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1 Ancient Indian Medicine General Introduction 1. Knowledge of the cause (hetu), Symptoms (linga), emedies (auadha) of disease. !.

"iseases are caused through the e#cess, deficiency and wrong administration of sense$o%&ects, the climatic characteristics of heat and cold and the misuse of intelligence. '. Aim of Ayur(eda$$prescri%e diet, medicine and a regimen of life to ena%le a healthy man to maintain the e)uili%rium of this dhatus and one who has lost this e)uili%rium to regain it, i.e. to ad(ise man how to preser(e or secure heath (dhtu-samya). *. "iet was considered the most important agent in causing the loss of harmony of the dhatus. +he use of %eneficial food is the only cause of the growth of a person, while the use of in&urious food is the cause of disease. -. +he regimen of life to %e followed was considered e)ually important. ( dina charya) It consisted of detailed regulations for daily life and also for the control of mind and conduct. +he daily regimen of a healthy person ought to %e such as to maintain the e)uili%rium of the dh.tus. /. +reatment was adopted with a (iew to perpetuate the harmony of the dhatus, to pre(ent them from %ecoming inharmonious and to %ring them %ac0 to their normal state of e)uili%rium when distur%ed. Ascertaining through the distur%ance of the dhatus, the physician should treat diseases that are cura%le with medicines, diet and a regimen of life, each possessed of (irtues contrary to the cause, to the disease or to %oth cause and disease, reflecting the while upon the )uestion of measure and time. 1. +hough the terms used are the same as in Vaieika yet they are used mostly indifferent senses in accordance, pro%a%ly, with medical tradition. Para means superiority or importance2 Apara means inferiority or unimportance. +his importance or unimportance is in regard to country, time, age and measure. Yukti means proper selection of medicines with reference to certain diseases2 Samyoga means the mi#ing up or compounding of two or more su%stances2 Vibhga means separation2 Pthktva means difference, difference of characters and difference of identity due to numerical distinction2 Parimna means measurement %y weight Samskra means production of new )ualities Abhysa means ha%it due to constant practice. 3. +he principles of Smnya (concrete things which ha(e similar constituents or characteristics) and Viea (concrete things which ha(e dissimilar and opposite constituents or characteristics) is the main support of 4yur(eda2 for it is the principle which underlies the application of and the course of diets. 5. Su%stances ha(ing similar constituents or characteristics will increase each other and those ha(ing dissimilar constituents or characteristics will decrease each other. +hus a su%stance ha(ing the characteristics of (.ta will increase (.ta and decrease sleman which is dissimilar to it and so on. 16. 7hara0a tal0ing a%out diagnosis says that there are three special means (pram.n.s), (1) the instruction of the inspired or wise (.ptopadesa) (!) perception (pratya0a) (') inference (anum.na) 11. 8ith regard to inference (anum.na) it was held to %e of great importance. 4yur(eda was occupied from the %eginning with the in(estigation of the nature of causes (hetu) and reasons (linga) for legitimate inferences in connection with diagnosis and the apprehension of symptoms. 7hara0a holds that all three methods, the cause and effect relation (nid.na), the method of in(aria%le prognostication (p9r(a$r9pa), and the method of concomitant (ariation (upas.ya, which includes anupas.ya also) are to %e employed either &ointly or separately for the ascertainment of the nature of disease which ha(e already occurred or which are going to happen in the near future.

! :y.ya also descri%es anum.na as %eing of three 0inds, (i;, from cause to effect, from effect to cause and inference from similarities. It is essentially these three forms of inference that are descri%ed in 7hara0a Samhita, though different terms are used to denote them. 1!. M.dha(a is considered the foremost authority on diagnosis (nid.na)2 while <.g%ha=a is unri(aled in the principles of medicine (s9tra), Susruta and 7hara0a are gi(en first ran0 in the 0nowledge of surgery and anatomy (sarira), and of therapeutics (chi0itsa0a), respecti(ely. 1'. >oth 7hara0a and Susruta de(oted sections of their samhitas called :id.na sth.na to the discussion of pathology and diagnosis and they also deal with diagnosis of diseases in the sections on therapeutics, %ut M.dha(a?s deals e#clusi(ely with :id.na2 hence its importance. +he "octrine of +ridosa. 8hen the dh.tus are in their normal measure they are said to %e in e)uili%rium and this state is called dh.tu$s.mya. 8hen their normal measure is either increased or decreased, their e)uili%rium is upset and this state is called dh.tu$(aiamya (7.S. I<. / 1$1-). @f all waste products (malas) (.ta, pitta and kapha are considered primarily responsi%le for all the mor%idities of the %ody. Aor the production of a disease three things are necessary, nid.nas, the doas and the dh.tus. +he nid.nas or causes of disease, cannot produce disease directly. +hey first (itiate the (.ta, pitta and kapha, and these in their turn (itiate the dh.tus and produce disease. >ecause (.ta, pitta and kapha are the (itiators of the dh.tus, they are called doas, while the dh.tus which are (itiated are called the d9yas. Bhysiology Bage '3 If an article contains an e#cess of the element fire, it has the hot and (ehement energies. 8hen the watery element predominates the cold and lu%ricating energies are found. In earthy and watery o%&ects the oily energy e#ists. @%&ects with e#cess of ether and water ha(e the softening energy. Air causes the drying energy 8hen earth and air predominate they produce the clearing energy.
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Aood is of four 0inds, 1. asita: sold food !. pta: li)uids '. ldha: lic0ing *. khdita: chewed +he four (arieties of food deri(ed from the fi(e elements and ha(ing the si# tastes, the two properties of heat and cold and many )ualities, when ta0en in the proper )uantity directed and thoroughly digested produce a fine su%stance im%ued with energy and fire (7.S. I 1*.'). +his su%stance, which is in the form of a &uice, is called .haa$pras.da, food su%stance and rasa. 7hara0a descri%es the process of digestion. 1. Br.na sei;es the food and %rings it down to the stomach. !. +he solidity is dissol(ed %y gastric &uices. '. Softened %y oily matter. *. +he fire, stirred up %y sam.na, %la;es forth and digests the food that has %een eaten properly and in the right amount. -. +he digesti(e fire coo0s the food in the stomach, con(erting it into rasa and mala e(en as (e#ternal) fire and water coo0 grains of rice in a (essel for use as food.

