The Physician in the Caraka and Suśruta Saṃhitās

In the Caraka and the Suśruta Saṃhitās, the physician is addressed as bhiṣak, vaidya or cikitsak and these terms are used interchangeably.^[1] However, the term bhiṣak is of relatively more frequent occurrence. The term vaidya, which is derived from “vidya” or knowledge, is generally used for the learned. It also implies one who is a follower of the Vedas or well-versed in them.^[2] The physician increasingly came to be known as vaidya from the time of the Epics.^[3] A.L. Basham points out that since the word is related to Veda, the term vaidya has religious overtones which the term bhiṣaj lacks. He further draws our attention to the fact that vaidya originally meant a learned man of any description; the Mahābhārata refers to brāhmaṇa vaidyas in the sense of those possessing Vedic knowledge.^[4] By the time Caraka [Charaka], however, its special meaning was fully established^[5] and the medical profession is referred to as vaidya-vṛttti.^[6]

In a medical system no other element is of greater importance than the physician and this has been stated in no uncertain terms by our classical authorities. Caraka^[7] and Suśruta^[8] define therapeutics as the combined effort of the quartet of the physician, the medicament, the attendant and the patient provided all possess the requisite qualities. Though each the four components of the quartet has a specific role and is responsible for the success of the treatment, yet the pivotal position is accorded to the physician by virtue of his knowledge, administrative authority and capacity for prescription.^[9] The other three components are only auxiliary to the physician in the same way as the vessel, the fuel and the fire are to the cook, or a favourable topographical position, an army and weaponry are to the conqueror.^[10] The aggravation and alleviation of the most difficult disease depends eventually on the skill of the clinician.^[11] For Suśruta the competence of an accomplished physician alone is sufficient for saving the life of the patient just as a helmsman is capable of steering his vessel out of danger even in the absence of oarsmen.^[12] The triad of medicament, the attendant and the patient is thus ineffectual in the absence of the physician.

Who is a physician or what are his essential attributes? Both our authorities have dealt with this issue at several places in their treatises. The essential attributes of medical professional are excellence in medical knowledge (śrute paryavadātatvaṃ), extensive practical experience (bahuśodṛṣṭakaramatā), dexterity (dākṣya [dākṣyaṃ]) and purity (śaucam [śaucam]).^[13] These are the four basic qualifications of a physician of which knowledge is foremost: it is the light that illuminates.^[14] “Paryavadāta” is literally perfectly pure, clean, very accomplished, well acquainted, conversant with, well-known or very familiar.^[15] Gaṅgādhara Kavirāja, a commentator of the Caraka Samitā takes it as implying those whose intellects have become clear in consequence of a proper or attentive study of the medical and other scriptures.^[16] Therefore, the very first attribute of a physician is to acquire a complete grasp of the subject.

Excellence in knowledge comes from attending on preceptors and study of medical scriptures.^[17] Suśruta also emphasises on proficiency in theory and practical knowledge as essential requirements of the medical practitioner.^[18] Practical experience for a surgeon is gathered through observation of surgeries (dṛṣṭakarman) and having performed them himself (svayaṃkṛta).^[19] Knowledge of the principles of aetiology of disease, treatment and application of drugs can be obtained by training and practicing the subject under the able guidance of a preceptor. Suśruta says that one who practices medicine after having received education from the preceptors, and having regularly meditated upon the same, is a physician in the true sense.^[20] Those without formal education are designated as charlatans. Caraka categorically states that a medical practitioner comes to be known as a “vaidya” only on the completion of his medical education.^[21]

Good physicians, however, are distinguished by their manifold attributes. According to Caraka says that the presence of any one of the following qualities would justify the use of the word “vaidya” by a physician: knowledge (vidyā), intellect (mati), practical experience (karmadṛṣṭi), continued practice (abhyāsa), success in treatment (siddhi) and dependence on an experienced preceptor (āśraya).^[22] However, when he combines in himself all these qualities, he deserves to be called “a true vaidya” and is capable of giving comfort to all living beings.^[23] Caraka, therefore, clearly differentiates between ordinary physicians (who possess one of the above qualifications) and excellent ones who are the repositories of multiple attributes. Suśruta, too, enumerates several other desirable traits of a good physician (surgeon): swift handedness, cleanliness, boldness, possession of the armamentarium and medicines, capability of taking decisions on the spot, intelligence, firm determination, erudition, truthfulness and virtue.^[24]

Such descriptions may be understood as idealised images of the physician. Caraka describes the quintessential physician as prāṇābhisara, who is constantly engaged in the study of the precepts of medicine, understanding their implications, mastering their application, and who has practical experience.^[25] The term prāṇābhisara, literally, is the one who follows the life-breaths, that is one who saves instead of destroying life. The sense is that of a companion or friend of the life-breaths.^[26] All the attributes of the physician mentioned above are manifested in the prāṇābhisara.^[27] He is also recognised by his noble lineage (kulīna), the presence of mind (pratipattijñāḥ) and the knowledge of the eight sections of Āyurveda in their entirety. He also exhibits the power of comprehension, retention and understanding of the text (grahaṇa-dhāraṇa-vijñāna).^[28] It is worth noting that question of lineage is not cited by either authority in the context of the essential attributes of the physician except when refer ring^[29] to the prāṇābhisara.

