Ancient Indian Medicine
General Introduction
1. Knowledge of the cause (hetu), Symptoms (linga),
Remedies (auadha) of disease.
2. Diseases are caused through the excess, deficiency and
wrong administration of sense-objects, the climatic characteristics of heat and
cold and the misuse of intelligence.
3. Aim of Ayurveda--prescribe diet, medicine and a regimen
of life to enable a healthy man to maintain the equilibrium of this dhatus and one who has lost this
equilibrium to regain it, i.e. to advise man how to preserve or secure heath (dh€tu-samya).
4. Diet was considered the most important agent in causing
the loss of harmony of the dhatus. The use of beneficial food is the only cause
of the growth of a person: while the use of injurious food is the cause of
disease.
5. The regimen of life to be followed was considered
equally important. (dina charya) It consisted of detailed regulations for
daily life and also for the control of mind and conduct.
The daily
regimen of a healthy person ought to be such as to maintain the equilibrium of
the dh€tus.
6. Treatment was adopted with a view to perpetuate the
harmony of the dhatus, to prevent
them from becoming inharmonious and to bring them back to their normal state of
equilibrium when disturbed.
Ascertaining
through the disturbance of the dhatus,
the physician should treat diseases that are curable with medicines, diet and a
regimen of life, each possessed of virtues contrary to the cause, to the
disease or to both cause and disease, reflecting the while upon the question of
measure and time.
7. Though the terms used are the same as in Vaieika yet they are used mostly
indifferent senses in accordance, probably, with medical tradition.
Para means superiority or importance;
Apara means inferiority or unimportance.
This importance or unimportance is in regard
to country, time, age and measure.
Yukti means proper selection of
medicines with reference to certain diseases;
Samyoga means the mixing up or
compounding of two or more substances;
Vibh€ga means separation;
Pth€ktva means difference, difference
of characters and difference of identity due to
numerical distinction;
Parim€na means measurement by weight
Samsk€ra means production of new
qualities
Abhy€sa means habit due to constant
practice.
8. The principles of S€m€nya
(concrete things which have similar constituents or characteristics) and Viea (concrete things which have
dissimilar and opposite constituents or characteristics) is the main support of šyurveda; for it is
the principle which underlies the application of and the course of diets.
9. Substances having similar constituents or
characteristics will increase each other and those having dissimilar
constituents or characteristics will decrease each other. Thus a substance having the characteristics
of v€ta will increase v€ta and decrease sleman which is dissimilar to it and
so on.
10. Charaka talking about diagnosis says that there are
three special means (pram€n€s):
(1) the
instruction of the inspired or wise (€ptopadesa)
(2)
perception (pratyaka)
(3)
inference (anum€na)
11. With regard to inference (anum€na) it was held to be of
great importance.
šyurveda
was occupied from the beginning with the investigation of the nature of causes
(hetu) and reasons (linga) for legitimate inferences in connection with
diagnosis and the apprehension of symptoms.
Charaka
holds that all three methods: the cause and effect relation (nid€na), the
method of invariable prognostication (p™rva-r™pa), and the method of
concomitant variation (upas€ya, which includes anupas€ya also) are to be
employed either jointly or separately for the ascertainment of the nature of
disease which have already occurred or which are going to happen in the near
future.
Ny€ya also
describes anum€na as being of three kinds, viz, from cause to effect, from
effect to cause and inference from similarities. It is essentially these three forms of
inference that are described in Charaka Samhita, though different terms are
used to denote them.
12. M€dhava is considered the foremost authority on
diagnosis (nid€na); while V€gbha˜a is unrivaled in the principles of medicine
(s™tra), Susruta and Charaka are given first rank in the knowledge of surgery
and anatomy (sarira), and of therapeutics (chikitsaka), respectively.
13. Both Charaka and Susruta devoted sections of their
samhitas called Nid€na sth€na to the discussion of pathology and diagnosis and
they also deal with diagnosis of diseases in the sections on therapeutics, but
M€dhava’s deals exclusively with Nid€na; hence its importance.
The Doctrine of Tridosa.
When the dh€tus are in their normal measure they are said
to be in equilibrium and this state is called dh€tu-s€mya.
When their normal measure is either increased or decreased,
their equilibrium is upset and this state is called dh€tu-vaiamya (C.S. IV. 6
1-15).
Of all waste products (malas) v€ta, pitta and kapha are
considered primarily responsible for all the morbidities of the body.
For the production of a disease three things are necessary,
nid€nas, the doas and the dh€tus.
The nid€nas or causes of disease, cannot produce disease
directly. They first vitiate the v€ta, pitta and kapha, and these in their turn vitiate the dh€tus and produce
disease.
Because v€ta, pitta
and kapha are the vitiators of the
dh€tus, they are called doas, while the dh€tus which are vitiated are called
the d™yas.
Physiology
Page 38
If an
article contains an excess of the element fire, it has the hot and vehement
energies.
When the
watery element predominates the cold and lubricating energies are found.
In earthy
and watery objects the oily energy exists.
Objects
with excess of ether and water have the softening energy.
