedic students started
dissecting human corpses, pra cticing the arts of sur gery on dummies, and
learning other practical arts such  as cookery (since diet was an essential aspect of
treatment), the collection and preparation of herbs, horticulture, and the
purification and preparation of mineral medicines. Each student usually
specialized in one of A yurveda’ s eight “limbs": Internal Medicine, sur gery , eye-
ear -nose, gynecology-obstetrics-pediatrics, psychology , toxicology , rejuvenation,
and virilization. At the end of the period of study , the disciple was thoroughly
tested, and after graduation was given a license to practice by the king. After A shoka, the emperor of most of North India about three centuries
before th e birth of Christ, embraced Buddhism, he furnished extensive support to
medicine and built charitable hospitals including specialized sur gical, obstetric
and mental facilities throughout his realm for both humans and animals, and his
emissaries spread Buddhism a nd Indian sciences in far -of f lands including
Central Asia and Sri Lanka. Du ring the later Indian empires o f the Guptas and
the Mauryas, the government expanded this active support for medicine by
planting gardens  of medicinal herbs, establishing hospitals and maternity homes,
posting physici ans in villages, and punishing quacks who tried to practice
medicine without proper learning and imperial license.During this era A yurveda was ta ught in lar ge Buddhist universities like the
one at Nalanda, established during the fourth century A.D. and which flourished
for a bout eight hundred years. S tudents came from all over the world to study at
these universities. More texts appeared, including V agbhata’ s Ashtanga Sangraha
(Collected T eachings of the Eight Limbs)  and Ashtanga Hr daya {Heart of the
Eight Limbs). These are condensations of Charaka and Sushruta’ s teachings, and
Madhava’ s Madhava Nidana {T ext on Diagnosis). A yu rveda was not limited to
humans; texts on the treatment o f trees, horses and elephants st ill exist, and may
have exi sted for  such varied ani mals as cows, goats, sheep, don keys, camels and
hawks. The Gol den Age of Indian cultu re ended when Muslim invaders inundated
Northern India after the tenth c entury . They slaughtered the Buddhist monks as
infidels, destroyed the universi ties and burned the libraries. Those who could
escape f led to Nepal and T ibet, and hence some A yurvedic texts whose originals
were lost at th at time survive solely in the T ibetan translation. Though the
Muslim conquerors imported their own system of medi cine into India,
fortunately A yu rveda did survive as did the Hindu culture. In the thirteenth or
fourteenth century a treatise on A yurvedic pharmacology , the Sharngadhara
Samhita,  a ppeared, and during the sixteenth century all Indian medical
knowledge was collected and compiled by the order of the Mughal Emperor
Akbar . The con quests of the Europeans, however , were nearly fatal to A yurveda,
especially after 1835 when the British decided neither to recognize nor support
Indian s ciences in their Indian dominions. While the Germans, and later other
W esterners developed plastic s ur gery from Sushruta’ s operation for repair of
damaged noses and ears, it took the upsur ge of Indian Nationalism at the
beginning of this century to reawaken interest in the native  Indian arts and
sciences in India itself. A yurveda began its renaissance then, an d today it is one
of the six medical systems in India which is of ficially recognized by India’ s
government, the others being Allopathy , Unani, Siddha, Homeopathy and
Naturopathy .2
T h e  S a n k h y a  P h i l o s o p h y
T he e volution of t he universe as detailed in the Sankhya system, one / of the six
systems of philosophy in India, forms the foundation for most A yurvedic
theories. Y oga uses the same approach with only minor al terations. In the
Sankhya philosophy , everything evolves from an Absolute Reality (purusha)
which is consciousness without any characteristic whatsoever , beyond time,
space, and causation, a single point which encompasses everything and which
cannot be perceived by mind o r accurately described in human language. All
potentialities exist within Absolute Reality in an unmanifested state. From this
Absolute Reality evolves Relative Reality , a sublime creative force called Nature
(prakriti). The sole dif ference between Nature and Absolute Reality is that the
Absolute knows  itself to be identical to Nature, whereas Nature  believes itself to
be dif fer ent from the Absolute. This passive awareness of dif fere nce then evolves
into a undif fer entiated Intellig ence (mahat), a faculty through which this
dif ference is actively perceived . Intelligence is thus Nature’ s unlimited self-
awareness. This undif ferentiated Intelligence then individua tes into discrete
bundles of limited self-awareness called Ego (ahamkara). Each of these is self-
aware, but aware only of that limited parcel of being with which it identifies. Nature, as manifested through individual bundles of Ego, has Three
Attributes (gunas): Sattva (equilibrium), Rajas (activity) and T amas (inertia). Rajas is  movement, T amas matter , and Sattva that subjectivity which perceives
matter . S attva ev olves into the t hinking mind, the five senses o f perception and
the five senses of action (communication, manipulation, locomotion, procreation
and excretion, represented in the human body by voice, hands, feet, genitals and
anus respectivel y). T amas evolves into the objects of the co gnitive senses—
sound, touch, form, taste and odor—which in turn produce  the Five Great
Elements (pancha mahabhutas) which make up the physical uni verse: Ether , Air ,
Fire, W a ter and Earth. Rajas is th e force which brings the senses  and their objects
together . I go to sleep as “I” at night and wake up as “I” the next morning
because Ahamkara identifies “I” with a particular body , a certain set of habits
and pref erences, and specific desires and disgusts. Sattva, Rajas and T amas are
the three powers through which Ahamkara creates self-image (see illustration 9).The Five  Great Elements are rea lly states of matter: Earth is the solid state,
W ater the liquid state, Air the ga seous state, Fire the power to change the state of
any subs tance, and Ether the fie ld which is both the source of all matter and the
space in  which it exists. Ether i s the most rarefied stage of matter and Earth the
solidest. Every substance in our world is made up of these Five Elements and can
be classi fied acc ording to which Element is predominant. Things which are solid
under n ormal conditions are composed primarily of the Earth Element,
substances which are normally gases are mainly composed of A ir , and anything