One other significant attribute of a true physician mentioned by Caraka while elucidating on the traits of the prāṇābhisara is yukti.^[30] Yukti is interpreted as practical knowledge by R.K.Sharma and Bhagwan Dash^[31] but it is a word with divergent meanings including application, practice, usage, reasoning, argument, the ability to induce or deduce from circumstances, etc.^[32] In the medical context it is used in the sense of application of reason to diagnose and treat diseases.^[33] The knowledge which sees the things produced by combination of multiple causative factors is yukti or logical reasoning.^[34]

Recognition of yukti as a means of valid knowledge (pramāṇa) is a characteristic of the Caraka Saṃhitā^[35] and the physician who is adept in reasoning is considered superior to the one who knows the drugs alone.

mātrākālāśrayā yuktiḥ, siddhiryuktau pratiṣṭhitā.
tiṣṭhatyupari yuktijñao dravyajñāvatāṃ sadā.^[36]

The success (of treatment) depends on application (of medicine). (Therapeutical) propriety depends on the dose (of the therapy) and the time (of administration). The physician who knows the application is always superior to those who are acquainted with (only) the medicine.

In fact it can be said that application of yukti is the hallmark of a true physician that separates the genuine practitioner from the fraudulent and from lay persons who have some acquaintance with drugs. Goatherds, shepherds, cowherds and other forest dwellers are familiar with drugs by name and form, but it does not imply that they know the principles governing the correct application of drugs.^[37] Caraka emphasises that is not enough to be able to identify the drugs or know their names but the rationale of their use.^[38]

The best physician knows the principles governing the correct application of drugs in consonance with the place, time and individual variation.^[39]

yogamāsāṃ tu yo vidyādeśakālopapāditam.
puruṣaṃ puruṣaṃ vīkṣya sa jñeyo bhiṣaguttamaḥ.

It is this knowledge of principles and administration that renders an acute poison to an efficacious drug, or alternatively, turns a drug into poison.^[40]

The primacy of reasoning or yukti in this medical school is not surprising when we consider that Caraka includes debates and discussions in the curriculum of the student and instructs that the practitioner should also engage in such exercises in his professional life.^[41] The physician is guided by yukti in his treatment for Caraka says: yuktimetaṃ puraskṛtya trikālāṃ vedanāṃ bhiṣak or in other words it is by this principle of reason that the physician treats all diseases, past, present or future.^[42]

While the attributes discussed so far is more in the nature of what is desirable for a physician, the requisites that render him eligible to practice are much more fundamental. Suśruta tells us that the prospective practitioner after having studied the subject (adhigatatantreṇa) and having acquired knowledge of the science from the teacher (upāsitatantrārthena), having observed the procedures himself (dṛṣṭakarmanā) and performed them experimentally (kṛtayogyena), and having developed the capability of quoting the texts meaningfully (śāstraṃ nigadatā) must obtain the permission of the king (rājanujñātena).^[43]

This is a direct confirmation of the system of registration of medical practitioners which must have existed at the time of compilation of the text. The permission or license to practice must have been given after the aspirant underwent an examination for evaluating his knowledge of the subject at the completion of his studies. Caraka does not mention the necessity of obtaining state permission but does speak of the need to regulate the profession.^[44] The necessity of some system of administrative supervision is alluded to and the king is held accountable for the ease and impunity with which the doctors of death (rogāṇāmabhisara) roam in society.^[45] This possibly implies that the system of registration of medical practitioners may have not have existed in Caraka’s time but came to be established later. The system of registration is advocated by the author of the Arthaśāstra as the city-superintendent is directed to undertake a census of individuals according to caste, family-name and occupation.^[46] The objective of such a practice would be to weed out the quacks, and besides, for the medical practitioners, the receipt of license from the highest authority of the land confers the profession with recognition and respect.