Air causes
the drying energy
When earth
and air predominate they produce the clearing energy.
digestion
Food is of four kinds:
1. asita: sold food
2. p…ta: liquids
3. l…dha: licking
4. kh€dita:
chewed
The four varieties of food derived from the five elements
and having the six tastes, the two properties of heat and cold and many
qualities, when taken in the proper quantity directed and thoroughly digested
produce a fine substance imbued with energy and fire (C.S. I 14.3). This substance, which is in the form of a
juice, is called €haa-pras€da, food substance and rasa.
Charaka describes the process of digestion.
1. Pr€na seizes the food and brings it down to the stomach.
2. The solidity is dissolved by gastric juices.
3. Softened by oily matter.
4. The fire, stirred up by sam€na, blazes forth and digests
the food that has been eaten properly and in the right amount.
5. The digestive fire cooks the food in the stomach,
converting it into rasa and mala even as (external) fire and water
cook grains of rice in a vessel for use as food.
The Waste-Product or ‘Malas’:
As a
result of metabolism two kinds of products are constantly produced in the
body--those which pollute the system--the mala,
and those which sustain and nourish it--the pras€da.
Malas are produced both in the digestion
of the food and the metabolism of the dh€tus.
The malas of food are faeces and urine.
The mala of rasa is kapha, that of
blood is pitta; that of flesh is the
waste in the apertures of the human body, e.g. dirt of the ears, eyes,
nostrils, or he pores of the body and the genital organs; of fat is sweat; of
bones is hair and nails; of marrow is the waste matter in the eyes and oiliness
of the skin.
The theory
of the waste products is that, in proper measure, they serve to sustain the
body and perform important functions, but when in excess of or below their
proper measure they pollute the body and may ultimately destroy it.
The Heart and its Functions:
The heart
is the chief receptacle of the three most important fluids of the body--the
rasa, the rakta and the ojas.
It is the
heart which is responsible for the distribution of these vital fluids to the
remotest parts of the body. This
function is accomplished through the numerous siras, dhamanis and srotas that arise from it.
Blood, it Character and Functions:
Charaka
describes the color of healthy blood.
“The blood that happens to be the color of molten gold or like that of
the insect indragopa or like that of the gem called padmaraga or like that of
gunja sees should be known as healthy.”
When the
blood is vitiated by the action of vayu, it becomes very re, frothy, unctuous
and thin.
If
vitiated by pitta, it becomes darkish-yellow in color and warm, so that in
consequence of its warmth Text takes long to congeal.
If
vitiated by the action of kapha, it become slightly pale, unctuous, fibrous and
thick. (C.S. I. 24.19-21).
It is pure
blood that brings about strength, good complexion, happiness and longevity, for
the life of living creatures is dependent on blood.” (C.S. I. 24.3).
The rasa
is continuously distributed through every part of the body simultaneously by
the vayu called vyana whose function is
to distribute. (C.S. VI. 15.30).
The
Doctrine of Tridoa
According to Charaka
Dh€tus,
including the pras€da-dh€tus and the mala-dh€tus, are modifications of the five
elements (bh™tas) which co-operate together to uphold the body.
Ki˜˜a or
mala is the refuse derived from the food after digestion, which is unfit to be
built into the dh€tus and fit only to be excreted.
A
distinction is made between the two terms, ki˜˜a and mala, the former being the waste-product
of the food after digestion, while the latter is used to signify ki˜˜a or
refuse above or below the normal quantity (prakrti-mana) necessary for the
maintenance of health, that is to say, in quantities capable of upsetting the
equilibrium of the dh€tus and producing disease.
The malas
include hose produced from food and also those derived from the dhatus, i.e.,
the dhatu-malas.
The term
doa is applied to the malas, v€yu, pitta and kapha, in their capacity as
vitiator of the dhatus when they are disordered by the various nidhanas.
They are
termed dhatus when in their normal measure.
Thus,
dhatus, malas and doas are differentiated according to whether they function
as supporters of the body or as vitiators of its proper functioning.
Vayu,
pitta and kapha are malas from the point of view of their origin; they are
dhatus when in their normal measure, and they are regarded as doas when they
become vitiators of the dhatus.
V€gbhata II
1. Considers the dhatus, doas and malas different
entities, assigning definite functions to each of them.
2. He does not regard dhatu-samya as health and
dhatu-vaisamya as disease but dosa-samya as health and dosa-vaisamya as
disease.
3. As the dosas are independent entities from the dhatus, a
disturbance of the former need not necessarily be a disturbance of the latter.
Origin of the dosas in the Body?
Charaka
considered the doas as substances in
the nature of internal waste products produced from the unabsorbed portion of
the food after digestion, i.e., from the refuse (ki˜˜a) of food.
Susruta
also expresses a similar opinion.
He says kapha
is the excreted portion of the rasa,
while pitta is that of blood, whereas
Charaka derives pitta from the flesh.
The Seats of the Doas:
Susruta’s
description is more precise and less diffuse than that of Charaka.
the normal and abnormal attributes
and functions of the doshas
V€yu--Dryness, lightness, clearness, coolness, motion, and
formlessness
Pitta: heat keenness, lightness, and slight oiliness; in
color it is not white; its scent is like that of raw meat; its taste is two
fold, bitter and sour
Kapha: whiteness, cold, heaviness, oiliness, sweetness,
firmness, sliminess, and softness like that of good earth or clay.
