Ancient medicine as per Charak Samhita

Atharva-veda, the youngest of the four Vedas (around 5000 BCE), contains hymns on diseases and their treatment. The Atharva-veda also talks of the 8 branches of Ayurveda. Shilajit (black bitumen), a material used as a drug even today in Ayurveda, was found in the Mohenjodaro excavations (around 3500 BCE). These two are indicative of the scientific handling of diseases in India from a very early date.

In this country, learning and preservation of knowledge has been through an oral tradition which is built on a succession of teacher-mentors and disciple-followers. In the field of medical science, these teacher-disciple lineages are traced to three original teachers:

• Atreya (Internal medicine)

• Dhanvantari (Surgery) and

• Kashyapa (Gynaecology and Paediatrics).

Some of these teacher-students had, defying the prevailing practice, chosen to document what they had heard, seen and learnt. The teachers to whom we owe the survival of the ancient knowledge are:

• Charaka (1st Century BCE) of the Atreya School, who codified the precept and practices in internal medicine.

• Sushruta (6th Century BCE) of the Dhanvantari school, who codified surgical practices.

• Vagbhata (6th Century AD) of the Kashyapa school, dealing with Gynaecology and Paediatrics.

The names of the authors vouch for their being compilers: Charaka – the one who has travelled (and learnt); Sushruta – the one who has heard well (and learnt); and Vagbhata – the one who is eloquent (in communicating what he has learnt).

The three epochal works (Charaka-samhita, Sushruta-samhita and Ashtanga-hridaya), of these illustrious authors, are referred to as the Brihat-trayi – the Big Three of Ayurvedic literature. Then there is the Laghu Trayi, the Small Three made of Sarangadhara-samhita, Madhava-nidana and the Bhava-prakasha.

The periods of the authors only indicate the time of the knowledge being codified and reduced to writing, while the knowledge itself would have endured for several centuries preceding the compilation.

Philosophy – Ayurveda is a system of medicine that is holistic in more ways than one

•     It looks at the body as a whole.

•     It looks at prevention and care in addition to treatment.

•     It at food as an essential ingredient of good health and treatment in addition to medication.

•     It looks at the body and the mind.

•     It considers genetic and environmental factors.

Ayurveda has a medico-social and medico-philosophical approach to health and treatment. It concerns itself as much with good health and disease-preventing lifestyle as with the treatment of illness.

Factors Responsible for Promotion of Strength

Balavrddhikarastvirne bhava bhavanti I Tadyatha

balavatpuruse kale ca sukhasca kalayogah

sattvasampacca svabhavasarnsiddhisca yauvanarn

ca karma ca samharsasceti I

Translated as – These factors are strength promoters. They are: birth in a place of strongmen in times of strong men and in pleasant climate, healthy seed and uterus, nourishing food, good physique, good maintenance, healthy mind, natural disposition, youth, action and cheerfulness.

Source

Charaka-samhita, Sarirasthanam, Adhyayah 6, / Paragraph 13 (1^st Century BCE)

Notes

The causative factors listed here include:

•     Generic and environmental

•     Physiological and psychological

Besides, there is no preoccupation with disease and treatment. The science emphasizes the role of factors like food.

Test of Cure

Karyarn dhatusamyarn tasya laksanarn

vikaropasamah I Partksa tvasya rugupasarnanarn

svaravarnayogah sariropacayah balavrddhih

abhyavaharyabhilasah ruciraharakale

abhyahrtasya caharasya kale sarnyagjaranarn

nidralabho yathakalarn vaikarinarn ca

svapnanarnadarsanarn sukhena ca

pratibodhanarn vatamutrapurisaretasarn muktih

sarvakarairmanobuddhTndriyaQam cavyapattiriti II

Translated as – The task is the equilibrium of the primary fluids (humors). Its characteristic feature is the pacification of aberrations. The test of the cure is the abating of the disease, normalcy of voice and color (of the skin), non-decay of the body, increase in strength, desire for eating, interest (Ruchi)* in eating, timely digestion of the food that is eaten, getting sleep at the proper time, not having nightmare, waking up happily, the release of wind, urine, excrement and semen, non- impairment of the mind, intellect and sense organs in all aspects.

