Internal medicine

Charaka-samhita is a classical textbook of internal medicine. It was probably first compiled around the 1^st century BCE. It is considered a prime work on the basic concepts of Ayurveda. Charaka represents the Atreya School of physicians. The Charaka-samhita is written in prose as well as in beautiful poetry, comparable to any Sanskrit classic.

Following points – related to the codification of the Atreya School – are useful in gauging the timeline of Charaka-samhita.

1.   Agnivesha, one of original students of Atreya School, flourished in the 10^th century BCE.

2.   Charaka composed his textbook on internal medicine in 1^st century BCE, again updated by Drudhabala in 4^th century AD.

3.   The dating of Charaka is corroborated by the fact that its language does not conform to the grammatical perceptions of the celebrated 3rd century BCE Sanskrit grammarian, Panini.

4.   Charaka-samhita and Sushruta-samhita are quoted in each other, which should not lead us to the conclusion that these works are contemporaneous. The quoting of Sushruta in Charaka comes about because of the later authors of Charaka-samhita referring to the original Sushruta-samhita. Otherwise, the former is clearly ahead of the latter.

5.   Bhela (7’h century AD) is another scholar of the Atreya school whose compilation – the Bhela-samhita – has survived the ravages of time.

Cardiology – Blood Circulation

Aharasya samyak parinatasya yastejo

bhutasarah paramasuksmah sa rasah ityucyate I

Tasya hrdayam sthanam sa hrdayat

caturvimsatirdhamaniranupravisya … krtsnam

sariramaharahah tarpayati vardhayati dharayati

yapayati ca adrstahetukena karmana II

The very subtle energy that comes from the well-digested food is called ‘rasa’. It resides in the heart. From the heart entering through the 24 arteries – 10 upwards, 10 downwards and 4 horizontal, it satisfies, grows, supports and maintains the entire body, day after day by unseen cause/activity.

The blood issues forth from the heart and therefrom goes everywhere; through the veins, it reaches the heart. Therefore, the veins are born of the heart.

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah 14, Paragraph 3 (6th Century BCE)

Etymology

1. Hr + da + yam = Harati + Dadati + Yati

= Receives + Propels + Circulates

= Heart.

This is a classic example of a Sanskrit noun – a word which not merely provides a ‘name’ for the object but also defines the object.

Western Reference

In 1553 AD, Michael Servetus, a Spanish physician, published a book anonymously on Theology, postulating that blood circulated from the heart to the lungs and back. But, his authorship was discovered and his unorthodox theological views resulted in his being burned at the stake by the ruler of Geneva, John Calvin (II – Chrono.140).

It was in 1628 AD that an English physician William Harvey published a book in Netherlands concerning the motions of the heart and the blood. In it, he describes the circulation of blood as accepted now. (II – Chrono.140). Harvey is usually credited as the discoverer of blood circulation.

However, Sushruta and Bhela as well as Charaka clearly indicate not only the existence of blood circulation, but also the purpose of the blood circulation i.e. supplying nutrition. It is interesting to note that Bhela describes the blood circulation even in the fetus.

Cardiology – Polypill

Asthibhangasthi samhare hitah

kaphavinasanah I

Pittasramatrsadahamehavatavinasakah II

Hrdrogam pandurogam ca visabadham

ksataksayam II

(The Arjuna tree) is good in joining disjointed bones, destroying phlegm (disorder), heart disease, jaundice, affliction due to poison. It is a terminator of injury.

Ghrtena dugdhena gudambhasa va pibanti

curnam kakubhatvaco ye I

Hrdrogajirnajvarapittaraktam hatva

bhaveyuscirajivinaste II

Those who drink the powder of Arjuna bark with ghee, milk or molasses water live long after being freed of heart disease, fever and profusion of blood.

* Botanical name of Arjuna Tree – Terminalia Arjuna

Source

Nighantu-ratnakarah Vrndah (Vedic period)

Current Relevance

Heart attack is caused by a multiplicity of factors like

·         Abnormal levels of cholesterol and imbalance in the levels of the proteins that transport it in the body,

·         Abnormal blood pressure because of blockage of the tubes that carry it,

·         High levels of harmful ammo acid homocystine which damages blood vessels and

·         Improper functioning of the blood cells called platelets, leading to blood clotting and vessel rupture.

Cardiologists assess the factor, which a patient is most vulnerable to, and prescribe medication. Two British doctors Dr. N.J. Wald and Dr. M.R. Law of Wolfson Institute have proposed in the 28m June 2003 edition of the British Medical Journal that a tablet –  (a polypill) a concoction of drugs addressing all the above factors – should be prescribed to achieve reduction in the incidence of heart attacks and strokes:

This idea of a polypill is under formulation and has been welcomed in the cardiac circles as path breaking. Arjuna is halfway to being the polypill as it addresses most, if not all, factors which cause a cardiac problem.

