The Cause of Diseases: Pitta, Vata, Kapha

Diseases arise from the unnatural excess or defect of the four natures out of which the body is compacted:

• earth
• fire
• water
• air

Disorders and diseases are produced when there is a wrong change in any of them:

• from its own natural place into another, or
• from any similar irregularity

Fire Diseases (Pitta in Ayurveda)

When any of them is produced or changed in a manner contrary to nature, all sorts of changes occur. The parts which were previously:

• cool grow warm
• dry become moist
• light become heavy
• heavy become light.

A thing can only remain the same with itself, whole and sound, when the same is added or subtracted from it, in the same respect and in the same manner and in due proportion.

Whatever comes or goes away in violation of these laws causes all manner of changes and infinite diseases and corruptions.

Water Diseases (Vata in Ayurveda)

There is a second class of structures which are also natural. This affords a second opportunity of observing diseases to him who would understand them.

Marrow, bone, flesh, and muscles are composed of the 4 elements. The blood is likewise formed out of them. The worst diseases happen when the generation of these substances proceeds in a wrong order. This destroys them.

The natural order is that:

• the flesh and muscles should be made of blood
• the muscles should be made out of the fibres to which they are akin
• the flesh should be made out of the clots which are formed when the fibres are separated.

The glutinous and rich matter which comes away from the muscles and the flesh, glues the flesh to the bones and nourishes and imparts growth to the bone which surrounds the marrow.

Because of the solidity of the bones, that which filters through consists of the purest and smoothest and oiliest sort of triangles, dropping like dew from the bones and watering the marrow.

Now when each process takes place in this order, health commonly results. When in the opposite order, disease.

When the flesh becomes decomposed and sends back the wasting substance into the veins, then an over-supply of blood of diverse kinds, mingling with air in the veins, having variegated colours and bitter properties, as well as acid and saline qualities, contains all sorts of bile and serum and phlegm.

For all things go the wrong way, and having become corrupted, first they taint the blood itself, and then ceasing to give nourishment to the body they are carried along the veins in all directions, no longer preserving the order of their natural courses, but at war with themselves, because they receive no good from one another, and are hostile to the abiding constitution of the body, which they corrupt and dissolve.

The oldest part of the flesh which is corrupted, being hard to decompose, from long burning grows black, and from being everywhere corroded becomes bitter, and is injurious to every part of the body which is still uncorrupted.

Sometimes, when the bitter element is refined away, the black part assumes an acidity which takes the place of the bitterness. At other times, the bitterness being tinged with blood has a redder colour. This, when mixed with black, takes the hue of grass.

Again, an auburn colour mingles with the bitter matter when new flesh is decomposed by the fire which surrounds the internal flame.

—to all which symptoms some physician perhaps, or rather some philosopher, who had the power of seeing in many dissimilar things one nature deserving of a name, has assigned the common name of bile.

But the other kinds of bile are variously distinguished by their colours. As for serum, that sort which is the watery part of blood is innocent, but that which is a secretion of black and acid bile is malignant when mingled by the power of heat with any salt substance, and is then called acid phlegm.

The substance which is formed by the liquefaction of new and tender flesh when air is present, if inflated and encased in liquid so as to form bubbles, which separately are invisible owing to their small size, but when collected are of a bulk which is visible, and have a white colour arising out of the generation of foam—all this decomposition of tender flesh when intermingled with air is termed by us white phlegm.

The whey or sediment of newly-formed phlegm is sweat and tears, and includes the various daily discharges by which the body is purified. Now all these become causes of disease when the blood is not replenished in a natural manner by food and drink but gains bulk from opposite sources in violation of the laws of nature.