The Functions of the Dosas:
The
functions of v€yu, when in its normal state, are: energy in respect of action
and movements, inhalation and exhalation of the breath, the proper functioning
of the physical organs (such as speech, thought, etc.), equable course of the
several elements of the body and equable or proper discharge of excreta and
urine and such other impurities as escape or are secreted out of the body.
(C.S. I 18.54).
Vision,
digestion, the heat that is natural to the body, hunger, thirst, softness of
the body, splendor of complexion, cheerfulness of mind, and intelligence are
due to the action of pitta in its normal state. (C.S. I. 18.55),
All oily
matter in the body, tightness of the joints, general tightness of the body,
weight of the body, sexual power, strength, capacity to bear or endure,
patience, and absence of renunciation of cupidity are due to the action of
kapha in its normal state (C.S. I. 18.56)
Etiology, Classification and Pathology of Diseases
Susruta describes in detail the various steps through which
the doas pass in the course of
production of disease:
1. The first stage (kaya)
is the stage of accumulation of the doas.
During this stage the doas collect in their respective places or sites.
2. Prakopa or
excitation. After accumulation, as a
result of the action of their respective nidh€nas
and lack of treatment, they become excited and, leaving their normal site, they
spread.
3. The third stage is called pras€ra. Something like
fermentation of the doas. This is
moved about by v€yu, which is the
cause of all motor activities. In
whatever part the fermented doas
spread, there the symptoms of disease are showered down as it were, like water
from the clouds.
4. P™rva-r™pa or
the stage of premonitory symptoms. The doas get localized in different parts
of the body (sthana-samraya). They produce diseases after reaching
different parts according to the nature of the structures contained in these
parts.
5. R™pa or the
fully fledged disease. This is the stage
of appearance or development of the disease.
Such diseases as inflammatory swellings, enlarged glands, large
abscesses, erysipelas, fever, diarrhea, are produced, which are readily
diagnosed by their symptoms.
6. Bheda
Termination. The healing begins or the
illness becomes full blown.
The Places of Lodgment of Deranged
Dosas and the Diseases They Produce
1. Diseases assume various forms owing to the different
modes in which the dosas, the dhatus, and the malas are mixed upon a particular
case, the different parts of the body in which they are deranged and the causes
by which the disorders are induced.
2. Susruta’s description amounts to surgical pathology.
3. Charaka in Vim€na
Sth€na, Chapter V says If the ducts
are in their normal state, the body cannot be affected by any disease.
dhamanis, sir€s and srotas ducts for the carriage of the products of metabolism and he
uses ‘ducts’ in the sense of srotas in this discussion.
Diagnosis and Prognosis
Examination of the Patient
1. To ascertain how long the patient has to live
Dependent
on ascertainment of his strength, including the amount the doas have been excited.
2. For the ascertainment of the strength of the patient
information on the following ten items is needed:
1. his normal constitution in health
2. the abnormal constitution that has set in
3. the predominance of the particular element or essence (s€ra) in his constitution
4. his compactness or otherwise
5. his proportions such as stature
6. what things are suitable to his constitution
7. his mental disposition
8. his power of assimilation
9. his power of exercise
10. his age.
1. A healthy constitution is one in which the three doas are in harmonious
proportions. Any one of the doas may predominate in a constitution
and thus we may have a v€tala, pittala or slemala constitution.
Knowledge
of the constitution is important as the effect of food and seasons vary in
different constitutions.
2. There are eight s€ras
(predominating essences or elements) in the body, mind, semen, marrow,
bones, fat muscle, blood and skin.
Satva (the mind)--
Memory,
veneration, wisdom, valor, purity, and devotion to useful works.
Semen
Luster of
the body and firmness and white color of the bones, teeth, and nails and sexual
desire
Marrow
Plumpness,
strength, splendor of the body, depth and softness of voice and largeness of
the eyes
Bones
Large head
and shoulders, firm teeth, jaws, bones and nails
Fat
Cool urine
and perspiration, soft voice, large body and capacity to bear hardships
Muscle
A body
without opening or cracks in it, deep-seated bones and joints and muscular
build
Blood
Smooth
copper-colored nails, eyes, palate, tongue, palms and soles
Skin
The luster
and softness of the skin
A person should be examined by the test of his essence (s€ra).
This prevents a physician from arriving at an erroneous conclusion by a
sight of the body alone of the patient.
Such conclusions should never be formed as that one is endued with
strength because his body is large or another is of little strength because his
body is lean, et. It is seen that men
whose bodies are of small dimensions or are lean are still possessed of
strength.
As regards examination of the patient by observation of his
body, that body can be called firm or compact which consists of symmetrical and
well-formed bones, well-knit joints, and well-placed flesh and blood. Those men who are possessed of firm and
compact bodies are endued with strength.
As regards
examination of the patient’s dimensions, certain standards are laid down in the
medical classics.
The entire
foot is 14 fingers in length, the lower leg 18 fingers, the thigh 32 fingers,
the two together being 50 fingers in length.
The distance between the penis and the navel, that between the navel and
the chest, that between the chest and the throat, and that between the two
breasts measure 12 fingers each. the
length of the arm from the shoulder tot he elbow is 16 fingers. The forearm including the hand measures 24
fingers. The circumference of the chest
in females is equal to the circumference of the waist in males. the breadth of the chest in females is 18
fingers, which is the breadth of the waist in males. the height of the male is altogether 120 fingers.
