Karma and Disease

The ancient physicians also had to deal with the doctrine of “karma” (actions of previous states of existence) as a disease determinant which undoubtedly presented a conundrum for them.

“The study of karma in the traditional Indian medical system, Āyurveda, shows how conflict between fatalistic aspects of an indigenous traditional concept must be reconciled with a practical system which necessarily assumes that the course of many human ills is not pre-determined.”^[1]

The correlation of karma and disease is evident in brahmanical law books. Viṣṇu attributes ślipada or elephantiasis to punishment by destiny for the breach of a vow or of chastity in an earlier birth.^[2] Manu correlates diseases with crimes committed in this life and some with sinful deeds of previous existence.^[3] Idiocy, dumbness, blindness, deafness and deformity are all brought on by remnants of the guilt of former crimes.^[4]

The term karma does not appear in the classification of Suśruta, which we have discussed above. Suśruta uses the term daiva for a category of diseases that are sent by the gods, or that is associated with destiny, fate or chance, etc.^[5]

Caraka, however, has used this term for pre-determined acts:

“The actions performed in the previous life, which are known as daiva (fate), also constitute in due course causative factors for the manifestation of diseases.”^[6]

Weiss comments that in Suśruta’s compendium, daiva is more directly related to the Devas in contrast to Caraka where daiva is often synonymous with karma.^[7] Caraka distinguishes between the acts in the previous life, that is, daiva, and the deeds of present life, that is, puruṣakāra. The effects of daiva are pre-determined while that of puruṣakāra is not as it depends on the individual’s efforts. The effects of both may be mild, moderate or strong. Strong effects of both daiva and puruṣakāra ensure longevity and happiness with a pre-determined life-span.^[8] Therefore, not only are their effects a causal factor for disease manifestation, the life-span of individuals is also determined by the strength or feebleness of past and present human action.

This would imply that life-span is always pre-determined which would be unacceptable to the science of medicine. Caraka make two postulations that effectively counteract this hypothesis. First, a weak daiva can be subdued by a strong puruṣakāra (and vice versa).^[9]

Strong puruṣakāra is generated by such actions of present life as:

1. righteous offerings and auspicious acts;
2. administration of medicaments including rejuvenation therapies.^[10]

Second, the effects of a strong daiva are invariably manifested depending upon the availability of a congenial atmosphere.^[11] Therefore, the condition of health depends on the individual’s regimen in the present life.

A salutary regimen and good conduct counteracts the harmful effect of his/her deeds of the previous life and ensures a healthy life.

“This implies that our ordinary non-moral action in proper care of health, taking proper tonics, medicines, and the like, can modify or arrest the ordinary course of the fruition of our karma.”^[12]

Caraka’s final argument against the theory of karma is that acceptance of predetermination is to negate the significance of incantations, religious rites and observances, and auspicious acts.^[13]

According to other theories the laws of karma are immutable. By differentiating karma into two components and shifting the emphasis of etiology from previous lives to the present, karma no longer remains immutable in Caraka’s theory.^[14] There is an excellent instance where karma is refuted as an aetiological factor in mental disorders. Some scholars hold the view that exogenous unmāda is caused by past deeds; however, Punarvasu Ātreya considers prajñāparādha or errors of judgment as the causative factor of this condition.^[15]

Weiss comments that the Suśruta Saṃhitā, on the other hand, is more reluctant to cite karma as an etiologic factor.^[16] Here we may cite an instance in favour of the statement. It is striking that while enumerating the etiological factors for kuṣṭha (skin disorders) in the Nidāna-sthāna, sinful deeds are not considered as a factor.^[17]

There is a reference at the end of the same chapter to the effect:

“It has been said that the evil acts of killing brāhmins, women and noble persons, and taking riches of others, etc., produce kuṣṭha as a disease of sin.”^[18]

