Basic Principles of Understanding Medicine

This entry will have a fair amount of Nepali medical jargon. Be warned! Also, be warned that this is more like a detailed cosmology of medicine than a textbook outline. I'm really only typing it up so I have a chance to study it, haha.

Class today was awesome but overwhelming. It was my first lesson with Dr. S.M. Adhikari, who happens to be Kopila's father, and occupies a position as the expert in medicinal plants in the Ministry of Medicine in the (so-called) government of Nepal and is President of the association of doctors. I am outrageously lucky to be taking class with him, and they are all so generous to me--with time and energy, which is even greater than material generosity. I feel humbled by how much effort they are putting into making my time here absolutely everything it can be. Until I go home I will be taking class with four doctors, covering so much ground...Dr. Koirala has immense wisdom, and his spiritual understanding of medicine is beyond what can be taught with words or pictures; Kopila brings the new perspective of the coming generation of doctors; her classmate Dr. L.P. Ghimire has a specialized knowledge of Ayurvedic pharmacology, and Dr. Adhikari is a most respected expert senior doctor...how amazing. And I get hours upon hours of time with them one-on-one. Pure teaching, and in Dr. Koirala's case, I feel that a great part of it is beyond that, into the realm of transmission.

Caitlyn had a very funny idea for an April Fool's Day trick to play on Yanik, which went over semi-well. We found it hilarious anyway...she called him up and told him I had run off to Nagarkot indefinitely with Sid, the bass player at Jazz Upstairs, and that my dad had called her panicking because I'd sent him an email letting him know I was skipping out of my program to go gallivanting. Yanik fell for it, but I think it got a little confused at some point. Quite funny anyway! And ama-la is very tricky; she got Caitiln to drink black tea thinking it was juice, which reminded me strongly of drinking the horrifying-tasting herbal concoction my dad used to drink when my mother indiscriminately put it into a Coke bottle and stuck it in the fridge.

Tonight are my remaining Watson interviews. Tomorrow we go to Gokharna for yoga in the morning, which will be new and interesting. With lessons getting so intense, I've had practically zero time to work on things for school back at home, which is going to be a problem soon...

Anyway, notes on the basic principles of understanding medicine:

There are three fundamental concepts of Ayurveda that the rest are founded on. One is pancamahabhuta, which is the five elements (earth, water, fire, air, space). The next is tridosha, which is the manifestation of the pancamahabhuta in vata, pitta, and kapha. The third is sattpadartha, which literally translates to "word which has meaning" and represents all that can be described in physical terms.

The ancient rishis or seers remembered six things that are the foundation of every science, including Ayurveda. We say "remembered" because the knowledge existed in the universe, and through their spiritual efforts they were able to channel this knowledge and turn it into a system for human use. These six things are as follows:

1) DRAVYA: Matter and material. There are nine aspects of dravya, which are the pancamahabhuta (5 discrete elements), time, direction or place, mind, and soul. The power of all matter comes from these aspects. Pancamahabhuta is animated by the power of the soul, the mind is the leader of all sense organs, and no phenomenon can be separated from its time and place. By saying the mind is the leader of the sense organs, we mean that for example vision is a sense organ, and its seat is the eye. Thus the power of the sense organ is the mind. These 5 aspects of dravya, counting pancamahabhuta now as one aspect, are known as the Causal elements. All other elements are the Effectual elements, because they are dependent upon these, and have their existence only as manifestations of the pancamahabhuta.

2) GUNAS: Properties or qualities of matter. The sartha refers to those gunas which can be perceived by the sense organs (which is the majority and the significant part according to pharmacology), though there are also those gunas which describe the structural aspect of the tridosha, which are invisible and intangible. The gunas can be further classified into the spiritual, the (meta)physical. The physical can be further classified into the specific and the general. There are 6 spiritual gunas, which can only be felt and are not found in senseless or nonliving dravya, such as desire, happiness, etc. The specific physical gunas are 5, specific to each sense organ; the general physical gunas are the 20 characteristics that distinguish the doshas (i.e. coarse, unctuous, sharp, etc.) and the 10 para apara, which are other distinguishing qualities (i.e. brightness, relative distance, etc.). These properties belong to the body, food, and medicine, which is why they are used to treat disease. There is a broad total of 41 properties. These gunas all stem from the greater emanations of the three mahagunas (greater gunas), which are the sattvic, rajasic, and tamasic qualities; these are understood as the speeds of vibration (fast, medium, slow), the active, passive, and neutral principles, etc.

3) KARMA: Action. Initiation or change of property or structure. Without karma there can be no modification of any state of existence, and in medicine helps us to understand the pharmacological action and therapeutic effect. There are two types of medicinal karma: pathophysiological and pharmacological. Change within the body is effected by drugs/medicine. To get the desired change, action is necessary. The qualities we cannot perceive directly, we can know by their action. In the sense of pharmacology we must see the action of the medicine in order to identify it, and to know whether it is an original or a duplicate substance. The drug alone does not perform the action; it must have qualities which must belong to material.

4 & 5) SAMANYA and VISHESHA: Similarity and difference. These two must always be taken and understood together. Similarity is the general that phenomena (or bodies, foods, medicines, etc.) have in common; the differences are specific and differentiate or separate the existence of one from another. What we perceive with the sense organs must have differences, but we all have common consciousness as the power behind perception. For example, my eyes are blue and another person's might be brown; my skin is pink but another's might be black; still, we all (generally) have two eyes, the same skin, etc.

6) SAMAVAYA: Relationship. There is an inherent relation between material and the properties or qualities that describe it. The continuity of this relationship, which applies to not only material but also the gunas and the karma, is inherent. However, as Krishnamurti famously said, "the description is not the described", and this is the principle meant by samavaya. For example, we call haritaki by its name because we both know and believe that it has certain qualities, properties, potency, and action. If it does not have this action or potency, this taste, this feel, this appearance, and so forth, it is not haritaki. If we say "this is hot", it must have a heating quality, otherwise it is not hot. In the same way, an action cannot happen without the property denoting that action. This relationship can have degrees of complexity as well; i.e. we may say something is dry, but its action might cause unctuousness in the body.


Regarding the dravya, the living body comes in contact with medicine and diet. Their use and prescription is based on the principle of similarity and dissimilarity. Dravya causes action on the living body due to its properties. Time, proportion, etc. may differ, but the properties that are the same will increase the same (like increases like). In other words, properties differ by way of the Causal elements, but need balance of the pancamahabhuta regardless.

Now we wonder how these processes actually occur. According to Ayurveda, the power of transformation is called agni, and in terms of the human body primarily refers to digestion and other metabolic processes. There are three main types of agni to be concerned with here: digestive, pancabhutic (enables the conversion, for example, of vegetables into nutrients--one form of the elements into another), and of the dhatus (bodily tissues or constituents). All of this acts and passes through the srota, or channels of the body. All the bodily systems (respiratory, circulatory, urinary, etc.) are srota; some are not visible, some are. They allow travel and passage throughout the body. All of this varies slightly in the body of each individual, which is why the patient's constitution must be considered wholly and in relationship to its aspects when prescribing medicine.

There are only three effects that dravya can have on the living body. One is to maintain, prevent, or cure disease; one is to have no action, and one is to cause disease. Whatever drug or medicine might be used, can only have these effects. The effects can only be had by either increasing or decreasing the dravya, the guna(s), or the karma, etc. in the body. Thus we measure by increase/decrease, excess/deficiency, etc. The dhatus and tridosha are the same depending on their state. It is also important to note that everything is necessary in the body in some amount. Even the excreta (stool, sweat, urine) are necessary in some amount; without them there is no state of health.