The Social Implications of Disease

Disease is a condition that represents deviance from the normal. It has certain social implications, and that raise questions about how society perceives disease and what is the attitude towards the sick.

We find in the Saṃhitās a correlation between disease and absence of dharma (righteousness). Disease arises from wrongful action when one deviates from the rightful path (dharma). According to a mythological narrative in our compendia, disease did not exist in the Satya Yuga but arose from primeval wrongdoing. At the end of Satya Yuga some people grew heavy and lethargic from over-indulgence. Fatigue and lethargy made them to amass things which in turn led to feelings of attachment and greed. Greed gave rise to malice in the Tretā Yuga from which in turn created negative behaviour, and, thus, a quarter of dharma disappeared. With each passing yuga, as dharma gradually diminished, living beings were afflicted with diseases.^[1] The origin of all diseases is traced to attachment or “parigraha”.^[2]

The Nidānasthāna of Caraka takes into account the aetiology of eight diseases: jvara (fever), raktapitta (haemorrhagic diseases), gulma (phantom tumour), prameha (obstinate urinary disorders including diabetes mellitus), kuṣṭha (skin disorders), rājayakṣmā (tuberculosis), unmāda (psychic disorders) and apasmāra (epilepsy). The common thread binding them is their origin -it is said that all the eight diseases arose from greed (lobha), wrong doing (droha) and anger (kopa) in the past.^[3] When Śiva was denied his rightful share of the sacrifice by Dakṣa Prajāpati, his wrath took the form of a deadly fire from which emerged fever and the other diseases. Śiva ordained that jvara and afflict people at birth and at death and also distress those who resort to erratic regimes (apacāra).^[4] In the narrative about the origin of rājayakṣmā, Chandra was afflicted with rajo guṇa arising from passion which clouded his purity of mind (suddha sattva). He failed to fulfill his duties towards his wives and was struck with consumption.^[5]

Thus, disease originated from the transgression of the rightful principles of behaviour, and the medical notion of prajñāparādha may be placed in the cause-effect continuum. Prajñāparādha, that is eventually responsible for humoral disharmony in the body and the mind, arises from willful indulgence in harmful behaviour. Therefore, it is, in effect, a willful transgression of the established norms. The origin of disease in prajñāparādha, thereby, invests the concept of disease with moral wrongdoing which undoubtedly has social implications. Caraka attributes all abnormalities eventually to errors of judgment. Even the external afflictions are caused by one’s misdeeds. “The wise man should not blame the gods, ancestors, or rākṣasas for diseases caused by his misdeeds due to errors of judgment. One should hold himself responsible his happiness and miseries.”^[6] This position is contrary to that of Sūtrasthāna ruta’s compendium wherein there is a section on bhūtavidyā.

The condition of abnormality of the body or mind, therefore, elicits some social response that may take the form of social disapproval or censure. For an understanding of how society viewed conditions of disease, we can get some evidence from other sources. From the Piṭaka texts it is known that ordainment or upasampadā was disallowed by the Saṃgha to men and women suffering from maladies such as apamāra (apasmāra or epilepsy),^[7] kilāsa (vitiligo),^[8] kuṭṭha (kuṣṭha),^[9] pakkhahata (pakṣāghāta or hemiplagia),^[10] sīpada (ślīpada or elephantiasis),^[11] and sosa (soṣa or consumption).^[12] These diseases must have caused social disapproval to the patients.

There evidence from the Manusmṛti on how society viewed certain kinds of afflictions.

According to the text:

“Some wicked men suffer from a change of their (natural) appearance in consequence of crimes committed in life, and some in consequence of those committed in former (existence).”^[13]

Diseased nails, black teeth, consumption, diseased skin, foul-smelling nose, stinking breath, deficiency in limbs, redundant limbs, dyspepsia, dumbness, white leprosy, lameness, blindness, loss of one eye, general sickliness, swelling in the limbs are all occasioned by sinful acts.^[14] Thus, deformed men are all despised by the virtuous and penances must always be performed for their purification for those whose sins are not expiated are born again with disgraceful marks.^[15] The issue of stigmatization of disease is obvious when it is ordained that persons afflicted with skin disease,^[16] deformed nails, black teeth,^[17] consumption,^[18] pāparoga,^[19] epilepsy, swelling of gland, vitiligo (śvitra), insanity, and blindness^[20] must be avoided at śrāddhas.