When the several parts of the flesh are separated by disease, if the foundation remains, the power of the disorder is only half as great, and there is still a prospect of an easy recovery;

Those disorders become worse when:

• that which binds the flesh to the bones is diseased
• no longer being separated from the muscles and sinews, ceases to give nourishment to the bone and to unite flesh and bone
• from being oily, smooth, and glutinous it becomes rough and salt and dry due to bad regimen
• it crumbles away under the flesh and the muscles and separates from the bone
• the fleshy parts fall away from their foundation and leave the muscles bare and full of brine
• the flesh again gets into the blood

When the bone itself, from the density of the flesh, does not obtain sufficient air and becomes mouldy, hot and gangrened and receives no nutrition, the natural process is inverted.

• the bone crumbling passes into the food
• the food passes into the flesh
• the flesh falls into the blood and makes all maladies more virulent

But the worst case is when the marrow is diseased, either from excess or defect. This leads to the greatest and most fatal disorders, in which the whole course of the body is reversed.

Wind Diseases (Vata in Ayurveda)

There is a third class of diseases which may be conceived of as arising in 3 ways. These are produced:

• sometimes by wind
• sometimes by phlegm
• sometimes by bile.

The lung is the dispenser of the air to the body. If it is obstructed by rheums and its passages are not free, some of them not acting, while through others too much air enters, then the parts which are unrefreshed by air corrode, while in other parts the excess of air forcing its way through the veins distorts them and decomposing the body is enclosed in the midst of it and occupies the midriff.

Thus numberless painful diseases are produced, accompanied by copious sweats.

When the flesh is dissolved in the body, wind, generated within and unable to escape, is the source of quite as much pain as the air coming in from without. But the greatest pain is felt when the wind gets about the muscles and the veins of the shoulders, and swells them up, and so twists back the great tendons and the sinews which are connected with them.

These disorders are called tetanus and opisthotonus because of the tension which accompanies them. The cure of them is difficult. Relief is in most cases given by fever supervening.

The white phlegm, though dangerous when detained within by reason of the air-bubbles, yet if it can communicate with the outside air, is less severe, and only discolours the body, generating leprous eruptions and similar diseases.

When it is mingled with black bile and dispersed about the courses of the head, which are the divinest part of us, the attack if coming on in sleep, is not so severe; but when assailing those who are awake it is hard to be got rid of, and being an affection of a sacred part, is most justly called sacred.

An acid and salt phlegm, again, is the source of all those diseases which take the form of catarrh, but they have many names because the places into which they flow are manifold.

Inflammations of the body come from burnings and inflamings.

All of them originate in bile.

When bile finds a means of discharge, it boils up and sends forth all sorts of tumours; but when imprisoned within, it generates many inflammatory diseases, above all when mingled with pure blood.

Since it then displaces the fibres which are scattered about in the blood and are designed to maintain the balance of rare and dense, in order that the blood may not be so liquefied by heat as to exude from the pores of the body, nor again become too dense and thus find a difficulty in circulating through the veins.

The fibres are so constituted as to maintain this balance. If anyone brings them all together when the blood is dead and in process of cooling, then the blood which remains becomes fluid. But if they are left alone, they soon congeal because of the surrounding cold.

Bile is merely stale blood.

The fibres have this power over the blood and bile. Flesh dissolves into blood. At the first influx, coming in little by little, hot and liquid, is congealed by the power of the fibres.

And so congealing and made to cool, it produces internal cold and shuddering.

When it enters with more of a flood and overcomes the fibres by its heat, and boiling up throws them into disorder, if it have power enough to maintain its supremacy, it penetrates the marrow and burns up what may be termed the cables of the soul, and sets her free.

But when there is not so much of it, and the body though wasted still holds out, the bile is itself mastered. Bile is either:

• utterly banished, or
• is thrust through the veins exiled into the lower or upper belly

This leads to diarrhoeas and dysenteries, and all such disorders.

• When the constitution is disordered by excess of fire, continuous heat and fever are the result.
• When excess of air is the cause, then the fever is quotidian
• When of water, which is a more sluggish element than either fire or air, then the fever is a tertian
• When of earth, which is the most sluggish of the four, and is only purged away in a four-fold period, the result is a quartan fever, which can with difficulty be shaken off.