*Ruchi means both interest and taste. One test of complete cure that is mentioned here is both interest in eating and appreciation of the taste while eating.

Karyaphalarn sukhavaptih, tasya laksanarn-

manobuddhlndnyasariratustih II

Translated as – Attainment of good health is the fruit of this effort. Its characteristic is the contentment of the mind, the intellect, the sense organs and the body.

Anubandhastu khalvayuh tasya laksanam

pranaih saha sarnyogah. II

Translated as – Is not longevity the long-term result? Its feature is union with life energy (prana)*.

*Prana: The breath of life, vitality, life, vital air, principle of life. Usually plural in this sense, the pranas being five – prana, apana, samana, vyana and udana indicative of the 5-fold metabolic functions of respiration (prana), excretion (apana), digestion (samana), reversal (vyana)- i.e. cough, sneeze, hiccups, vomit etc. and circulation (udana).

Source

Charaka-samhita, Vimanasthanam, Adhyayah 8, Paragraph 89-91 (1^st Century BCE)

Notes

1. The three paragraphs narrates the students and the practitioners of medicine the application of their craft in the immediate, intermediate and long terms levels.

2. The first quote contains an amazingly simple ‘Process for Treatment’ as well as the ‘Test for Cure’.

In the antibiotic regime, initially the patient suffers from the disease and later from the debilitating effect of the antibiotic, though the patient would have been declared cured once the thermometer hits the 98.4° mark.

The Ayurveda test is simply what every single patient looks for and understands as relief from illness. The tests are health-centric and match well with the patient’s understanding of well-being. The nature of the tests warrants the attending physician eliciting the status from the patient, as he cannot declare the patient cured through measurable parameters like temperature or blood pressure. In the contemporary period, the doctors of the country delivered cure in a manner the patients were aware of. Such process for discharging treatment to a patient was relevant for any kind of illness as such.

Western Reference

Hippocrates Aphorism (460 BCE)

“In every disease, it is a good sign when the patient’s intellect is sound and he enjoys his food; the opposite is a bad sign.”

Eight Specialties in Ayurveda

Tasyayurvedasyanganyastau tadyatha

kayacikitsa salakyarn salyapahartrkarn

visagaravairodhikaprasamanarn bhutavidya

kaumarabhrtyakarn rasayanarn vajikaranamiti II

Translated as – The parts of this Ayurveda are eight, they being internal medicine, relating to the upper branches of ear, nose, throat and eye, surgery, toxicology, psychiatry, pediatrics, science of rejuvenation and the science of aphrodisiacs.

Source

Charaka-samhita, Sutra-sthanam, Adhyayah 30, Paragraph 28 (1^st Century BCE)

Etymology

1.   Kaya + cikitsa  = Body + treatment = Internal medicine

2. Sala + Salakyam = Relating to upper branches = of ear, nose and throat and the eyes

3. Salya + apa + hartrkam = To be removed by thorn (knife) = Surgery

4. Visa + gara + vairodhika + pra + samanam = Poison + venom + resisting + pacification = Toxicology

5. Bhuta + vidya = Ghost + knowledge = Psychology

6. Kaumara + brtyakam = Child + service = Pediatrics

7. Rasayanam = Treatment with chemicals (Rejuvenation techniques)

Notes

The very name for pediatrics – Kaumara-brityakam (in the service of the child) is suggestive of the attitude that physicians should bring to bear in the treatment of children.

Classification of Diseases

Tacca duhkham trividham adhyatrnikam

adhibhautikam adhidaivikamiti II

Translated as – They (the classification of diseases by origin) are of three types – exogenous, endogenous, psychic or natural.

