Integrative Ayurveda Training Program. CME Module 1. Ayurvedic Physiology

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1 Integrative Ayurveda Training Program CME Module 1 Ayurvedic Physiology

2 Definition of a Healthy Individual One whose Doshas are balanced, Whose digestive fire (Agni) is balanced, Whose bodily tissues (Dhatus) and elimination processes (Malas) are functioning normally, And whose senses (Indriya), mind (Manah), and Self (Atma) are filled with bliss, Such a one is called a healthy person. -Sushruta Samhita, Su

3 The Body s Inner Intelligence The body has an inner intelligence that underlies all physiological structure and function ( biological memory ).

4 The purpose of all prevention and treatment approaches is to enliven the body's inner intelligence, to promote homeostatic and self-repair mechanisms

5

6 Ayurvedic Physiology: Principal Components The human physiology is an expression of: One underlying unified field of intelligence: Atma, the inner intelligence The 3 controlling principles (Doshas) 13 aspects of the digestive fire (Agni) 7 primary tissues (Dhatus) 3 processes of excretion (Malas).

7 Primordial Qualities: The Gunas Ayurveda identifies 20 primordial qualities of Nature the 20 Gunas. These qualities are expressed in all aspects of physiology, including the Doshas (controlling principles), Dhatus (tissues), and Malas (waste products). Foods, herbs, and Ayurvedic treatments are also based on these qualities.

8 The Twenty Qualities - Gunas 1. Heavy / Light Guru / Laghu 2. Cold / Hot Shita / Ushna 3. Wet / Dry Snigdha / Ruksha 4. Dull / Sharp Manda / Tikshna 5. Smooth / Rough Slakshna / Khara 6. Dense / Flowing Sandra / Drava 7. Soft / Hard Mridu / Kathina 8. Static / Mobile Sthira / Chala 9. Gross / Subtle Sthula / Sukshma 10. Sticky/ Clear Picchila / Vishada

9 The Five Elements All aspects of the universe are made up of different combinations of the five elements or Mahabhutas. They are: 1. Akasha: Space 2. Vayu: Air 3. Agni (Tejas): Fire 4. Āpa (Jala): Water 5. Prithivi: Earth

10 Qualities of the 5 Mahabhutas 5 Mahabhutas Quali-es Akasha Space Subtle, so2, clear, smooth, expanding Vayu Air Rough, dry, light, cold, mobile Tejas Fire Hot, sharp Āp Water Flowing, wet, dull, so2, cloudy Prithivi Earth Gross, heavy, stahc, hard, dense

11 The Three Doshas Fundamental Controlling Operators of the Physiology

12 Elements Combine Within the Doshas Space Air Fire Water Water Earth VATA PITTA KAPHA

13 Ayurveda-Quantum Physics Correlations Hagelin JS. Is Consciousness the Unified Field? Modern Science and Vedic Science 1987; Vol. 1, No. 1, pp

14 2011 The Institute for Functional Medicine. Used with permission granted by The Institute for Functional Medicine

15 2011 The Institute for Functional Medicine. Used with permission granted by The Institute for Functional Medicine

16 Root Dynamics of Physiological Processes

17 Doshas are three: Vata, Pitta and Kapha. In their balanced state, they maintain the body. When imbalanced, they afflict the body with imbalances and diseases. Charaka Samhita,Vimanasthan, 1.5

18 The Doshas: Three fundamental governing factors of the physiology -- "mind-body operators." Vata Pitta Kapha

19 Vata Dosha Movement and Transport Constituent elements: Space and Air Qualities: Quick, Light, Cold, Moving, Dry, Rough, Subtle

20 Pitta Dosha: Digestion and Metabolism Constituent elements: Fire and Water Qualities: Sharp, Hot, Acidic, Intense, Pungent

21 Kapha Dosha: Structure and Fluid Balance Constituent elements: Water and Earth Qualities: Heavy, Oily, Slow, Cold, Stable, Dull, Sticky

22 Functions of the Doshas Vata: Governs bodily functions concerned with movement (e.g., circulation, heartbeat, respiration, peristalsis and elimination) Pitta: Governs bodily functions concerned with heat, metabolism and energy production (e.g., digestion, assimilation, hunger, thirst) Kapha: Governs bodily functions concerned with physical structure and fluid balance (e.g., lubrication, mucus production, tissue formation)