The male
and female attain their full development at the ages of 25 and 16
respectively. If their bodies measured
by their own fingers at these ages correspond with the measurements given above
they attain long life and riches. If the
measurements are of moderate length their lives and riches will be moderate,
and if very short, then their lives will be short.
Capacity
for food--eating and digestion. Strength
and longevity are both dependent on food.
Capacity
for exercise--capacity for action, for bearing weights and for the time he can
perform labor.
Time: Two
kinds, the year and its division into various seasons and the age of the
patient. Acknowledge of the seasons is
of special importance in connections with the administration of medicines and
correctives. the age of the patient is
of value in ascertaining his life expectancy. (C.S. III. 8).
The methods of diagnosis (pram€nas)
1. The instructions of the inspired or wise (€ptopadesa)
2. observation (pratyaka)
3. inference (anum€na)
1. Instruction of the wise
One should first fully examine a disease by means of these
three. The knowledge from the inspired
is the most important.
2. Observation (pratyaka)
Susruta lays particular stress upon the interrogation of
the patient in the ascertainment of certain facts about the disease: The time or season of its first appearance;
the caste to which the patient belongs,; things or measures which tend to bring
about a manifest amelioration or prove comfortable to the patient (s€tmya), as
well as the cause of the disease the aggravation of pain; the strength of the
patient; this state of digestion and appetite; the emission of stool, urine and
flatus or their stoppage; and maturity of the disease in regard to time. Charaka adds to this list the dreams of the
patient.
3. Inference (anumana)
The two
principal kinds in practical use were the inference from cause to effect and
that form effect to cause. Charaka
mentions a third kind, inference of disease from its early prognostications
(purva-rupa).
That
similar things produce similar effects and opposite things opposite effects are
two of the accepted postulates of the law of s€manya and visea. Now applying these two principles, it is held
that if the application of any particular kind of element increases an effect (
a particular kind of disease) and the application of its opposite decreases it,
then that particular element may be regarded as the cause of the effect. (concomitant variation)
(upasaya and anupasaya)
Charaka
says diagnosis is based on nid€na (causes), p™rva-r™pa (premonitory
indications), r™pa (symptoms), upasaya (administration of drugs and diet), and
sampr€pthi (fullness or development).
Nid€nas
are the causes of the which excite the doas and induce disease
P™rva-r™pa
implies those indications which manifest themselves before the appearance oft
he disease
R™pa are
those symptoms which manifest themselves on the appearance of the disease
Upasaya is
the prescription, followed by relief or recovery, of medicines, diet, and
practices that are contrary to the conjectured causes of the disease or to the
disease itself as tentatively diagnosed or to both
Sampr€pthi
is the full development of the disease through the action, local or extending
over the whole body, of the excited
fault (doa) or faults (doas) which constitute the immediate nid€na of that
disease. Distinguished by considerations
of samkhya (number or enumeration), pradh€nya (predominance), vidhi(kind),
vikalpa (solution of doubt), bala(strength), and k€la(time) (C.S. II.
1.5&6).
The first
problem for diagnosis is the presence of dh€tu-vaiamya , that is the increase
or decrease of some of the dh€tus, i.e., the seven dh€tus, the doas and the
malas.
Charaka
and Susruta give in detail the causes, signs and symptoms of the decrease,
increase and vitiation of each dh€tu, doa and mala.
The next
problem is the stage of dh€tu-vaiamya.
Susruta enumerates five stage in its development--cherry, porkpie,
pras€ra, p™rva-r™pa and r™pa. The
disease has to be diagnosed in all these stages.
After
having diagnosed a disease, the next thing to be done is to ascertain whether
it is a primary or independent one or merely an accessory or sympathetic one or
the premonitory indication of an incipient one.
Diseases
at first remain as principal ones. They
then become causes of other diseases.
Example
from excessive heat of fever arises blood-bile, and from blood-bile springs
fever and from these two springs consumption.
There are
endless varieties of symptoms and varieties of diseases.
There is
no absolute difference between a cause and an effect, and that which is a cause
may be an effect and that which is an effect may also in turn be a cause.
Charak
thus sums up the whole problem of diagnosis:
:Without doubt, having carefully noticed the particulars
relating to the inducing causes (nid€na), premonitory indications (p™rva-r™pa),
symptoms (r™pa), applicability of medicine, diet, course of conduct (upasaya),
the varieties of diseases (samkhya), the predominance of v€ta, pitta and kapha
in diseases (pradh€na), the class under which the disease falls (vidhi), the
precise measure in which the faults have been excited (vikalpa),s strength, and
age or season, the physician with concentrated mind, should specially attend to
the knowledge (analysis ) of the tastes, articles, faults, derangements,
medicine, country, season, strength, body, diet, predominance of constituent
elements (of the body, such as skin, blood, et.),assimilation, mind,
constitution, and age, because of the dependence of curative operations on a
conversant with such analysis of the tastes etc.” (C.S. III. 1.1.).