Tattu saptavidhe vyadhavuparupatati I Te

punah saptavidha vyadhayah I Tadyatha

adibalapravrttah janrnabalapravrttah

dosabalapravrttah sanghatabalapravrttah

kalabalapravrttah daivabalapravrttah

svabhavabalapravrtta iti II

Translated as – Diseases are of three types – endogenous, exogenous and cosmic. They fall under seven categories of diseases. They are:

• Those caused by pre-conception hereditary factors

• Those caused by post-conception hereditary factors

• Those caused by vitiation of humors

• Contagious

• Seasonal

• Those caused by divine forces (of unknown origin) and

• Those that is natural to the body.

Vyadhivisesastu pragabhihitah sarva evaite

trividhah sadhyah yapyah pratyakhyeyasca

Translated as – Diseases have been mentioned earlier. All these are of three types – treatable, to be endured and to be rejected.

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah I, Paragraph 24; Adhyayah 24, Paragraph 4; Adhyayah 35 Paragraph 18 (6^th Century BCE)

Notes

1. While quotes 1 and 2 above deal with the origin of diseases, quote 3 above concerns itself with the response to diseases.

2. Even though it does not emerge from this quote alone, the 7 disease types are classified under three main groups:

1. Endogenic = Pre and Post conception hereditary diseases and those caused by vitiation of humors.
2. Exogenic = Contagious and seasonal
3. Cosmic = Of unknown origin and those natural to the body.

Anatomy – Parts of the Body

Tvaficah sapta kalah sapta asayai) sapta

dhatavah sapta sapta sirasatani pafica

peslsatani nava snayusatani trinyasthisatani

dye dasottare sandhisate saptottararn

marrnasatarn catur-vimsatirdhamanyah trayo

dosah trayo malah nava srotamsi sodasa

kandarah sodasa jalani sat kurcah catasro

rajjavah sapta sevanyah caturdasa sanghatah

caturdasa simantah dvavirnsatiryogavahani

srotarnsi dvikanyantrani ceti samasah II

Translated as – (The human body) is a collection of 7 layers of skin, 7 tissues, 7 receptacles, 7 elements, 700 tubular vessels, 500 muscles, 900 sinews, 300 bones, 210 joints, 107 vital parts, 24 (blood) vessels, 3 humors, 3 impurities, 9 sense organs, 16 tendons*, 16 plexuses#, 6 bunches (of muscles), 4 (muscular) chords, 7 (fibrous) sutures, 14 bony complexes, 14 terminal formations, 22 capillaries and 2 intestines.

*Tendons – a band of fibrous tissues attaching a muscle to a bone or other structure

# Plexuses – a network

Source

Sushruta-samhita, Sarirasthanam, Adhyayah 5, Paragraph 6 (6^th Century BCE)

Etymology

1. Kalah = Parts or divisions = Tissue which is an aggregation of many parts

2. Dhamani = Reed / tube = Blood vessel

3. Srotah = That through which (the mind) pours out = Sence organs

4. Jalam = Web (of muscles, veins, ligaments and bones) = Plexus

5. Yoga + vahini = Vehicle through which blood flows = Capillary

Notes

With the exception of tendons, the numbers indicated here for the various body components are remarkably close to the modern knowledge.

Vulnerable Spots (Marma)

Tatraikadasa marnsamarmani ekacatvarimsat

siramarmani saptavimsatih snayurnarrnani

astavasthimarrnani vimsatih sandhimarmani

ceti I Tadetat saptottararn marmasatarn II

Muscle related vulnerable spots are 11

Blood vessel related vulnerable spots are 41

Sinew related vulnerable spots are 27

Bone related vulnerable spots are 8

Joints related vulnerable spots are 20

These are the 107 vulnerable spots.

Tesarnekadasaikasmin sakthi bhavanti

etenetarasakthibahu ca vyakhyatau

udarorasordvadasa caturdasa prsthe

grivampratyurdhvam saptatrimsat II

These vulnerable spots are in

The thighs – 11 each

The two arms – 11 each

Stomach/Chest – 12

Back – 14

Neck and above – 37

Saptottararn marmasatam I Tani rnarmani

paficatmakani bhavanti tadyatha

marnsamarmani siramarmani snayumarmani

asthimarmani sandhimarrnani ceti I Na khalu

mamsasira-snayvasthisandhivyatirekeI:Janyani

marmani bhavanti yasmannopalabhyante II

Vulnerable spots (are) 107. These vulnerable spots are five-fold, they being:

•       Muscle-related vulnerable spots

•       Blood vessel-related vulnerable spots

•       Sinew-related vulnerable spots

•       Bone-related vulnerable spots and

•       Joints-related vulnerable spots.

