Why We Get Sick

What is health? What is disease? Are sick­ness and health just a matter of luck, or of which bacteria you happen to encounter in your daily life? What can we do to main­tain a positive state of health and avoid getting sick?

These are questions that the five-thou­sand-year-old tradition of Ayurvedic medi­cine has considered in depth. The answers, drawn from deep insight and generations of practical experience, can help us prevent illness from developing and heal it if it arises.

Let's begin by examining the Ayurvedic understanding of health. Then we will look at ten potential causes of illness and how you can counteract them. Once you are aware of the factors that can either maintain health or disturb your body's equilibrium and set the disease process in motion, you can organize your life for health and balance. Finally, we will consider the Ayurvedic understanding of how illness develops, from its earliest, invisi­ble stages until it is fully grown.

The Definition of Health

According to Ayurveda, health is not simply the absence of disease. It is rather a state of balance among body, mind, and con­sciousness.

Health consists of a balanced state 01 the three humors (doshas), the seven tissues C dhatus), the three wastes C malas), and the gastric fire (agni), together with the clarity and balance of the senses, mind, and spirit.

Although you will not need to master all these terms and considerations in order to effectively use the remedies in Part III, an acquaintance with them will give you a big­ger picture of the depth and practicality in this science.

You are already familiar with the three doshas, the biological humors or principles that govern all activity in the body:
vata, the energy or principle of movement; pitta, the energy of digestion and meta­bolism; and kapha, the principle of lubrica­tion and structure. Balance of the three doshas maintains health; imbalance leads to disease.

The dhatus are the basic bodily tissues. They are responsible for the entire structure of the body and the functioning of the dif­ferent organs and systems. Crucial to the development and nourishment of the body, the dhatus unfold successively as follows, starting with the nourishment derived from the product of digestion:

1. Rasa (plasma or cytoplasm) contains nutrients from digested food and subse­quently nourishes all tissues, organs, and systems.
2. Rakta (blood) governs oxygenation in all tissues and vital organs and thus maintains life-function.
3. Mamsa (muscle) covers the delicate vital organs, performs the movements of the joints, and maintains the physi­cal strength of the body.
4. Meda (fat) maintains the lubrication of the tissues and serves as insulating material to protect the body's heat.
5. Asthi (bone and cartilage) gives support to the body's structure.
6. Majja (bone marrow and nerves) fills up the bony spaces, carries motor and sen­sory impulses, and facilitates communi­cation among the body's cells and organs.
7. Shukra and artava (male and female reproductive tissues) contain the pure essence of all bodily tissues and can create a new life.

Each dhatu is dependent on the previous one. If the raw materials of digestion are inadequate, or if there is a problem in any stage, each successive dhatu will not receive the nourishment it needs and the respective tissues or organ systems will suffer. So for good health, all seven dhatus must develop and function properly.

The three waste products (malas) are feces, urine, and sweat. The body must be able to produce these in appropriate amounts, and to eliminate them through their respective channels.

Agni is the biological fire or heat energy that governs metabolism. It can be equated with the digestive enzymes and metabolic processes involved in breaking down, digesting, absorbing, and assimilating our food. Agni maintains the nutrition of the tissues and the strength of the immune system. It destroys microorganisms, foreign bacteria, and toxins in the stomach and intestines. It is an extremely vital factor in maintaining good health.

Agni sustains life and vitality. An individ­ual endowed with adequate agni lives long and has excellent health. But when agni becomes impaired because of an imbalance in the doshas, metabolism is adversely affected. The body's resistance and immunity are impaired, and the person begins to feel unwell. When this vital fire is extinguished, death soon follows.

In addition to these bodily factors, the senses, mind, and spirit also playa vital role in maintaining good health, as we will dis­cuss in the next section. When all these fac­tors are balanced, it produces a state called swastha, which means "totally happy within oneself."

This state of happiness and balance can be created and sustained by maintaining a healthy lifestyle in accordance with nature and the requirements of your own constitu­tion. Proper nutrition, proper exercise, healthy relationships, positive emotions, and a regulated daily routine all contribute to a healthy life. On the other hand, wrong diet, inadequate exercise, troubled relationships, negative or repressed emotions, and an erratic schedule are at the root of disease. These causative factors upset the balance of the doshas, weaken agni and the dhatus, and lead to poor health.