which is  usually  liquid is mainly  made of W ater . Reactive or unstable substances
are u sually Fiery in nature, and Ether predominance in a substance is shown by
its rarefaction or lack of density . Our physical bodies are also made up of these Five Great Elements; in fact,
the Law of Microcosm and M acrocosm (according to the Charaka Samhita)
states th at everything that exists in the vast external universe,  the macrocosm,
also appears in t he internal cosmos of the human body , the microcosm, in altered
form. Th e universe is thus continually influencing us, and likew ise we influence
it. Prana , Subtle  Fire (tejas) and  Essence (ojas) are the quintessential expressions
of th e Fi ve Elem ents as applied to embodied life. Furthermore, Prana, Subtle Fire
and Essence individually expre ss the intrinsic attributes of Air , Fire and W ater
Elements, respec tively , in their g reatest degree. Prana is the life  force, the power
which holds body , mind and spirit together and compels t hem to function
together . Prana is not air , though  oxygen is one of its vehicles. S ubtle Fire causes
the tran sformations necessary to allow influences to pass fro m one plane of
existence to another , and Essence is the subtle glue which cements body , mind
and spirit together , integrating them into a functioning individual.3
T h e  T h r e e  D o s h a s
P rana, Subtle Fire and Essence are too subtle to satisfy all of a living body’ s
ener gy r equirements and so they metamorphose into doshas, a dosha being a fault
or error , a thing which can go wrong. The Three Doshas inside a living body—
V ata, Pitta and Kapha—are grosser forms of Prana, Subtle Fire and Essence
respectively . They , too, are condensed from the Five Great Ele ments: V ata arises
from Ai r and Ether , Pitta from Fire and W ater , and Kapha from W ater and Earth. Therefore each Dosha is compr ised of two Elements; one fun ctions as its active
component whil e the other acts  as the passive medium throug h which the active
element is expressed. Thus V ata , Pitta and Kapha are most representative of Air ,
Fire and W ater , respectively . All movements of any kind in the physical body of every living being in our
world ar e governed by V ata. All transformations of every kin d, and particularly
those involving digestion of food and information, are governed by Pitta. Stability ,
including such functions as lubr ication of joints and or gans, is governed by Kapha. Though direct perception of thes e Doshas, which do not exist on the physical plane
is not possible, i t is possible to discern their presence and influence by examining
their ef fe cts on the or ganism. Bile, phlegm and other bodily secretions are vehicles
for the Three D oshas, substances through which they display their qualities and
perform their actions. All Five Elements are essential to life, and their harmony ,
which a rises wh en V ata, Pitta an d Kapha are balanced, determines an individual’ s
condition of health or disease. A healthy or ganism produces just enough of the
Three D oshas to meet physical needs, while an unhealthy body overproduces or
underproduces t he Doshas at th e expense of the body’ s vitalit y , adaptability and
immunity . Whether a substance increases o r decreases a Dosha depends upon the Law
of Like and Unlike, according  to the Charaka Samhita. “Like increases like”
means that when you eat, drink, inhale or otherwise imbibe  a substance, the
qualities of that substance increase those parts of your syst em which possess
similar q ualities. Substances wh ich are mainly composed of Earth and W ater will
increase the body’ s proportion  of Earth and W ater and will therefore increase
Kapha, constituted of Earth and W ater . For example, ice cream being mainly
composed of Earth and W ater  and being cold, heavy , wet,  sticky and denseincreases body constituents wit h  like qualities, e.g. mucus. T en pairs of qualities
are commonly recognized in A yurvedic analyses of substances:
heavy and light
cold and hot
wet and dry
dull and acute
stable and mobile
soft and hard
clear and sticky
smooth and rough
subtle and gross
solid and liquid
What is unlike a thing tends to reduce it; black pepper , for example, is hot,
light, an d dry; is not sticky or d ense, and thus tends to decrease the body’ s mucus. Whether ice cream will be bette r for you than black pepper or not depends upon
what your system requires to remain in balance at any particular moment. A
substance can exert three possib le ef fects on an or ganism: it can act as food and
nourish it, act as medicine and harmonize it, or act as poison and derange it. The Thr ee Doshas, like the Elements from which they arise, increase and
decrease in the b ody according to the qualities present in the body; qualities which
we absorb from our food, drink and our environment, and derive through our
intrinsic chemis try . Even our thoughts and emotions have qualities that af fect the
body’ s Doshas. Each of these Doshas has its own set of qualities:
V ata  is dry , cold, light, unstable, clear , rough, and subtle;
Pitta  i s sligh tly oily ,  hot, intense, light, fluid, malodorous (a raw-m eat-like
smell), and mobile;
Kapha  is oily , cold, heavy , stable, viscid, smooth, and soft. Whatever goes into the system i nfluences the system with its ch aracteristics. The most important of all inpu ts is food which af fects the system thrice: before
digestion when it is tasted by th e tongue, during digestion while it moves through
the gut, and afte r digestion when it passes into the tissues. These ef fects are called
taste, potency and post-digestive ef fect respectively . Six taste s are described in A yurveda: sweet, sour , salty , punge nt, bitter and
astringent (see illustration 10). Sweet, sour and salty tend to in crease Kapha and
decrease V ata; pungent, bitter and astringent exert precisely the opposite action,increasing V ata and decreasing Kapha. Sweet, bitter and astringent relieve Pitta,
while so ur , salty and pungent increase it. These tastes are derived from the Five
Elements; each a composite of two elements in the same manner as the Doshas. Sweet is composed of earth a nd water; licorice root is a good example of a
substance that is primarily  swee t in taste. The sour taste, as of hibiscus, is made up
of earth  and fire. W ater and fir e combine to form the salty taste; which appears
mainly in salt and seaweeds. Pungent substances like chilies and cloves are mainly
composed of air and fire. Genti an and barberry are examples o f plants which are
predominantly bitter in taste with air and ether as the main elem ents. W itch hazel
and unripe persimmons are mainly astringent; in these air and earth dominate.Although the pairs of strong po tencies include heavy/light and  wet/dry , the