23 QUALITIES AND FUNCTIONS OF KAPHA DOSHA OILY HEAVY KAPHA STABLE STICKY COOL SLOW DULL STRUCTURE COHESION LUBRICATION

24 Balanced Vata Dosha Manifests as: Mental Alertness Proper formation of body tissues Normal digestion Strong immunity Sound sleep Enthusiasm Creativity

25 Imbalanced Vata Dosha Manifests as: Dryness (skin, joints, colon) Irregular digestion Bowel irregularity, constipation Tension headaches Underweight Anxiety/Insomnia Cold intolerance Fatigue

26 Balanced Pitta Dosha Manifests as: Normal body temperature Strong mental concentration Strong digestion Sharp intellect Lustrous complexion Good energy Contentment

27 Imbalanced Pitta Dosha Manifests as: Short-temper, impatience Inflammatory conditions Skin rashes Hyperacidity, acid reflux Loose stools Migraine headaches Premature gray hair/ balding Heat intolerance

28 Balanced Kapha Dosha Manifests as: Muscular strength Calmness Strong immunity Affectionate, generous nature Strong joints and bone structure Good stamina

29 Imbalanced Kapha Dosha Manifests as: Sinus and nasal congestion Overweight/Obesity Sluggish digestion Oily skin Excessive mucus Lethargy, dullness Tendency toward diabetes Possessiveness

30 Constitutional Type (Mind-Body Type)

31 Somatotyping Western biomedical concept that arose independently of Ayurveda: Elaborated by William H. Sheldon in 1940s Over 2000 PubMed references Based on 3-fold taxonomy corresponding to the 3 embryonic germ layers: ectomorphic, mesomorphic, endomorphic Some correlations to Ayurveda 3-dosha theory Vertinsky, P (2007). "Physique as destiny: William H. Sheldon, Barbara Honeyman Heath and the struggle for hegemony in the science of somatotyping". Canadian Bulletin of Medical History 24 (2): PMID

32 Personalized Medicine Personalized Medicine is a relatively recent area in biomedical science which seeks to identify genetic and metabolic differences between individuals and prescribe drugs and treatments based on those differences. Ginsburg GS, Willard HF. Genomic and personalized medicine: foundations and applications. Transl Res Dec;154(6): doi: /j.trsl Epub 2009 Oct 1.

33 Doshas and Gene Expression Recent studies have suggested that the three basic governing principles of Ayurveda--the Doshas--are correlated with specific groups of genes and physiological functions in the body.

34 Correlating Ayurvedic Dosha-Types with Genomics and Clinical Markers (1) Cross-sectional study of 96 subjects: Ayurvedic constitutional types (Vata-Pitta-Kapha Prakriti) exhibited significant differences in: Biochemical markers including liver function tests, lipid profiles, and hematological parameters including hemoglobin. Functional categories of genes engaged in core biological processes such as transport, regulation of protein kinase activity, immune response, and regulation of blood coagulation. Prasher B, et al. Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda. Journal of Translational Medicine 2008;6:48.

35 Correlating Ayurvedic Dosha-Types with Genomics and Clinical Markers (2) Cross-sectional study of 76 subjects: Significant correlation between Ayurvedic Prakriti types and human leucocyte antigen (HLA) DRB1 types Complete absence of the HLA DRB1*02 allele in the Vata type and of HLA DRB1*13 in the Kapha type was especially significant Patwardhan B, et al. Classification of Human Population Based on HLA Gene Polymorphism and the Concept of Prakriti in Ayurveda. The Journal of Alternative and Complementary Medicine. April 2005, 11(2):