Footnotes and references:

[1]:

For eg., the term bhiṣak occurs in Caraka Saṃhitā Sūtrasthāna 1.122; Caraka Saṃhitā Sūtrasthāna 1.133; vaidya in Caraka Saṃhitā Sūtrasthāna 11.50 and cikitsaka at Suśruta Saṃhitā Cikitsāsthāna 20.42.

[2]:

Monier-Williams, p. 1022.

[3]:

P.V. Sharma, “Medical Data in Epics and Purāṇas” in P.V. Sharma (Ed.), History of Medicine in India (From Antiquity to 1000 A.D.), New Delhi,1992, p. 88.

[4]:

A.L.Basham, “Practice of Medicine in Ancient India”, in C.M. Leslie, Asian Medical Systems: A Comparative Study, Berkeley and Los Angeles, 1976, p.23.

[5]:

A.L.Basham, “Practice of Medicine in Ancient India”, p. 23.

[6]:

Caraka Saṃhitā Sūtrasthāna 9.26.

[7]:

Caraka Saṃhitā Sūtrasthāna 9.3. bhiṣagdravyāṇyupasthātā rogī pādacatuṣṭyam. guṇavat kāraṇaṃ jñeyaṃ vikaravyupaśāntaye.

[8]:

Suśruta Saṃhitā Sūtrasthāna 34.15/2-16/1. vaidyo vyādysṛṣṭaśca bheṣajaṃ paricārakaḥ. ete pādāścikitsāyāḥkarmasādhanahetavaḥ

[9]:

Caraka Saṃhitā Sūtrasthāna 9.10.

[10]:

Caraka Saṃhitā Sūtrasthāna 9.11-12.

[11]:

Caraka Saṃhitā Sūtrasthāna 9.14.

[12]:

Suśruta Saṃhitā Sūtrasthāna 34.18/2-19/1.

[13]:

Caraka Saṃhitā Sūtrasthāna 9.6.

[14]:

Caraka Saṃhitā Sūtrasthāna 9.24.

[15]:

Monier-Williams, p. 607.

[16]:

A.C. Kaviratna, Charaka-Samhita translated into English, Calcutta, 1892, p.403.

[17]:

Cakrapāṇidatta on Caraka Saṃhitā Sūtrasthāna 9.6.

[18]:

Suśruta Saṃhitā Sūtrasthāna 3.47.

[19]:

Suśruta Saṃhitā Sūtrasthāna 34.19/2.

[20]:

Suśruta Saṃhitā Sūtrasthāna 4.8.

[21]:

Caraka Saṃhitā Cikitsāsthāna 1:4.52.

[22]:

Caraka Saṃhitā Sūtrasthāna 9.22.

[23]:

Caraka Saṃhitā Sūtrasthāna 9.23.

[24]:

Suśruta Saṃhitā Sūtrasthāna 34.19/2-21/1.

[25]:

Caraka Saṃhitā Sūtrasthāna 9.18.

[26]:

A.C. Kaviratna, Charaka-Samhita, p.403.

[27]:

Caraka Saṃhitā Sūtrasthāna 29.7.

[28]:

Caraka Saṃhitā Sūtrasthāna 29.7.

[29]:

Caraka Saṃhitā Sūtrasthāna 29.7.

[30]:

Caraka Saṃhitā Sūtrasthāna 29.7.

[31]:

Caraka Saṃhitā, Vol. I, p.589.

[32]:

M.Monier-Williams, p. 853.

[33]:

S.K.R.Rao, Encyclopaedia of Indian Medicine, Vol.2, Bombay: Popular Prakashan, 2005 (reprint), p.223.

[34]:

Caraka Saṃhitā Sūtrasthāna 11.25.

[35]:

Caraka Saṃhitā Sūtrasthāna 11.17.

[36]:

Caraka Saṃhitā Sūtrasthāna 2.16.

[37]:

Caraka Saṃhitā Sūtrasthāna 1.120-121.

[38]:

Caraka Saṃhitā Sūtrasthāna 1.122.

[39]:

Caraka Saṃhitā Sūtrasthāna 1.123.

[40]:

Caraka Saṃhitā Sūtrasthāna 1.126.

[41]:

Caraka Saṃhitā Vimānasthāna 8.16.

[42]:

Caraka Saṃhitā Śārīrasthāna 1.94/1.

[43]:

Suśruta Saṃhitā Sūtrasthāna 10.3.

[44]:

Caraka Saṃhitā Sūtrasthāna 29.8.

[45]:

Caraka Saṃhitā Sūtrasthāna 29.8.

[46]:

R.P.Kangle (Ed.), The Kautilya Arthaśāstra: An English Translation with Critical and Explanatory Notes (Part II), Delhi, Reprint 2003, 2.36.3. Hereafter Arthaśāstra