most important duality is that of hot and cold. Hot food enhances the fire available
to t he body , w hile cold food reduces it. Generally  sour , salty and pungent
substances are hot while sweet, bitter and astringent substances are cold. There a re three types of post- digestive ef fects derived from the natural
qualities of the food and the strength of the digestive process: sweet tends toexpand the tissues, enhances Kapha, and builds up the body; sour increases Pitta
and may  burn away the tissue s; and pungent augments V ata and dries out the
tissues. I n gener al, sweet and sa lty substances lead to a sweet post-digestive ef fect,
while sour substances lead to a sour one, and bitter , pungent and astringent
substances result in a pungent post-digestive ef fect (see illustration 11). Certain foods, medicines, and poisons possess specialized attributes or
powers (prabhav a). When a sub stance possessing a special power is consumed, it
may produce unusual ef fects i n the body and mind, ef fects  which cannot be
predicted by the classificatory knowledge of taste, potency or post-digestive ef fect. Charaka, in summarizing the id eal attributes of a medicinal sub stance, says:
“A medicine is one which enter s the body , balances the Dosha s, does not disturb
the h ealthy tissue, does not adhere to them and gets eliminated through the urine,
sweat and feces. It cures the dis ease, gives longevity to the bodi ly cells and has no
side ef fects." 4
T h e  D o s h a s  i n  t h e  B o d y
T h e  Thr ee D oshas pervade the entire body but concentrate only in /  those tissues
in w hich they ar e particularly required. Thus V ata accumulates b elow the navel to
help cou nteract the force of gra vity by pumping blood, lymph and wastes from
the lower parts of the body back into the torso; whereas Kapha accumulates above
the diaphragm to keep V ata from moving upward too strongly , and to ensure
lubrication for those or gans whi ch require it most (the heart, lungs and alimentary
canal); and Pitta, the mediator and fulcrum between V ata and Kapha, occupies the
region between the diaphragm and the navel, near the body’ s center of gravity . Certain body or gans generally store higher concentrations of each of the
Doshas:
V A T A —brain and nervous system, heart, lar ge intestine, bones,
lungs, bladder , pelvis, thighs, ears and skin. PITT A —brain, liver , spleen, gallbladder , small intestine, endocrine
glands, skin, eyes, blood and sweat. KAPHA —brain, joints, mouth, head and neck, stomach, lymph,
chest (especially lungs, heart and esophagus), kidneys and fat. V ata, Pitta and Kapha each has five particularized aspects. The f ive Kaphas
manifest in specialized body l ubricants such as stomach mucus, pleural and
pericardial fluid, saliva, synovi al fluid, and cerebrospinal fluid. The five Pittas
appear in transformative subs tances including digestive jui ces, hemoglobin,
melanin, rhodop sin, and various neurotransmitters. The five V ata s divide the body
into spheres of influence as follows:
The fiel d of activity of Forwa rd-Moving (prana) V ata extends from the
diaphragm to the throat; it is in char ge of taking in of things like food, water and
air , i nto the syst em. All five V atas are derived from Prana, but since this V ata is
particularly involved with the intake of the life force itself, it has been ascribed
this name. The field of Upward-Moving (udana) V ata extends from the t hroat to the
top of the head , and it controls self-expression: speech, endeavor , enthusiasm,
memory , vitality , complexion (o ne of the body’ s means of expressing its innate
state) and the like.The Dow nward-Moving (apana) V ata, operates from the navel to the anus. It expels things from the body: urine, feces, gas, semen, menstr ual blood, and the
fetus. The Pervasive (vyana) V ata pervades the entire body from its seat in the
heart, distributing nourishment by causing blood and other fluids to circulate and
producing locomotion, extension and contraction, perspiration, and other similar
actions. The fiel d of Equalizing (samana) V ata extends from the diaph ragm to the
navel. I t directs the processes of digestion and assimilation, and helps keep
Forward-Moving and Downward-Moving V atas balanced. V ata, Pitta and Kapha act through the body’ s tissues and waste products. Actually it is th e Doshas which really make the body function , since the tissues
are arranged and nourished and the wastes sequestered and excreted by the
Doshas. A human being is a fac tory in which raw materials are operated upon by
the Doshas to pr oduce products and byproducts. While the build ing, the machines
and the  raw materials are all essential ingredients for prod uction of goods;
without the workers (the Doshas) there is no production! The products of
digestion are the seven tissues w hich anchor mind and spirit firm ly to the physical
body . T hey are Sap (rasa), Bl ood (rakta), Flesh (mamsa), Fat (medas), Bone
(asthi), Marrow (majja) and Reproductive T issue (shukra) (see illustration 12). Sap (ras a), the foundation of the body , is the first “juice” absorb ed from the
digested food; it includes but is not limited to chyle. Sushruta emphasized Sap’ s
importance thus : “Knowing that humans are the product of Rasa, one must be
specially carefu l about the pre servation of Rasa.” Each tissue acts as the raw
material for the next; that is, B lood is formed from Sap, Flesh from Blood, Fat
from Flesh, and so on. At eac h stage of transformation the next tissue in the
sequence is produced along with a waste and a secondary tissue. Reproductive T i ssue includes all the body’ s reproductive fluids, male and
female; it produces no waste, and its secondary tissue is the fetus it creates. The
action o f a very subtle form of  Fire on Reproductive T issue g enerates Essence
(ojas), t he glandular secretion which cements body , mind and spirit together . Although semen  is produced in the testicles, the ener gy which that semen carries
comes f rom Bone and Marrow . Since Reproductive T issue is the raw material
from which Essence is produced , excessive loss of Reproductive T issue depletes
Essence, weaken ing immunity and digestive capacity . When E ssence is firm the
mind is firm; ex cessive sex robs the mind of its firmness bec ause Essence and
Reproductive T issue are continually lost. It takes time for ingested food toproceed through the tissues to nourish Reproductive T issue, though milk, honey ,
onions a nd alche mically prepare d mercury are some of the substances reported to
replenish the body’ s Reproductive T issue almost instantly . Essence is both the cause and the ef fect of good digestion, and
its  conservation is essential to good health because it controls the immune system
