Disease as an entity or as a process

The two dominant views of disease theory in the history of medicine have been: the ontological and the physiological. The ontological concept emphasises the specific reality and distinctiveness of the disease entity in contrast to the person harbouring it; but upon entering the body, it manifests itself and causes the onset of disease.^[1] Ontologists believe that disease itself exists independently of a patient who has the disease. The foreign entity invading the organism, according to this view, is the disease.^[2] The physiological concept, on the other hand, construes disease as a consequence of imbalanced functions occurring in the individual, and emphasises the uniqueness of each person’s afflictions. Instead of invading entities, the morbidity is ascribed to dysfunction occurring inside the body.^[3]

The Vedic notion of disease may be described as primarily ontological for it is generally seen as originating from external sources, the demon theory being the most popular. The internal functioning of the body is hardly touched upon; hence, though most diseases and many remedies were known, nothing in the way of nidāna, or causes of diseases is specified.^[4]

It is in the early medical Saṃhitās of Caraka and Suśruta that importance is accorded to the notion of causation which rests on the theory of doṣas. Diseases are seen as the outcome of a physiological process: it has its cause (nidāna), premonitory symptoms (pūrvarūpa), manifested symptoms (liṅga), exploratory treatment (upaśaya) and pathogenesis (samprāpti). It is on the basis of these five aspects that the disease is diagnosed.^[5] Caraka also differentiates between symptoms and disease.^[6]

It is interesting to note that certain pathological conditions are attributed to parasitic infestation (kṛimidoṣa), as for instance, diarrhoea (atisāra).^[7] However, in their conceptualization, organisms (krimi) of various types and sizes are generated in the body and not transmitted from any external source. Indigestion, consumption of food before the previous meal is digested, unwholesome or incompatible food, unhygienic food, sedentary habits, etc., are identified as factors responsible for vitiating kapha and pitta which in turn cause the production of krimi.^[8]

While there is awareness of the role of pathogenic organisms in some diseases, it is not considered the primary cause of the disease. Pathogens come into the picture after the disease has progressed to some extent.^[9] The notion of pathogens attacking a healthy body and thereby becoming the direct cause of disease is not found in the classical texts of Āyurveda.^[10]

The emphasis on the humoral theory of the human constitution notwithstanding, early Āyurveda accepts the conception of disorders originating from abstract entities external to the body. In the exogenous type of psychological disorders (unmāda) the individual is afflicted any of the following categories of bhūtas: gods (deva), ṛṣis (sages), gandharvas (celestial musicians), piśācas (a category of demons), yakṣas (semi-divine celestial beings), rākṣasas (a category of demons) or pitṛs (manes).^[11] Each type of spirit or abstract being exhibits a specific set of behavioral characteristics which are described in detail in the texts.^[12] The afflicted individual then manifests such behaviour as is the characteristic of that particular entity. Bhūtas may be described as supernatural beings or abstract metaphysical beings, and hence, this category of disorders is also known as bhūtonmāda. In Suśruta’s work, such afflictions are placed in a separate chapter titled “amānuṣāḥupasarga” (afflictions by non-human elements) which not discussed as a part of unmāda, and the term “graha’ is used for the causal agents.^[13] Almost all afflictions of infants are attributed to the nine grahas.^[14]

Neither of the authorities discuss the humoral implications of bhūta or graha afflictions. The general understanding is that in bhūtonmāda, the patient exhibits the characteristics and behaviour pattern considered intrinsic to that particular class of beings by which he is seized. These beings do not actually come in contact with nor enter the human body (na te manuṣyaiḥ sa saṃviśanti ṣyān kvacidāviśanti).^[15] The nature of such affliction is analogous to

the reflection of an image in a mirror, or cold and heat penetrating the body, or sun rays entering the suryakānta maṇi (the sunstone).^[16] The patient, thus, personifies a particular being without taking on his or her physical likeness. However, there is the alternate view that the dreadful followers (paricāraka) of grahas who roam about at night, enter the human body in innumerable numbers, and thrive on blood, fat and flesh.^[17] Suśruta also uses the terms graha and niśācara to indicate wound infection which we shall discuss in chapter 9.

The humoral pathology of these diseases as also of pediatric diseases attributed to grahas is less understood in the early Saṃhitās. The pathogenesis of disorders caused by divine fury, spells and imprecations is also not addressed by the authors. It is simply stated that they too cause imbalance of all the three doṣas.^[18] The nature of disease etiology in the Saṃhitās, therefore, may be described as primarily physiological supplemented by ontological conception.

Footnotes and references:

[1]:

P. Carrick, Medical Ethics in the Ancient World, Washington, D.C., 2001, p. 35.

[2]:

T. Schramme, “Classic Concepts of Disease” in K. Heggenhougen and S.Quah (ed.), International Encyclopaedia of Public Health, Vol.I, San Diego, Academic Press, 2008, pp. 726- 733.

[3]:

P. Carrick, Medical Ethics in the Ancient World, p.35.

[4]:

S.N. Dasgupta, A History of Indian Philosophy, Vol. II, p.301.

[5]:

Caraka Saṃhitā Nidāna-sthāna 1.6.

[6]:

Caraka Saṃhitā Nidāna-sthāna 8.40.

[7]:

Caraka Saṃhitā Cikitsāsthāna 19.8; Suśruta Saṃhitā Uttaratantra 40.5.

[8]:

Suśruta Saṃhitā Uttaratantra 54.3-6/1.

[9]:

Manohar, P. Ram, “Accounts of Pathogenic Organisms in the Early Texts of Ayurveda” in Indian Journal of History of Science, Vol. 47, no.4, December, 2012, pp. 45-559.

[10]:

Manohar, P. Ram, “Accounts of Pathogenic Organisms in the Early Texts of Ayurveda”.

[11]:

Caraka Saṃhitā Cikitsāsthāna 9.16.

[12]:

Caraka Saṃhitā Cikitsāsthāna 9.20.

[13]:

Suśruta Saṃhitā Uttaratantra 60.4.

[14]:

Suśruta Saṃhitā Uttaratantra 27.3-5.

[15]:

Suśruta Saṃhitā Uttaratantra 60.21.

[16]:

Caraka Saṃhitā Cikitsāsthāna 9.18; Suśruta Saṃhitā Uttaratantra 60.19.

[17]:

Suśruta Saṃhitā Uttaratantra 60.22.

[18]:

Caraka Saṃhitā Cikitsāsthāna 3.118-119.