Ayurvedic Definition Of Health: WHO vs Ayurveda

Aims of Ayurveda, the Indian system of medicine are two, as quoted in Sushruta Samhita.
a. To maintain the health of the healthy individual and
b. To treat the disease of the diseased.
A complete and comprehensive definition of health is highly important to know whether we are totally healthy or not.
There are two major definitions of health. 

WHO definition of health

1. World Health Organization has defined health as follows – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Ayurvedic definition of health

2. ‘Health is a state where in the Tridosha, Digestive fire, all the body tissues & components, all the physiological processes are in perfect unison and the soul, the sense organs and mind are in a state of total satisfaction (prasanna) & content”

Analysis of these two definitions of health:
WHO definition of health covers three major aspects – physical, mental and social well-being. physical and mental well-being are quite easy to understand. The social well-being refers to how a person interacts positively with the people around him etc.

Ayurvedic definition of health is elaborate.

TridoshaBalance in Tridosha means Vata, Pitta and Kapha. This refers to physical well-being.

Digestive fire – Ayurveda believes that the imbalance in digestive fire (Agni)  is the root cause for most of the diseases. Ayurvedic experts analyse Agni not only as digestive fire, but energy behind all the metabolic processes of the body. This also refers to physical well-being.

Body tissues and processes – This component refers to physical health

Total satisfaction of Soul, Sense organs and Mind – The explanation of these components are quite difficult and subjective. These not only refer to mental & social well-being, but also spiritual well-being.

The verse from Sushruta Samhita containing the definition of health –
sama dosha sama agnishcha samadhatu mala kriyaaha|
Prasanna atma mana indriyaha swastha iti abhidheeyate || 

Definition as per Charaka  

(Ref: Charaka Samhita Sutrasthana 21/18-19)
samamāṃsapramāṇastu samasaṃhanano naraḥ|
dṛḍhendriyo vikārāṇāṃ na balenābhibhūyate||18||
kṣutpipāsātapasahaḥ śītavyāyāmasaṃsahaḥ|
samapaktā samajaraḥ samamāṃsacayo mataḥ||19||

Sama Mamsa pramana – proportionate musculature
Sama Samhana – compactness of the body
Druda indriya – strong sensory and motor
Cannot be overcome by the onslaught of diseases
Kshut Pipasa Atapa Saha – Ability to withstand hunger, thirst, the heat of the sun,
Sheeta Vyayama Samsaha – Ability to withstand cold and physical exercises.
Samapakta, Samajara – Ability to digest and assimilate food easily,
Sama Mamsa Upachaya – good muscular body.

Acharya charaka in aShTau ninditiiya chapter of suutrasthaanam adeptly explains the features of the robust state of healthy human being.

samamaaMsapramaaNastu :- The person’s musculature must be congruous or well matching in its shape and size, as per the contour of the body part. Acharya ChakrapANi while commenting on the word mAMsa advices on par with the above statement as – ‘maaMsashabdenehopachayo vivakShitaH, tena samamupachayasya pramaaNaM yasya sa tathaa’.
In other words, the flexor group of muscles of a particular area of the body must be congruous with the extensor group of the muscles of the isolateral and contra lateral area.
Having such a balanced shape and size of muscles of opposite group of actions, helps maintain the equality of the muscle tones.
The equality in the tones of the antagonistic muscles helps in executing the movement related to the parts without any tremors or involuntary movements resulting by the cause of difference in the action potential of the muscles exhibiting varied muscle tones. In other words, the workload of both the components of antagonistic muscle will be on par and equal, that the work executed (movement related to those antagonistic muscles) will be smooth and efficient.

samasaMhanano naraH| :- The entire musculature of human body needs to be compact in their place and position maintaining its appropriate length and tensile strength, providing an appearance of well built physique. Acharya ChakrapANidatta interprets the word samhanana to be understood as – ‘saMhananaM melakaH|’.
The word sama saMhanana need not be confused with, an excessively built muscle mass aka hypertrophied muscle mass as induced with body building exercises where in the increase in dimension is due to an increase in the size (not length) of individual muscle fibers. In other words, the tensile strength of the muscles be maintained to be rigid and equal and be seen to it that is not lost to exhibit flabbiness of the muscle be considered on par for the term sama samhanana word mentioned by Acharya Charaka.

 dRiDhendriyo :- The word dRRiDha refers to strong or strength and indriya refers to sensory organs.
The mAMsa mentioned over this context need not be concise and restrictive to the skeletal muscles of the human body, but needless to say is inclusive of the smooth and cardiac muscles too.

The sensory organs like tongue, eyes get their strength and ability by means of the intrinsic and extrinsic muscles which are associated with them.

