Charaka Samhita and Sushruta Samhita

by Nayana Sharma | 2015 | 139,725 words

This page relates ‘Aetiology of Disease’ of the study on the Charaka Samhita and the Sushruta Samhita, both important and authentic Sanskrit texts belonging to Ayurveda: the ancient Indian science of medicine and nature. The text anaylsis its medical and social aspects, and various topics such as diseases and health-care, the physician, their training and specialisation, interaction with society, educational training, etc.

Aetiology of Disease

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The aetiology of disease in classical Āyurveda derives from an understanding of the basic physiological principles of the human body. The three basic components of the body that determine its physiological state are the doṣas, the dhātus or the tissues and the malas or waste products (doṣadhātumalamulaṃ hi śarīra).^[1] The three doṣas, vāta (wind), pitta (bile), and sleṣman/kapha (phlegm) constitute the three pillars of support of the human body. They are the basis of its creation, sustenance and destruction. Therefore, the body is described as tristhūṇa.^[2] Their bodily function is comparable to that of air, the sun and the moon in the sustenance of the universe.^[3] Doṣas undergo constant variation. In their normal condition, they ensure growth, strength, happiness, etc.; when their equilibrium is disturbed, they cause various types of diseases.^[4] The word doṣa is derived from the root duṣ meaning bad, ill, etc.,^[5] which is the equivalent of the Greek prefix “dys” having similar implication.^[6] Therefore, doṣas are the pathogenic factors of the body while those of the mind are rajas and tamas.^[7] Doṣa imbalance may occur singly or in combination in somatic and psychic maladies, and diseases as such are innumerable in number.^[8] Caraka cites the numbers of the commonly manifested ones: those of vātika origin are 80 in number, 40 of paittika origin, and 20 of kapha origin.^[9]

Suśruta understands that there is a fourth factor, śoṇita/rakta or blood which plays an equally important role with the three ḍoṣas at birth, during life and at death;^[10] but it is not considered an independent pathogenic factor since perturbation of blood cannot occur in the absence of vitiation of the other doṣas.^[11] Nonetheless, we notice that in a few diseases, blood is treated as an independent vitiating factor as in the case of piles.^[12] The importance given to blood in this compendium is understandable given that it deals primarily with surgical procedures.

The second aspect of disease aetiology for the physician is the understanding the factors and processes involved in the perturbation of the doṣas. The principle of causality is vital to therapeutics.

Hence, Caraka comments:

“The state of equilibrium of the dhātus is not disturbed nor is the imbalanced state brought to normalcy without some causative factors. It is the causative factors which determine the equilibrium or imbalance of the dhātus.”^[13]

Caraka’s exposition on causality identifies three causal factors for the aggravation or the diminution of doṣas:

asātmeyendriyārthasaṃyoga, i.e., unwholesome contact of the sense organs with their respective objects;
prajñāparādha, i.e., errors of judgment; and
kāla-pariṇāma, i.e., seasonal vagaries.^[14]

1. Unwholesome contact of the sense organs:

The first factor, asātmeyendriyārthasaṃyoga occurs in three ways:

from contact of the five sense organs with their objects (indriyārthaḥ);
from actions relating to speech, mind and body (karman);
time (kāla).^[15]

(a) The five sense organs

The objects of the five sense organs-auditory, tactile, visual, gustatory and olfactory sensations are sound (śabda), touch (sparśa), form (rūpa), taste (rasa) and smell (gandha).^[16] The manner of utilization of these objects determines the outcome of the contact which can be beneficial or harmful for the person. Unwholesome contact implies flawed utilization which may occur in three ways: by excessive (atiyoga), deficient (ayoga) or incorrect (mithyāyoga) utilization of the objects.

Caraka explains these three categories of flawed utilization of the sense faculties by some examples.^[17]

Instances of atiyoga take place in the following manner:

sight-by gazing at highly luminous object;
hearing-by listening to the loud noise of thunder, kettle-drums and loud cries;
smell-by taking in exceedingly sharp, acute or intoxicating odours;
taste-by excessive intake of substances of various tastes;
touch-by having exceedingly cold and hot baths, massage, unction, etc.

