Internal Medicine (c): Disorders of Humours/Elements

The last two subsections have dealt with diseases in relation to the humours of pitta (bile) and vāta (wind). In this subsection, two pieces of information found in the Chapters on Medicine pertaining to humours will be examined.

These two accounts are as follows:

Theravāda:—“At that time a certain monk was having a body full of humours. ‘I allow, monks, to drink a purgative.’ There was a need of clear rice-gruel. ‘I allow, monks, the clear rice-gruel.’ There was a need of undone soup. ‘I allow, monks, the undone soup.’ There was a need of done and undone [soup]. ‘I allow, monks, the done and undone [soup].’ There was a need of meat broth. ‘I allow, monks, the meat broth.’”^[1]

Dharmaguptaka: “At that time the Exalted One was in Vaiśālī. Then the monks had a lot of offerings of food and drink. The monks were afflicted with being moist in the body. They informed [this] to the Buddha. The Buddha said: ‘[I] allow making a medicine leading to vomiting and purgation. [If] there is a need of thick soup [and] porridge, these should be provided. [If] there is a need of wild bird meat, it should be given.’”^[2]

In the Theravāda record, the sick monk having full of humours in the body was treated wih a purgative and then different “post-treatment” foods. These foods seemingly should have been supplied one by one from light food to heavy one.

The Samantapāsādikā provides us with annotations on these diets:

“‘Clear rice-gruel’ is the top part of rice water. ‘Undone soup’ is a drink [in which] the green gram is cooked [but] is not soft. ‘Done and undone [soup]’ is that [soup in which the green gram] is just a bit soft. ‘With meat broth’ [means] with the flavour of meat.”^[3]

In the Dharmaguptaka case, monks suffered from a condition of “being moist in the body” after having abundant food and drink. Treatment with a medicine leading to emesis and purgation was prescribed and, like the Theravāda case, certain posttreatment foods would be consumed if needed.

What are the conditions of “body full of humours” and “being moist in the body”? In the Samantapāsādikā (V. 1092), a body full of humours is explained as one with excessive humours (abhisannakāyo ti ussannadosakāyo). This illustrates an increase of humours in the body. According to the Aṣṭāṅga Hṛdaya Saṃhitā, an increase of humours is usually due to over-nourishment, and this is later followed by an increase of phlegm humour (Sūtrasthāna 11. 27-28). Due to the fact that phlegm humour is closely connected with waterelement (Ninivaggi 2010, 51), the condition of body full of humours should be associated with that of being moist in the body. Moreover, this also explains why, in the Dharmaguptaka account, monks with abundant food and drink were afflicted with being moist in their bodies. Hence, these two accounts of illness–relating to excessive humours and water-element–can be understood as illnesses relating to phlegm humour.

In Āyurveda, elimination of increased humours is chiefly achieved by the use of emesis and purgation (Suśruta Saṃhitā Cikitsāsthāna 33. 4). After a preparatory procedure of lubrication (internally and/or externally, by applying oily substances), the sick person is caused to vomit and later to evacuate by means of suitable medicines. The treatment of emesis or purgation is usually followed by post-treatment measures, such as inhalation of medicinal smoke, taking a warm bath, and consumption of light to heavy food in sequence^[4] (Aṣṭāṅga Hṛdaya Saṃhitā Sūtrasthāna 18. 12-18, 27-29, 42-43). Thus, we can understand why the treatments mentioned in the Theravāda and Dharmaguptaka cases were prescribed.

How can we comprehend the above illnesses in terms of modern medicine? Unlike bile humour and wind humour which can been associated with, respectively, the digestive-metabolic system and the neurological system on the basis of their main functions, a possible corresponding system for phlegm humour is not apparent.

The Caraka Saṃhitā describes the normal and abnormal functions of phlegm humour as:

“[it] brings about good or bad effects according to its normal or abnormal state, e.g. sturdiness and looseness, plumpness and emaciation, enthusiasm and laziness, potency and impotency, wisdom and ignorance and such other pairs of qualities” (Sūtrasthāna 12. 12).