Surely, there are no vulnerable spots other than these – muscle, blood vessel, sinew*, bone and joint-related vulnerable spots; because none else is found.

*Sinew – That which joins a muscle to a bone

Tanyetani pafica vikalpani marrnani bhavanti I

Tadyatha – sadyahpranaharani kalantaraprana-

harani visalyaghnani vaikalyakarani rujakarani ceti

Translated as – These vulnerable spots are of five kinds, they being:

• Those immediately fatal

• Those that are debilitating

• Those belatedly fatal

• Those which are painful.

• Those which would be fatal when touched by instruments

Tatra sadyabpranahardnyekonavirhSatihkaldntarapr4naharani trayastrinn§atat trini

viSalyaghnani catu§catvdrirhSadvaikalyakarani

astau rujakardniti II

Translated as – There

• Those immediately fatal = 19

• Those belatedly fatal = 33

• Those which would be fatal when touched by instruments = 3

• Those that are debilitating = 44

• Those that are painful = 8

Source

Sushruta-samhita, Sartra-sthanam, Adhyayah 6, Paragraph 3-5 & 8 (6th Century BCE)

Notes

The word ‘marma’ in Sanskrit connotes the following:

• Vital • Vulnerable • Hidden.

Wherever the word ‘vulnerable’ has been used in this translation, the word should be understood as enveloping all these attributes.

Current Relevance

1. The text presents the vulnerable spots from three different windows

• The system (sinew or skeleton) they form part of

• The part of the body they are present in and

• The extent of their vulnerability.

These vulnerable spots match with those contained in the martial art literature underscoring a certain commonality in the Indian system of knowledge. An understanding and validation of this insight could help minimize the risks incidental to allopathic surgical procedures.

2. An application of this principle of ‘Vulnerable Points’ is found in the martial art form ‘Varmam’ which is still found in practice fairly widely in the state of Kerala and to a lesser degree in Tamil Nadu. One of the offshoots of this science is Acupuncture, which, ironically, is more commonly known and is seeing a revival. This science and its art form are finding application in Sports medicine.

Some interesting facts

The White House Commission

Eastern systems of medicine attach more importance to nutrition and prevention of disease than western medicine, and we should be more open minded to indigenous Asian systems of medicines like Ayurveda and Tai Chi. Certain CAM (Complementary & Alternative Medicine) practices such as acupuncture, bio- feedback, yoga, massage-therapy and Tai Chi may be useful in contributing to the achievements of the nation’s health-goals and objectives. The application of CAM practices to cure chronic diseases and disabilities is a largely unexplored area. CAM principles and practices are useful not only in preventing some of these diseases but also in enhancing recovery and preventing further illness. Increased research in this area will help to determine how CAM principles and practices can best be used to meet the goals of the healthcare system.

The White House Commission headed by Dr. James S. Gordon

(The Economic Times 23.03.2002)

Handling the Root Cause

Here is a passage from Ashtanga-hridaya of Vagbhata, an author who continued the tradition outlined by Bhela.

“Sages know man as having his root in his mind (Bhela’s context here) and the branches below (i.e. the seat of the body controlled by this mind). Therefore (a physician) who strikes at the (very) root (i.e. the mind, the crucial factor, in any disease whatsoever) would conquer the diseases more quickly.”

Bhela-samhita K.V. Krishnamoorthy and Edited by P.V. Sharma, page xviii

References

Pride of India: A Glimpse Into India’s Scientific Heritage

Compiled by Bharatiya Bouddhik Sampada ‘Anand Vilas’

Published by Samskrita Bharati