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Alter (1999) notes that modern Ayurvedic medicine has been transformed by colonial policy, Western science, capitalism, postcolonial modernization, and various nationalist ideologies (Arnold 1993; Bala 1991; Cohen 1995; Leslie 1992; Obeyesekere 1992; Trawick 1987, 1991). As Trawick (1987, 1991), Obeyesekere (1992) Leslie (1980, 1992), Nandy (1995), and Nichter note, modern practitioners find ways to improve these textual sources and Ayurveda is not dogmatic and encourages experimentation (Nandy 1995: 186-95). Indeed Alter admits that Ayurveda has been used for centuries and even millennia to treat disease before the influence of the West. However, this influence has resulted in widespread misunderstanding of Ayurvedic medicine and made Ayurveda's application as "healthcare" problematic for Westerners today in much the same way as Cartesian dualism made the biomedical treatment of psychosomatic illness very difficult because of the sharp ontological distinction it makes between mental and physical domains.

Metabolic, Humoral Body-building and the Heap Body

Alter describes Ayurveda as a method of metabolic, humoral body-building and cosmic self-improvement; a quest for perfection in an inherently and naturally imperfect world. Zimmermann explains that modern Western physiology is the science of organic functions while Ayurveda is a medicine of properties or virtues and metamorphoses (1987: 167). Ayurveda sees the body as naturally imperfect and therefore perfectible, while Western medicine sees the body as naturally perfect and healthy and therefore prone to disease and irrevocably mortal. The body is viewed as composed of fluids, essences, humors, saps and elements that ebb and flow (Daniel 1984, Daniel and Pugh 1984, Trawick 1983, Marriott 1990, Zimmermann 1979).

Rao (1987: 8) speaking of the classical works of Panchasikha, an important early philosopher-psychologist, and Caraka, the editor/compiler of one of the most important Ayurvedic treatises, explains that the human constitution is key for emancipation (apavarga) and health (arogya) and is made up of 24 elements or "categories" (tattvas) in two groups, prakrti (nature, in the sense of causative factors) and vikaras (modifications thereof, in the sense of effects). The first group contains eight categories: five subtle elements, "consciousness stuff" (buddhi), "egoity" (ahamkdra), and the "unmanifest" primordial principle (avyakta) while the second group contains sixteen factors (five gross elements with specific characteristics, five organs of knowledge, five organs of action, and mind.)

All of these elements are piled up into a "heap" (rasi) or conglomeration which is a body-mind complex that makes a person or "heap person" (rasi-purusha). The biochemical, metabolic and humoral composition of the heap person has been explored by various authors (Majumdar 197 1:235-38; Dasgupta 1987:51-91; Seal 1985:56-85, 202-43). When bodies are built as heaps their natural constitutions can vary between people which makes health highly relativistic and tied to local ecological conditions. Dasgupta notes that at the embryonic level according to the variation of sattva a man may vary to a great extent and some twenty types of men are known (see Caraka (1987:791), Basham (1976), Jolly (1977:1-25), Majumdar (1971), Meulenbeld (1996), Mitra (1974), and Rao (1985).

Pathogenic Birth

The very act of exposure to the outside world at birth leads to ill-health, according to Ayurveda, and a specific regimen must be followed during life to return to the state of health before birth. Ayurveda has two primary constituents, the universal soul, purusa, and cosmic substance, prakrti. Prakrti is composed of three perfectly balanced constituent qualities or strands: sattva (lightness, brightness, truth, and beauty), rajas (force, action, vitality), and tamas (dullness, lethargy, inaction). As manifest in prakrtic form, these strands are inanimate. They have no volition. When the animating principle of purusa is combined with prakrti , the strands come to life, but in an imperfect manner. All evolution starts from the disturbance of an original state of equilibrium (samyavastha), wherein the primal constituents (gunas) are all perfectly balanced. But then somehow there is a disturbance, and consequently the struggle for ascendency is instituted among the primal constituents. There is a degree of compe titive violence built into this manifest body, a kind of survival of the fittest gunas. And the creation of the universe is not an act of perfection but a series of compromises and recombinations that exist in perpetual imbalance and lead to inevitable death (Babb 1983; White 1984:43). White (1996:21) explains that as long as a human being is not exposed to the outside world (when in the womb, for example), it enjoys a perfect balance but when it becomes exposed to the outside world, the dosas fall out of balance and the individual becomes subject to health disorders. As a result, human experience according to Ayurveda is inherently klishta, that is, painful, full of suffering, and illusory to the extent that it is bounded by a samsaric cycle of life and death rather than by the unbounded nature of the incombinant, primordial, immutable universe. This gives perspective to critics of Western medicine's medicalization of pregnancy, since in Ayurveda even birth is considered pathogenic.

The Three Dosas as Agents of Corruption

In Ayurveda, tridosa is a theory of pervasive humoral balance and basic human constitution comprised of vata (wind), pitta (bile), and kapha (phlegm).

In turn, these invisible humors are derived from the five elemental forms of matter known as pahchabhuta: prthvi (earth), ap (water), agni (fire), vayu (air), and akasa (ether). These elements exist in different combinations thus creating the infinite variability and diversity of the material world. Dosa is usually translated as "humor" yet it literally means "corrupting agent" or "cause of disease." However, the tridosa are also regarded as the "three pillars of positive health" (Filliozat 1964:28; Rao 1987:65). Thus the body is seen as naturally morbid and corrupted with disease but potentially perfectible which is very different from our idea of natural good health. Zimmermann (1987: 169) explains that these humors are ambiguous since they are fluids irrigating the tissues from the perspective of materials but also pathogenic factors.

As fluid irrigants each has five subtypes and regulate different body processes. Pacaka pitta is located in the stomach and is associated with digestion. Alocaka pitta regulates vision. Bhrajaka pitta maintains body temperature and gives luster to the skin (Singhal and Patterson 1993:27). Apjha vayu is located mainly in the lower gut and pelvis and is associated with movement and excretion (Singhal and Patterson 1993). The relative balance of the three dosas is responsible for the constitutional peculiarities of individuals and their susceptibility to various diseases (Rao 1987:67). The humors can be combined in 62 ways with health considered the sixty-third. Also, each of the three dosas is affected by an infinite number of ecological factors such as diet, rate and context of food consumption and digestion, time of day, climate, direction of wind, age, rest, accidents, state of mind, and exercise. Thus, since a person is always in flux as their humors ebb and flow it is impossible to establish "one" universal standard of natural g ood health. Majumdar (1971:237) seconds this when he explains that the infinite number of possible combinations makes a 'perfect' organism a near impossibility hence, health is only a state of optimum balance. According to Majumdar "all individuals have a predominance of one of the three humors and, therefore, an inherent imbalance. In short, health is not so much a state as a process. It is a process that moves from a condition of managed morbidity (the 62 possible combinations) toward an ideal of perfect health and long life (the 63rd configuration of dosas). Note how different this is from the Western medical model of great health initially in life, followed by a gradual decline towards death and old age.

Sara: Constitutional Essences and Uniqueness

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