The allusion to the correlation between kuṣṭha and sin here is an indicator of what appears to be either the popular perception or the view of some other authorities, and merits no more than a cursory mention. In fact, of the more than twenty types of diseases discussed in this section of the Saṃhitā, there is no reference to notion of sinful deeds as a causative factor in disease except in skin disorders. In the Śārīra-sthāna, some terrible kinds of foetal abnormalities,^[19] limb deformities, humpback, dumbness, indistinct speech^[20] are medical conditions attributed to sins (pāpa-kṛita). Interestingly elsewhere, abnormalities of limbs, humpback, dumbness, etc. are recognised entirely as vāta disorders. For the ancient clinicians, therefore, the notion of karma is not a crucial factor in disease etiology. Suśruta uses the term karmaja for a category of diseases arising originating in past human action only in the Uttaratantra^[21] to connote those diseases for which there is no evident etiological factor.^[22] Cakrapāṇi also clarifies that daiva, implying sinful acts of previous life, is the common cause of all the diseases. However, when a specific aetiological cause of the disease is not found, then from the effect (i.e., the manifested disease) one can infer that the cause is daiva or karman.^[23]

Both Caraka and Suśruta are, therefore, unambiguous that all diseases, in the ultimate analysis, are clinical manifestation of the imbalance of the doṣas, even when they are caused by the fury of the gods, imprecations, spells and evil spirits.

Here we may cite from Suśruta:

“The root cause of all diseases is vitiation of vāta, pitta or śleṣman only (sarveṣāṃ ca vyādhināmvātapittaśleṣmāṇa eva mūlaṃ), as their features can be observed (in the diseased state) and as the treatment proves successful if they are treated (on the basis of the doṣas concerned)…”^[24]

Any abnormality of the human body cannot be isolated from the doṣas. The multifarious manifestations of diseases can be attributed to the interaction among the doṣas, dhātus and malas, the specific location of the perturbed doṣa, and diverse aetiological factors involved. Thus, the vitiated doṣa may affect any the tissue and the disease is designated accordingly.^[25]

Footnotes and references:

[1]:

M.G. Weiss, “Caraka Saṃhitā on the Doctrine of Karma”, in W.D. O”Flaherty (Ed.), Karma and Rebirth in Classical Indian Tradition, Berkeley and London, 1980, p.90.

[2]:

J. Jolly (trans.), The Institutes of Viṣṇu, 45.29.

[3]:

Manusmṛti XI.49-52.

[4]:

Manusmṛti XI.53.

[5]:

On the basis of the meaning of “daiva” in Monier-Williams, p.497.

[6]:

Caraka Saṃhitā Śārīrasthāna 1.116.

[7]:

M.G. Weiss, “Caraka Saṃhitā on the Doctrine of Karma”p.93.

[8]:

Caraka Saṃhitā Vimānasthāna 3.29-32.

[9]:

Caraka Saṃhitā Vimānasthāna 3.33.

[10]:

Cakrapāṇidatta on Caraka Saṃhitā Vimānasthāna 3.29-32.

[11]:

Caraka Saṃhitā Vimānasthāna 3.35.

[12]:

S.N. Dasgupta, A History of Indian Philosophy, Vol. II, p.403.

[13]:

Caraka Saṃhitā Vimānasthāna 3.36.

[14]:

S.N. Dasgupta, A History of Indian Philosophy, Vol.II, p.403; M.G. Weiss, “Caraka Saṃhitā on the Doctrine of Karma”, p.95.

[15]:

Caraka Saṃhitā Nidāna-sthāna 7.10.

[16]:

M.G. Weiss, “Caraka Saṃhitā on the Doctrine of Karma”, p.93.

[17]:

Suśruta Saṃhitā Nidāna-sthāna 5.3.

[18]:

Suśruta Saṃhitā Nidāna-sthāna 5.30.

[19]:

Suśruta Saṃhitā Śārīrasthāna 2.50.

[20]:

Suśruta Saṃhitā Śārīrasthāna 2.52.

[21]:

Suśruta Saṃhitā Uttaratantra 40.163.

[22]:

Suśruta Saṃhitā Uttaratantra 40.164.

[23]:

Cakrapāṇidatta on Caraka Saṃhitā Cikitsāsthāna 30.7-8.

[24]:

Suśruta Saṃhitā Sūtrasthāna 24.8.

[25]:

Suśruta Saṃhitā Sūtrasthāna 24.8.