Clinical Care in Ayurveda or the Role of Our Five Material Bodies (Panchakosa) in Treatment Planning

By Nimai Nitai Dasa*

There are three fundamental approaches to Ayurveda that reflect particular psychological dispositions of different types of therapists and patients, derived from a predominating tendency toward manifesting balance (sattva), assertiveness (rajas), or passivity (tamas).

Therapists and patients with a passive disposition often disregard the powerful effect of proper diet, exercise, and rest to protect health, and instead rely on medications, whether “natural” or synthetic, to treat disease conditions. This tamasic clinical approach consists mostly of prescribing herbo-mineral compounds and recommending basic, and mostly interim, dietary restrictions.

Therapists and patients with an assertive disposition are often fond of techniques such as harsh purification therapies, physical manipulation, invasive procedures, and other aggressive interventions. Assertive patients are attracted to arduous exercises and practices, in the expectation that such intrusive measures will result in improved health. In the rajasic approach, the patient secures the services of various therapists, or else engages in numerous — and often conflicting — therapeutic modalities in the hope of preventing disease. This rajasic approach frequently relies on the practice of strong elimination procedures that can drain vitality.

Patients with a balanced disposition, however, are actively involved in maintaining and protecting health, and an Ayurvedic practitioner can act as a knowledge resource. Persons with such a sattvic approach learn from the practitioner how to protect their own health through the adoption of a suitable lifestyle, and rely on daily disciplines and self care practices for their well-being. Their focus is on protecting and cultivating health, rather than on avoiding or treating disease. This approach is called svasthya vrtta, or Positive Ayurveda.

Therapists and patients habituated to conventional western medicine (allopathy) and homeopathy often tend to prefer the tamasic, passive approach. Therapists and patients inclined to favor “holistic” systems of healing, including western naturopathy, chiropractic, Chinese medicine, and even some forms of modern Ayurveda, tend to prefer the rajasic, assertive approach. Patients who are interested in Self Care, and who are convinced that health is the result of cumulative positive practices, prefer the sattvic, balanced approach.

Seeking Balance

Suddha Ayurveda understands health as natural equilibrium or balance. This equilibrium emanates from our spirit soul and expands into progressively denser levels or layers of existence. One can visualize human existence as composed of a series of superimposed layers, each extending farther away from the soul, and becoming denser. There are five such layers, or koshas, which form the three bodies (sharira) of all living entities in this plane of existence.

The causal body, which survives even the cyclic mahapralaya, or great dissolution of the manifest universes, is composed of one layer, the anandamaya kosha. The subtle body, which survives the physical death of the living entities and transmigrates to new physical bodies, but does not survive the cyclic mahapralaya, is composed of three layers: vijnanamaya kosha, manomaya kosha, and pranomaya kosha. The physical body, which perishes upon the observable death of all entities in this plane of existence, is composed of one layer, annamaya kosha.

According to the laws of karma, or cause and effect, the soul manifests the first subtle layer of existence, sustained by delight (anandamaya kosha). This layer constitutes the first projection of the soul into the external energy of the Absolute. Contrary to a common misconception in popularized accounts of Ayurveda and some impersonalist schools of Vedanta, this is not the “layer of bliss,” but rather the layer sustained or permeated by the bliss that is one of the intrinsic qualities of the soul in its original state.

The anandamaya kosha is the first projection into the realm of matter. It is the point at which the soul, which is of the nature of sat-chit-ananda (eternity-consciousness-bliss), is veiled by nescience. At this particular juncture, the principle of egoism is generated. This differentiation is fundamentally important, because otherwise one will fall into the error of believing this layer to be free from material contamination and transcendent of false ego, or ahamkara.

At this level, balance is sought and expressed through purification of consciousness (chitta-suddhi). The aim of this purification is to orient the soul away from the external energy and toward the internal energy of the Absolute. Because the soul is marginal energy, incapable of sustaining independence vis-à-vis the internal and external energies, it must perforce submit to the attraction of one or the other.