These ordinations leave us in no doubt that disease, particularly disease with visibility, was strongly despised. Manu’s pronouncements indicate the association of diseases with social disapproval and censure. The diseased in some cases even faced legal disability as contracts made by the mentally diseased or the grievously disordered by disease are deemed invalid.^[21] Even in the medical texts, deformity meets with disapproval; messengers who are deformed or who have superfluous or fewer body parts are not regarded as auspicious.^[22]

Disorders of the skin have always aroused much dread and caused its patients to suffer social isolation and ostracism. The term pāparoga appearing the above context could possibly refer to kuṣṭha as it is known by this appellation in the medical texts,^[23] for it is believed to be caused by the sinful acts of the present and previous lives.^[24] The concept of sin has been linked with skin dermatoses since the Atharvaveda.^[25] The negative perception of skin disorders is known in other civilizations too. The ancient Iranians believed leprosy was a divine retribution for sinful deeds.^[26] The Bible describes leprosy as a disease sent by God. Lepers were excluded from society by law and banished into the country and uninhabited places-a law from which even kings were given no respite.^[27]

In the ancient Indian context too, skin dermatoses served as a marker of social isolation. The Brahmanical texts disallow marriage to a patient as well as into those families who have a member suffering from skin dermatoses.^[28] The offspring of kuṣṭha patient is maligned as “kuṣṭhī’.^[29]

According to Suśruta, no other disease is as distressing as kuṣṭha for if one destined to suffer from the same disease even in the next birth.

mriyate yadi kuṣṭhena punarjāte(a)pi gacchati.
nātaḥ kaṣṭtaro rogo yathā kuṣṭhaṃ prakīrtitam.^[30]

Suśruta also states the popular perception that kuṣṭha is believed to be caused by evil deeds, such as, killing of a brāhmaṇa, a woman, a good person or appropriating belongings of others, thereby earning the disease the popular epithet of pāparoga.^[31] Moreover, by nature it is an aupasargika disease which spreads by touch and breath, and through activities like sexual intercourse, eating together, and sharing the same bed, clothes, garlands and cosmetics,^[32] which renders any kind of interaction with the patient hazardous. Such references are evidence enough for the degree of social ostracism that the sufferer of kuṣṭha had to confront. By reiterating the Atharvavedic and Dharmaśāstric notions of disease as retribution for reprobate behaviour, the medical authorities appear to persist with traditional concepts though as an etiologic factor, as we have discussed earlier, sinful deeds is of lesser significance in the texts. The physicians were only too well aware of the general social perceptions that could not be dismissed altogether. Nonetheless, in the treatment of kuṣṭha we notice that the texts do deviate from the brahmanical ideas.

It is acknowledged that obstinate skin diseases (kuṣṭha) do not yield easily to curative measures owing to its complex pathogenesis involving all the three doṣas and four other tissues-skin, blood, muscle and lymph (dūṣayanti sa kuṣṭhānāṃ saptako dravyasaṃgraha).^[33] This does not prevent the physicians from providing medical care. While discoursing on the prognosis of kuṣṭha, Caraka mentions that certain cases are not to be treated and includes maggot infestation as one of the conditions.^[34] The texts do not call for the social isolation of the patients of kuṣṭha even where there is maggot infestation in the skin patches. Yet elsewhere in the chapter, we find formulations for treatment of cases where patches show appearance of maggots (kṛmi)^[35] or where there is sloughing of skin and loss of fingers.^[36] There are medical prescriptions even for advanced cases where there is dreadful physical deformity, or where there is serious exudation and maggots in the ulcers.^[37] The physician is not deterred from attending to the patient with such severe symptoms. Other than the use of the appellation “pāparoga” for kuṣṭha (as we have already noted), there is no overt statement stigmatizing kuṣṭha patients. The absence of a moralizing attitude is noteworthy. Nonetheless, the contagiousness of kuṣṭha, the hereditary nature of the disease and its association with immoral and unprincipled conduct are reasons enough for the disease and the patient to be socially stigmatized.