Ten factors in Health and Illness

Illness does not suddenly appear. There is a direct causal link between the factors that influence us and the effects they produce. The cause is the concealed effect, and the effect is the revealed cause. The cause is like a seed, in which the as-yet-unmanifested tree is con. cealed. The tree is the expressed value of the seed. Health is the effect of a healthy lifestyle and healthy habits; disease is the "tree" sprouted from unhealthy habits.

According to the Charaka Samhita, Both the patient and the patient's environment need to be examined in order to arrive at an understanding of the disease and the causes of disease. It is important to know where the patient was born and raised, and the time of onset of the imbalance. It is also important to know the climate, customs, common local diseases, diet, habits, likes and dislikes, strength, mental condition, etc.
This enumeration opens the door to the wide variety of factors constantly influencing our health. Let us consider some of them.

LIKE INCREASES LIKE

The first important principle in consider­ing the potential causes of disease is "Like increases like." A dosha is increased by ex­periences and influences (such as food, weather, and seasons) with qualities similar to it. Dry foods, dry fruit, running, jogging, jumping, always being in a rush, and working too hard are all factors that aggravate vata in the system. Pittagenic factors, such as hot spicy food, citrus fruit, fermented food, and hot humid weather, provoke excess pitta. Cold, cloudy, damp weather, eating dairy products, wheat, and meat, and sitting and doing nothing increase kapha.

The antidote to "like increases like" is "opposite qualities decrease or balance." This is the key to healing.

NOTE: In general, one's prakruti indicates one's disease proneness. Individuals of pitta constitution, for example, tend to have pitta diseases. But this is not inevitable. A person of vata constitution who eats a lot of hot spicy food, drinks alcohol, lies in the sun, smokes cigarettes, and represses anger will definitely get a pitta disease. If he or she eats candy, cookies, ice cream, and other dairy products and is exposed to cold weather, there will be a susceptibility to congestive kapha disorders.

FOOD AND DIET

We have already touched on the effects of food on the doshas, and chapter 8 will dis­cuss this important topic in depth, so we won't go into it at length here. The principle is simply that eating the right kinds of food for your prakruti maintains vitality and bal­ance, while eating the wrong kinds creates imbalance in the doshas, the first step in the genesis of disease.

Eating spicy food or sour or citrus fruit and drinking alcohol all increase heat and acidity in the body, something a pitta person cannot afford. For a vata individual, dried fruits, beans (including garbanzo, pinto, and aduki) are hard to digest and will provoke vata. Raw salads, which are cold and astrin­gent, will likewise increase vata. For a kapha individual, dairy products, cold drinks, and fatty fried foods definitely add to kapha. So a vata person eating a vatagenic diet, a pitta person eating a pitta-provoking diet, and a kapha person eating kapha-aggravating food are definitely creating imbalance and sowing the seeds for ill health.

Wrong food combinations, stale food, food with chem­ical additives, and wrong eating habits, such as eating too much late at night or eating in a rush, also contribute to imbal­ance and lead to poor digestion and poor health. Diet is thus one of the main potential causes of ill health-but by understanding these principles and eating according to the guidelines for our constitutional type, it is also one of the major ways we can take control of our lives and maintain healthy balance.

SEASONS

Ayurveda classifies the seasons according to their predominant dosha. The windy, cool, dry weather of autumn is largely vata, followed by the dark, heavy, damp, cloudy kapha qualities of winter. Early spring is still primarily kapha, but as late spring arrives, the increased warmth, light, and brightness express pitta qualities, which blossom in their full intensity in the summer.

Each of these seasons brings its own chal­lenges to health. The predominant dosha of the season will tend to build up at that time and can cause aggravation especially in someone of the same prakruti. If we act intel­ligently, we can avoid this accumulation and aggravation.

For example, because autumn and early winter tend to increase vata, individuals with a vata-predominant constitution need to eat warm foods, dress warmly, avoid cold food and drinks, and stay out of nasty weather. Otherwise they will fall prey to vata illnesses and discomforts, such as constipation, insomnia, and lower back pain. lf pitta indi­viduals want to remain free of anger, as well as hives, rash, and diarrhea, they need to keep cool in the summer, avoiding spicy foods, overexertion, and overexposure to the hot sun. Kaphas need care in the heart of winter and early spring if they are going to avoid colds, coughs, allergies, and sinus con­gestion in the damp, cool, heavy weather.

