Is Blood, The Fourth Dosha? Controversy And Discussion

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Sushruta, master of surgery, has mentioned Rakta (blood tissue) as the fourth Dosha. Some schools of Ayurveda accept Sushruta’s opinion and many other discard this theory against standard theory of tridoshas. All Ayurveda textbooks have enumerated number of doshas as three – Vata, Pitta and Kapha. Understanding Blood Functions, Vitiation And Treatment As Per Ayurveda

Table of Contents

Points of support

Points in support of theory ‘blood is fourth dosha’

Sushruta being a Surgeon was obviously dealing with lot of ‘blood’ as he operated on many conditions. He found blood as a cause for many diseases.

Blood, like doshas are present during formation, development and destruction of body – Vata, pitta and kapha are responsible for formation of physical body. They form one’s body type and determine his / her constitution till end of one’s life. They also are involved in maintenance of body and are thus responsible for one’s existence and health. They also bring about destruction and damage of body when they are in a state of vitiation. Their imbalance is also responsible for one’s death. Sushruta tells that blood, just like vata, pitta and kapha is involved in formation, responsible for existence and destruction of physical body. Three doshas and blood are four entities present during formation, existence and destruction of human body. Therefore blood should be considered as fourth dosha. Read – Rakta Pradoshaja Rogas – When Blood Is Vitiated By Doshas

Blood is involved in formation of body, just like doshas – Blood is one of prime factors responsible for formation of body along with vata, pitta and kapha. Therefore, all these four components of body are considered as doshas. Through fetal circulation, blood of mother carrying nutrients passes placenta and nourishes embryo in womb, and enables its timely development and maturity. If supply of blood from mother to child is blocked, fetus doesn’t develop and eventually it dies. Read – Blood Formation, Causes of Impurity, Diseases, Treatment – Charaka Sutra 24

Similarity in properties between doshas and blood – Each of three doshas has its own site / sites in body, specific qualities, factors for aggravation, set of diseases which they cause and specific treatments and medicines to which they respond to. Similarly, blood too has its own seat of formation and circulation, its specific qualities, factors of aggravation, set of diseases which it causes and specific treatments to which it responds. Therefore, just like vata, pitta and kapha, blood is also a dosha, a fourth dosha. Read – Bleeding Disorders: Ayurveda Treatment, Diet, Home Remedies

Blood, like doshas move all through body – Doshas do not have assigned channels for their circulation but they move in all available channels of body from one place to other. They circulate all through body. Similarly, blood too moves all through body in blood vessels. This movement of blood to all corners of body would provide nutrition and oxygen to all cells, tissues and organs.

Flow of blood in blood vessels is said to be ‘sign of existence of life’ in body. When this ceases, we do not live. doctors examine pulse of patient by palpating arteries to see if any movement exists in it to find out if life exists or not. Non availability of pulse is sign of death. Doshas too move through blood all through body. Blood is medium of travel for doshas. Therefore, blood is a dosha. Read – Shringa Method Of Bloodletting Therapy – Procedure, Benefits

Many diseases are caused by vitiated blood – Just like vitiated doshas cause many diseases in body, vitiated blood also causes many diseases. doshas can contaminate blood and cause diseases but blood also can cause diseases independently when it gets vitiated. Thus, like vata, pitta and kapha, blood is also a dosha.

Many diseases are cured after bloodletting just like when doshas are expelled – Cleansing of body is very much essential to establish equilibrium of body functioning. To achieve this, vitiated doshas which are causing damage to tissues and organs should be expelled from body by administering panchakarma therapies i.e. 5 treatments adapted for detoxifying body. Once doshas are expelled, diseases caused by them are cured. Similarly, many diseases get cured when vitiated blood is expelled from body through various methods of raktamokshana i.e. bloodletting. This is yet another point in support of accepting blood as fourth dosha. Read – Alabu Avacharana – Bloodletting Method Using Bottle gourd

Opposing points

2. Points opposing theory ‘blood is fourth dosha’

All Ayurvedic masters have accepted only 3 doshas – All ancient Ayurvedic masters have accepted doshas to be only three in number and not more than that.

Blood has been mentioned as dhatu – tissue Blood tissue has been mentioned as a tissue in almost all treatises. If we accept blood as a dosha, dosha number will increase to four and tissue number will come down to 6. This will go against universal acceptance of dosha and dhatu (tissues) theory. Therefore it is better to accept blood as a tissue rather than a dosha.