A particular skin disorder kilāsa (a type of leucoderma) is attributed to rather dishonourable and unethical conduct. Its causative factors are untruthfulness, ungratefulness, disrespect for the gods, insult to the preceptors, sinful acts (pāpakriyā), misdeeds of past lives apart from the intake of mutually contradictory food.^[38] It would not be wrong to assume that patients of this disease would have suffered social ostracism. Another disease that is associated with the notion of wrongdoings is rājayakṣmā (tuberculosis). Manu says that a slayer of a brāhmaṇa gets consumption.^[39] There is reference to the social isolation of the patient in the Kāmasūtra.^[40]

Social stigma and discrimination is also associated with mental disorders which is true even today. As we have noted earlier, the treatment procedure often involved isolation and brutalization of the patient. It is not just the violent patients or those disobeying the physician’s directions who were subject to physical isolation. It appears to be an integral part of the therapy for Caraka advises the patient be administered medicated ghṛta and kept confined to an underground cellar or a dark house (śvabhre rundhyādgṛhe api va).^[41] It would not be wrong to maintain that sufferers of psychological distress had to suffer isolation, brutality and social ignominy as we have already noted above that psychological disorders have their origin in the contravention of the established social behavioural norms and non-performance (or incorrect performance) of spiritual observances.

This is especially true of disorders perceived to be caused by evil entities like Brahmarākṣasas (a category of fierce demon spirits) or Piśāca who are characterized by abominable behavioural traits. Persons seized by the first category of beings (Brahmarākṣasas) indulge in excessive laughter and dance, and harbour hatred and disobedience to the gods, vipras (learned theologians) and physicians (prahāsanṛtyapradhanaṃ devavipravaidyadveṣāvajñābhiḥ) and inflict self-injury.^[42] Thus, Brahmarākṣasas seize such persons who bear similar traits, such as abhorrence to the study of religious scriptures (svādhyāya), penance (tapa), observance of scriptural rules (niyama), fasting (upavāsa), celibacy (brahmacarya), and disrespect for the gods, yatis (recluses) and gurus (preceptors),^[43] which is to say antipathy to brahmanical culture. Hatred to the twice-born and physicians is also seen in seizures by Yakṣas.^[44]

Some signs of affliction by Piśācas are unsound mind (savasthacitta), engagement in dancing, singing, laughter and incoherent speech, walking in dirty streets and over dirty clothes, nudity, and the inability to stick to one place.^[45] In fact, persons who are possessed by Rākṣasas and Piśācas have all the negative traits, such as, lack of will power, backbiting, fondness for women, greed and deception.^[46] Harsher methods in the form of recourse to brutalization (krūrakarma) are prescribed in such cases, that is, affliction by Yakṣas, Brahmarākṣasas, Rākṣasas and Piśācas but it is avoidable in cases of seizures by devas, ṛṣis, pitṛs (manes) and Gandharvas.^[47]

At the same time Haldipur argues: “A case can be made that since insanity is referred to in a treatise on medicine and its treatment was the prerogative of physicians, and not the shamans, it was perceived as a disease. But so were the spirit possessions. From vedic belief in demoniacal possession, one sees in Charaka Samhita several centuries later, adherence to both demoniac and biologic explanation.”^[48]

Patients of yet another disease, apasmāra or epilepsy, had to possibly endure the same social stigma for the disorder shares similarity in aetiology, pathogeny and treatment with psychological disorders. The prognoses for seizures, epilepsy and psychic disorders are not negative in Suśruta’s work which prescribes formulations such as siddhārthaka ghṛta and pañcagāvya ghṛta as effectual cures for these disorders.^[49]

The attitude of our Saṃhitās towards disease is not prejudicial and there is no upfront expression of disapproval of any particular clinical condition. Physicians are expected to attend to any clinical situation without being judgmental. Perhaps, we can find only veiled indications of censure of the patient when it is disease is correlated with a faulty lifestyle and a weak mind. It is said that an individual who abstains from meat and alcohol and consumes only wholesome food, who is disciplined and pure and has strong will power, does not get afflicted by either endogenous or exogenous type of psychological disorders.^[50] There is another similar comment that consumption does not remain long in the patient who is constantly strong minded.^[51] Incurability of the disease is the principal condition on which medical intervention can be denied by the physician though there a few other conditions of refusal which we have seen are not clinical in nature or related to the disease per se but to the social factors. The physician is entitled to exercise his discretion in taking up a case.

There is an interesting evidence of how popular notion of disease varied from medical theory. In the discussion of the clinical condition of false pregnancy, Caraka refers to how the appearance of particular symptoms is taken by the ignorant as case of real pregnancy. When they disappear and the menstrual flow begins once again, some people believe that the foetus has been removed by some evil spirit who move about at night and feed on body of the foetus. This argument is, however, rejected in the treatise for had this been the case, the evil spirit would have fed on the ojas of the mother as well causing her death. The popular notion of malevolent beings drawing sustenance from fetuses is directly countered by Caraka.^[52]

The curative process as conceptualized in the classical ancient Indian medical system is a two pronged process is aimed not only at the purification of the body but also of the mind by the removal of negative tendencies that invite maladies. It has been commented that the perception of diseases in antiquity appear to be a curious blending of demonstrative accuracy and traditional confusion.^[53] The definitions of health and disease in physiological terms are laid out by the Saṃhitā authors, but subsequently we notice importance being attached to extraneous concepts such as those of rebirth, effects of past and present deeds (karma), divine retribution, the role of supernatural agents and recourse to spiritual therapy which dilute the empirico-rational content of ancient Indian medicine. These concepts create ambiguities that are difficult to reconcile.

