Root Cause vs Symptom Relief

Every treatment answers one of two questions. What will make this stop now? Or, why does this keep happening? The first question leads to symptom relief: an antacid for burning, a painkiller for a joint, a laxative for a hard stool. The second leads to root-cause treatment: finding what is producing the burning, the pain or the constipation, and removing it.

Modern medicine is very good at the first question and increasingly attentive to the second. Classical Ayurveda was built around the second. The Sushruta Samhita compresses the whole of treatment into one line: in brief, treatment is the avoidance of the cause. Much of the rest of the text is detail on how to find the cause and what to do while it is being removed.

Neither approach is superior in the abstract. A patient in acute pain needs the pain treated. A patient whose acidity has returned every year for a decade needs the cause found. Dr. Arvinder Singh Bali's practice is built on the second question, but he is direct about when the first one should come first.

Nidana means cause, and in the classical texts it also names the whole discipline of diagnosis. The Madhava Nidana, the standard text on the subject, opens each disease with its causes before its symptoms. The order is deliberate. A physician who knows the cause can predict the course; one who knows only the symptoms can only react to it.

Causes fall into recognizable groups, and the first consultation is largely an audit of them. Dr. Bali asks about each in turn, not because any single one is decisive, but because the pattern across them usually points clearly to one Dosha and one organ system.

• Diet: what is eaten, in what quantity, at what time, and in what combination.
• Routine: sleep, waking time, work hours, exercise and rest.
• Season and climate: heat, cold, damp, and the change between them.
• Suppression of natural urges: holding stool, urine, hunger, sleep or tears.
• Mental strain: grief, fear, anger and prolonged worry.
• Prior illness and treatment: what has been tried and what it did.

Once the cause is named, the first line of treatment is to remove it. This is Nidana Parivarjana, and it is unglamorous. For a patient with recurring acidity whose cause is a late dinner and a fast lunch at the desk, the first prescription is a meal time, not a medicine. For a patient with insomnia whose cause is a screen at midnight, the first prescription is a bedtime.

Patients sometimes find this disappointing, because they have come for a formulation. Dr. Bali's answer is that a formulation taken while the cause is still operating will work only while it is being taken. Remove the cause and the formulation has less to do, works faster and can be stopped sooner. This is why diet and routine appear in every plan, including plans for conditions that seem to have nothing to do with food.

Agni is the digestive fire: the capacity to break down food and turn it into tissue. Charaka writes that strength, health, life and vitality all depend on it, and that when it is disturbed, disease follows. Many chronic complaints that arrive in the clinic in Chandigarh, whether joint pain, a skin condition or fatigue, turn out on history to have started with a period of disordered eating or digestion.

Ama is what results when Agni fails. Food that is incompletely digested leaves a residue: sticky, heavy and toxic in the classical description. It coats the tongue, dulls the appetite, makes the body heavy and the mind slow, and travels to whichever tissue is weakest. Ama in the joints presents as stiffness; in the skin as eruptions; in the gut as bloating and irregular stool.

Treating Ama is a step, not a slogan. It usually means a period of lighter food, warm water, digestive spices, and a formulation such as Triphala or Musta to clear the gut before any tissue-building or strengthening treatment is started. Giving nourishing treatment on top of Ama, in the classical view, feeds the disease rather than the patient.