The strength is nothing but the force exerted by the muscle over itself.
For example if the force be applied in the muscle at the area of point where it gets inserted into the bone, the strongest part of the muscles would be seen in the area of that particular muscle with the largest cross section of the area.
Each muscle fiber can exert a force on the order of 0.3 micro-newton. The strongest muscle of our body is usually considered to be the quadriceps femoris or the gluteus maximus.

The fact that the muscle strength is determined by cross-sectional area, the shorter muscles will be stronger than a longer muscle of the same cross-sectional area.

The myometrial layer of the uterus may be the strongest muscle by weight in the female human body. During childbirth, the uterus exerts 100 to 400 Newtons of downward force with each contraction.

The external or extrinsic muscles of the eye are comparatively large and strong in relation to the small size and weight of the eyeball. Given with the work of maintaining the eyeball in position the three antagonistic pairs of muscles control eye movements too. The lateral and medial rectus muscles, the superior and inferior rectus muscles, and the superior and inferior oblique muscles are the 3 pairs of extrinsic muscles. These muscles are responsible for movements of the eye along three different axes: horizontal, either toward the nose (adduction) or away from the nose (abduction); vertical, either elevation or depression; and torsional, movements that bring the top of the eye toward the nose (intorsion) or away from the nose (extorsion). Horizontal movements are controlled entirely by the medial and lateral rectus muscles; the medial rectus muscle is responsible for adduction, the lateral rectus muscle for abduction. Vertical movements require the coordinated action of the superior and inferior rectus muscles, as well as the oblique muscles. The relative contribution of the rectus and oblique groups depends on the horizontal position of the eye. In the primary position (eyes straight ahead), both of these groups contribute to vertical movements. Elevation is due to the action of the superior rectus and inferior oblique muscles, while depression is due to the action of the inferior rectus and superior oblique muscles. When the eye is abducted, the rectus muscles are the prime vertical movers. Elevation is due to the action of the superior rectus, and depression is due to the action of the inferior rectus. When the eye is adducted, the oblique muscles are the prime vertical movers. Elevation is due to the action of the inferior oblique muscle, while depression is due to the action of the superior oblique muscle. The oblique muscles are also primarily responsible for torsional movements.

When reading, the eye moves continuously along a line of text, but makes short rapid movements (saccades) intermingled with short stops (fixations). There is considerable variability in fixations (the point at which a saccade jumps to) and saccades between readers and even for the same person reading a single passage of text.

Thus the mAMsa provides dRRiDhata to the sensory organ eye.

vikaaraaNaaM na balenaabhibhuuyate||18||:- It does not allow the diseases to overpower the body. Otherwise to say it ensue the pain threshold or pain withstanding capacity.

kShut sahaH :- The person with robust musculature can tolerate hunger.
Regulation of food intake is controlled by the brain and is an integration of hormones signalling hunger or satiety originating from peripheral tissues such as muscle, gut and adipose tissue, together with hunger inducing and satiety inducing neuropeptide hormones produced in the brain.

Muscle has not been considered as a major endocrine organ until recent research identified several hormonal signals originating from muscle with the potential to alter metabolism.

The hormone interlukin-6 originating from muscles during exercise acts within the brain as a satiety factor reducing short-term food intake, demonstrating the potential of muscle as a source of hormones that have a role in the regulation of food intake.

pipaasaa sahaH:- Tolerance to thirst.  Sveda is the mala of medas aka muscle fat. In a robust person the muscle fat is comparatively less than an obese person. Hence the mala of medas the sveda aka sweat gets expelled in lesser quantity thereby preventing dehydration, which in turn gives an impression that a robust musculature person is capable of withstanding thirst. It may be noted that in an obese individual, the slightest amount of exertion induces sweating, where as in a robust person, that amount of exertion do not expel sweat of the same volume.

aatapasahaH:- Tolerance to heat rays of the sun.

shiita saMsahaH:-  Tolerance to cold weather. The study ‘Greater body mass index is related to greater self-identified cold tolerance and greater insensible body mass loss’ by Dahee Jung1 et.al., confirms the above observation of Acharya Charaka.

vyaayaama saMsahaH:-  A well built and robust musculature provides withstanding or coping ability with the exercise of the body during ones day to day activities involving prasarana, aakuNchana etc.