On the one hand, Caraka argues that knowledge has four sources- āptādeśa (scriptural testimony), pratyakṣam (observation), anumāna (inference) and yukti (reasoning).^[54] Yukti is the utilization of the rational faculties. The intellect that perceives things as an outcome of combination of multiple causative factors, valid for the past, the present and the future, is known as yukti.^[55] It is accorded the status as an independent source of knowledge by Caraka. D.P. Chattopadhyaya has with erudition attempted to establish that the basic theoretical premise of Āyurveda is svabhāva-vāda, literally “the doctrine of nature”, or “”the doctrine of the laws of nature”.^[56] This doctrine has no scope for the operation of a force like aḍṛṣṭa or the “unseen” when it is said in the context of the effect of a substance on the body element, that the action (karma) of the substance is not influenced by anything else other than the inherent nature of the substance (karma na anyat apekṣate),^[57] The implication of this statement is significant. There is disavowal of the possibility of any other factor affecting the body.^[58]

Another important piece of evidence comes from the discussion between Maitreya and Ātreya on the role of therapeutics in the alleviation of diseases. The former has doubts on the efficacy of therapeutics for some patients manage to heal without physicians, medicines and attendants. Ātreya points out that those who are incurable will certainly not respond to intervention. Those curable respond quicker in the presence of medical intervention. This is similar to helping a healthy person to lift himself up when he falls. If he is helped, he is likely to get up without much difficulty.^[59] On the other hand, we have noted how spiritual therapy and strength and weakness of karma have been given importance in the alleviation of some diseases. The rationalization for the existence of diseases caused by divine displeasure is acknowledged to the observation and experiences of physicians that certain disorders do not correspond to the aggravation of the doṣas.^[60] The inadequacy of theoretical understanding was taken over by supernaturalism. For D.P. Chattopadhayaya, these alien elements are in the nature of grafts (conscious or unconscious). They are hostages offered to counter-ideology to partially evade the censorship of the law-givers.^[61]

The emphasis on reasoning is evident in the advisory on the manner of conducting a diagnosis. A wise physician is advised not to come to a conclusion exclusively on the suggestions made in the text. He should use his discretion and reasoning in arriving at a correct decision (svayamapyatra vaidyen tarkyaṃ buddhimatā bhaveta).^[62] The reason given is that owing to the nature of the habitat, time and strength of the patient, situations may arise where the therapy indicated for an ailment becomes ineffective, and a prohibited therapy may become useful.^[63] This is, however, relevant only for an intelligent physician who should understand things by reasoning and implication using the aphorisms as a guide.^[64] It is better for one of average intelligence to follow the text as he is incapable of determining the exact requirements of therapy by reasoning. The significance of reasoning for the practitioner is again underlined by the emphatic statement that the success achieved without the exercise of the power of reasoning (tarka) is nothing but only success perchance (binā tarkeṇa ya siddhiryadṛcchasiddhireva sā).^[65] S.K.R.Rao believes that admission of the possibility of supernatural agencies at work is more in the nature of a concession to popular beliefs than in the nature of a medical doctrine.^[66]

It is in the above context that the inclusion of certain chapters in the Indriya- sthāna of Caraka (as also in the Sūtra-sthāna of Suśruta) relating to prognostication of cases is significant. Prognosis was an important tool in the hands of the ancient physician even in ancient Greece. Edelstein pointed out that it was the primary way the doctor could establish his credentials, and at the same time protect himself against accusations of malpractice. The ability to announce the outcome beforehand would earn him credit for the cure; he would also be able to defend himself should the patient die if he had made a negative prognosis.^[67] However, prognostication on the basis of dreams, shadows, appearance of the messenger, and other signs and symptoms that are in no way clinically relevant, becomes difficult to comprehend.

