Charaka Samhita and Sushruta Samhita

by Nayana Sharma | 2015 | 139,725 words

This page relates ‘Knowledge of Dietetics’ of the study on the Charaka Samhita and the Sushruta Samhita, both important and authentic Sanskrit texts belonging to Ayurveda: the ancient Indian science of medicine and nature. The text anaylsis its medical and social aspects, and various topics such as diseases and health-care, the physician, their training and specialisation, interaction with society, educational training, etc.

Knowledge of Dietetics

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The importance of food (ahara) for living beings cannot be overestimated. Food is recognised as one of the supports of life-the vital substance of living beings from which they derive their strength, complexion and vitality.^[1]

As Ātreya explains to his students:

hitāhāropayoga ekaeva puruṣavṛiddhikaro bhavati,
ahitāhāropayogaḥ punarvyādhinimittamiti.^[2]

“Wholesome food is one of the causes for the growth of living beings and unwholesome food for the growth of diseases.”

The Saṃhitās are concerned with two kinds of dietetics -one in relation to nutrition (and prevention of disease) and second for the alleviation of disease. The physiology of digestion and absorption of ingested substances has been explained. Alimentary substances and living beings are composed of the same five primordial elements-earth, water, fire, air and ether.^[3] After ingestion, these substances undergo digestion and metabolization to produce a nutritious essence which is known as rasa (plasma). Rasa is the essential juice that constantly moves from the heart through twenty-four vessels (dhamanis) to all parts of the body. It performs the functions of snehana (lubrication), jīvana (vitalization), tarpaṇa (nourishment) and dhāraṇa (maintenance).^[4] The body owes its growth, development, nourishment, lubrication and sustenance to this primordial fluid. All the tissues or dhatus (blood, muscle, fat, bone, bone-marrow, and semen) are derived from rasa. Hence, this nutrient fluid needs to be preserved by keeping a careful watch on diet and regimen.^[5]

Knowledge of dietetics, especially the beneficial and harmful aspects of food articles, is absolutely vital for the medical practitioner. Ancient medical theoreticians seek to analyse the pharmacodynamics of drugs and dietetic substances in terms of rasa (taste), guṇa (property), vīrya (potency), and their pharmacokinetics thorough the concepts of vipāka (final taste after digestion)^[6] and prabhāva (specific action).^[7] The best kind of diet incorporates all the six rasas.^[8] The guṇas or physical properties are twenty in number.^[9] An understanding of these concepts is essential for the physician since diet has been attributed a major aetiological role in diseases according to the Saṃhitās. We have noted earlier that dietary imprudence features in the aetiology of almost all internal disorders with the exception of a few.^[10] Fever,^[11] haemorrhagic disorders (rakta-pitta),^[12] phantom tumour (gulma),^[13] urinary disorders (prameha),^[14] skin disorders (kuṣṭha),^[15] consumption (śoṣa),^[16] oedema,^[17] abdominal colic,^[18] heart disease,^[19] diarrhoea,^[20] anaemia,^[21] morbid thirst,^[22] hiccough and breathlessness (śvāsa)^[23] are some of the ailments brought on by faulty dietary regimen. Certain types of food are correlated to particular disorders; thus, habitual consumption of acrid, sour, salt alkaline, sharp and hot substances as well as those which produce acidity is associated with rakta-pitta;^[24] hot (uṣṇa) and heavy (guru) food substances with vāta-rakta,^[25] etc. Even eye diseases are caused by excessive intake of vinegar, sour gruel, acidic food, kulattha and māṣa pulses.^[26]

In its final effect, food can be either wholesome or unwholesome; the former contributes to growth and its reverse to disease. Dietetic regimen plays a therapeutic role in Āyurveda along with saṃśodhana (elimination of vitiated doṣas through pañcakarma), saṃśamana (drug therapy) and ācāra (rehabilitative measures).^[27] Dietary regulation is often the first step of therapeutics, as for instance, in the treatment of inflammations.^[28] Abstinence from food (apatarpana) is advised to pacify the vitiated doṣas after taking into consideration the doṣa involved and the strength of the person.^[29] One of the effects of various eliminative therapies, like oleation, emesis, purgation, blood-letting, enema and such therapies is weakening of the digestive power. Its revival is possible by following a dietary plan in correlation with the quantity of doṣas eliminated. The patient is given easily digestible items in the beginning in small quantities and is gradually introduced to solid items in increased quantities.^[30] The analogy given here is that small pieces of wood help in stoking the fire rather than pouring fuel in large quantity.^[31]

Therefore, as nutritionists, one of the chief concerns of physicians lay in the identification of dietary properties of various substances and other factors that account for wholesomeness or otherwise for individuals.