Am I Healthy? 7 Checkpoints Video

Muscle contractions rarely reach maximum levels during our daily activities. However, much of what we know about the tension that whole muscles produce, and thus their function, is derived from experiments on maximally activated isolated muscle fibres [Baylor SM, Hollingworth S. et.al., 2003 Sarcoplasmic reticulum calcium release compared in slow-twitch and fast-twitch fibres of mouse muscle. J. Physiol. 551, 125–138.] Mammalian muscle contains many muscle fibres that are activated in groups called motor units. However, muscles are typically considered to act as if they were individual fibres that had been scaled up to the size of whole muscle [Wakeling JM, Lee SSM. et.al.,  2011 Modelling muscle forces: from scaled fibres to physiological task-groups. Proc. IUTAM 2, 317–326.].

The forces that a muscle produces during a dynamic contraction can be modelled using phenomenological Hill-based relations. These describe how the muscle force is influenced by factors including its length, velocity, and activation level. Motor units are the functional contractile units within a muscle and contain a group of fibres with similar contractile properties that are activated together. Once the activation states of different types of motor unit have been  established, it would make sense to incorporate these into the simulation of muscle force. However, the muscle models used to date typically consider the muscle to be treated as a scaled-up fibre with a single contractile element that takes on general properties of the muscle fibres within the muscle. However, muscles contain mixed populations of different fibre types with each muscle fibre type having distinct biochemical and mechanical properties. So the mechanical output of a muscle depends not only on the composition, but also depends on the recruitment of the fibres within it. Given that the recruitment of the different muscle fibres can vary between tasks, it is likely that the actual mechanical output of the muscle depends on the recruitment of its muscle fibres, and that this should be incorporated into muscle models. [Modelling muscle forces: from scaled fibres to physiological task-groups; James M.WakelingSabrina S.M.Lee et.al..,Procedia IUTAM -Volume 2, 2011, Pages 317-326].

Muscle forces are a strong determinant of bone structure, particularly during the process of growth and development. The gender divergence in the bone-muscle relationship becomes strongly evident during adolescence. In females, growth is characterized by increased oestrogen levels and increased mass and strength of bone relative to that of muscle, whereas in men, increases in testosterone fuels large increase in muscle, resulting in muscle forces that coincide with a large growth in bone dimensions and strength. In adulthood, significant age-related losses are observed for both bone and muscle tissues. Large decrease in oestrogen levels in women appears to diminish the skeleton’s responsiveness to exercise more than in men. In contrast, the ageing of the muscle-bone axis in men is a function of age related decline in both hormones.

Emerging research indicates that muscles release factors that are detected by bones and that may affect bone structure and strength independently of mechanical loads. In a study of mice lacking a muscle-specific phosphatase (MIP/MTMR14;MIPKO), Brotto et al. reported increases in intracellular phosphate accompanied by impaired calcium homeostasis, decreases in the function of skeletal, cardiac, and smooth muscle, as well as deterioration of trabecular structure with no effect on cortical bone – [The Bone-Muscle Relationship in Men and Women Thomas F. Lang et,al.. Journal of Osteoporosis _ Volume 2011 (2011), Article ID 702735, 4 pages].

The fitness of the muscle depends upon the motor units which in turn depends on the usage of the individual muscle fibres within the mass of the muscle, which can be maintained through a regime of stretching exercises involving the over all movements that the groups of muscles could produce within our body like flexion, extension; pronation, supination; elevation, depression; protraction, retraction; inversion, eversion; dorsi-flexion, plantar-flexion etc.,.

But at the same time, the regimen should be planned to maintain the balance between the paired muscles working in synchronization with each other. For example, the muscles usually work in pairs or groups, e.g. the biceps flexes the elbow and the triceps extends it which falls under the antagonistic muscle action. The working muscle is called the prime mover or agonist (since it is in agony of getting strain of doing the work..!). The relaxing muscle is the antagonist. The other main pair of muscle that works together is the quadriceps and hamstrings.  The prime mover is helped by other muscles called synergists. The synergists contracts simultaneously on par with the prime mover, so as to hold the body in position, that the prime mover can work smoothly. When muscles cause a limb to move through the joint’s range of motion, they usually act in the following mutually cooperating groups:

Agonists – These muscles cause the movement to occur. They create the normal range of movement in a joint by contracting. Agonists are also referred to as prime movers since they are the muscles that are primarily responsible for generating the movement.

Antagonists  – These muscles act in opposition to the movement generated by the agonists and are responsible for returning a limb to its initial position.

Synergists – These muscles perform, or assist in performing, the same set of joint motion as the agonists. Synergists are sometimes referred to as neutralizers because they help cancel out, or neutralize, extra motion from the agonists to make sure that the force generated works within the desired plane of motion.

Fixators – These muscles provide the necessary support to assist in holding the rest of the body in place while the movement occurs. Fixators are also sometimes called stabilizers.