Chattopadhyaya argues that the Saṃhitās contain many ideas and attitudes, whether of the soul, karma, after-life or mokṣa (liberation), that are really extrinsic to medicine and should be ignored or ejected for a true understanding of the real core of medical science. The presence of these elements is not without a purpose; they are in “the nature of ransom offered to the counter-ideology” without which it is not easy for the physicians to save their science. The exaggerated piety of the Caraka Saṃhitā is the nature of “defence reaction”.^[68]

Acceptance of karma as a causative factor in disease causes etiological ambiguities. The most significant instance of such a situation is evident in the case of etiology of kuṣṭha. Karma does not occur in the etiology of the disease in the Nidāna-sthāna of both our compendia but is mentioned in their respective Cikitsā-sthāna.^[69] While karma may have been a later interpolation, it is our contention that the doctrine is important to medical theorists and practitioners when clinical intervention did not show the desired results or the case proved to be incurable despite prognosis to the contrary.

We have also pointed out the absence of karma in the etiological classification of diseases by Suśruta but later inclusion in the Uttara-tantra. The three categories of disease on this basis, i.e., (a) karmaja which arise from the past deeds (karma); (b) doṣaja or humoral; and (c) those caused by both karman and vitiated doṣas (karmadoṣajābhavāḥ),^[70] is actually more relevant from the therapeutic than from the etiological point of view. Hence, it is explained that treatment accordingly follows divergent lines of treatment. Those of the first category have no evident aetiological cause and they subside without any treatment or else with treatment but only on the abatement of the effects of the past deeds. The second category of diseases is cured with the pacification of the aggravated humors.

The manifestation of the third category of diseases can be of two types: the condition can be painful though the causative factors may be minimal (as the doṣas are not excessively vitiated) or the symptoms may be mild despite the severe doṣa vitiation. Here, measures for alleviation of the effects of the past deeds and the doṣas have to taken for successful treatment.^[71] In such cases, both spiritual and rational therapies are adopted.^[72]

The statement is an admission of the inadequacy of therapeutics alone in the healing of obstinate maladies and emphasizes the importance of what may be regarded as non-pharmacological aspects of healing, such as rituals, behavioural modification, paying respect to preceptors, brāhmaṇas, etc. Besides, when two cases with similar symptoms show different results, the physician could fall back on the notion of karma. The intrusion of non-rational elements can be attributed to popularity of such perception among lay persons as also to inadequacies of the medical theory itself to explain particular clinical symptoms.

Footnotes and references:

[1]:

Caraka Saṃhitā Vimānasthāna 3.24-27.

[2]:

Cakrapāṇidatta on Caraka Saṃhitā Cikitsāsthāna 3.14.

[3]:

Caraka Saṃhitā Nidāna-sthāna 1.15.

[4]:

Caraka Saṃhitā Cikitsāsthāna 3.15-25.

[5]:

Caraka Saṃhitā Cikitsāsthāna 8.10.

[6]:

Caraka Saṃhitā Nidāna-sthāna 7.21-22.

[7]:

J. Mitra, A Critical Appraisal of Āyurvedic Material in Buddhist Literature with special reference to Tripiṭaka, p.237.

[8]:

Mahāvagga I.68.126.

[9]:

Mahāvagga I.68.126.

[10]:

Mahāvagga I.62.119.

[11]:

Mahāvagga I.62.119.

[12]:

Mahāvagga I.68.26.

[13]:

Manusmṛti XI.48.

[14]:

Manusmṛti XI.49-52.

[15]:

Manusmṛti XI.53-54.

[16]:

Manusmṛti III.151.

[17]:

Manusmṛti III.153.

[18]:

Manusmṛti III.154.

[19]:

Manusmṛti III.159.

[20]:

Manusmṛti III.161.

[21]:

Manusmṛti VIII.163.

[22]:

Suśruta Saṃhitā SU.29.8.

[23]:

Suśruta Saṃhitā Cikitsāsthāna 9.45.

[24]:

Caraka Saṃhitā Cikitsāsthāna 7.8,177; Suśruta Saṃhitā Cikitsāsthāna 9.3.

[25]:

Sukla Das, “In Quest of the Antiquity of Leprosy: The Early Indian Context”, Journal of Ancient Indian History, Vol. XXIV, 2007-2008, pp. 33-42.

[26]:

Aparna Chattopadhyay, “Diseases Caused by Sins and Cure by Divine Blessings or Penance” in A. Chattopadhyay, Studies in Ancient Indian Medicine, Varanasi, 1993.

[27]:

E. Robinson, (revised), Calmet’s Dictionary of the Holy Bible as published by the Late Mr. Charles Taylor with the Fragments Incorporated, Boston, 1832, p.614.