Prognosis
Susruta “Men die from their actions in a former life, from
improper treatment, and from the uncertainty of human life. When life is about to depart, spirits,
ghosts, infernal imps, and demons approach the dying and, from their desire to
kill, prevent the action of medicine; hence no treatment is effective with
persons whose lives are at an end.”
(S.S. 1.31).
The physician on approaching a patient should first test
his longevity and see if he has any vitality in him. Susruta
Charaka at the commencement of Indrya-sth€na mentions several items that should be examined and
attended to by the physician desirous of ascertaining what the patient’s life
expectancy is.
The following characteristics indicate long life: large
hands, feet, sides, back, nipples, teeth, face, shoulders, forehead, joints,
fingers, eyes, and arms; extended eyebrows, broad space between the breasts,
long breath, short legs, penis and neck, deep intellect, low voice and navel,
firm breasts, large hairs growing on the ears, the top of the head being behind
the median line; the body commencing to dry from the head downwards after
inunction of oil and bathing, the region of the heart being the last to
dry. A patient possessing the above
characteristics should be known as long-lived and should be treated (S.S. I.
35).
Any symptom from which he nearness of death is inferred is
called an arita.
Seems to
hear a noise or confounds various noises with each other, if he gets irritated
at the voice of a friend and rejoices at that of an enemy, feels cold as hot
and heat as cold, feels burning heat in chilblains, does not feel a blow or
even a cut on a limb, thinks he sees the stars and moon by day and the sun at
night, if his eyes are remarkably restless or motionless, if brown, red, blue
or yellow shadows follow him, if his teeth have become brown or have suddenly
fallen out, if his tongue is white, or brown, dry, heavy, numb, coated or
rough, his mouth smells badly, his limbs become suddenly heavy or remarkably
light, if his veins stand out on his forehead when they did not previously, if his
sneezing, cough, et., sound differently from usual, if strong perspiration
occurs without cause, if the patient cannot sleep or sleeps continuously, if
his feet and hands are cold, his breathing labored, et.; these are all
considered ominous signs foretelling death.
If any part of the body changes its natural color, consistency,
dimensions, position, like an erect part hanging down or a hanging part
becoming erect, if any part of the body suddenly becomes cold, hot, dry, oily,
discolored or enervated, then that part has changed its usual character.
Page 103-104 different symptoms and diseases which are
fatal.
Susruta says, “the physician should not be called in the
following lunar asterisms: K Kttika,
šrdra, Aslesh€, ¤agh€, M™la, P™rvaph€lguni, P™rv€shada, P™rvabh€drapada, or
Bharani and on the following days of the moon: the fourth, sixth and ninth and
the day of the new moon.”
Susruta says: “The appearance, address, dress and action of
the messenger sent to call a physician, the star, hour and lunar day on which
he is called, the birds seen at the time, the residence, speech and mental and
bodily actions of the physician, all afford omens from which a favorable or
unfavorable prognosis may be formed of the patient’s illness.”
It was counted as a happy omen if the messenger sent to
fetch the physician was clean, dressed in white, of the same caste as the
sufferer and came riding in an ox-cart.
it was inauspicious if the messenger was of a higher caste, a eunuch or
a woman, himself sick or afraid, if he ran, if he wore shabby or dirty clothes,
rode on an ass or a buffalo, came at mid-night or mid-day or at a time of an
eclipse of the moon or if he arrived when the physician was asleep or lay
unclothed upon the ground.
Omens on page 104-105
Auspicious visions in dreams are: gods, brahmins, “Twice
born” people of the three upper castes, living friends and kings; a brightly
burning fire, or flawless clear water promises luck and the vanishing of
disease, Meat, fish, fruit, white garlands and clothes purport financial
success and the vanishing of disease. if
the dreaming person ascends stately terraces, climbs trees laden with fruit,
mounts elephants, A patient who sees
auspicious dreams of his kind may be
diagnosed as possessed of long life (d…rgh€yus)
and the doctor should accept the treatment of the case.
Materia Medica
Physicians
should look upon the four factors of food, conduct, earth, and time as the
accumulators, aggravators and pacifiers of the deranged bodily doas and of the diseases resulting form
them.
The term
medicine signifies drugs and their virtues, tastes, potency, inherent efficacy
(prabh€va) and reactionary properties
(vikalpa). (S.S. I. 1).
The action of medicines is called karma, its potency v…rya,
the place where it operates €di-k€raŠa,
the time of operation, k€la‚ the mode
of operation, up€ya, and the result
achieved, phala.
Dravya is a
substance which is independent by itself.
Guna qualities
Susruta The substance (dravya)
exerts its medicative influence through its qualities, rasa, vip€ka, and v…rya.
This being so, the qualities or guŠas
may be considered the sakti (power)
by which the dravya) exerts its
action. Hence rasa, v…rya, vip€ka must be considered the sakti (potency) of the substance (dravya).
Also the
dravya has its influence called prabh€va.
Charaka: V…rya in
its general sense means the potency or power of medicines to produce effects
and as such includes within it both rasa
and vip€ka, but since these have
special names the term virya is not applied to them.