' +DC 8AS+C$B @"E7+ @ FMA AS?, As a result of meta%olism two 0inds of products are constantly produced in the %ody$$those which pollute the system$$the mala, and those which sustain and nourish it$$the prasda. Malas are produced %oth in the digestion of the food and the meta%olism of the dhtus! +he malas of food are faeces and urine. +he mala of rasa is kapha, that of %lood is pitta2 that of flesh is the waste in the apertures of the human %ody, e.g. dirt of the ears, eyes, nostrils, or he pores of the %ody and the genital organs2 of fat is sweat2 of %ones is hair and nails2 of marrow is the waste matter in the eyes and oiliness of the s0in. +he theory of the waste products is that, in proper measure, they ser(e to sustain the %ody and perform important functions, %ut when in e#cess of or %elow their proper measure they pollute the %ody and may ultimately destroy it. +DC DCA + A:" I+S AE:7+I@:S, +he heart is the chief receptacle of the three most important fluids of the %ody$$the rasa, the rakta and the o"as. It is the heart which is responsi%le for the distri%ution of these (ital fluids to the remotest parts of the %ody. +his function is accomplished through the numerous siras, dhamanis and srotas that arise from it. >G@@", I+ 7DA A7+C A:" AE:7+I@:S, 7hara0a descri%es the color of healthy %lood. H+he %lood that happens to %e the color of molten gold or li0e that of the insect indragopa or li0e that of the gem called padmaraga or li0e that of gun&a sees should %e 0nown as healthy.I 8hen the %lood is (itiated %y the action of (ayu, it %ecomes (ery re, frothy, unctuous and thin. If (itiated %y pitta, it %ecomes dar0ish$yellow in color and warm, so that in conse)uence of its warmth +e#t ta0es long to congeal. If (itiated %y the action of 0apha, it %ecome slightly pale, unctuous, fi%rous and thic0. (7.S. I. !*.15$!1). It is pure %lood that %rings a%out strength, good comple#ion, happiness and longe(ity, for the life of li(ing creatures is dependent on %lood.I (7.S. I. !*.'). +he rasa is continuously distri%uted through e(ery part of the %ody simultaneously %y the (ayu called (yana whose function is to distri%ute. (7.S. <I. 1-.'6). +he "octrine of +ridoa According to 7hara0a "h.tus, including the pras.da$dh.tus and the mala$dh.tus, are modifications of the fi(e elements (%h9tas) which co$operate together to uphold the %ody. Ki==a or mala is the refuse deri(ed from the food after digestion, which is unfit to %e %uilt into the dh.tus and fit only to %e e#creted. A distinction is made %etween the two terms, 0i==a and mala, the former %eing the waste$ product of the food after digestion, while the latter is used to signify 0i==a or refuse a%o(e or %elow the normal )uantity (pra0rti$mana) necessary for the maintenance of health, that is to say, in )uantities capa%le of upsetting the e)uili%rium of the dh.tus and producing disease. +he malas include hose produced from food and also those deri(ed from the dhatus, i.e., the dhatu$malas. +he term doa is applied to the malas, (.yu, pitta and 0apha, in their capacity as (itiator of the dhatus when they are disordered %y the (arious nidhanas. +hey are termed dhatus when in their normal measure. +hus, dhatus, malas and doas are differentiated according to whether they function as supporters of the %ody or as (itiators of its proper functioning.