We will look further at the seasons, their effects, and how we can best live in harmony with their rhythms and changes in chapter 5, where we discuss the ideal Ayurvedic life­style, including daily and seasonal routines.

EXERCISE

Exercise is another factor that can pro­foundly influence your health for better or worse. Regular exercise improves circulation and increases strength, stamina, and immu­nity. It helps one to relax and to sleep peace­fully. It benefits the heart and lungs, is vital for effective digestion and elimination, and helps the body purify itself of toxins through sweating and deep breathing. Exercise increases the rate of combustion of calories, so it is good for maintaining body weight and for weight loss. It also makes the mind alert and sharp and develops keen perception.

On the other hand, insufficient exercise, overexertion, or exercise that is inappropri­ate for one's constitution can lead to ill health.

Lack of exercise eventually brings a loss of flexibility and strength and puts one at greater risk for many diseases, such as dia­betes, hypertension, osteoporosis, and heart disease.

Some amount of sweating helps to elimi­nate toxins, reduces fat, and makes you feel good. But overexertion may cause dehydra­tion, breathlessness, chest pain, or muscle aches, ultimately leading to arthritis, sciatica, or a heart condition.

Yoga stretching and some aerobic exercise are valuable for all body types, but the amount and intensity of your exercise should be based upon your constitution. Kaphas can do the most strenuous exercise, pittas can handle a moderate amount, and vatas require the gentlest exercise. Even though fast-mov­ing vatas are attracted to active sports, qui­eter exercises such as walking and yoga stretching are better for them. They should leave jogging, fast bicycling, aerobic dancing, and fast walking to pitta and kapha types. Kaphas are the most reluctant exercis­ers, preferring to do little or nothing, but it is important for them, or they will tend to put on weight and feel emotionally heavy and dull.

So here again, self-knowledge-knowl­edge of your constitution-plus a few pieces of vital information give you the opportunity and the challenge to maintain good health or fall into imbalance and illness.

You will find additional information about exercise in Part II, where we discuss the Ayurvedic daily routine.

AGE

Ayurveda divides the human life span into three stages. At each stage, certain diseases and types of disease are more common. Childhood is the age of kapha. Children's bodies are growing and building up their structure, so kapha
dosha is more predominant. Their bodies are soft and gentle (qualities of kapha), they require more sleep than adults, and they are susceptible to kapha illnesses such as colds and congestion.

Adulthood exhibits more characteristics of pitta. Adults are more competitive, aggressive, and ambitious than children; they work hard, they require less sleep, and they fall prey to pitta-type disorders such as gastritis, colitis, and peptic ulcers.

Old age is the age of vata. Elderly people sleep quite a bit less, and their sleep is bro­ken. They tend to get constipation, cracking and popping of joints, degenerative diseases such as rheumatoid arthritis and Alzheimer's disease, and suffer from forgetfulness, all characteristic of vata dosha.

This shows that our age and stage of life are factors that have to be considered in the choices we make to keep our doshas in bal­ance and remain healthy. Elderly people, for example, should not engage in strenuous exercise, and if possible they should mini­mize travel, among many factors that increase vata. They should favor a vata-balancing diet, with more warm, moist foods, more oil, and less salad and dried fruit.

MENTAL AND EMOTIONAL FACTORS

Our life is a whole, consisting of body, mind, and pure consciousness. Both health and disease have psychological as well as physi­cal origins. Illness may begin in the mind and emotions and then affect the body; men­tal imbalance creates physical imbalance. Equally, physical disorders and imbalances can generate mental disorders. Because of this, mind and body are never considered separately in Ayurveda.

Every perception, thought, feeling, and emotion, whether positive or negative, is a biochemical event that influences the doshas and affects the cells, tissues, and organs of the body. Fear, anger, grief, hatred, envy, possessiveness, and other negative emotions disturb our doshic balance; likewise, when the doshas are already out of balance, they may give rise to these same negative emotions.

Increased vata is associated with anxiety, insecurity, fear, nervousness, restlessness, confusion, grief, and sadness.

Increased pitta is associated with anger, envy, hate, ambition, competitiveness, criti­cism, judgmental attitude, sharp speech, per­fectionism, and the need to be in control.

Increased kapha is associated with greed, attachment, possessiveness, boredom, lazi­ness, and lethargy.