Disease is the result of the increase or decrease of the
dhatus and the main aim of Ayurveda is the restoration of the ingredient dhatus
of the body to their normal state. The
main task of the Indian Materia Medica was, therefore, to investigate how this
aim could be attained by the use of diet and medicines. These have an effect on the dhatus of
the body and on their disequilibrium
through the influence of rasa, vipaka, virya and prabhava. Dravya, rasa, vipaka and virya, each exerts
an action on the dosas.
Samanya and Visesa:
Substances having similar constituents or characteristics will increase
each other, while those having dissimilar constituents or characteristics will
decrease each other.
All articles or objects in the world may be classified as
medicines, and if they are endowed with energy and other properties and are
employed according to reason and necessity, they prove serviceable in the cure
of diseases.
A knowledge of the composition of articles and the
predominance of a particular bhuta or bhutas in them is of great help in the
selection of drugs for use as medicine.
Articles
containing an excess of the bhutas earth and water are heavy and owing to their
weight they have a tendency to fall downwards.
it would seem, therefore, that they act as purgatives owing to their
tendency to go downwards.
Articles
containing an excess of the bhutas of air and fire are light, as both air and
fire are light, and owing to their lightness they have a tendency to
ascend. It would seem, therefore, that
they cause emetics from their tendency to ascend.
Articles
which posses in abundance both property of going upwards and downwards act both
as emetics and purgatives.
Articles
which posses in abundance ether--alternatives.
Air--astringents
Fire--digestion
Air and
fire--absorbents or liquefacients
Earth and
water--nutrition
The primary cause of disease is dhatu-vaisamya that is the
increase or decrease of the dosas, vata, pitta and kapha, either singly or in
combination. The chief use of medicines
is for their action on the dosas.
Sweet (madhura) increases the dhatus of the body, improves
complexion, strengthens the body, heal wounds and ulcers, and purifies the rasa
and the blood.
The acid (sour--amla) carminative and digestive, expels
wind from the bowels, accumulates secretive impurities n the tissues.
The saline group (lavana) purifies tissues, is digestive
and relaxing, separates impurities, accumulates excretions in the system,
causes the body to lose its tone, i.e., relaxes it, clears the outlets of the
system and produces softness of all the structures of the body.
The pungent group (ka˜u) increases digestive power,
purifies the body, prevents corpulence, causes relaxation of ligaments of the
joints and of the system in general; diminishes formation of milk ,semen and
fat.
The bitter group (tikta) separates the doshas, is
appetizing, digestive and purifying, improves secretion of breast milk, and
reduces the quantity of faeces, urine, perspiration, fat, marrow and pus.
The astringent group (ka€ya) is styptic (serving to contract organic
tissue; astringent;
binding. 2. serving to check hemorrhage or bleeding, as a drug; hemostatic.) and favors the healing of ulcers, checks all
discharges, separates impurities from tissues, reduces corpulence and
superfluous moisture.
Some authorities held that this potency virya was only of two kinds, hot (una) and cold (s…ta).
Charaka and Susruta held that it is of eight kinds, hot cold moist dry
moving slippery soft and sharp.
Charaka writes that the articles called ‘light’ contain
largely the properties of air and fire, while those called ‘heavy’ contain
largely those of earth and water.
Susruta says that the sastras mention two sorts of digestion, sweet and
hot. Of these, the sweet digestion is
heavy and the hot is light.
He is regarded as a physician that is conversant with the
tastes (rasas), all articles of (food and drink), the dosas, and diseased, in
respect of their potency (or virtues),and that knows (the virtues of ) place
and time, as also of the body (i.e., the elements that constitute it and their
respective unctions) (C.S. III.1.35).
Medicines are employed in treatment for the purpose of
restoring the deranged dosas and dhatus
to their normal state. The only logical
and rational classification is that based on the action of drugs on the doshas
and dhatus. The dosas may collect and
then get excited and then begin to spread.
Later they increase in amount beyond the normal measure. In the first case, they have to be brought to
their normal state and in the second case, they have to be got rid of from the
system. Accordingly, Susruta divides
medicines into two classes, viz., samsamana and the samsodhana. the former are medicines which rectify the
deranged state of the dosas and calm their excited action without promoting
their excretion This class is
sub-divided into three orders: v€tasamsmana varga, pittasamsamana varga and
slemansamsanana varga. The latter are
medicines which remove collections of deranged dosas from the body by promoting their excretion. This class of drugs include emetics,
purgatives, errhines, depuratories.
Treatment Chapter VII
The sole
aim of Ayurveda is to advise diet, medicine and a regimen of life, such that,
if properly followed, a normal healthy person may maintain the balance of the
dhatus and one who has lost this may regain.
Treatment
is adopted with a view to perpetuate the harmony of the dhatus, prevent their
disharmony and bring them and the dosas back to their normal state of
equilibrium when their harmony is disturbed
by any cause. (C. S.I. 16.51 and 52).
When
persons in health conduct themselves improperly, in respect of diet and
deportment, forgetting considerations of measure and season, diseases are
generated. One endued with intelligence
and desirous of maintaining health should bestow great care upon everything
connected with food, deportment and practices. (C.S. I. 7. 43 & 55).