Caraka enumerates eight factors that determine the beneficiality of various food substances:^[32]

(i) Prakṛti/ nature of the substance which in turn is determined by its inherent properties. For instance, mugda (Phaseolus mungo Linn.) and meat of eṇa deer are light but māṣa (Phaseolus radiatus Linn.) and sūkara or boar meat are heavy.^[33]

(ii) Karaṇa/ method of processing: Processing causes transformation of inherent attributes of substances through dilution, application of heat, cleansing, churning, storing, maturing, flavouring, saturation, preservation, and storage in a particular kind of container.^[34] As for example, the vrīhi type of corn and saktu (roasted corn flour) are naturally heavy and light. When cooked, however, vrīhi becomes light and saktu becomes heavy.^[35]

(iii) Saṃyoga/combination: Combination of certain substances are particularly harmful, as for instance, honey and ghṛta or honey, fish and milk.^[36] Incompatibility of tastes is explained by Suśruta.^[37]

(iv) Rāśī/ quantity is the total quantum of food or of individual substances whose effects determine if the dosage is proper or not.^[38] The quantum differs from individual to individual and depends on the power of digestion and metabolism.^[39]

(v) Deśa/habitat determines the inherent properties of substances. Thus, plants and animals inhabiting the desert are light; those of marshy areas are heavy.^[40] Therefore, intake of dry and sharp substances in desert areas and unctuous and cold items in marshy areas would be harmful.^[41]

(vi) Kāla/ time relates to time of the day or night, condition of health as well as the age of the individual. The condition of health is relevant for the stage of the disease.^[42]

(vii) Upayogasaṃsthā are rules governing the intake of food and are for most part dependent on the symptoms of digestion.^[43] Consuming food before the previous meal has been digested is understood to provoke all the three doṣas.^[44]

(viii) Upayoktṛ is the subject in question. Wholesomeness depends on the one who consumes.^[45] In the prescription of a diet regimen, the physician has to take into consideration factors such as the nature of the disease, habits, constitution and digestive capacity of the patient, the locality and the season.^[46] Those who are inactive, tender, of weak digestion or comfort loving need to consider the nature (i.e., attributes) of food items; but these considerations are not necessary for active persons with good digestive power.^[47]

Lightness or heaviness of eatables is to be determined by taking all these factors into consideration. Strength (bala), health (ārogya), longevity (āyu) and vital breath (prāṇa) are dependent upon the power of digestion (agni).^[48]

As Ātreya explains:

“Alleviation and aggravation of all doṣas are dependent on agni (power of digestion and metabolism). Therefore, it is always necessary to maintain agni and to avoid factors responsible for the vitiation of agni.”^[49]

The authors of the Saṃhitās have analysed the pharmacological properties of dietary articles. Caraka classifies them (including liquids and prepared foods) into twelve groups,^[50] while Suśruta classifies food items into eleven groups with sub-groups^[51] and liquids into ten groups.^[52] Properties of metals and precious stones have also been included by the latter.^[53] Observance of hygiene in the preparation of food^[54] and in the dining area^[55] has been emphasised. Suśruta has also described the regimen to be followed at meal time, i.e., the utensils to be used, the order in which items should be served, the posture in which one should eat, the manner of eating, and the appropriate time of dining.^[56] The post-meal regimen has also been explained.^[57] Both in the classification of dietary articles and in the description of meal regimen, Suśruta’s work is far more comprehensive.

Considering the importance of diet to human sustenance and its nutritional complexities, it is not surprising that Suśruta has recommended the appointment of a physician to the post of the superintendant of the kitchen. The physician had necessarily to be involved in the preparation of the patient’s diet. Besides, dietary articles are usually cooked with the requisite drugs; thus, meat soup prepared with bitter and pungent drugs or pulse soups with similar spices is offered to the convalescent.^[58] This necessitates a thorough understanding of the nature of transformation of inherent dietary properties by processing, etc., consideration of habitat, the condition of the individual in question and suitable food combinations. In certain combinations food items can turn poisonous.^[59]

Footnotes and references:

[1]:

Caraka Saṃhitā Sūtrasthāna 11.35.

[2]:

Caraka Saṃhitā Sūtrasthāna 25.31.

[3]:

Suśruta Saṃhitā Sūtrasthāna 1.22; 14.3.

[4]:

Suśruta Saṃhitā Sūtrasthāna 14.3.

[5]:

Suśruta Saṃhitā Sūtrasthāna 14.12.

[6]:

Caraka Saṃhitā Sūtrasthāna 25.36; Suśruta Saṃhitā Sūtrasthāna 40.1-10.

[7]:

Caraka adds the concept of prabhāva to understand the dissimilar actions of two drugs having similar rasa, vīrya and vipāka; Caraka Saṃhitā Sūtrasthāna 26.67.

[8]:

Caraka Saṃhitā Vimānasthāna 1.20. The six rasas or tastes are madhura (sweet), amla (sour), lavaṇa (salty), kaṭu (acrid), tikta (bitter) and kaṣāya (astringent). See Suśruta Saṃhitā Sūtrasthāna 42.3.

[9]:

Caraka Saṃhitā Sūtrasthāna 25.36. Substances can be heavy (guru), light (laghu), cold (śita), hot (uṣṇa), unctuous (snigdha), dry (rūkṣa), mild (manda), sharp (tikṣṇa), stable (sthira), fluid (sara), soft (mṛdu), hard (kaṭhiṇa), non-slimy (viśada), slimy (picchila), smooth (ślakṣṇa), rough (khara), fine (sūkṣma), stout (sthūla), viscid (sāndra) and liquid (drava).