and gen erates th e body’ s aura, the halo of lustre which is the  essence of one’ s
being. Lustre which is “expansive, glossy and broad” is auspicious, while a “dry ,
soiled or contracted” lustre betokens inauspicious-ness and disease.5
C h a n n e l s  o f  F l o w
W hen balanced the Doshas support the body by irrigating the tis-Vv sues
with Sap  (rasa) as water irrigat es a field. Like crops in a field  the tissues
require channels through which  the nutrient juices can flow to reach them. The bod y posse sses many Channels (srotamsi), lar ge and small, through
which n utrients and wastes move. Many of these channels, such as the
digestive tract, look like pipes even to the naked eye, while others are less
tube-like. The digestive tract is the most important of all the bodily
channels, since it takes in the E lements necessary to replenish body tissues
and maintain the system’ s continuity . Though innumerable, fourteen of these channels are primary . Three
of them deal wi th nutrition from outside: the Prana Channel, composed of
the respiratory system and the  heart; the W ater Channel, wh ich extends
from the palate to the pancreas; and the Food Channel, extending from the
esophagus to the lar ge intestine. Seven channels deal with tissue nutrition:
the Sap Channel consists of the heart and its great vessels, the Blood
Channel is based in the liver an d spleen, the Flesh Channel consists of the
muscles and skin, the Fat Chan nel includes the kidneys and omentum, the
Bone Ch annel c onsists of the fat  and the hips, the Marrow Channel consists
of the bones, the joints and eve rything which is encased within bone, and
the R eproductiv e T issue Channel consists of the testes and penis in the male
and their corresponding structu res (the ovaries, vagina and cli toris) in the
female. Three more channels de al with the elimination of waste s: the Urine
Channel consists  of the bladder and kidneys, the Feces Channel of the colon
and rectum, and the Sweat Channel of the fat and hair follicles. The fourteenth channel, the Ch annel of Mind, pervades the entire
body; the body i s in a sense the mind’ s special channel. There is  nowhere in
the b ody mind c annot and does not go. T wo more channels are peculiar to
the f emale: the M ilk Channel and the Menstrual Channel, both of which are
secondary to the Sap Channel. The Milk Channel includes the breasts andnipples, and the Menstrual Chan nel the uterus, cervix and vagin a. When all
flows are regular in the vario us channels the or ganism is h ealthy and
therefore happy ,  just as when a field is well-watered its crops grow well. Should the circulation in any c hannel become obstructed, nutrients and/or
wastes will accumulate and cau se the bodily equivalent of a flooded field,
yielding imbalance and disease . There are four possible disturbances to
flow in a chan nel: increase or decrease in flow , a “knotted ” condition
(obstruction), a nd deviation of its flow into abnormal spaces. Any
disturbance to a channel’ s flow will disturb V ata. One imp ortant cause of such disturbances is due to the restraining of
the thirteen ur ges, namely the ur ges to: expel urine, feces, and flatus; vomit,
sneeze, belch, and yawn; eat w hen hungry , drink when thirsty , cry when
sad, sle ep when sleepy , pant after exertion, and ejaculate semen when
irresistibly arou sed. Restraint of these ur ges causes V ata to move in an
abnormal direction in these channels, vitiating first the channel involved
and then the en tire system. Other ur ges even though not physi cal reflexes
can still disturb V ata. These include especially the negative mental ur ges
like gree d, sorro w , fear , anger , e nvy , pride, shame, disgust, and t he like, and
ought always to be restrained, though not suppressed.6
S u b t l e  A n a t o m y
T he  h uman body is composed of a  number of intricately interwoven / layers,
like an onion, among which are the changeable body of fluids, including the
tissues and wastes; the relative ly less changeable body of muscles, bones, and
nerves; the subtle body , which is the field of mind; and the causal body . Though
we cannot dissect these “bodies" apart from one another , we call them “bodies"
because in certain ways they beh ave as if they were separate structures within the
unified o r ganism. These layers or Sheaths (kosas) are generated as consciousness
descends into denser and den ser matter , with the subtler Sheaths acting as
patterns for the grosser ones. It is as if each level of or ganization tries to
reproduce the previous level, bu t cannot do so precisely because  of the increased
density of the matter it must work with. The physical body is the Sheath  of Food; it is composed of and  nourished
by t he juices extracted from our food. The Sheath of Prana, the vital body ,
connects the Sheaths of Food an d Mind and permits them to operate together . It
is co mposed of and nourished by Prana alone. Prana is “ener gy ,” but it is also a
form of matter when viewed in  the context of consciousness. The or ganism’ s
Prana is replenished in two ways: “instantly” in which the lungs during breathing
absorb the Prana found in the air , and “delayed,” in which th e lar ge intestine
absorbs the Prana found in well-digested food. The Sheath of Mind is the astral
body , which is c omposed of and nourished by words, images an d emotions, all of
which are made out of “mind-stuf f,” a very subtle form of matter . The role of the  Sheath of Foo d, in which T amas predominates, is the
stabilization of consciousness,  while the Sheath of Prana, in which Rajas
predominates, is  meant to activa te it. The job of the Sheath of Mind is to mediate
between the other Sheaths to en sure that the Prana and the physical body remain
in ba lance with the mind. Since an excess of either Rajas (overactivity) or T amas
(inertia) will disturb its balance , Rajas and T amas are called the mind’ s Doshas,
and whe n either  appears in exce ss the mind becomes deranged. When the Three
Doshas of the body become imbalanced they can also imbalance the mind; the
mental and physical Doshas inte ract with and af fect one anothe r continuously byway of Prana, t he force which binds them together . Mind, Prana and body are
concurrently and inherently joined together as long as life continues in a body . In th e physical body ener gy and  fluids move through visible cha nnels (like
the nerves and b lood vessels), while in the vital body Prana moves through the
subtle co nduits a nd plexuses called Nadis and Chakras, respectively . The vital or
Pranic b ody exe rts its ef fects by  stimulating the physical channels which flow in
synchrony with its Nadis. The body’ s most important Nadi, w hich is also the