It may be noted that a study by Power GA, Allen MD et.al., – on active Octogenerian  master runners was conducted to compare the motor unit number and their transmission stability, and interestingly found out that the functional motor units irrespective of ageing were producing action potentials that too on a higher level when compared to the control subjects of middle age group.

Presenting the words of the author PowerGA et.al., from the excerpt of their study for better understanding –  “Our group has shown a greater number of functioning motor units (MU) in a cohort of highly active older (65 yr) masters runners relative to age-matched controls. Because of the precipitous loss in the number of functioning MUs in the eighth and ninth decades of life it is unknown whether older world class octogenarian masters athletes (MA) would also have greater numbers of functioning MUs compared with age-matched controls. We measured MU numbers and neuromuscular transmission stability in the tibialis anterior of world champion MAs (80 yr) and compared the values with healthy age matched controls (80 yr). Decomposition-enhanced spike-triggered averaging was used to collect surface and intramuscular electromyography signals during dorsiflexion at 25% of maximum voluntary isometric contraction. Near fiber (NF) MU potential analysis was used to assess neuromuscular transmission stability. For the MAs compared with age-matched controls, the amount of excitable muscle mass (compound muscle action potential) was 14% greater (P 0.05), there was a trend (P  0.07) toward a 27% smaller surface-detected MU potential representative of less collateral reinnervation, and 28% more functioning MUs (P 0.05). Additionally, the MAs had greater MU neuromuscular stability than the controls, as indicated by lower NF jitter and jiggle values (P 0.05). These results demonstrate that high-performing octogenarians better maintain neuromuscular stability of the MU and mitigate the loss of MUs associated with ageing well into the later decades of life during which time the loss of muscle mass and strength becomes functionally relevant. Future studies may identify the concomitant roles genetics and exercise play in neuroprotection. – [Reference-  Motor unit number and transmission stability in octogenarian world class athletes: Can age-related deficits be outrun? – Power GA, Allen MD, Gilmore KJ, Stashuk DW, Doherty TJ, Hepple RT, Taivassalo T, Rice CL. J Appl Physiol 121: 1013–1020, 2016].
Thus it may be understood that the [vyaayaamasaMsahaH] and the muscles are inter related.

Get cues from this link explaining about the motor nerves and exercise –
samapaktaa:- The proper digestion of food helps in maintaining the stability of the core muscles and the stability of core muscles helps maintain proper digestion. They both are complimentary to each other. Though the statement sounds tricky, one may understand it after the following inputs.

For example, let us assume that the food consumed do not get digested properly and results in indigestion, it immediately result in bloating of the abdomen, thereby stretching the rectus abdominis, transverses abdominis and oblique abdominal muscles, which are the prime and core abdominal muscles, that maintain the intra abdominal pressure  and which there by exerts expulsive strength during natural reflexes like cough and sneezing or during strenuous exercises like squat or dead lift etc.,

When due to bloated abdomen, the core muscles get stretched and remains in the same stretched position, the occurs a disturbance in their normal and sequenced patterns of contraction from their motor units, which in turn becomes a cause for the stiffness of musculature in the back causing back ache and due to faulty local and global movement pattern of the core abdominal muscles the gait too gets altered and sometimes may even cause breathing disturbances.

Like wise when due to indulgence in food that cause constipation, the pelvic floor muscle get tightened and stretched thereby curbing the normal movement. It may be noted that the fascia of the obturator internus is well connected to the pelvic floor, hence when the pelvic floor gets stretched, the obturator internus too gets stretched and thereby restrict the free movement of the hip joints.

On the contrary, when the food intaken causes diarrhoea, interestingly the pelvic floor muscle become loosened and start pulling the peritoneum, the connective tissue protecting the viscera like liver, stomach and intestines downwards. It may be noted that the peritoneum is attached to the core abdominal muscles in the inside of the abdominal wall.

Thus it may be noted that when the core muscle that which maintains the posture and stability of the body gets affected at one point of an area, the interdependent sequential actions of the other core muscles too start getting affected producing the symptoms depending upon the disturbed sequential pattern.

Maintaining the stability, tone and structure of the core abdominal muscles, will certainly help maintaining the intra abdominal pressure by not giving away to the stress caused either by the bloating, since the weak stressor areas of the origin and insertion of the core muscles would be maintaining their muscular tone from not giving up to the resulting pressure, and thus help expel the bloated gas downwards and help maintain with proper peristaltic movement by pushing the chyle downwards along the long intestine to complete the process of digestion successfully.

samajaraH sama maaMsa chayo mataH:- The robust muscle maintaining person when attains senility with the muscle mass getting shrunken,  still would be maintaining the congruous or well matching of the shape and size of the built muscles, as per the contour of the body part, and would be good looking in appearance.