36 Correlating Ayurvedic Dosha-Types with Genomics and Clinical Markers (3) Hypothesis: Ayurvedic Prakriti types have different drug metabolism rates associated with drug metabolizing enzyme (DME) polymorphism. Cross-sectional study, 132 subjects. Results: significant correlation found between CYP2C19 (Phase I DME) genotype and the major classes of Prakriti types, with fast and slow metabolism being one of the major differentiating characteristics: The extensive metabolizer (EM) genotype was found to be predominant in Pitta Prakriti (91%). Poor metabolizer (PM) genotype was highest (31%) in Kapha Prakriti when compared with Vata (12%) and Pitta Prakriti (9%). These observations are likely to have significant impact on phenotype-genotype correlation, pharmacogenomics, and personalized medicine. Joshi K, et al. Traditional medicine to modern pharmacogenomics: Ayurveda Prakriti type and CYP2C19 gene polymorphism associated with metabolic variability. Evid Based Complement Altern Med 2011;2011:

37 Correlating Ayurvedic Dosha-Types with Genomics and Clinical Markers (4) Cross-sectional hospital-based study of 300 patients. Ayurvedic Prakriti type was strongly correlated with cardiovascular risk factors, including: Insulin resistance and diabetes Hypertension Dyslipidemia Inflammatory markers Mahalle N, et al. Association of constitutional type of Ayurveda with cardiovascular risk factors, inflammatory markers and insulin resistance. J Ayurveda Integr Med 2012;3(3):150 7.

38 Some Further References Patwardhan B, Bodeker G. Ayurvedic Genomics: Establishing a Genetic Basis for Mind Body Typologies. The Journal of Alternative and Complementary Medicine. June 2008, 14(5): Kurup RK, Kurup PA. Hypothalamic digoxin, hemispheric chemical dominance, and the tridosha theory. Int J Neurosci 2003;3(5): Hankey A. Establishing the Scientific Validity of Tridosha part 1: Doshas, Subdoshas and Dosha Prakritis. Anc Sci Life. 2010;29(3): Sumantran VN, Tillu G. Insights on personalized medicine from Ayurveda. J Altern Complement Med. 2013;19(4): Rotti H, et al. Immunophenotyping of normal individuals classified on the basis of human doshaprakriti. J Ayurveda Integr Med 2014;5(1): Lakhotia SC. Translating Ayurveda's Dosha-Prakriti into objective parameters. J Ayurveda Integr Med. 2014;5(3):176. Juyal RC, et al. Potential of ayurgenomics approach in complex trait research: leads from a pilot study on rheumatoid arthritis. PLoS One. 2012;7(9):e doi: /journal.pone

39 Two Fundamentals of Individual Assessment in Ayurveda Identification of constitutional type or mindbody type (Prakriti) Identification of underlying patterns of imbalance at the basis of current or future disease (Vikriti)

40 Approach to Assessment A specialized Ayurvedic clinical interview, physical examination and pulse diagnosis (nadi vigyan) Pulse Diagnosis nadi vigyan

41 Significance of Constitutional Type All aspects of prevention and treatment should be tailored to the individual s constitutional type-- including food, spices, herbal preparations, lifestyle routines. What will promote balance for one constitution may produce imbalance for another.

42 Constitutional Type (Prakriti) All individuals have Vata, Pitta, and Kapha in their constitutional make-up, but usually 1 or 2 of these doshas is dominant in a particular person

43 Ten Basic Constitutional Types Monodoshic: Vata, Pitta, and Kapha Bidoshic: Vata-Pitta, Pitta-Vata, Vata-Kapha, Kapha-Vata, Pitta-Kapha, Kapha-Pitta Tridoshic: Vata-Pitta-Kapha

44 Kapha Vata Pitta

45 Vata Type Lighter, thinner build Quick to grasp new information, quick to forget Performs activity quickly Tendency toward worry Tendency toward constipation Aversion to cold weather Tendency to light and interrupted sleep Irregular hunger and digestion Tendency toward dry skin

46 Vata

47 Pitta Type Moderate build Tendency toward irritability and anger Performs activity with medium speed Enterprising and sharp in character Aversion to hot weather Prefers cold food and drinks Sharp hunger and digestion Cannot skip meals Tendency toward reddish hair and complexion, moles, and freckles Medium memory and time to grasp new information Good public speakers Sound sleep

48 Pitta

49 Kapha Type Solid, heavier build Tranquil, steady personality Greater strength and endurance Slow to grasp new information, slow to forget Slow, methodical activity Slow to become excited or irritated Oily, smooth skin Sleep is heavy and long Slow digestion, mild hunger Hair is plentiful and tends to be darker in color

50 Kapha

51

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