In a similar manner, deficiency in the utilization of the sense faculties, constitutes ayoga.

Deliberate wrong utilization of the sense faculties or mithyāyoga take place in the following manner:

sight-by observing things too close or too far away or that are awful or terrifying or surprising, contemptuous, frightful, deformed or alarming;
hearing-by listening to harsh words, news of the death of a dear one, violent, insulting or terrifying sounds;
smell-by inhaling odours that are exceedingly putrid, unpleasant, dirty, putrefied or cadaverous, or inhaling poisonous gases;
taste-by intake of food without observing the prescribed rules;
touch-by having cold or hot baths, massage and unction in the wrong sequence, touching uneven place, dirty objects, bhūta (impure things?), injurious objects.

(b) Speech, mind and body

Asātmeyendriyārthasaṃyoga may also arise from certain kinds of verbal, physical and mental activities, especially when they are excessive, deficient or improper. Instances of wrong utilization of the body are the suppression of the natural urges or their artificial manifestation, etc. Wrong utilization of speech refers to back-biting, lying, useless quarrelling, unpleasant words, irrelevant and unfavourable talk and harsh expression. Fear, anxiety, anger, greed, confusion, vanity, envy and misconceptions are mental activities that are categorized as incorrect.^[18]

(c) Time (kāla)

The third component of asātmeyendriyārthasaṃyoga is the incorrect utilization of time. An action done after it should have been done, or much sooner than it should be, or when it is not to be done at all, or executed in an improper manner (excessive, deficient or incorrect) is included in this category, as it is likely to become injurious to the mind, body or both.^[19]

2. Errors of judgment

When an individual utilizes his sense organs in the wrongful manner, there arises prajñāparādha or errors of judgment.^[20] The concept of prajñāparādha is central to the understanding of aetiology of disease. Caraka states that actions devoid of intelligence, resolution and mindfulness (dhī-dhṛti-smṛti-vibhraṣṭaḥ-karma) constitute prajñāparādha.^[21] When the mind is allowed to be dominated by rajas and tamas, there is impairment of intelligence, resolution and memory.^[22]

When something eternal is viewed as ephemeral and something harmful as beneficial or vice versa, that is indicative of impairment of the intellect.^[23] When the mind indulging in worldly enjoyments cannot be restrained from harmful objects, there is impairment of resolution.^[24] Mindfulness or memory is impaired when the mind is dominated by rajas and tamas.^[25]

Both improper ascertainment (viṣama vijṅāna) and improper conduct (viṣama pravartana) represent prajñāparādha.^[26] Therefore, error of judgment is by nature an improper ascertainment and in its manifestation, an impulse to an improper conduct.^[27]

Caraka cites the following examples of prajñāparādha:

forcible stimulation of natural urges and suppression of manifested ones
exhibition of undue strength
overindulgence in sex
negligence of the time of treatment
initiation of action in improper time (excessive, deficient or wrong utilization of therapies)
immodesty
absence of good conduct
disrespect for those worthy of respect
enjoyment of harmful things
improper conduct in keeping with age time, place or situation
company of wicked folk
neglect of regimen for health
undesirable emotions like malice, vanity, fear, anger, greed, ignorance, intoxication and confusion or bad actions arising from any of them
other physical evil acts arising from rajas and tamas.

Such harmful conduct constitutes one the causes of perturbation of doṣas.^[28]

3. Seasonal vagaries

The behaviour of doṣas is continually affected by a third factor, kāla-parināma, i.e., the diurnal and seasonal changes. Consequently, doṣas normally undergo accumulation, aggravation and alleviation in cyclical manner through the year.^[29] However, when temperature, precipitation and seasonal characteristics deviate from the normal being excessive, deficient, or unseasonal (as for instance, rainfall in winter, cold in the rainy season, etc.),^[30] then the normal course of accumulation, aggravation and alleviation of the doṣas is disturbed.