least used by th e average individual, is called the Central Conduit (sushumna). The Chakras are arranged like flowers in a garland along t he thread of the
Central Conduit , which flows w ithin the central sulcus of the spinal cord—or it
would do so if it existed on t he physical plane! More precisely the Central
Conduit flows through the same space which on the physical level is taken up by
the centr al sulcu s of the spinal cord. Since these two structures exist on dif ferent
levels of being they can occupy the same space simultaneously , an impulse in
one often engendering an impulse in the other by resonance. The body’ s next two most important Nadis (ida and pingala) flow in
conjunction with the two nostrils. Most of the time we breathe only through one
nostril, shifting unconsciously from right to left and back every two to three
hours. The left nostril (or rather its Nadi, the pingala) cools and calms the
or ganism, while the right (ida) heats and excites it. Heat expands, and cold
contracts; in the body of a living being heat generally dilates the channels and
cold co nstricts them. These two Nadis govern and maintain the rhythmic
contraction and expansion of the body and its physiology , a heat-cold duality
which fuels the circulation of V ata in the body very much as the dance of hot and
cold air masses fuels the circula tion of atmospheric air . Excess or lack of heat in
the body  obstructs V ata’ s movement and predisposes to disease. Physicians who
use the esoteric form of diagnosis, called “svarodaya” in Sanskrit, detect the
subtle dif ference s in the directi on and rate of flow of the breath in their own
nostrils to indicate the condition of the flow of Prana in their patient’ s Nadis. While most of the Nadis work in consonance with body structur es, Central
Conduit and its Chakras reside in a plane of existence so subtle that the average
human b eing never suspects their presence. The Chakras, which exist in the
Central Conduit , function only when Prana flows through that Nadi, and unless
ener gy is actually flowing throu gh a Chakra it cannot really be even said to exist,
remaining instead in an inactive, potential form. Many sensitive people report tha t they can see “ener gy vortices" , “spinning
patterns” and other concentrations of power within the living hu man body . Whileit is true that such flows often exist near in space to the regions were the Chakras
are said to be located, all such flows appear in the layers of the or ganism that are
superficial to the Chakras. Only the most spiritually advance d of beings can
directly perceive the Chakras. The body possesses many pot ential Chakras in whose region varying
amounts of ener gy may concentrate. Six major Chakras are generally agreed
upon, however: at the perineum; sex center; solar plexus; heart; throat; and
between the eyebrows. The ener gy center on top of the head, known as the
“Thousand-Petalled Lotus” (sahasrara) is not a Chakra; it marks the boundary
between the region of the micro cosm in which the Prana is restricted to moving
within the Nadis, and the region of the macrocosm, where the Prana has
“thousands” of paths in which to move. Each of the five princip al lower Chakras
connects the or ganism to a specific Element. Speech, a funct ion of the Ether
Element (which has sound as its special quality), manifests at the throat. The Air
Element, which moves incessantly , is concentrated in the chest , the home of the
ever -mobile heart and lungs. The digestive or gans, liver and spleen, all “hot”
or gans, cluster around the are a near the solar plexus genera ted by the Fire
Element. The W ater Element, without which no life exists, is responsible for the
genitals. The Earth Element, the foundation of physical existence, is located at
the perineum, the foundation o f the torso. This lowest Chak ra, the home of
Mother Earth, is the lower pole  of an axis whose upper pole, t he “Sky-Father ,”
lies with in the brain, just as Earth and Sky are the two poles of the macrocosm
(see illustration 13). The Na dis direct the activity of the physical channels through which
ener gy f lows, including the nerves, bones, joints, muscles, ligaments and glands,
which then move the body’ s juices around. This system lik e any system is
weakest at those points where things join together . A Marma is a point on the
human body beneath which vital channels intersect. Some of these intersections
are physically identifiable while others are subtle structures. Some Marma points
are iden tical wit h acupuncture points and others are nearly identical. Since V edic
times warriors in India tar geted Marmas on the bodies of their enemies to inflict
maximal damag e and sur geons used their knowledge of Marmas to treat such
injuries. The Sushruta Samhita,  A yurveda’ s sur gical text, classifies 107 Marmas
on t he basis of the structure (muscles, blood vessels, ligaments, nerves, bones,
joints), on the regional location, the dimension, and the consequences of injury
(swift death, death after some delay , death as soon as any foreign body is
extracted from the wound, disability , or simply intense pain) (see illustration 14).In th e southern s tate of Kerala th e practitioners of the martial art known as
kalarippayattu ( see illustration 19 in Part 3), which like Hatha Y oga involves a
set of prelimina ry physical exercises that lead both to physical and mental
control, recogni ze 160 to 220 Marmas in martial practice, and use the 107
Marmas of Sushruta in therapy . According to kalarippayattu, injury to a Marma
blocks or cuts the associated N adi at that point, interrupting both the flow of
Prana—the life force, and the fl ow of V ata—Prana’ s waste product and servant,
in that area. For serious damage  to occur a blow must penetrate an inch or more
into the  tissues  beneath the spot; a mere slap will not be so harmful. An
immediate antidote for such an injury is a firm stroke or sla p to the similar
Marma on the opposite side of the body which gets the Pran a moving again. Such a counter - application mu st be given within a specified time in order to
work, and must then be followe d by treatment for the imbalan ce of the Doshas
caused by the injury .Like a Chakra, a Marma is not really a “structure” in that it does not exist
at al l times. Ma rmas exists only insofar as there is Prana in the  body—that is, a
dead body has n o Marma within it—and any Marma is only activated fully when
Prana is  actually moving in it; the death or damage predicted for injury to a
Marma o ccurs o nly when such a  Marma is active. Prana’ s move ment through and
concentration in the body’ s Marmas is controlled by the luna r day . In this the
doctrine of Marma is strikingly similar to that of Indian sexology , which details
the specific areas of a woman’ s  body which are awake to erotic excitement on