Contrary to the opinion of impersonalist speculators, the external energy is not an unqualified, undifferentiated void (sunya), but rather the full expression of the eternal individuality of the Absolute and all its inconceivably separate and united parts. Within this internal energy, the soul exists eternally in one of five amorous relationships with the Supreme Being, Sri Krishna, who is described in the Vedas as sat-chit-ananda vigraha, the eternal form of existence, consciousness, and bliss.

The second layer is that of intellect (vijnanamaya kosha), where balance is expressed as the ability to make correct determinations regarding what is positive or negative, desirable or undesirable, healthful or unhealthy. The intellect is that faculty responsible for making value judgments based on received wisdom and codes of morality.

The third layer is that of mind (manomaya kosha), where balance is expressed as the ability to perceive, process, and evaluate accurate information from the environment. The mind is that faculty responsible for reacting to sensory input with either attachment to pleasure or aversion to pain. The mind on its own, regardless of how sophisticated or convoluted its methods, only expresses crude likes and dislikes. Under the guidance of intellect, the mind is capable of processing information dispassionately.

The fourth layer is that of life force (pranomaya kosha), where balance is expressed as the ability to react appropriately to the environment, by adapting to changes according to time, place, and circumstance. Prana is that faculty that connects and integrates the diverse layers and levels of existence, animating the physical and bringing it under the control of the mind, intellect, and ego. Together, the second, third, and fourth layers are known as the subtle body, or sukshma sharira. Balance in the subtle body is attained through sattva-suddhi, or purification of assertive (rajasic) and passive (tamasic) qualities and the cultivation of balance (sattva).

The final and densest layer is that of the physical body (annamaya kosha), where balance is expressed as homeostasis, or the maintenance of the proper equilibrium among the biological principles, the tissues, and the excretions. The physical body is composed of the five elemental states of matter, and exhibits their attributes in proportion to their predominance in bodily tissues and structures. The fifth layer is called the physical body, or sthula sharira, and balance at this level is pursued through the practice of purification of the gross material elements (bhuta-suddhi).

The Three Pillars of Health

There are three pillars of health that radiate from the soul and that pervade, interpenetrate, and integrate the subtle and gross bodies. Although we speak of them as three separate principles, they are in essence three expressions of the one life-sustaining power of consciousness. This power of consciousness adopts these three fundamental forms in order to create, preserve, and destroy whatever is necessary for the expression of embodied existence.

The first of these expressions of soul-consciousness is prana, the life force. Prana is the animating principle that confers action to every layer of existence. In the layer of ego, prana manifests as the divine sound vibration in the core of the heart. In the layer of intellect, prana is the organizing pattern that communicates and maintains higher order. In the layer of mind, prana quickens the senses of cognition and action, bringing perceptions from the environment to the mind, and communicating the mind’s reactions to the environment. In the layer of energy, prana establishes the central and peripheral flow patterns that provide the reliable connection between the mind and the physical body. In the physical layer, prana regulates the functions of the heart and the lungs, and governs all transport of sensations and material particles throughout the organism.

When prana is flowing unimpeded, we feel invigorated and alert. We have strong vitality and enthusiasm, and there is healthy appetite, proper elimination, normal tissue formation, and sound sleep.

The second of these manifestations of soul-consciousness is agni, the power of assimilation. In the layer of ego, agni manifests as the principle of austerity, or service to the Divine. In the layer of intellect, agni is the capacity to recognize, accept, and understand truth, as communicated through sound vibration. In the layer of mind, agni is the ability to digest perceptions and experiences, and to organize them in ways that allow us to react rationally to changing events. In the layer of energy, agni is the warmth that allows and sustains our internal homeostasis. In the physical layer, agni is the ability to digest and assimilate nutrients from the external environment, and to transform them into extensions of the self.

When agni is well regulated, intellect is composed, perception is keen, emotions are controlled, digestion is sound, there is proper bodily heat and thirst, and the skin becomes soft and lustrous.