Dermatology – Skin Layers

Atha sapta tvagvarnanam –

Prathamasvabhasini nama ya sarvan

varnanavabhasayati pancavidham ca chayam

prakasayati I Sa vriherastadasabhagapramana

sidhmapadmakantakadhisthana I

The description of the 7 (layers of) skin is as follows –

The first called Avabhasini, it exudes 5 varieties of shades. It is 1/18^th a grain of rice in size. It is the abode of scab and the thorn of lotus (black head).

Dvitiya lohita nama vrihisodasabhagapramana,

tilakalakanyacchavyangadhisthana I

The second, Lohita, is 1/16^th a grain of rice in size, the abode of mole and hallow deformation.

Trtiya sveta nama vrihidvadasabhaga-

pramana, carmadalajagallimasakadhisthana I

The third, Shveta, is 1/12^th of a grain of rice in size, the abode of broken skin, wart and Mashaka, (literally mosquito, a type of skin disease).

Caturthi tamra nama vriherastabhagapramana,

vividhakilasakusthadhisthana I

The fourth, Tamra, is 1/18^th a grain of rice in size, the abode of different scabs and blotches.

Pancami vedini nama vrihipancabhaga-

pramana, kusthavisarpadhisthana I

The fifth, Vedini, is 1/5^th a grain of rice in size, the abode of creeping leprosy.

Sasthi rohini nama vrihipramana, granthya-

Pacyarbudaslipadagalagandadhisthana I

The sixth, Rohini, is equal in size to a grain of rice, the abode of swelling, gathering tumor, elephantiasis and goiter (large swelling of the throat caused by thyroid gland malfunction).

Saptami mamsadhara nama vrihidvaya-

pramana, bhagandaravidradhyarsosdhisthana I

The seventh, Mamsadhara, is twice the size of a grain of rice, the abode of fistula, abscess and piles.

Source

Sushruta-samhita, Sarirasthanam, Adhyayah 4, Paragraph 4, (6th Century BCE)

Etymology

1.	Tila + kalaka =	Black + mole	= Mole
2.	Alaja + galli  =	The nipple hanging from goat’s neck	= Wart
3.	Kill+ Kilasa   =	To become white	= Blotch
4.	Ku + stha     =	Bad +Position	=Deformation	= Leprosy
5.	Stli + pada    =	Swelled +foot	=Elephantiasis
6.	Gala + ganda =	Lump in the neck

Notes

1. The names of the seven layers of the skin are descriptive of their function or form:

1.	Avabhasini	The one that exudes shine
2.	Lohita	Copper Red
3.	Shveta	White
4.	Tamra	Copper
5.	Vedini	Altar/Base
6.	Rohini	Healer of wound
7.	Mamsadhara	The one that supports the flesh

In the above names, 2 to 4 get their name from their color or appearance and the other four by their function.

2. The indication of the layer, in which various diseases of the skin reside, could be the starting point in the treatment of these diseases.

3. Today’s dermatology talks of only five layers of skin, whereas Sushruta mentions seven. The autopsy procedure of Sushruta (mentioned later) is a lot subtler than the allopathic method of carving with scalpel. It is conceivable that the subtler methodology has helped identify two additional layers of skin.

Autopsy

Samastagatramavisopahatamadirgha –

vyadhipiditamavarsasatikam

nihsrstantrapurisam purisa-

mavahantyamapagayam nibaddham panjara-

stham munjavalkalakusasanadinamanyatamena-

vestitanga pratyangamaprakase dese kathayet,

samyak prakuthitam coddhrtya tato deham

saptaratradusirabalavenubalvajakurcanamanyatamena

sanaih sanairavargharsayamstvangadin

sarvaneva bahyabhyantarangavisesan

yathoktan laksayeccaksusa II

(Select) the body of a person complete with all organs, not poisoned, not afflicted with any chronic illness and not over a hundred years of age. After evacuating his faecal matter, cover the body with munja grass, bark, dharba grass or hemp (jute); tie the body in a dark place in a river.

After putrefying every organ of the body, lift the body and rubbing it very slowly for seven days with usira grass, bamboo sapling, bark or brush, observe all organs – external and internal – minutely.

Source

Sushruta-samhita, Sutra-sthanam, Adhyayah 5, Paragraph 49 (6th Century BCE)

Notes

This is a set of instructions to students of medicine on performing autopsy. Since the intention is for the students to see and understand the internal organs of a normal person, the operating procedure starts with the selection of a body for performing autopsy. The text mentions the age of the deceased (for autopsy) should not exceed 100 years which indicates that at this period in time (600 BCE) many people lived for over a hundred years. Another heartening feature is that the students learn to and get to do autopsy by themselves (there appears to be no role for a teacher).

Western Reference

If Hippocrates (460 BCE Cos Island, Greece) represented the foundation of Greek Medicine, Galen (130 – 201 AD) its apex. Galen had crystallized and documented the knowledge of all the best medical schools that preceded his time. Galen’s documentation was extremely exhaustive and revered; anatomical and physiological research of no value occurred in the next 1000 years; for Galen had said everything that had to be said in these two fields of medicine.

