Ayurvedic Concepts of Health and Illness

Ayurveda, or “the science of life,” is heavily influenced by the Sankhya school of philosophy, most notably through the concepts of purusa (pure consciousness) and prakrti (nature or materiality) (Mishra 482; Rodrigues 123). In this model, prakrti creates all materiality out of her three qualities, or gunas (Gopinath 105; Rodrigues 123):

  • Sattva, which is bright and pure,
  • Rajas, which is mobile and stimulating,
  • Tamas, which is heavy and dull.

The gunas recombine in various proportions to form the 23 elements that make up the manifest universe (Rodrigues 123). Important to concepts of physiology in Ayurveda are the five gross elements (mahabhutas), which combine to form the body’s 7 dhatus (tissues) and 3 dosas (humors) (Prioreschi 238; Rodrigues 124). It is the equilibrium between the dhatus, dosas, and their waste products, malas, which determines good health, while stress to this equilibrium causes disease.


Dated back to the Vedas, the pancabhuta (five elements) theory suggests that all matter is composed of the five mahabhutasprthvi, ap, tejas, vayu, and akasa (Prioreschi 238; Subbarayappa 12). Although often understood in terms of the Greek elements of earth, water, fire, air, and ether, respectively, to do so is to diminish the meaning of the Sanskrit word (Subbarayappa 12):

  • Prthvi gives mass, roughness, inertia and density, and is associated with smell and the nose.
  • Ap gives fluidity, viscosity, coldness and softness, and is associated with taste and the tongue.
  • Tejas gives hotness, dryness, sharpness, and courage, and is associated with colour and the eyes.
  • Vayu gives movement, pulsations, and the sense of lightness, and is associated with touch and the skin.
  • Akasa, which should not be equated with Ether, is an omnipresent element giving space. It is mainly associated with sound and the ears.

Interestingly, even at their most pure, each element also has the others present in it, but in smaller proportions. The interaction between these elements is the basis for the formation of the physical and physiological body (Gopinath 99 – 100).


The 7 permanent tissues (dhatus) that make up an organism are each composed of all five mahabhutas, but in different proportions. The dhatus include rasa (the essence of digested food, basically lymph and chyle), rakta (blood, which is rasa coloured red), mamsa (flesh), meda (fat), asthi (bone), majja (bone marrow), and sukra (reproductive essence, or sperm) (I.P. Singh 121; Prioreschi 256; Vir 414).


While the physical body is composed of the 7 dhatus, its physiological functioning depends on the 3 dosas, or troubles (Prioreschi 259). Each person has two sources of dosas. The first is inherited, and is termed dosa prakrti (R.H. Singh, 131). This represents the individual’s normal proportion of the dosas, which also determines the physical, physiological and mental characteristics of that person (Gopinath 80; I.P. Singh 120). Physical characteristics include strength, eating and bowel habits, and skin, hair and eye colour (Gopinath 80). While dosa prakrti does not change over time, the dosas obtained from food do fluctuate, depending on the type of food ingested, as well as the climate, geography, age and emotional state of the individual (I. P. Singh, 120). The three dosas are vata (wind), pitta (bile), and kapha (phlegm), but again, our translations do not carry the full meaning of these words, and a more descriptive explanation is necessary (Subbarayappa 17).

Vata has a high proportion of vayu and akasa, and is regarded as the regulatory dosa, governing all metabolic activity and the movement of the other two dosa (Gopinath 100, 104; I.P. Singh 120). It is responsible for excretion, voluntary actions, all mental and motor activity, respiration, circulation, and enthusiasm (Subbarayappa 17; Gopinath 104; Mishra 484). The mental characteristics associated with vata include cowardliness, grief, ungratefulness and humbleness (Gopinath 80). A decrease in vata results in sluggish movements and speech, while an increase results in twitches, pain, and sleep loss (Susruta 159, 163). Diseases resulting from irregular vata, which is aggravated by excessive exercise, bitter tastes, and the cold, include dwarfism, insomnia and paralysis (Govindan 31). There are five forms of vata: prana, udana, samana, vyana, and apana (Prioreschi 259; Susruta 156-7).

Pitta is mainly composed of tejas/agni and is regarded as the excitatory dosa, responsible for catabolism (breaking things down) and producing heat (Gopinath 104; I.P. Singh 120). It is thus responsible for digestion, tissue metabolism and vision, as well as boldness, arrogance, energy, and forbearance (Subbarayappa 17; Gopinath 80, 104; Mishra 484). A decrease in pitta is felt in low body temperature and digestion, while an increase results in a liking for cold, loss of strength, and fainting (Susruta 159, 163). Pitta is aggravated by anger, heat and pungent, sour or hot foods, while diseases include fever, jaundice, herpes and bad breath (Govindan 33). Again, there are five forms: aloca, karanjaka, sadhaka, bhrajaka, and pacaka (Prioreschi 250; Susruta 156-7).

Kapha has a high proportion of ap and prthvi (Gopinath 100). Contrary to pitta, it is an inhibitory dosa, responsible for anabolic activity and the maintenance of cellular and intracellular structures and the body’s internal environment (I.P. Singh 120; Gopinath 104; Mishra 484). In essence, it is responsible for strength and stability of the body as well as the mental states associated with strength, such as courage, knowledge, vitality and zest, but also devotion, faithfulness and forgiveness (Subbarayappa 17; Gopinath 80; Mishra 484). Symptoms of decreased kapha include thirst and loss of sleep, while the opposite results in coldness, drowsiness and stiffness (Susruta 159, 163). Diseases include anorexia, obesity, goiter, and lethargy, which stem from laziness, sweet and sour foods, and wheat products (Govindan 34). The five forms are kledaka, avalambaka, tarpaka, bodhaka, and slesmaka.