Under
tucharya Charaka describes the dietetic regulations to be followed in the various seasons. In hemanta (15 November to 15 January) one should eat
fat, sour and salt, sauce, flesh of watery and marshy animals, goats, etc. because cold increases the digestive power
which enables one to digest heavy and rich food. One should take liquor, milk preparations,
sweets, fats, oils, new rice and hot water.
he also recommends the use of ointments, massage, anointing the head
with oil, staying in a warm room, in the sunshine, in a warm underground place
or an inner room., etc.
Similar rules
are given for sisisra (15 January to
15 March). Only one should look for a
still better and warmer room protected from the wind, and avoid pungent, light,
cold and similar food and drink. In both
these cold seasons man is at his best strength.
In vasanta (Spring, 15 March to 15 May) the
accumulated kapha provokes many diseases; therefore emetics etc. should be
taken and heavy, sour, oily and sweet food, as well as sleep by day should be
avoided. Exercise, massage, inhalations,
water-gargling, ointment, washing, and bathing in cold water are likewise
recommended. As for food and drink,
barley and wheat and the flesh of the stage, hare, antelope and quail and
certain kinds of liquor are recommended.
In gr…ma (summer, 15 May to 15 July) one
should eat tasty, cold, fluid, oily things, cold preparations of barley with
milk and sugar, flesh of deer, ghee, milk and rice. Spirituous drinks should be taken only in
small quantities or not at all or mixed with plenty of water. Salt, sour, pungent and hot things, as well
as physical exercise, cohabitation and sleeping by day in a cool place should
be avoided. At night one should sleep in
a place which has been cooled by rays of the moon, particularly on the windy
roof of the house, should anoint oneself with cooling sandal-ointment, etc.
In vara (rainy season, 15 July to 15
September) the digestive system is weakened; therefore, one should keep to a
diet, should avoid sleeping by day, physical exercise, cohabitation, sun-heat,
etc., should eat barely, wheat and old rice and drink medicinal liquor in small
doses with honey, rain-water or boiled water.
Massage, baths, residence in dry places, etc., are also advised. In summer and in the rainy season man is at
his weakest.
In sarad (autumn, 15 September to 15
November) one should eat in moderate quantity things which are sweet, light,
cold ,bitter and deficient in pitta,, as well as rice, barley and wheat; should
use pure water from a spring, for washing, drinking and bathing, avoid bitter drinks, ghee, purgatives,
blood-letting, fat and oil, and keep out of the east wind (C.S.1.6)
Along with
the proper and well-controlled exercises of the moral functions, Charaka
advises one to take to well-controlled physical exercise (vy€y€ma). When moderately performed, this gives
lightness, power of work, steadiness (sthairya) and fortitude (C.S. I 7.30).
A correct diagnosis is the foundation
of rational treatment. The indications
for treatment are derived from the
diagnosis. Before commencing treatment
the physician should ascertain whether the disease is curable or not.
From the
point of view of treatment, diseases are divisible into two classes, curable
and incurable. Curable diseases may
again be regarded from three points of view, those that are capable of being
cured by easy means, those that are curable by means neither easy nor difficult
and lastly those that are curable by difficult means.
The
characteristics of diseases that are easily curable are:
1. the causes, premonitory indications and present symptoms
are slight
2. the derangement has no sympathy with the inducing causes
of the disease, the derangement that has brought about the disease is not
capable of being aggravated by the constitution of the patient.
3. the inducing derangement is not sympathetic with the
season in which the disease has appeared;
4. the place does not interfere with the treatment
5. only one part of the body is affected by the disease.
6. the disease is new
7. there are no violent symptoms from the disease
8. the cause of the disease originated from the disturbance
of only one doa.
9. the body can tolerate all kinds of medicine.
10. a good doctor, nurse medicine and patient are present.
(C.S.I.
10.12.14).
The
characteristics of diseases that are curable with difficulty are that the
causes, premonitory indications, and present symptoms are neither slight nor
very grave; that any of these, that is, the season of the disease, its nature,
and the character of those ingredients of the body which are know by the name
of d™ya is sympathetic with the
derangement that induces the disease; that the disease appertains to an elderly
woman, an old man o an infant; that it is not characterized by excessively
violent symptoms; is such that is should be treated with the aid of operations
by (surgical) instruments, by caustic alkali, or by fire; that it is chronic;
that it affects some vital limb or some joint of the body or affects only one
part; that the four principal requisites of treatment are wanting in some
particular and the disease affects two parts; that the disease is not very old
and lastly that the disease has been induced by a double derangement; such
diseases should be known as curable with difficulty. Even diseases that are incurable, in
consequence of the exhaustion of one’s allotted period of life, may be kept in
a suppressed state by means of regulated diet and proper nursing (C.S.1.10
15-18).
When the
disease is deeply ingrained (in the marrow and such other constituents of the
body) when it affects many of the constituent parts, when it is attached to the
vital limbs and joints of the body, when it manifest itself continuously, when it is chronic and
very old, when it is born of the derangement of two of the three ingredients
(of vat, pitta, kapha) or of all the three, when it is beyond the operation of
treatment, when it affects all the organs, when the patient is thoroughly
cheerless and despairing, when the disease is characterized by a stupefaction
of the mind, when it weakens all the organs (of knowledge and action), when it
has reached the highest limit of aggravation and the patient has become
entirely strengthless, and lastly, when it shows indications of the patient’s
dissolution, it should be regarded as one that should not be taken up for
treatment (C.S. I 10.19-21).