particular lunar days because of the movement of Prana the rein. V ata’ s gati
(cognate with the English word “gait") is defined as both its way of moving
through the body and the direction taken by this movement. Diagnosis is a report
on the path taken by the system’ s V ata and other Doshas, and ret urn of V ata’ s gait
to normal is an essential part of any therapy .7
C o n s t i t u t i o n
E veryone has a typical rhythm, an innate gait, determined by  our genes and
chromosomes. A human’ s gait, like an animal’ s, reflects the bod y’ s internal ener gy
equation. All of us tend to favor particular ener gy pathways, or gans, glands,
nerves, limbs, thoughts and images. The sum total of this preference produces our
own ind ividual gaits. A yurveda calls a person’ s characteristic physical and mental
constitution, prakriti, to be distinguished from vikriti—the co ndition or current
state of a person’ s health which  dif fers from moment to moment. The sages used
the w ord prakriti advisedly since  it also means the manifested universe as a whole,
and a person’ s constitution is a representation of that person’ s intimate universe. Personal constitution, which i s fixed at the moment of conception, is
determined by conditions prevailing in the bodies and minds of the child’ s parents
at th at time. If,  for example, d uring sexual intercourse the force of Kapha was
increased in the father and V ata  predominated in the mother , th e child will always
be, all through its life, constitutionally prone to over -activity of both Kapha and
V ata. Pit ta will still be present, as it is in all living beings, but its role will be less
prominent. Seve re disease may make the underlying constitution irrelevant to
diagnosis, but that pattern is etched permanently into the genetic  material. The diet
and activity of the mother du ring pregnancy , conditions in the womb during
pregnancy , and events during delivery may also influence the child’ s subsequent
health and happiness, but these are all secondary to constitution. There are eight principal constitution types:
(1)  Balanced: in which all three Doshas tend to remain in equilibrium. (2)   V ata: in wh ich V ata is sign ificantly stronger than both Pitta and
Kapha. (3)   Pitta: in which Pitta is significantly stronger than both V ata and
Kapha. (4)   Kapha: in which Kapha is  significantly stronger than both Pitta
and V ata. (5)   V ata-Pitta or Pitta-V ata: in which these two Doshas are both
significantly stro nger than Kapha, though one of them  may be slightly
stronger relative to the other . (6)   Pitta-Kapha  or Kapha-Pitta: in which these two Doshas are both
significantly stro nger than V ata, though one of them may be somewhat
stronger relative to the other . (7)   V ata-Kapha  or Kapha-V ata: in which these two Doshas are both
significantly stronger than Pitt a, and one of them may be s lightly
stronger relative to the other . (8)   Imbalanced: in which the three Doshas tend to go out of
equilibrium altogether . Most people have double predominance, though considering the possible
permutations of the degree of predominance of these Doshas the number of
constitutional types becomes infinite. People are classified by constitution to help
them select appropriate habits and lifestyles to enhance health maintenance. The
accompanying chart (illustration 15) details the constitutional attributes of the three
main Doshas.8
D i s e a s e  C a u s a t i o n
A ccording to A yurveda there are basically three types of diseases: endogenous
(breakdowns fro m within), exogenous (attacks from without), an d mental; any of
which ca n subsequently lead to others. The tissues and wastes are the “thing” in
the body which are vitiated by the Doshas, the vitiation spreading from one tissue
or waste to other tissues. Disturbed channels spread their corruption only to other
body channels and polluted tiss ues to other tissues alone, “whereas V ata, Pitta
and Kapha when vitiated pollute the entire or ganism, being, as they are, of a
vitiating nature." T ime, like personal constitutio n, is one of the more significant factors
implicated in the generation of disease. Diseases are said  to arise at the
“junctions” of the seasons. This applies literally to the junctions of winter with
spring (Kapha aggravation), spring with summer (Pitta inflammation) and
summer with fall (V ata disturb ance). This is because the bod y must adapt to
changing extern al conditions, but becomes imbalanced if the adaptation is less
than perfect. It also applies to other “seasons” of one’ s life: the day , age, and
digestion. After eating and before digestion actually begins, Kapha predominates;
Pitta dominates during digestion; and during assimilation V ata predominates. Y outh (birth to t he end of bone growth) is the Kapha time of lif e; adulthood (end
of youth  to menopause or the m ale equivalent) is the Pitta perio d; and during the
senior y ears V ata rules. Kapha predominates for roughly the firs t third of the day
(i.e. sunrise to midmorning) and the first third of the night (sunset to late
evening), Pitta for the middle thirds of the day and the night, and V ata for the last
thirds of day a nd night (i.e. th e periods just before sunrise and sunset) (see
illustration 16). No s ingle factor is wholly responsible for either health or disease; they are
the r esult of the  concerted action of many causes. Since however all diseases to
some degree disturb a proper functioning of the Three Doshas, diseases are
usually classifie d according to the underlying causative Dosha . Most causes of
disease are individual and preve ntable, but most of us fail to prevent the diseases
by a cting contrary to what we k now is in our own self-interest  mainly , due to a
weakness of the mental will. Every one of us must “digest” all the senseperceptions whi ch inundate us. When the temptation to enjo y a thing or the
desire to  avoid another , overwh elms our innate common sense and leads us to
perform actions resulting in an i mbalance of the Doshas, it sho uld be clear to us
that our mental “digestion” (the  ability to know what is appropriate and what is
inappropriate for health) has become disturbed. This violation of good sense or
perversity of mind, which arise s from attempts to rearrange the world to suit
oneself while ignoring the inherent rhythm of the universe, is known as
prajnaparadha, meaning literally , “a transgression against wisdom.” Such sins of
omission or commission are the ultimate causes of all pathological conditions,
and can af fect any activity of speech, mind or body , directly o r indirectly . Such
transgressions usually involve either improper use of the sense or gans or
inattention to the changes in diet and lifestyle necessitated by daily , seasonal or