The third among these expressions of soul-consciousness is ojas, the energy of preservation. In the layer of ego, ojas manifests as the determination to sustain a lifelong spiritual discipline (sadhana). In the layer of intellect, ojas is the perseverance of correct discrimination, and attachment to the instruction of the preceptor, the saints, and the scriptures. In the layer of mind, ojas restrains excessive pleasure and aversion, and confers equipoise. In the layer of energy, ojas bestows endurance for longevity and efficient resistance to challenges from other living entities and the environment. In the physical layer, ojas provides cohesion, lubrication, and stability to every bodily tissue, organ, and structure.

When there is sufficient ojas, we experience contentment, courage, and dignity. The body is properly proportioned and strong, and the skin is smooth and moist.

From Theory to Practice

Ayurvedic practitioners promote public health measures to protect the health of the entire community, creating an environment that is conducive to individual health. When addressing personal health, practitioners systematically apply mental hygiene measures to increase balance, and decrease assertiveness and passivity. Finally, practitioners prescribe and adopt individualized diurnal, nocturnal, seasonal, social, and developmental disciplines of salutary conduct. When and if a disease process occurs, therapy is the last resort.

The passive Ayurvedic approach focuses its efforts on the gross physical layer and the reactive aspects of the energetic layer. The assertive approach focuses on the internal aspects of the gross physical layer, the core physiological functions of the energetic layer, and the most external aspects of the mental layer. Acting on these layers through herbo-mineral formulas, elimination therapies, and dietary restrictions is considered sufficient for maintaining physical and emotional health in the passive and assertive approaches.

However, the balanced approach of Suddha Ayurveda is anchored on the understanding that the subtlest aspects of existence always precede and control the grosser manifestations of matter. Therefore, treating the mental, energetic, and physical layers of existence only, without first addressing the subtlest and most central layers of intellect and soul, is both ineffective and inefficient. At best, one may achieve a partial or temporary healing, with every possibility that the same causes that produced the disorder in the first place will cause further imbalances. At worst, the treatment will be suppressive, and the organism will manifest deeper and more central imbalances.

This is not some esoteric philosophical concept, but a practical realization. Before one can erect a tower, for example, there must first of all be the will to build it. From the will arises the determination of the project’s feasibility, and much additional planning must ensue before the ground is ever broken for construction. The final product, a solid tower of imposing physical weight and volume, is but the expression of that subtle initial will, progressively made denser and more tangible.

Ayurveda shares with all Vedic culture the understanding of this vital truth, which finds expression in the concept of the five elemental qualities and the five elemental states of matter as constituting the foundation of material manifestation. The five elemental qualities of matter are, in descending order from the subtlest to the densest: sound, touch, sight, taste, and smell. The five elemental states of matter are: the field state, derived from sound; the volatile state, derived from touch; the radiant state, derived from sight; the liquid state, derived from taste; and the solid state, derived from smell. Each of these elemental states is denser than the preceding one, and each succeeding state incorporates all the qualities of the previous one.

There is a useful correspondence between the layers of existence (koshas), the elemental qualities (mahagunas), and the elemental states (mahabhutas). The ego is closely related to sound and the field state; intellect to touch and the volatile state; mind to sight and the radiant state; energy to taste and the liquid state; and the physical body to smell and the solid state. Although some relations seem more intuitively obvious than others, deep connections exist that are often reflected in the way we express ourselves in everyday speech. For example, we speak of hearing bells when we are in love, grasping ideas with the intellect, seeing with the mind’s eye, feeling drained of energy, or smelling something when it has become very prominent.

Establishing Balance in the Five Layers of Existence

Taking full advantage of these correspondences, Suddha Ayurveda’s approach begins by focusing on the organizing power of sound vibration emanating from the highest and most internal realm of existence. When chitta-suddhi acts on the layer of ego, balance manifests as pure joy, a celebration of the intrinsic nature of the soul as dependent upon and united with the absolute center in dedication, meditative contemplation, and love. From this plane, sound vibration descends, progressively aligning the layers of intellect, mind, energy, and the physical body.

Through the application of sattva-suddhi, balance manifests in the layer of intellect as wisdom to act according to time, place, and circumstance. It is at this level that decisions can be made regarding doing that which is ultimately correct and desirable, rather than what is temporarily pleasant or expedient. Interventions that are specific to this layer include accepting instruction from the qualified preceptor, hearing and reciting the scriptures, and adopting the basic observances and injunctions of spiritual conduct.