Doshas form body types, tissues don’t – As a rule; doshas form our constitution, body types. But tissues do not form one’s constitution. Blood being a tissue is not involved in formation of Body type (prakriti). Therefore, blood is a tissue and not a dosha. Read – Prakriti – Ayurveda Body Types, Importance In Treatment And Remedies

Richness of doshas form prakriti, richness of tissues are called sara – When doshas are in a state of balance, they are said to be rich and best in terms of conducting their functions and maintaining health of body. Since they are balanced they will be considered as prakriti, natural. Same term has not been given to tissues, blood in this context. We do not find any reference of Rakta Prakriti. In fact richness of blood tissue is called Rakta sara.

Blood is a site for pitta Dosha– According to concept of ashraya ashrayi bhava i.e. residence-resident relationship, particular tissues are said to be abodes of particular doshas. Blood tissue is said to be a residence of pitta dosha. Therefore, pitta and blood coexist. One dosha cannot be an abode for another dosha. Therefore blood cannot be a dosha. Read – Ashraya Ashrayi Bhava: Relationship Between Tissues And Doshas

Blood and pitta share similar properties – Etiological factors leading to vitiation of blood, signs and symptoms of vitiated blood and blood borne disorders and treatment of blood disorders are same as that of pitta. Thus, blood, sharing an inseparable relationship with pitta forms a mirror image of pitta. Therefore blood is not a dosha. Read – Understand Pitta Dosha By Its Functions

Blood has not been defined – All doshas are defined in classics. Va gati gandhanayoh vata. Tapa santape pitta. Shlish alingane shleshma. If blood would be a dosha, it should have carried its own definition. Read – Vata Dosha Dominance In Different Body Parts – How it affects health?

No particular seat allotted to blood – While explaining dosha sthanas i.e. specific seats for doshas, Sushruta has mentioned pelvic cavity and rectum with anus as chief sites for vata, middle part of stomach and intestine as site for pitta and stomach as site of kapha. But he has not mentioned any specific seat for blood. There looks no uniformity in explanation and hence blood doesn’t qualify to be among elite group of doshas. Read – Kapha Dosha Dominant Places in Our Body

Blood misses out on a simily – Sushruta has equated vata to wind, pitta to sun and kapha to moon. Since he has considered blood as fourth dosha, he should have explained it on same lines by giving a simily, but this has been missed out. Read – Nourishing, Depleting and Distributing Functions Of Tridosha (Visarga, Adana And Vikshepa)

Blood tissue doesn’t form fourth pillar that supports body – Sushruta considers vata, pitta and kapha as tri-sthuna i.e. three pillars which support and behold body in a state of balance throughout life. Being involved in formation of body and contributing towards formation of one’s body type, vata, pitta and kapha support body being located in lower, middle and upper parts of body.

Since Sushruta has mentioned blood as fourth limb, he should have included it as another pillar supporting body, i.e. blood should have been fourth pillar of body. But blood has not been credited with this rank of supporting body in spite of being considered as dosha.

This goes against a principle and doesn’t follow uniformity. Therefore we can consider only vata, pitta and kapha as three doshas while not considering blood as a dosha.

Doshas can independently vitiate other tissues while blood cannot – Doshas are called as doshas because of their capacity to contaminate body components including tissues independently. Blood on other hand doesn’t have capacity to vitiate other tissues and elements of body. In fact, blood itself is contaminated by doshas. On other hand, blood cannot contaminate doshas. This shows that blood lacks property of independently contaminating body elements so as to qualify to be a dosha. Thus, blood cannot be considered as a dosha. Read – Dhatu – 7 Body Tissues As Explained In Ayurveda

Blood has its own channels of transportation and flow, but doshas move in all channels – Blood has its own channels of transportation through which they travel from one place to another. They are called rakta vaha srotas (blood crayying channels), their roots being situated in liver and spleen. Doshas on other hand do not have their specific channels to travel. They travel in all channels of body from one place to other being motivated by vata. Read –

Doshas support body when in state of balance and destroy body when they are vitiated, blood being a tissue can only support body –

Sanskrit verse

That which contaminates body is called dosha. That which supports body is called dhatu, i.e. tissue.

We have references in Ayurvedic classics that show doshas also acting as tissues in terms of protecting and supporting body. When in a state of balance, doshas behold body and support it by performing all functions of body. When same doshas are disturbed, they cause many diseases and trouble body. Thus, doshas are defined in terms of both contaminants and tissues. But tissues are only defined in terms of supporting body and not in terms of vitiating body components. Doshas can vitiate and damage tissues but tissues cannot vitiate and damage doshas. Blood is also a tissue; it can support body but not vitiate it. It can be vitiated by doshas but cannot vitiate doshas. Read – Increase And Vitiation Of Tissues – Dhatu Vruddhi