In their state of aggravation and diminution, doṣas manifest signs and symptoms in accordance with the degree of vitiation.^[31] The effects of vitiated doṣa /doṣas are then felt on the structural components of the body. It is the interaction among doṣas, tissues (dhātus) and waste products (mala) at a specific site that manifests itself in the form of disease.^[32] These sites are plasma (rasa), blood (śo ita), muscles (maṃsa), adipose tissue (meda), bone (asthi), bone marrow (majja) and sperm (śukra).^[33] Dhātus in themselves are not responsible for any disease. It is only when their equilibrium is disturbed do they bring about disease.^[34]

Conclusion:

It is noteworthy that the notion of perturbation of the doṣas is understood entirely in terms of human behaviour, that is to say, indulgence in insalutary dietary habits and imprudent conduct are actions whose effects cause disturbance of the doṣas. Both are conscious actions arising from the impairment of the intellect. The agency of any supernatural or malevolent force in the above exposition is conspicuously absent which is in striking contrast with the medical notions of the Vedic hymns. Caraka and Suśruta perceive the manifestation of disease as a biological process and not as manifestation of some demonic entity. This is true of internal maladies as Caraka categorically states that all endogenous diseases occur invariably due to the vitiation of the vāta, pitta and kapha (sarva eva nijā vikārā nānyatra vātapittakaphebheyo nirvartante).^[35]

This is not to say, however, that the classical Saṃhitās are entirely bereft of the notions of malevolent forces or the agency of supernatural beings, spells and black magic in inflicting maladies. Black magic (abhicāra) and spells are identified as causative factors in fever;^[36] Abstract entities cause some mental disorders^[37] and pediatric diseases.^[38] In fact, Suśruta’s classification of diseases includes a category caused by piśācā and other such malevolent beings as we shall see below.

Caraka makes a distinction between somatic (nija) diseases and exogenous diseases (āgantu) on the basis of disease causation.^[39] Psychological disorders and traumatic illnesses are not included in the category of somatic disorders as is evident from the following three-fold classification of diseases:

(i) nija (endogenous/constitutional)-caused by the morbid doṣas;

(ii) āgantu (exogenous/accidental) -caused by demoniac seizures (bhūta), poisonous substances (viṣa), wind (vāyu), fire (agni) or trauma (saṃprahāra), etc.;

(iiii) manasā (mental disorders)-caused by association with agreeable and disagreeable things.^[40] The main point of divergence between the first two classes of diseases lies at their points of origin. Nevertheless, even though the origin of the exogenous disorders is external to the body, the process of doṣa vitiation is not absent. In somatic diseases, the perturbation of the doṣas is followed by manifestation of pain; whereas in exogenous diseases, it is the other way round. Pain is the primary manifestation and the vitiation of the doṣas follows subsequently.^[41]

Suśruta’s classification of diseases is four-fold:

(i) traumatic (āgantu)-caused by injuries;

(ii) somatic (śarīra)-caused by disequilibrium of vāta, pitta, kapha and śonita;

(ii) psychic (mānasa)-caused by different types of likes and dislikes;

(iv) natural (svābhāvika)-include processes like hunger, thirst, senility, death, sleep and those caused by the constitution.^[42]

It is interesting to note that these natural processes of the body are viewed as diseases by Suśruta.^[43] Caraka describes aging and death as kālaja diseases (occurring with passage of time) which are natural but irremediable.^[44]

The medical authors have classified diseases on varying criteria, such as, prognosis, severity, site of affliction (adhiṣṭhāna), site of origin,^[45] or according to the vitiated doṣa,^[46] etc. There is no fixity in the norms of disease classification, and an individual is at liberty to determine his own criteria for classification^[47] as diseases are innumerable.^[48] The etiologic basis of classification is contextually relevant here for a clearer understanding the concept of disease in our two Saṃhitās. Such a disease classification occurs in the chapter is titled “vyādhisamuddeśīyo(a)dhyāya’ or “Classification of Diseases” in Sūtrasthāna of the Suśruta Saṃhitā which the most comprehensive.

On the basis of aetiology, Sūtrasthāna ruta recognises seven types of diseases which are placed in three groups:

ādhyatmika,
ādhibhautika and
ādhidaivika.^[49]

The prefix “ādhi” indicates discomfort, in particular mental discomfort and is mostly used in association with vyādhi, especially bodily disease.^[50] All adhyatmika diseases are intrinsic disorders while the other two categories originate from extrinsic causes.