Mala, or excreta, are those elements that are formed from the different dhatus. While these include more obvious excretions such as urine and sweat, the dosas are also produced as byproducts of certain tissues (I.P. Singh 121).

Relationship between the dosas, dhatus and malas

Each of the 7 dhatus, except for semen, has three components – its own essence, a mala, and the essence of the next, more pure substance:

  • Rakta is purified from rasa, whose mala is kapha.
  • Mamsa is purified from rakta, whose mala is pitta.
  • Meda is purified from mamsa, whose malas are excretions of the orifices.
  • Asthi is purified from meda, whose mala is sweat.
  • Majji is purified from asthi, whose malas are hair and nails.
  • Sukra is purified from majji, whose malas are feces and skin.
  • Sukra is the purest of the dhatus; it produces no malas and no other dhatu is purified from it.

It should be noted that both pitta and kapha are formed as waste products, but there is no mention of vata production. It is actually formed based on the proportion of food to agni (digestive agent). There also seems to be a grey area between dosa, dhatu and mala. In essence, dhatus are substances that help in the normal functioning of the body, dosas are those that disturb the normal functioning, and malas are those that cause imbalance in the normal state. This means that a dhatu can become a dosa or a mala when in an abnormal state, and a dosa or a mala is a dhatu in its normal state (I.P. Singh 122).


Dosas and malas are transported through the body by a system of channels, or nadi (R.H. Singh 149). If these channels become blocked by an excess or stagnation of malas, the elements cannot flow freely, causing further stagnation and disease (R.H. Singh 149). Thus, early diagnosis and intervention is a fundamental philosophy in Ayurveda. There are six stages to the pathogenesis of disease (satkriyakala), each of which mark opportune times for intervention (R.H. Singh 135):

  • Sancaya is the buildup of dosas in their normal sites – vata in the bones, pitta in the blood, kapha in the lymph and muscles (Gopinath 104). Symptoms felt at this stage are those of the increased dosa, not of any disease.
  • Prakopa is aggravation (usually called vitiation) of the dosas. At this point the dosas become abnormal, but the damage is still reversible.
  • Prasara is the spread of the vitiated dosas outside their normal sites. Unless the causative agent is removed immediately, this is usually the point where pathogenesis becomes irreversible.
  • Sthanasamsraya is the localization of the vitiated dosas to a weak site in the body. This allows the vitiated dosa to interact with the surrounding dhatus, which produces symptoms of a disease for the first time.
  • Vyakti is the stage where the disease manifests itself fully. The exact disease depends upon which dosa is vitiated, with which dhatu it is interacting, and to what extent they are mixing.
  • Bheda is the final stage of disease progression, where the disease is mostly diagnosed by its complications. Treatment of this chronic disease includes dealing with both the main disease and its complications.

There are a variety of different ways to relieve symptoms of disease. These include bloodletting, the use of drugs, and eating foods that either increase or decrease the vitiated dosa (Susruta 134, 355) [See R.H. Singh pages 148-155, Susruta, and Govindan for information about treatments].

References and Related Readings

Gopinath, B.G. (2001) “Foundational Ideas of Ayurveda.” In Subbarayappa, B. V. (Ed) History of Science, Philosophy and Culture in Indian Civilization (Vol IV Part 2) (pp 59-107). New Delhi: Bhuvan Chandel.

Govindan, S.V. (2003) Fundamental Maxims of Ayurveda. New Delhi: Abhinav Publications.

Mishra, S.K. (2001) “Ayurveda, Unani and Siddha Systems: An Overview and their Present Status.” In Subbarayappa, B. V. (Ed) History of Science, Philosophy and Culture in Indian Civilization (Vol. IV Part 2) (pp 479-516). New Delhi: Bhuvan Chandel.

Prioreschi, Plinio (1991) A History of Medicine: Volume 1 Primitive and Ancient Medicine. Queenston: The Edwin Mellen Press.

Rodrigues, Hillary (2006) Introducing Hinduism. New York: Routledge.

Singh, I.P. (2001) “The Concept of Sarira (Human Body).” In Subbarayappa, B. V. (Ed) History of Science, Philosophy and Culture in Indian Civilization (Vol. IV Part 2) (pp 108-125). New Delhi: Bhuvan Chandel.

Singh, R.H. (2001) “Kayacikitsa (Internal Medicine).” In Subbarayappa, B. V. (Ed) History of Science, Philosophy and Culture in Indian Civilization (Vol. IV Part 2) (pp 128-156). New Delhi: Bhuvan Chandel.

Subbarayappa, B. V. (2001) “A Perspective.” In Subbarayappa, B. V. (Ed) History of Science, Philosophy and Culture in Indian Civilization (Vol. IV Part 2) (pp 1-38). New Delhi: Bhuvan Chandel.

Sustra (1999) Susruta Samhita (Vol. 1) (Priya Vrat Sharma, Trans. and Ed.). Varanasi: Chaukhambha Visvabharati.

Vir, Kaviraj Dharam (2000) “Utility of Ayurveda in the Programme of Health for All After 2000 AD.” In Vaidya Banwari Lal Guar and Vaidya Santosh Kumar Sharma (Eds) Researches in Ayurveda: Past & Present (pp. 413-420). Jaipur: Sheetal Offset Printers.

Related Topics for Further Investigation

Caraka Samhita
Dasa Vidha Pariksa (tenfold examination)
Karma in Ayurveda
Susruta Samhita
Therepeutic approaches
Vedic medicine

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Written by LeeAnna Tavernini (March 2008) who is solely responsible for its content.