If blood is a dosha, all other tissues too should be doshas – Tissues, including blood tissue would harm body when they undergo pathological increase or decrease or when they are contaminated and damaged by doshas. Diseases caused by contaminated tissues are called as dhatu pradoshaja vikaras. Not only blood but other tissues too cause similar diseases when they undergo imbalance. On this basis, if blood is considered as dosha, other tissues i.e. plasma, muscle, fat, bone, marrow and semen too should be given status of doshas. But classics have not mentioned so. Thus, blood is only a tissue and not a dosha. Read – Srotas: Body Channels and Duct systems – Easy Explanation

Subtypes of doshas exist, that of blood doesn’t – Vata, pitta and kapha, each of these doshas have 5 sub-types. Each sub-type has been allocated a different seat in body and specific functions. If blood would be a dosha, it too would have been of five types. Sub-types of blood have not been mentioned in texts. Therefore blood is not a dosha, it is a tissue and is of only one kind. Read – Types Of Doshas And Their Functions

Evidences from classics

Other evidences from classics to oppose blood as fourth dosha –

Difference in formation of doshas and blood tissue – Doshas are formed from food. Blood is formed from its previous tissue i.e. rasa.

Three greater qualities, doshas and blood – Doshas are made up of three great qualities i.e. sattva, rajas and tamas, whereas relationship of blood or any other tissue with these qualities have not been explained.

Doshas get deep seated in tissues, other way is not possible – Among pathological manifestations of vata, dhatu gata avastha i.e. doshas getting deep seated in tissues has been explained. Among these conditions, raktagata vata i.e. vitiated vata deep seated in blood has also been explained. A dosha cannot get lodged in another dosha. Thus, blood is not a dosha. Read – Samprapti Vighatan in Dosha Kriya Kala – Breaking Early Stage Pathogenesis

Separate mention of doshas and blood in pathogenesis of diseases – Among pathological elements participating in formation of diseases, at instances we have references wherein doshas and tissues have been mentioned as different entities. Example, in etio-pathogenesis of skin disorders, list of pathological elements includes – tridosha, skin, blood and watery components of body. Here, author has mentioned tridoshas and blood separately. If blood were a dosha it would have been blended with dosha group. Thus, blood is a tissue and not a dosha. Read – Charak Samhita Kushta Chikitsa – 7th Chapter

Dosha tissue amalgamation view – No disease forms without pathological amalgamation of dosha and tissue, process called as dosha dushya sammurchana. Diseases are also caused by amalgamation of dosha and blood. Therefore blood is a tissue and not dosha.

Doshas control digestive fire, blood doesn’t – Gut fire, tissue and elemental fires determine metabolism and functional status of body. Fire should be intact for all activities to take place in an uninterrupted way. It is said that if fire ceases to be, person will be dead.

We also have a quote in Ayurveda telling that almost all systemic diseases are manifested due to weakness of digestive fire. Quality and quantity of tissue fires and elemental fires are maintained by gut fire. This quality and quantity of this gut fire is controlled by doshas. Read – Understanding Agni: Concept, Definition, Functions, Types

Samagni – fire is balanced and all metabolic activities happen in a smooth way if doshas are balanced. This fire is called sama agni, determines perfect health.
Mandagni – fire is mild when it is controlled by kapha. This type of fire is responsible for slow digestion of food.
Teekshnagni – fire is intense when it is controlled by pitta. This type of fire digests anything coming in its way in quick time.
Vishamagni – fire is variable and fluctuant when it is controlled by vata. This type of fire sometimes digests food in a good way, sometimes in a bad way.

But there is no evidence that blood controls fire. Instead, there is a fire inside blood tissue which is responsible for its formation, maintenance and conduct of functions. This tissue fire of blood is also controlled by gut fire which behaves in accordance to doshas. Therefore blood is not a dosha. It is a tissue. On other hand, if blood were a dosha, it would have influenced fire.

Gut reactivity – Dosha, Blood

Doshas cause gut reactivity, blood doesn’t – Three types of gut reactivity has been mentioned depending on predominant dosha influencing gut.

Krura koshta – hard bowel is caused by predominance of vata.
Madhyama koshta – moderate bowel movement is caused by predominance of kapha.
Mrudu koshta – soft / smooth bowel movement is caused by predominance of pitta.

If blood were a dosha, it would have influenced gut motility. Read – Koshta – Large Anatomical Body Cavities

Some activities which doshas does but blood doesn’t –

Vata causes displacement of doshas i.e. ashayapakarsha, avarana i.e. obstruction to other elements of body and meddling into their functions. Blood is not involved in such activities. Blood itself is mobilised by vata which is a dosha.

Doshas undergo 6 stages of pathogenesis. They also undergo increase and decrease in response to climatic variations, changes in parts of day and night and different phases of digestion. If blood is a dosha, it should have behaved in same way, it isn’t.

All above mentioned statements are evidences in support of rakta i.e. blood not being a dosha.