other time cycles.All diseases are due either to un der -nourishment (drying out th e body) or
over -nourishment (making it too wet). Substances and activities which cause the
“wetness” of the system to incr ease weaken the digestive fire in the same way
that wetness weakens an external fire. Most diseases in af fluent societies are due
to ex cess of wet ness because most af fluent people over -consum e everything. The
poor , and those people who deliberately under -consume (through prolonged
fasting, anorexia, bulimia and the like), develop diseases of un der -nourishment. Because dryness is a characteristic of V ata, the drying out of the body by under -
nourishment usually leads to V ata-type diseases. Both under -nourishment and
over -nourishment predispose one to weakness of the physical and/or mental
digestive fire, thus leading to th e production of Digestive T oxins (ama, literally
meaning “raw , uncooked, unripened"). Digestive T oxin is a gene ric term for food
(or thought) which is absorbed into the system without having first been properly
digested. Such partly-digested material cannot be used by the system, clogs it and
creates a toxic reaction. The usu al process by which dis ease due to excess “wetness” develops is
known a s “Obst ruction to the P athways” and involves the plugging of some of
the chan nels of body and mind by Digestive T oxins thus preventing V ata from
moving in its no rmal direction. This “angers” or disturbs V ata, c ausing it to move
abnormally thro ugh the or ganism, oft dragging Pitta or V ata along, until it finds a
weak point. There the Doshas accumulate, disordering the system and creating a
specific disease. The symptoms of such diseases often dif fer fro m the symptoms
of aggra vated V ata because V ata accepts the qualities of whate ver it transports. When V ata increases under “ dry” conditions, as when the body becomes
emaciated or when a hollow or gan remains empty for too long, Digestive T oxins
are n ot much in volved and the disease produced is usually due mainly to V ata
excess alone. Disruption of V ata’ s natural direction or rhythm occurs in all diseases. Under the influence of a misdi rected V ata the Doshas may m ove up, down or
sideways. The rishi Sharngadhara, paraphrasing Charaka concurs:  “Pitta is lame,
Kapha is lame, the tissues and wastes are lame; like the clou ds these shower
wherever the wind (V ata) carries  them.” Every disease follows it s own path along
one or more of t he three disease pathways representing deepeni ng penetration of
the disease process into the system. These three are the Internal or V isceral
Pathway , External or Periphera l Pathway , and Medial or Marma Pathway . The
Internal Pathway , which is the digestive tract and the tissue Sap, is usually the
first to be af fec ted by the Do shas, which naturally concentr ate in the majordigestive or gans . If the Doshas  are not adequately dealt with at this stage they
will begin to flow into instead of out of the body , entering the Peripheral Pathway
consisting of the other six tissues. If the imbalance is then fu rther suppressed
then the toxins and/or the Dos has dive deeper into the tissues and enter the
Medial P athway , which contain s all the essential or gans. Disea se manifestation
generally tends to confine itself to a single Pathway at a time; but if more than
one Pathway becomes embroiled, treatment becomes much more dif ficult.9
D i a g n o s i s
I n A yurv eda the diagnostic tests investigate a person’ s “state,” the pattern
of move ment of  tissues, wastes, and Doshas in the body and mind. Y our
present s tate reflects your past activities and indicates the directi on in which
you are moving. A yurvedic diag nosis begins with an examination of what is
right wi th you, namely how well-nourished, perfectly toned or “excellent”
your tissues are. A ruddy com plexion, well-formed flesh an d fat, solid
bones, s trong ne rvous system, and skin and eyes full of luster i ndicate that
the tissu es are well-nourished and full of healthy Sap. Only after these
“excellences” have been inventoried does one begin the search for
deficiencies. Direct perception is the best way in which to discern a patient’ s state,
though it is sometimes unreliable due to defects of perception. Whatever
cannot be known directly mus t be elicited through three oth er methods:
logical inference , analogy , and the testimony of experts. Seeing, feeling and
hearing are the three main me thods of direct perception, especially with
regard to feces, urine, pulse, tongue and face. Some doctors question their
patients closely ,  while others ask only a few questions. Eac h physician
develops a diagnostic technique in conformity with his or her own
constitution. Physical symptoms are then correlated to the particular Dosha
responsible. Excess of Kapha causes mucus and its other vehicles to
accumulate within the body , creating obstructive cond itions, viz. indigestion, lethar gy , cough and nausea. Insuf ficient Kapha leads to
problems like weakness, dryness  of skin and mouth, body ache, palpitations
and insomnia. Even proper am ount of Kapha may accumulate if some
obstruction prevents its excretion. Over -production of Pitta generates excess
bile and  the like, creating such  ailments as anger , acidity , increased body
heat, burning sensations, yellow ness of body and mind, diminished sleep,
and excessive hunger and thirst . Obstructed Pitta may also caus e these andother varied problems, while insuf ficient Pitta accounts for signs of
coldness, lack of vigor and joy , stif fness, loss of lustre, and weakened
digestion. Excess V ata promotes weakness, emaciation, dryness, flatulence,
constipation, pain, insomnia, tre mors and tics, giddiness, and impairment of
sensory and motor functions, whereas decreased V ata reduces metabolism
and disturbs the digestion. As mentioned earlier , an or ganism’ s state of health is characterized by
the rhyth m or gait of V ata. Puls e diagnosis is the method of choice for an
examination of these gaits. The  radial pulse is examined first, and in some
cases other arteries (the carotids or the dorsalis pedis in particular) may also
be selec ted for further examination. T raditionally a man’ s right arm and a
woman’ s left arm are selected f or examination, with the examiner ’ s index
finger p laced cl osest to the wri st and the ring finger placed farthest away
from the wrist. The index finger reads the condition of the patient’ s V ata,
while the middle finger reads Pitta, and the ring finger Kaph a. Because
none of the major texts provide specifics of pulse-diagnostic methods, most
practitioners evolve their own system, and some use pulse primarily to