To conclude, one can maintain a robust physique by eating healthy [hita bhuk, mita bhuk] and easily digestible food [laghu aahara], doing physical exercises [vyayama] involving all the groups of muscles to maintain the motor units [vyAna vAyu gati] of the muscles through yogasanas, or stretching of muscles through physiotherapy, in not getting deteriorated from their functional capacity, thereby increasing ones physical performance limit, pain endurance capacity and maintaining the agility of the physique.
Article partially contributed by Vd. Rangaprasad Bhat

Swastha Swasthya Yogi Rogi

Explain these terms: Swasthya, Swastha, Yoga, Bhoga, Roga
Dr JV Hebbar
Swasthya = health  
Swastha = healthy person 
The aim of Ayurveda are two 
Swasthasya Swasthya Rakshanam – to maintain health of a healthy person 
Aturasya Vikara Prashamanam – to treat diseases of the patient 

Yoga = combination
Medicines, Aushadha yoga = combination of different herbs in the form of a medicine. 
In spirituality, Yoga = combination or meeting point of Jeevatma (soul) with Paramatma (eternal soul / Diety / Completeness) 
Bhoga = enjoyment, a quality of Rajas and tamas persons. 
Especially, more rajas, a person has, more she seeks Bhoga. 

Roga = effect of excess Bhoga = roga = disease. 
Excess sweets enjoyment leads to Sthoulya – obesity  

There is a famous proverb in Kannada. 
Ondu sala tinnuvavanu Yogi – If a person eats only once a day, he is Yogi. 
Eradu sala tinnuvavanu Bhogi – If a person eats twice daily, he is Bhogi – he is enjoying his life 
Mooru sala tinnuvavanu Rogi – If a person eats three meals a day, then he is more likely to become a patient 
Nalku sala tinnuvavanannu ettu kondu hogi – If a person eats four meals a day, then he will be dead soon! Carry him for cremation!  
Read: How Much Food to Eat per Day? How Many Meals per Day?

Perfect vs Optimal Health

Some people talk about perfect health as the objective of Ayurveda, for me it seems that it would be more accurate to talk about optimum wellness – because each one of us has a maximum potential of health —if you understand what I mean..
Dr JV Hebbar  
For a young and healthy person, it is healthy  to have perfect health. 
For an older person, or a person with incurable diseases such as type 1 DM, chronic rheumatoid arthritis etc., the aim can be to achieve optimum health = health status, that enables them to perform their daily routine. 

Optimal health can be defined as 
Health status, that enables a person to perform daily routines without much ailments or pain. 
Living a healthy life, albeit with the help of Panchakarma and daily medicine intake. 
Keeping the mind free from disease (perfect mental health, despite long standing illness, good sleep, good mental energy). 
Keeping the mind at a higher level so that even physical / mental disorders do not disturb the person’s happiness. – In such a person, though there is pain, there will not be suffering. (phrase is borrowed from Divine Park
Can the person laugh at a joke despite illness? 
Can the person move on his own? Is the person self reliant for most of the tasks? Can the person feel hunger, does he sleep well? 
Does the person have a caring and loving family? 
Does she do the work that she enjoys? 
Is he respectable? Is she responsible? 

3 comments on “Ayurvedic Definition Of Health: WHO vs Ayurveda

  • yasharya

    21/08/2012 - 7:27 pm

    very good analysis. I agree completely.

    Then, between 700 and 1000AD, India was invaded by the Middle East. The Muslims went on anti-Hindu crusades and destroyed many of the ancient books. The knowledge of Ayurveda began to slip away. In the 1800s the British invaded India, destroying what was left. Schools were closed and books were destroyed, until Ayurveda vanished into the corners of society. In place of the Ayurvedic schools, western medical schools were established.

    Reply to comment
    • Dr J V Hebbar MD(Ayu)

      26/08/2012 - 7:03 pm

      True. When foreigners invaded India repeatedly, most of the sciences prevalent in India like Ayurveda, astrology, engineering works, metallurgy, and what not, everything were lost or stolen. But The fun with Ayurveda was, the science of Ayurveda and Ayurvedic text books were there in each and every household. Which saved this amazing science of health.

      Reply to comment
  • Manas

    21/09/2014 - 12:24 pm

    Here one thing is not mentioned. The definition of Ayurveda-“Hitahitam sukham dukham ayushtasya Hitahitam manam tachh yatrotkam ayurvedah cha ucchate” also define HEALTH. Here Hitahitam =Hit+ahit means social health or social well being…and sukhm dukham means personal physical and mental health. So WHO just follow Definition of Ayurveda for define Health.

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