Charaka
and Susruta describe the four requisites of successful treatment. These are the physician, the patient,
medicines and the attendant on the patient.
Physician--learned
in the sastras, practical experience, sensible, furnished with instruments and
medicines.
Patient--vitality,
strength, and a curable disease, can procure all articles necessary for
treatment, self-controlled, faithful and obedient to the physician
Medicine--grown
in pure soil, collected on an auspicious day, and administered in proper doses
and times, which are pleasing, and endowed with their proper colors odors and
tastes which can remove the disorders of the doas and cure diseases, which do
not cause injury when given under misapprehension, are said to possess their
necessary qualities.
The
attendants should be amiable, capable of preserving secrets, strong in body and
devoted to the care of the patient. They
should carry out the orders oft he physician and never be tired (C.S.I.34 and
1.9).
Disease must be treated in the earliest possible stage
Three seats of disease (s€kh€) the external
the vital parts (middle),
the ko˜a the internal
S€kh€ includes the skin and the dh€tus, except rasa
The vital parts are the arms, brain and the like, the
bone-joints of the different bones and the arteries and veins attached to them
Charaka considers that the disease is incurable if it
affects the vital parts and ko˜a.
As long as the disease affects only the three or four first
stages into which the food-juice or rasa of the organism is gradually
transformed, blood, skin and flesh may be cured. If it reaches the subsequent stages of
metabolism, the more vital and subtle transformations of rasa, namely the
bones, marrow and semen the disease is beyond cure.
Charaka describes six processes which, as method of
treatment, are sufficient for all diseases.
langhana,
brimhana, r™kshana, snehana, swedana and sthambana.
1. Langhana--anything that lightens or attenuates the
aggravated dhatus and dosas.
2. Brimhana--that which promotes nutrition and puts on
weight
3. R™kshana--that which brings about dryness, roughness and
paleness of the body
4. Snehana--that which leads to secretions of oily matter,
softness of the body and increase of impurities
5. Swedana--anything that produces perspiration and
destroys stiffness and heaviness and sensation of cold
6. Sthambana--that which constipates or stops the motion of
such constituents of the body as are liquid and restless and enduced with
motion
The four kinds of corrective process: administration of
emetics, of purgatives, or errhines or cerebral purgatives and dry enemata, as
also the bearing of thirst, and winds and the heat of the sun, drinking of
medicines called p€chana, fasts and physical exercise, are included under
langhana.
Treatment of vata foremost is enemas
Treatment of pitta foremost is purgatives
Treatment of kapha foremost is emetics
Susruta divides medicines into two classes with reference
to their action on the dosas
Samsamana
and samsodhana
Samsamana class is comprised of medicines which rectify the
deranged state of dosas and calm their excitement without promoting the
excretions.
Samsodhana
class is comprised of medicines which remove collections of deranged dosas and
discharge them through the excretions.
The samsamana
group of drugs “suppress” the disordered dosas and the samsodhana group “clear
up” the accumulated dosas.
Charaka divides treatment into two kinds, santarpana and
apatarpana
Santarpana
is the prescribing of food and practices that have a soothing an nutritive
effect on the system.
Apatarpana
is a course of treatment that dries up the dosas.
Certain diseases were recognized as produced by
over-indulgence in sedative and nutritive food and practices. Certain others were produced by rigorous
abstinence from such kind of food and practices.
For all
diseases generated by apatarpana, there is no alleviation without purana or
santarpana; as for diseases generated by purana or santarpana, there is no
alleviation without apatarpana.
Atatarpana
is of three kinds: 1. langhana; 2. langhana-pachana and 3. do€vasechana.
Langhana is to be used for dosas slightly provoked. A dosa slightly provoked and of little
strength becomes dried up through the increase of digestive fire and of vayu
brought about by langhana, just as a shallow pool is dried up by heat and wind.
A dosa
that is provoked a little more than what would be called slight and that
processes medium strength is dried up by the administration of both langhana
and p€chana, just as a slightly larger pool is dried up by the wind and the
rays of the sun, as also by dust and ashes falling upon it. P€chana are medicines which digest undigested
food without increasing the appetite.
In cases
where the dosas have been excited to a great degree it is necessary to drain
them out. this process is called
avasechana. The means adopted for this
purpose are the administration of correctives such as emetics and purgatives
and the application of swedana and snehana.
Of these
three kinds of treatment, langhana and langhana-p€chana come under the heading
of samsamana and do€vasechana under that of samsodhana (C.S. III.3. 57-62).
In the
treatment of disease regimen of life and diet were considered at least of equal
importance with drugs and more strictly therapeutic measures.
Charaka
considers diseases which require treatment by instruments and caustics to be
curable with difficulty (C.S.I 10. 15-18).
Charaka recognizes three varieties of mental disease: those
produced by the disorders of the bodily dosas, those produce by the mental
dosas, and those produced by a combination of the two.
The
disharmony of the dosas of the body is to be treated in the rational way and
the derangement of the mental dosas by mantras an other theurgic practices.
(C.S.II 4 and C.S. VI.9).
Surgery in Ancient India
1. A marma is a junction or meeting place of the five
organic structures, that is, of ligaments, blood vessels, muscles, bones and
joints.