Furthermore, modern scholars render phlegm humour as “to embrace” or “to hold together,” as it “is responsible for the body’s strength, cohesion, and construction … [it] is the source of the body’s developmental and reproductive activity. It regulates vata and pitta [sic] and controls patience, sexual power, and strength … maintains immunity” (Koopsen and Young 2009, 179); it “maintains the stability of the bodily tissues and imparts a quality of protection” (Ninivaggi 2010, 51). Thus, phlegm humour seems to be associated with the endocrine system, owing to that this system is responsible for “the regulation and integration of cells and organ systems by a group of specialized chemical substances called hormones” (Elmendorf 2013, 589). The endocrine system, through various hormones, regulates many aspects of human physiological functions, such as water regulation; balance of electrolytes; metabolism of glucose, amino acids, lipids, and many other substances; growth; reproductive function; and so on.^[5] In addition, phlegm humour could also possibly pertain to the immune system, which is responsible for protection of the body against disease by identifying and eliminating pathogens (such as bacteria, fungi, viruses, and parasites) and tumour cells, through the actions of special cells and molecules (Peakman 2012, 49; Waite 2013, 188). In fact, it is generally accepted by medical scientists that the endocrine and immune systems are closely related, through mutual interactions of many hormones and immue molecules (Chryssikopoulos 1997). The two aforementioned accounts of sickess in the Chapters on Medicine could then be certain disorders of the endocrine-immune system.

In endocrinology, treatments for hypofunction disorders generally involve replacement of peripheral hormones or use of certain drugs that reduce the resistance to or stimulate the effect of the concerned hormone; for hyperfunction disorders, radiation therapy, surgery, and/or drugs are used so as to suppress the production or activity of the hormone (Morley 2013). For immune disorders, immunotherapies–such as immune molecules, immunosuppressive drugs, stem cell transplantation, and so on–are used to modulate (inhibit or enhance) immune responses (Haynes, Soderberg, and Fauci 2012, 2683-2684).

The two cases of illness mentioned in the Chapters on Medicine–body full of humours and body being moist–should be associated with phlegm humour. They were treated with emesis and/or purgation, followed by post-treatment diets. Such treatments are consistent with those employed in Āyurveda for phlegm humour diseases. In terms of modern medicine, such illnesses would probably be disorders of the endocrine and immune systems.

Footnotes and references:

[1]:

Theravāda Vinaya Piṭaka I. 206: “tena kho pana samayena aññataro bhikkhu abhisannakāyo hoti. anujānāmi bhikkhave virecanaṃ pātun ti. acchakañjiyā attho hoti. anujānāmi bhikkhave acchakañjikan ti. akaṭayūsena attho hoti. anujānāmi bhikkhave akaṭayūsan ti. kaṭākaṭena attho hoti. anujānāmi bhikkhave kaṭākaṭan ti. paṭicchādaniyea attho hoti. anujānāmi bhikkhave paṭicchādaniyan ti.”

[2]:

Taishō Tripiṭaka 1428. 876c28-877a2: “爾時世尊在毘舍離。時眾僧多有供養飲食，諸比丘身患濕，白佛，佛言：「聽作吐下藥，須羹粥與羹粥，須野鳥肉應與。」”

[3]:

Samantapāsādikā V. 1092: “acchakañjikan ti taṇḍulakamaṇḍā. akaṭayūsan ti asiniddho muggapacitapāniyo. kaṭākaṭan ti so’va thokaṃ siniddho. paṭicchādanīyenā’ti maṃsarasena.”

[4]:

The post-treatment diets usually include thin gruel; thick gruel; soup without fat, salt and sours; soup with fat, salt and sours; and then meat broth (Aṣṭāṅga Hṛdaya Saṃhitā Sūtrasthāna 18. 29).

[5]:

Intrigued readers may read, e.g. Chapters 19 and 20 of Kumar &Clark’s Clinical Medicine, 8th ed., on endocrine disorders, or equivalent chapters in other medical texts.