Emotions have an affinity with certain organs: grief and sadness with the lungs, anger with the liver, and hatred with the gall bladder. The kidneys may become the seat of fear, and the heart (as well as the lungs) the abode of grief and sadness. Nervousness is associated with the colon, while the stomach is the home of agitation and temptation, and the spleen may be related to attachment.

As we have discussed, emotions have a physical as well as a psychological aspect. Emotions are reactions to situations. If we do not understand and maintain clear awareness of the total movement of an emotion, from its arising to its dissolution, it will tend to adversely affect a particular organ, causing stress and weakness and creating what is known as a "defective space" (khavaigunya), where a future disease may manifest.

STRESS

Modern medicine often views stress as the result of a particular lifestyle, or of overwork, emotional trauma, and so on. Ayurveda con­siders stress less as a result or condition than as a causal factor in disease. A regular daily routine, nourishing diet, positive emotions, and loving relationships result in strength and health. But keeping late hours, eating food that is aggravating to one's constitution, traveling a lot, using the mind or stimulating the senses too much, repressing negative emotions such as anger or fear, and main­taining problematic relationships all put stress on the body and mind. In addition, toxins in food, water, air pollution, excessive noise, and many other environmental factors are also stressful.

Stress is a major factor in many diseases. It may trigger allergies, asthma, and herpes, and it may even lead to heart conditions.

Stress disturbs the doshas and can create disequilibrium of vata, pitta, or kapha, de­pending on the individual's constitution. Vata individuals may develop vata condi­tions such as anxiety or fearfulness. Pitta individuals may react to stress in the form of anger, or they may suffer from hypertension, peptic ulcer, ulcerative colitis, and other pitta disorders. Kapha individuals under stress tend to eat and eat and eat.

In Part III you will find many suggestions to minimize the impact of stress on your life, and to relieve symptoms caused by stress if they develop.

OVERUSE, UNDERUSE, AND WRONG USE OF THE SENSES

Our senses give us great pleasure as well as vital information. Through ordinary experience our senses of taste, touch, smell, sight, and hearing can nourish us, and we can also find healing through sense therapies such as aromatherapy, color therapy, mantras and other healing sounds, massage, and the tastes in herbs and foods.

But because all our perceptions, as well as our thoughts and feelings, are biochemical events as well as experiences in conscious­ness, improper use of the senses can create imbalance or damage in the body and result in illness.

Overuse of the senses strains and stresses our nervous system. To use a simple example, repeated exposure to bright light hurts the retina and strains the optic nerve, which trig­gers pitta, and sooner or later a person's eyesight will be affected or neuritis-like symptoms will arise. If we listen to loud music or hear loud sounds, the eardrum and the rest of our hearing apparatus are hurt and weakened; if it occurs often, the person can become deaf. Loud sounds also affect sys­temic vata dosha, giving rise to vat a symp­toms such as arthritis or degenerative changes in the bones. Lying in the sun strains the sense of touch, aggravates pitta, and may lead to skin cancer.

Misuse of the senses means using them in a wrong way, such as trying to read very small letters, or looking through a microscope or telescope (which creates a strain on the eyes), or reading while lying down (which changes the angle of focus and builds up stress on the muscles of the eyeball), which will eventually result in pitta or vata disorders. Eating a large quantity of wrong food, such as hot, spicy, stimulating food contain­ing cayenne pepper, is a misuse of the taste organ. Listening to loud sounds over the telephone, and long phone conversations, both aggravate vata. Exposing the senses to wrong inputs, such as watching violent movies on television, is also a misuse of the senses.

Underuse of the senses means not perceiv­ing with total attention, ignoring what we perceive, or not making full use of our won­derful sensory equipment. This can lead, for example, to accidents. SAD (seasonal affec­tive disorder) is a form of depression that affects people who don't get enough sunlight during the winter-a kind of underuse of the sense of sight. "Cabin fever," the discomfort and restlessness born of staying indoors for a long time, is at least partly the result of sen­sory deprivation. Prolonged fasting-under­use of the sense of taste-aggravates vata.

"KNOWING BETTER"

Very often we get sick because we disregard our own knowledge or wisdom. Understand­ ing our prakruti, our psychobiological consti­tution, is self-knowledge; understanding how certain foods, for instance, can disturb the balance of our mind-body system and lead to illness, while other food is balancing and strengthening for us, is knowledge we can use to remain healthy. And yet often we fol­low the impulses of the moment and choose foods that will cause us problems.