examine the condition of specific or gans. It is  however m ore common to investigate the pulse’ s pace, or  gait. The pulse-gait in V ata disturban ce, for example, often resembles that of a
snake or  leech as it slithers und erneath the skin. Pitta disturbed pulse tends
to hop like crows or frogs, and the pulse-gait in a Kapha prone disturbance
resembles the swimming movement of a swan. Each disease has its own
gait and rhythm; so long as your or ganism is “possessed” by a d isease your
ener gy will move according to its whims. The strength and direction of the
disease’ s gait indicates the length and strength of its existence. Investigation of  both the beginning (the tongue) and the end  (the
feces and urine) of the alimentary canal is used to gain information on the
level of  the body’ s toxicity an d on the condition of the doshas in the
digestive tract. The first one-thi rd of the tongue represents the  area of the
body that is governed by Kapha (primarily the chest and head), the middle
one-third represents the area that Pitta rules (the area between the
diaphragm and the navel), and the back one-third stands for V ata’ s region
(that which is below the nav el). No major A yurvedic text details the
locations of the various or gan reflexes on the tongue; however , at least oneoral trad ition of or gan-mapping  does exist. According to this tradition, the
tongue’ s tip represents the throa t, the tongue’ s root represents th e perineum,
and all body stru ctures between the throat and perineum are projected onto
the tongue’ s body . Examination of feces predominantly consists of the
color , co nsistency , odor , and presence or absence of undigested food. The
color , re lative h eat or cold, and froth or lack thereof of the urine also
reflects body’ s condition; in par ticular , the way a drop of oil sp reads when
dropped onto the surface of t he urine indicates which dosha currently
predominates. These an d other  techniques provide the physician with diagnostic as
well as prognos tic information  on the patient. T o know an individual’ s
condition is only half the story; the other half is to know how easy it will be
to re ctify that co ndition, and how much of the patient’ s previous vitality can
in fa ct be restor ed. Diseases are categorized as easily curable, c urable with
dif ficulty , ameliorable (the dise ase remains under control only so  long as
treatment goes on) or incurable. In an incurable condition excessive
measures to prolong life are not commonly employed, nor an imminent
demise predicte d. Instead, the patient is made comfortable and is
encouraged to prepare for eventual death, for A yurveda regards a good
death as being the consummation of a good life.1 0
T r e a t m e n t
D iseases m anifest due to the imp act of many causes at an opportune time
and plac e, and they disappear by  change of time or place or by withdrawal of
their ca uses. The essence of t reatment is removal of the cause. Diseases
mainly due to p hysical causes require “scientific” therapy (the use of herbs,
diet, manipulation, and so on). Those mainly due to psychological
disturbance requ ire “conquest of the mind,” necessitating restraint of the
mind from the desire for unwh olesome objects. And diseases  of the spirit
need “divine” therapy , spiritual  rituals and penances. Since “crimes against
wisdom” motivated by desire  are the ultimate causes of disease, the
elimination of desire is the ultim ate treatment for disease.
_OceanofPDF.com_Tao_and_Dharma_-_Svoboda.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        In critical
circumstances d uring the course of a chronic illness, palliative treatment of the
Branch is the first necessity, while the Root is not addressed initially so as to
forego taxing the delicate vitality of the patient. Another important principle of treatment is that of Y in-Y ang rec onciliation,
i. e. to reduce conditions of exc ess and to build up conditions of deficiency. In
practice usually this is done dire ctly to the Or gan, Meridian, Su bstance or to the
pathogenic factor present. In all situations, once there is a positive progression towards balance,
attention will once again shift to prevention by strengthening the  body’ s ability to
self-regulate and adapt to its env ironment; thereby avoiding future maladies. This
philosophy is expressed in a Chinese proverb: “W aiting to treat illness after they
manifest is like waiting to dig a well after one is thirsty. " In Chin ese med ical therapy acupuncture-moxibustion, Interna l Medicine
(therapeutic use of medicinal substances), dietetics, massage and remedial
exercises are utilized as the pr inciple modalities. All these modalities share a
common theoret ical foundation and if required, can be applied in combination. Sur gery is used sometimes when all else fails. The venerated physician Hua T uo
who live d in the Eastern Han Dynasty (25-220 A. D. ) is cred ited for his great
sur gical skill and promoted the use of Indian hemp anesthesia. It was unfortunate,
however, that after the era of Hua T uo, sur gery was lar gely neglected until
modern times. Diet and  the usage of medicinal substances from plant, animal and mineral
kingdoms depended upon the or ganizational models of Y in-Y ang and the Five
Element theories. Specifically, substances were classified by temperature, i.
Palliative treatment, while not addressing the root cause, to avoid further straining the patient's vitality.
What is the primary focus in treating a patient with a chronic illness?
Sweating, vomiting, clearing, draining, harmonizing, warming, reducing, tonifying, and the use of medicinal substances.
What are the 8 general strategies of treatment in Internal Medicine?
Substances can either increase or decrease the body's tissues and waste products, depending on their temperature, taste, and direction of action.
How do substances interact with the body's tissues and waste products?
The 14 types of doshas are not mentioned in the provided text. However, the text does discuss the 3 main doshas (Vata, Pitta, and Kapha) and their relationships to the Five Elements.
What are the 14 types of doshas, and what is their relationship to the Five Elements?
The concept of "like increases like" suggests that when a substance with similar qualities to the body's tissues is consumed, it can increase the body's tissues and potentially lead to an imbalance.
What is the significance of the concept of "like increases like" in Ayurveda?
The goal of Chinese medicine is to strengthen the body's ability to self-regulate and adapt to its environment, avoiding future illnesses. The approach to diagnosis involves examining the tongue, pulse, and other bodily secretions to understand the patient's condition.
What is the goal of Chinese medicine, and what is its approach to diagnosis?