Tridosha (three doshas)

The introduction says every medical system rests on an account of how the body works in health and how it is disordered in disease, and that in Ayurveda the body is made of the three dhātus, with doṣa, dhātu and mala as its root. The three dhātus sustain and nourish the body: while balanced they keep it healthy, and when they become unequal the body begins to deteriorate.

The introduction says health lasts while the dhātus are balanced and fails when they are unbalanced, and that the three are called dhātus only while they are in balance, running, growing and keeping the body healthy. Through unsuitable contact of the senses with their objects (asātmyendriyārtha-saṁyoga), errors of judgement (prajñāparādha) and the effect of time (pariṇāma) their balance is lost; once unbalanced they harm the body instead of helping it, and are then called doṣas. Doṣas are thus the dhātus in an unbalanced state, vitiated substances whose properties and actions are quite different, and they are the cause of disease; like the dhātus they exist in gross, subtle and very subtle forms, and they disorder bodily and mental activity as the dhātus keep it in order.

The introduction sums up that the body is made of three kinds of substance: the dhātus, so called because they sustain it; the doṣas, because they vitiate it; and the malas, because they soil it; hence the saying that the body has doṣa, dhātu and mala as its root. Doṣas, like the dhātus, are always present in the body and dwell very close to them.

The same footnote says that the five kinds named for each dosha all share one set of characteristics and receive separate names only because they dwell in particular sites and do particular work.

The doshas are counted as ten: three singly, three in pairs (vāta-pitta, vāta-kapha, kapha-pitta) and four in the three-dosha combination (sannipāta): all three together, vāta and pitta dominant with mild kapha, vāta and kapha dominant with mild pitta, and pitta and kapha dominant with mild vāta.

The commentary says that the humans of the present land of action, whose lives can be cut short, came to suffer great fear from the aggravation of vāta, pitta and kapha.

No disorder (disease) is said to be able to arise without the three doshas, vata, pitta and kapha.

The text says that every kind of disease arises from disorder of vata, pitta and kapha, and that the physician should treat after knowing the sequence of the doshas.

When all three doshas are aggravated together, the colours of all three are said to appear at once.

Vata disorder is described as causing severe pain, pitta disorder burning and thirst, and kapha disorder bulkiness, density, firmness and itching.

It says the body is never without activity even for a moment; even in sleep its work goes on, and only the activities that stop count as rest. Because the dhātus are used up in the work of vāta, pitta and kapha, some imbalance always arises and doṣa substance is formed. As long as the strength of the dhātu substances is greater, health lasts; when the strength of the doṣa substances grows they vitiate the dhātus and spoil health, and when the sustaining dhātus are vitiated by doṣas and malas disease arises. This is called the analysis of dhātu and doṣa.

Note: आदिक in the quote is read as अधिक.

The body has three doshas known as vāta, pitta and kapha, which, when increased, produce many diseases.

Vata, pitta and kapha, singly, in pairs or all three together, or together with blood, become aggravated by their own causes and, lodging in the various parts of the body, produce bodily, mental, external (aupasargika) and congenital diseases; these are to be overcome, once well understood, with reasoned treatment suited to each.

No disease arises without vata, pitta and kapha; so diseases or subtypes that are not described should be treated with suitable pacifying drugs after deciding from the signs which dosha is primary and which subordinate, and describing them again would only grind what is already ground.

Because no disease arises without the doshas, the text says diseases not described by name are to be identified by their dosha signs and treated accordingly.

The three doshas, vāta, pitta and kapha, are counted among the body's parts under the special name 'pillars' (sthūṇa).

It says the three dhātus are extremely subtle and pervasive, present in the body's systems, organs, cells and even atoms, each with its own sites and with functions that go on day and night; though named vāyu, pitta and kapha, some medical works, especially the Bhela Saṁhitā, call them 'pratimūladhātu'. It adds that the sites and functions of vāta, pitta and kapha are described in detail in the Kalyāṇakāraka.

It says the three dhātus are the root basis of life and must exist in every creature: even the tiniest creature has water in its body made of śleṣma, takes in, digests and grows from its food through the pitta in its body, and has the rasa dhātu.

In the human body, it says, the three dhātus have distinct sites, functions and qualities; each is not a single substance throughout the body but a group of kinds, one in class but different in form, existing in gross, subtle and very subtle forms. Their activity is both bodily and mental: vāyu, pitta and kapha act on the three guṇas of the mind, sattva, rajas and tamas, and mental activity is regulated by them; though pervasive, they have specific sites and functions.

The introduction says the gross forms of the dhātus can be shown directly while digestion goes on: the release of pācaka pitta (the juices of the stomach, the svādupiṇḍa, the liver and the pakvāśaya) can be demonstrated by experiment, as the Russian Pavlov did by collecting through a tube the juices secreted at a meal; the release of moist kapha with them and the work of samāna vāyu can also be proved, and the gas within the food can be measured with an instrument. It then asks: if these are the three dhātus, what is special about Ayurveda and why is it needed as a separate science?

Its answer is that the secreted pitta and kapha must arise from something: since organs, their cells and atoms are alike everywhere and properties and actions depend on a substance, subtle pitta, kapha and the like must reside mostly in particular organ divisions, and that is why pitta and kapha are released from them; this is said to be established by reasoning. The gross parts receive their strength from the subtle parts, the work of the subtle and very subtle dhātus goes on down to the atoms, and in each organ the gross work of the dhātu that predominates there goes on. Life cannot continue without all three dhātus.

The introduction says vāyu, pitta and kapha themselves must be nourished and kept in balance, since they are used up in daily activity; if they are not nourished and do not stay balanced they decline and health suffers. They are nourished by diet and conduct: the rasa formed in the vipāka of food with the six tastes, that is, the vīrya of the food, sustains them. The three dhātus in the body increase with food of similar qualities, through its rasa, vīrya and prabhāva, and decrease with food of dissimilar qualities, and the daily loss is made good by similar rasa and vīrya.

It says the three dhātus act on the mind and the mind acts on them, so the two are bound together and both depend on food. Food is of three kinds, sāttvika, rājasa and tāmasa, which act on the body's dhātus and on the mind's sattva, rajas and tamas; medicine, like food, also acts on the three guṇas of the mind.

A footnote says the fixed seats given for the three doshas are those of the undisturbed doshas, not the disturbed ones, and that the doshas are not confined to them: all the doshas are present throughout the body.

A footnote records the variant reading pañcadaśaivātra (fifteen here) for daśaivātra (ten here) in verse 61.