If a person who knows that her constitu­tion is largely pitta decides to eat hot spicy
food for lunch and then spends the rest of the summer afternoon working in the gar­den, she is disregarding her intelligence and understanding and asking for trouble.

As individuals, we are all part of the Cos­mic Consciousness, the universal intelli­gence that so beautifully organizes all of nature. That intelligence is within us, and by following the time-tested principles of Ayurveda and paying attention to our own intuition and inner wisdom about what is right for us, we can regulate our lives in har­mony with it.

RELATIONSHIPS

Our life is relationship. We are related to the earth, the moon, the sun, the air we breathe, the water we drink, the food we eat. You are related to your friends, your parents and children, your spouse, and your co-workers, as well as to your own body, your thoughts and feelings, your job, and your bank account. In our daily life, relationships are most important.

Often we use our personal relationships as a sort of power game, to control others. Then relationships become a battlefield rather than a field of love. When a negative emotion comes up in a relationship, such as resentment of a past hurt or insult, anger, fear, anxiety, or criticism, pay attention to the feeling. Don't judge the other person or yourself. When your spouse says something and you feel hurt or angry, look inside to see what your thoughts and feelings are saying to you. Be honest. Out of honesty, clarity comes.

When clarity is lacking, feelings are repressed, or communication is absent at times of crisis in our relationships, stress builds up, and this is one of the causes of ill­ness. Stress disrupts our inner biochemistry, the doshas are thrown out of balance, and the seeds of disease are sown.

Husband and wife, brother and sister, par­ent and child-all our relationships must be absolutely clear. Clarity in relationships de­velops compassion, and compassion is love. Therefore love is clarity. And as we all know, love is the key to successful relationships.

lf you look back over the ten factors pre­sented in this section, you will see that you have a great deal of choice and control over whether they will create a potentially dis­ease-producing imbalance in the doshas. This is true even of such apparently uncon­trollable factors as the seasons and the weather: if it is cold, you can dress warmly; if it is hot, you can take it easy and stay out of the sun.

How Disease Develops

According to Ayurveda, illness is the end result of a long process that can be detected and addressed at any stage. This process has been thoroughly studied and its phases delineated in great detail.

The disease process begins with distur­bances in the balance of the doshas. Tempo­rary imbalances are common and quite normal; problems arise if the aggravated con­dition is not corrected. In the normal course of events, vata, pitta, and kapha go through cycles of change in three stages: accumula­tion, provocation or aggravation, and pacifi­cation. Pitta, for example, begins to build up and accumulate in the late spring. It is provoked or aggravated in the hot sum­mer months, and it naturally becomes paci­fied when the weather cools down in the autumn.

If the increased dosha isn't pacified natu­rally through a change in seasons, it under­goes further changes and disease may result. If a person with a predominantly vata consti­tution experiences some degree of increased vat a in the fall due to the cool, dry, windy weather, but it returns to normal soon after,

disease will not develop. The person can aid the process of restoring balance, for exam­ple, by eating moist, warming foods and dressing warmly in the windy weather.

If the condition of aggravated vata contin­ues, vata will move into the general circula­tion and into the deep connective tissue, where it will generate pathological changes. Disease will develop. Imbalance is disorder, and disorder is disease.

Disease is like a child. It has its own cre­ation within the womb of the body, accord­ing to a process known as samprapti or pathogenesis, literally "the birth of pain." In brief, this is how it happens:

1. ACCUMULATION

Due to various causes, such as diet, weather, seasons, emotions, and others we have dis­cussed, the doshas begin to accumulate in their respective sites: vata in the colon, pitta in the intestines, and kapha in the stomach. This is the easiest stage at which to treat any incipient health problem. A trained Ayurvedic physician can feel the imbalance
in your pulse even at this stage, and you may be able to detect it yourself.

Vata accumulation may be experienced as constipation, abdominal distension, or gases in the colon. Pitta buildup may be felt as heat around the belly button area and can be observed as a slightly yellowish discoloration in the whites of the eyes, or dark yellow-colored urine. The person will be very hungry and will crave candy and sugar. Accumulated kapha leads to feel­ings of heaviness, lethargy, and loss of appetite.

At this stage the individual is still quite healthy, and when a dosha starts to build up, the body's intelligence creates an aversion to the causal factor and a craving for opposite qualities, which can restore balance. For example, if you've eaten ice cream three days in a row and kapha is building up, the thought of more ice cream will not be appealing; rather, your body will crave cayenne pepper or other spicy food to burn up the kapha and counteract it. One should listen to this wisdom and not continue increasing the cause.