At the level of mind, balance manifests as freedom from the five mental afflictions: nescience, false identification, attachment, aversion, and clinging to the temporal material body. These five afflictions create static patterns of behavior that limit our adaptive potential when faced with changing circumstances. Freedom from these five afflictions allows us to react swiftly and appropriately to challenges from other living entities and the environment. Ayurvedic interventions that are specific to the mental layer include association with like-minded practitioners of spiritual discipline, austerity, and proper utilization of sense objects.

In the layer of energy, balance manifests as synchronicity among the three pillars of health, and confers the ability to protect the life force, regulate metabolism, and cultivate endurance. Ayurvedic interventions at this level include energetic therapies, physical and breathing exercises, and complete rest.

Through the application of bhuta-suddhi to the layer of the physical body, balance manifests as equilibrium among the biological principles (vata / air, pitta / bile, kapha / phlegm), the bodily tissues, and the three malas, or excretions (urine, feces, and sweat). It confers the ability to ingest, transform, appropriate, and excrete nutrients and other elements from and to the external environment. Ayurvedic interventions at this level consist of purification, normalization, individualized nutrition, and regeneration. Because natural equilibrium rests on the three pillars of life force (prana), metabolism (agni), and endurance (ojas), Suddha Ayurveda practitioners strive to protect prana, regulate agni, and cultivate ojas, both in health and in disease. These three cardinal intentions should always guide Ayurvedic treatment planning and clinical interventions.

*About author of article Kj. Nimai Nitai Dasa, ND(Ay), MPH, MTh, recently retired from the faculties of the Department of Family Medicine and Community Health at Tufts University School of Medicine and the Department of Social and Behavioral Sciences at Boston University School of Public Health. He currently directs the Dharma Academy at New Gundicha, Boston, USA.

Related materials in our Category: Ayurveda

P.S. Words from table 1 and table 2 for search websites like google.com, yahoo.com.

Table 1 (see table picture in text)
Jivatma Soul – Eternal Spirituar body

Five material bodies (Panchakosa) form subtler matter (top) till denser matter (bottom):
Anandamaya kosha – Sustained by bliss
Vijnanamaya kosha – Sustained by intellect
Manomaya kosha – Sustained by mind
Pranamaya kosha – Sustained by energy
Annamaya kosha – Sustained by food

Karana sharira – Causal body
Sukshma sharira – Subtle body
Sthula sharira – Physical body

Table 2 (see table picture in text)
Ego — Intellect — Mind – Energy — Body
Prana — Respect — Order — Receive / send impulses — Energetic flow patterns — Function / transport
Agni — Inquiry — Truth — Digest / organize experience — Warmth of internal environment — Digestion / assimilation
Ojas — Service — Positive behavior — Store / retrieve memories — Resistance / endurance — Preservation /replacement

Table 3 (see table picture in text)
Layers of existence — Elemental states — Elemental qualities
Ego — Sound — Field
Intellect — Touch — Volatile
Mind — Sight — Radiant
Energy — Taste — Liquid
Physical — Smell — Solid

Table 4 (see table picture in text)

Layers — Interventions
Ego — Sound vibration, Meditation, Dedication
Intellect — Accepting instruction, Hearing and reciting scripture, Observances and injunctions
Mind — Good association, Austerity, Proper utilization of sense objects
Energy — Energetic therapies, Physical exercises, Integral rest
Physical – Purification, Normalization, Individualized nutrition, Regeneration

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About BVG Janaka dasa das

The counsellor, trainer and lecturer of Balanced and Healthy lifestyle, body, art, music, trance etc philosophy, psychology and psychotherapy. The leader of personal development and team building groups and private practice of psychotherapy.
This entry was posted in 1 Physical health, 2 Mental health, 5 Spiritual health, Accepting responsibility for our life, Ayurveda, Balanced and Healthy lifestyle Philosophy, Holistic health, Prevention for health disorders and tagged , , . Bookmark the permalink.

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