[28]:

Sukla Das, “In Quest of the Antiquity of Leprosy: The Early Indian Context”, pp. 33-42.

[29]:

Sukla Das, “In Quest of the Antiquity of Leprosy: The Early Indian Context”, pp. 33-42.

[30]:

Suśruta Saṃhitā Nidāna-sthāna 5.31.

[31]:

Suśruta Saṃhitā Nidāna-sthāna 5.30.

[32]:

Suśruta Saṃhitā Nidāna-sthāna 5.33-34.

[33]:

Caraka Saṃhitā Cikitsāsthāna 7.9.

[34]:

Caraka Saṃhitā Cikitsāsthāna 7.37.

[35]:

Caraka Saṃhitā Cikitsāsthāna 7.48; 116, 159.

[36]:

Caraka Saṃhitā Cikitsāsthāna 7.134; 157; Suśruta Saṃhitā Cikitsāsthāna 51-53.

[37]:

Caraka Saṃhitā Cikitsāsthāna 7.157; Suśruta Saṃhitā Cikitsāsthāna 9.51-57.

[38]:

Caraka Saṃhitā Cikitsāsthāna 7.177.—vacāṃsyatathyāni kṛtaghnabhāvo nindā surāṇāṃ ṣanaṃ. pāpakriyā pūrvakṛtaṃ ca karma hetuḥ kilāsasyavirodhi cānnam.

[39]:

Manusmṛti XI.49.

[40]:

P.V. Sharma, Indian Medicine in the Classical Age, p. 60.

[41]:

Caraka Saṃhitā Cikitsāsthāna 9.58.

[42]:

Caraka Saṃhitā Cikitsāsthāna 9.20.

[43]:

Caraka Saṃhitā Cikitsāsthāna 9.21.

[44]:

Caraka Saṃhitā Cikitsāsthāna 9.21.

[45]:

Caraka Saṃhitā Cikitsāsthāna 9.21.

[46]:

Caraka Saṃhitā Cikitsāsthāna 9.21.

[47]:

Caraka Saṃhitā Cikitsāsthāna 9.88.

[48]:

C.V. Haldipur, “Madness in Ancient India: Concept of Insanity in Charaka Samhita (1^st Century A.D.)”, Comprehensive Psychiatry, Vol. 25, No. 3 (May/June), 1984, p.335-344.

[49]:

Suśruta Saṃhitā Uttaratantra 61.31-38.

[50]:

Caraka Saṃhitā Cikitsāsthāna 9.96.

[51]:

Caraka Saṃhitā Cikitsāsthāna 8.163.

[52]:

Caraka Saṃhitā Śārīrasthāna 2.7-10.

[53]:

Sukla Das, “In Quest of the Antiquity of Leprosy: The Early Indian Context”, pp. 33-42.

[54]:

Caraka Saṃhitā Sūtrasthāna 11.17.

[55]:

Caraka Saṃhitā Sūtrasthāna 11.25.

[56]:

D.P.Chattopadhyaya, Science and Society in Ancient India, p.155.

[57]:

Caraka Saṃhitā Sūtrasthāna 1.51-52.

[58]:

D.P. Chattopadhyaya, Science and Society in Ancient India, pp. 152-154.

[59]:

Caraka Saṃhitā Sūtrasthāna 10.4-5.

[60]:

Caraka Saṃhitā Śārīrasthāna 6.27.

[61]:

D.P. Chattopadhyaya, Science and Society in Ancient India, pp. 2-3.

[62]:

Caraka Saṃhitā Siddhisthāna 2.25.

[63]:

Caraka Saṃhitā Siddhisthāna 2.26.

[64]:

Caraka Saṃhitā Vimānasthāna 8.149.

[65]:

Caraka Saṃhitā Siddhisthāna 2.28.

[66]:

S.K.R.Rao, Encyclopaedia of Indian Medicine, Vol.II, p. 175.

[67]:

V. Nutton, Ancient Medicine, Oxon, second edition, 2013, p.88.

[68]:

D.P.Chattopadhyaya, Science and Society in Ancient India, p.375.

[69]:

Caraka Saṃhitā Cikitsāsthāna 7.8; Suśruta Saṃhitā Cikitsāsthāna 9.3.

[70]:

Suśruta Saṃhitā Uttaratantra 40.163.

[71]:

Suśruta Saṃhitā Uttaratantra 40.164-166/1.

[72]:

Ḍalhaṇa on Suśruta Saṃhitā Uttaratantra 40.166/1.