2. AGGRAVATION

The accumulated dosha continues to build up in its own site. The stomach gets brimmed up with kapha, the intestines fill with pitta, or the colon overflows with vata. These accumulated doshas then try to move from their sites. Kapha tries to go up into the lungs, pitta tries to move into the stomach and gallbladder, and vata tries to move into the flanks.

You can feel this stage, too. For example, if you eat too much kapha food on Saturday night, you might feel full when you wake up on Sunday and think to yourself, "Maybe I should fast or eat very lightly today." But then someone invites you out for Sunday brunch, and you eat heavily again. The next day you might get a cough or a feeling of congestion in the lungs as the kapha starts to move upward. Excess pitta in the second stage may cause heartburn or acid indiges­tion, even nausea. Vata rising up may cause pain in the flanks or midback, or even breathlessness.

According to Ayurvedic therapeutics, the disease process can be addressed at any stage, but specific treatments are needed for specific stages. In these first two stages, one can reverse the process by oneself, using common sense to apply the principle of opposite qualities, and taking some home remedies. Once the disease process has gone beyond the gastrointestinal tract and entered the third phase, it is no longer under one's own control, and trained medical help is needed.

3. SPREAD

The dosha begins to spread from its place of origin, overflowing into the bloodstream and the general circulation of the body, "looking" for a place to enter. Here the disease process has progressed to the point where eliminating the causal factor will not be enough. A panchakarma purification program (or a similar cleansing regimen) is needed in order to return the doshas to their respective sites in the gastrointestinal tract so they can be excreted from the body.

4. DEPOSITION OR INFILTRATION

The aggravated dosha enters an organ, tis­sue, or system that is weak or defective, due to previous trauma, genetic predisposition, accumulated emotional stress, repressed emotions, or other factors. These weak areas in the body can be described as negative locations, like potholes in the road. Smoking cigarettes, for example, creates weakness in
the lungs; eating too much sugar creates weakness in the pancreas and blood tissue, and so on.

The newly arrived, aggravated humor (dosha) creates confusion within the cellular intelligence of the weaker tissue and over­whelms it, changing its normal qualities and functions. The quality of the aggravated dosha suppresses the normal qualities of the tissue and combines with it, creating an altered state, changed in structure and func­tion. In this way, the "seeds" of disease begin to sprout.

Up to this point, the disease has not appeared on the surface, but it can be detected by a skilled physician or recognized by imbalances in the doshas such as those mentioned above. An alert person can feel subtle changes in the body. If the condition is not interrupted at this stage, it will erupt as a full-blown disease.

5. MANIFESTATION

In this stage, qualitative changes become apparent. The signs and symptoms of an actual disease appear on the surface; the person becomes sick. Whether in the lungs, kidneys, liver, joints, heart, brain, or wher­ever, the seeds of disease now sprout and begin to manifest in the area of the defective tissue.

6. CELLULAR DEFORMITY LEADING TO STRUCTURAL DISTORTION

Now the pathological process is fully devel­oped and the disease completely manifested. Structural changes appear, and complica­tions of other organs, tissues, or systems become evident. This is also the stage it which the disease, now fully developed, is therefore most difficult to treat.

In the fifth stage, for example, when aggravated pitta dosha is invading the wall of the stomach, it may manifest as an ulcer. But in the sixth stage, the pitta will perforate the ulcer and cause hemorrhaging, or it may pro­voke a tumor. Function begins to be dis­turbed in the fifth stage, but here the structure of the tissue is affected, as well as the surrounding tissues and systems.

Obviously, treatment-restoration of bal­ance and normal functioning-is far easier at earlier stages. That is why prevention is emphasized so strongly in Ayurveda. It is much more effective to treat the illness in its seed stage, before it sprouts and grows.

Both health and disease are processes. Disease is a process of abnormal movement of the doshas, while health is a process of their normal functioning. The wise person
understands that the normal rhythm and quality of the process can be reestablished by changing diet and lifestyle and avoiding the etiological factors that cause disease.

The key is awareness. The more you are alert to how your mind, body, and emotions are reacting to changing circumstances; the more you are aware of your constitution and the moment-to-moment choices you can make to maintain health, the less opportunity you create for becoming sick.