History of Indian Medicine (and Ayurveda)

by Shree Gulabkunverba Ayurvedic Society | 1949 | 162,724 words | ISBN-13: 9788176370813

The History of Indian medicine and Ayurveda (i.e., the science of life) represents the introductory pages of the Charaka Samhita composed of six large sections dealing with every facet of Medicine in ancient India in a Socio-Historical context. Caraka is regarded as one of the pioneers in the field of scientific healthcare. As an important final a...

Chapter 13 - Regulations of Society and State Regarding Treatment

The Vaidya is very often nick-named “the brother of the God of death” (yamarājasahodara) but the society as well as the state took every possible measure to prevent him from emulating the example of his comfrere, the god of death. The rules of the society and of the state of those days seem to have been so strict that the Vaidya was afraid of taking responsibility in serious or incurable diseases. He was caught between the horns of a dilemma where his natural humane feeling and strict rules regarding his responsibility often ran counter to each other.

The responsibility cast on the Vaidya to treat only curable cases helped in evolving the science of prognostics to determine the curability or otherwise of a disease to an astonishing degree. This was the stage when the development of clinical methods made great progress.

The necessity and importance of the knowledge of prognostics is greatly emphasised in the Caraka Samhita in order to help the physician to steer clear of the risks in undertaking incurable cases.

[Carakasaṃhitā Sūtrasthāna 10.7-8]

“The physician who knows the differential diagnosis between the curable and the incurable diseases and begins treatment with full knowledge of the case and in time, obtains success for his effort without fail. But the physician who undertakes to treat incurable diseases will invariably suffer loss of income, tarnish his learning and fame, and earn for himself disrepute and unpopularity to boot.”

The whole section consisting of 12 chapters of the Indriya-sthana shows the marvellous development of minute clinical observations indicating the prognostics of the case. Dreams, omens, the messenger, environmental circumstances besides a host of such things were taken into account in the prognostic calculation. All this shows the meticulous care they took in order to draw a recognisable line between the curable and the incurable diseases.

A Vaidya is advised not to undertake to treat certain conditions. Incurable disease is one of such conditions.

[Carakasaṃhitā Vimānasthāna 3.5]

“However, neither the therapy of elimination of morbid matter nor any other kind of medication should be administered even when indicated, to the following kinds of patients one who has not justified his honour when questioned; one who is without wealth or attendants, one who fancies himself to be a doctor, one who is fierce tempered, one who is envious, one who fakes keen pleasure in vicious acts, one who has lost his strength, flesh or blood to an inordinate extent, one who is afflicted of an incurable disease, and one who presents the prognostic signs By treating such a patient, the physician incurs opprobrious odium”.

The physician was also warned against treating persons who were regarded as anti-social and evil in nature, such as—

[Carakasaṃhitā Siddhisthāna 2.4-7]

“The man that is fierce, rash, cowardly, ungrateful or fickle, who is aha ter of good persons kings and physicians or he who is hated by them or he who is afflicted with grief, or is a fatalist or one doomed to death, one who is devoid of the means for treatment or an enemy, impostor or one devoid of faith, a confirmed sceptic or who does not carry out the directions of the physician—such a man should not be taken up, by a wise physician, for treatment. The physician who treats. Such cases invites many difficulties Persons other than such should be treated well with all modes of treatment. Classifying the various morbid conditions, we shall now describe the indication and the contra-indications of the five purificatory procedures with reference to them.”

[Carakasaṃhitā Vimānasthāna 8.13]

“No persons, who are hated of the king or who are haters of the king or who are hated of the public or who are haters of the public shall receive treatment. Similarly those that are of very unnatural, wicked and miserable character and conduct, those who have not vindicated their honour and those that are on the point of death and similarly women who are unattended by their husbands or guardians shall not receive treatment”.

The rules were not only negative in form but strict and, positive injunctions were laid down as to how a Vaidya was to conduct himself under certain circumstances such as discharging a patient after cure.

It was enjoined upon a Vaidya to exhibit his patient to his kinsmen to be recognised as being fully cured and then discharged.

[Carakasaṃhitā Sūtrasthāna 10.17]

“On finding that he has regained his vitality, complexion and cheerfulness of mind, and after he has slept happily, digested his food well, taken a full bath, and' painted the body with sandal, has put on garland and untorn clothes, and has adorned himself with befitting ornaments, he should be shown round to his kinsmen after being presented to his friends, Thenceforward, he should be left to resume his normal activities.”

[Carakasaṃhitā Cikitsāsthāna 13.175-177]

“When the abdominal disease due to the gathering of fluid has gone beyond the stage of treatmentor if the humoral tridiscordance has not got subdued. the physician should summon the patients’ kinsmen, well wishers, wives, brahmins, state authorities, and elders and speak to them about the precarious condition of the patient.

If not treated the patients’ death is certain. But if treated by poison-therapy he may have a chance to survive. Having spoken thus and being permitted by the patients well-wishers to proceed (he must administer poison to the patient combined with his food and drink)”.

The last citation shows that when a bold Vaidya wanted to give a chance of cure in a cage believed to be incurable by means of special therapeutic measures, he had to take permission of the kinsmen, friends, wife and others of the patient. This bold and rather out of the ordinary treatment was undertaken and full opportunity was given to ambitious Vaidyas to attempt to bring the hitherto incurable diseases within the compass of curability.

Still the Vaidya had to be very careful and shrewd enough not to take any responsibility for failure on his shoulders. In case of any doubt about success in treatment, the Vaidya, to be on the safe side would declare the case to be incurable before the patient’s relations and then begin his treatment.

[Carakasaṃhitā Cikitsāsthāna 18.149]

“The patient suffering from cough born of consumption with all the symptoms of consumption fully developed, and who is debilitated should be considered incurable but if the cough is of recent origin and the patient is strong the treatment should be undertaken despite declaring it to be of the incurable type.”

Or he might take up the treatment of such cases only if the patients kinsmen approached the Vaidya and besought him for treating the case.

[Carakasaṃhitā Indriyasthāna 9.16]

“If the patient’s kinsmen beseech the physician with great importunity for treatment, he should prescribe the diet of meat-juice, but no purificatory therapy should be administered.”

Thus in keeping with the spirit of the age and the social conventions prevalent then, great restrictions were placed on the physician’s choice of undertaking cases for treatment. Yet there was a large scope left for his higher nature and humanity to function as a source of social helpfulness and guidance by his being allowed to give society the advantage of his skill and learning after declaring the hazardous nature of his efforts and absolving himself of responsibility for failure despite his best endeavours. In no society pertaining to any age can a physician be expected to behave otherwise. Thus judged by any standard, the humanity, goodness and wisdom of the ancient physician are beyond question All the rules and regulations of society as well as the State were only calculated to prevent the Vaidya from all chance of injury to public health as well as to his own reputation and profession.

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