While as the surgeon to the Emperor, Galen had gained some experience treating the wounded gladiators, bulk of his ‘understanding’ of the human anatomy was based on dissection of animals, mainly Barbary apes.

Galen’s (wrong) ideas prevailed till the 15^th/ 16^th Century. Leonardo da Vinci (1452 – 1515 AD) chose to ignore Galen’s writings, dissected thirty corpses and made remarkable pencil drawings of his findings. Unfortunately, his works bore no impact on the medical science as he didn’t publish them. The fame of the genius stayed confined to art and engineering.

A Belgian, Andreas Vesalius (1514 – 1564 AD), like Leonardo da Vinci, ignored Galen, performed dissections and published his De Humani Corporis Fabrica and changed the face of anatomy. In his publication, Andreas Vesalius pointed out over 200 errors in Galen techniques.

Dermatology – Parasites in Excreta

Tatra malo bahyascaabhyantarasca. Tatra

bahyamalajatan malajan samcaksmahe. Tesam

samutthanam … mrjavarjanarn sthanam …

kesasmasrulomapaksmavasamsi; samsthanam …

anavastilakrtayo bahupadasca varnah … krsnah

suklah; namani … yukah pipilikasca; prabhavah

kandujananam kothapidakabhinirvartanam ca

cikitsitam tu khalvesamapakarsanam malopaghatah

mulakaranam ca bhavanamanupasevanamiti II

Excrements are external and internal and there are various parasites born out of the external excrement.

Their origin –                 Lack of cleanliness

Source –                       Hair, facial hair, body hair, eyelashes and clothing.

Their form –                  Atomic, sesame seeds sized and multi-pede.

Color –                         Black and white.

(Common) names –       Louse and ants.

Effects –                       Recurrence of itching, ringworm and pimples.

Treatment –                  Obviously is their (of louse/ant) dispelling.

Removal of excrement – Not entertaining the factors that cause the uncleanliness.

Source

Charaka-samhita, Vimanasthanam, Adhyayah 7, Paragraph 10 (1^st Century BCE)

Notes

In Allopathy, skin rashes have traditionally been seen as reaction to contact with plant and other allergy generating sources. Relating rashes to infection(s) in uterine area and seeing the need to address the same shows the maturity of the medical science at that point in time.

Orthopaedics – Fractures

Kandabhagnamata urdhvam vaksyamah

Karkatakam asvakarnam curnitam piccitam

asthicchallitam kandabhagnam majjanugatam

atipatitam vakram chinnam patitam

sphutitamiti dvadasavidham II

About different types of fractures: –

1.     Karkataka –        Crab like fracture

2.     Asvakarna –        Horse ear like fracture

3.     Curnita –            Powdered fracture

4.     Piccita –             Processed / flattened fracture

5.     Asthicchallita –    Crust of the bone fracture

6.     Kandabhagna –   Breaking of limbs fracture

7.     Majjanugata –     Reacting the bone narrow fracture

8.     Atipatita –           Severely struck fracture

9.     Vakra        –              Twisted fracture

10.    Chinna –             Broken fracture

11.    Patita –              Pierced fracture

12.    Sphutita –         Fissured fracture

Thus fractures are of 12 kinds.

Prathame vayasi tvevam masat sandhih sthito

bhavet I

Madhyame dvigunat kaladuttare trigunat

smrtah II

In childhood, the joint (for fractures) will become firm within a month; in middle-ages in twice the time and later in thrice the time.

Source

Sushruta-samhita, Cikitsa-sthanarn, Adhyayah 3, Slokah 17, J 9 (6th Century BCE)

Orthopaedics – Dislocation (Shoulder Joint)

Musalenotksipet kaksamamsasandhau

visamhate I

Sthanasthitamca badhniyat svastikena

vicaksanah II

The expert should raise the dislocated (bone of) the shoulder and the armpit with a surgical instrument, and tie with cross bandages, when properly placed.

Avanamitamunnahyedunnatam cavapidayet I

Anchedatiksiptamadho gatam copari vartayet II

Anchanaih pidanaiscaiva

sanksepairbandhanaistatha II

Raise the one (the base) that is bent down; push down the one that is raised. Set the one that is severely damaged. Bring up that which has gone down. By setting, compressing, shortening and also bandaging;

Sandhincharire sarvamstu calanapyacalanapi

Etaistu sthapanopayaih sthapayenmatiman

bhisak II

The intelligent physician should set all the moving and non-moving joints in the body by these methods.

Source

Sushruta-samhita, Cikitsa-sthanarn, Adhyayah 3, Slokah 17-19 (6th Century BCE)

References

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

Compiled by Bharatiya Bouddhik Sampada ‘Anand Vilas’

Published by Samskrita Bharati