* <ayu, pitta and 0apha are malas from the point of (iew of their origin2 they are dhatus when in their normal measure, and they are regarded as doas when they %ecome (itiators of the dhatus. <.g%hata II 1. 7onsiders the dhatus, doas and malas different entities, assigning definite functions to each of them. !. De does not regard dhatu$samya as health and dhatu$(aisamya as disease %ut dosa$samya as health and dosa$(aisamya as disease. '. As the dosas are independent entities from the dhatus, a distur%ance of the former need not necessarily %e a distur%ance of the latter. @rigin of the dosas in the >odyJ 7hara0a considered the doas as su%stances in the nature of internal waste products produced from the una%sor%ed portion of the food after digestion, i.e., from the refuse (0i==a) of food. Susruta also e#presses a similar opinion. De says kapha is the e#creted portion of the rasa, while pitta is that of %lood, whereas 7hara0a deri(es pitta from the flesh. +he Seats of the "oas, Susruta?s description is more precise and less diffuse than that of 7hara0a.
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<.yu$$"ryness, lightness, clearness, coolness, motion, and formlessness Bitta, heat 0eenness, lightness, and slight oiliness2 in color it is not white2 its scent is li0e that of raw meat2 its taste is two fold, %itter and sour Kapha, whiteness, cold, hea(iness, oiliness, sweetness, firmness, sliminess, and softness li0e that of good earth or clay. +DC AE:7+I@:S @A +DC "@SAS, +he functions of (.yu, when in its normal state, are, energy in respect of action and mo(ements, inhalation and e#halation of the %reath, the proper functioning of the physical organs (such as speech, thought, etc.), e)ua%le course of the se(eral elements of the %ody and e)ua%le or proper discharge of e#creta and urine and such other impurities as escape or are secreted out of the %ody. (7.S. I 13.-*). <ision, digestion, the heat that is natural to the %ody, hunger, thirst, softness of the %ody, splendor of comple#ion, cheerfulness of mind, and intelligence are due to the action of pitta in its normal state. (7.S. I. 13.--), All oily matter in the %ody, tightness of the &oints, general tightness of the %ody, weight of the %ody, se#ual power, strength, capacity to %ear or endure, patience, and a%sence of renunciation of cupidity are due to the action of 0apha in its normal state (7.S. I. 13.-/) Ctiology, 7lassification and Bathology of "iseases Susruta descri%es in detail the (arious steps through which the doas pass in the course of production of disease, 1. +he first stage (kaya) is the stage of accumulation of the doas. "uring this stage the doas collect in their respecti(e places or sites. !. Prakopa or e#citation. After accumulation, as a result of the action of their respecti(e nidhnas and lac0 of treatment, they %ecome e#cited and, lea(ing their normal site, they spread.

'. +he third stage is called prasra! Something li0e fermentation of the doas. +his is mo(ed a%out %y vyu, which is the cause of all motor acti(ities. In whate(er part the fermented doas spread, there the symptoms of disease are showered down as it were, li0e water from the clouds. *. P#rva-r#pa or the stage of premonitory symptoms. +he doas get locali;ed in different parts of the %ody (sthana-samraya). +hey produce diseases after reaching different parts according to the nature of the structures contained in these parts. -. $#pa or the fully fledged disease. +his is the stage of appearance or de(elopment of the disease. Such diseases as inflammatory swellings, enlarged glands, large a%scesses, erysipelas, fe(er, diarrhea, are produced, which are readily diagnosed %y their symptoms. /. %heda +ermination. +he healing %egins or the illness %ecomes full %lown. +DC BGA7CS @A G@"GMC:+ @A "C A:GC" "@SAS A:" +DC "ISCASCS +DCK B @"E7C 1. "iseases assume (arious forms owing to the different modes in which the dosas, the dhatus, and the malas are mi#ed upon a particular case, the different parts of the %ody in which they are deranged and the causes %y which the disorders are induced. !. Susruta?s description amounts to surgical pathology. '. 7hara0a in Vimna Sthna, 7hapter < says &' the ducts are in their normal state( the body cannot be a''ected by any disease! dhamanis( sirs and srotas ducts for the carriage of the products of meta%olism and he uses Fducts? in the sense of srotas in this discussion. "iagnosis and Brognosis C#amination of the Batient 1. +o ascertain how long the patient has to li(e "ependent on ascertainment of his strength, including the amount the doas ha(e %een e#cited. !. Aor the ascertainment of the strength of the patient information on the following ten items is needed, 1. his normal constitution in health !. the a%normal constitution that has set in '. the predominance of the particular element or essence (sra) in his constitution *. his compactness or otherwise -. his proportions such as stature /. what things are suita%le to his constitution 1. his mental disposition 3. his power of assimilation 5. his power of e#ercise 16. his age. 1. A healthy constitution is one in which the three doas are in harmonious proportions. Any one of the doas may predominate in a constitution and thus we may ha(e a vtala( pittala or slemala constitution. Knowledge of the constitution is important as the effect of food and seasons (ary in different constitutions. !. +here are eight sras (predominating essences or elements) in the %ody, mind, semen, marrow, %ones, fat muscle, %lood and s0in. Satva (the mind)$$ Memory, (eneration, wisdom, (alor, purity, and de(otion to useful wor0s. Semen Guster of the %ody and firmness and white color of the %ones, teeth, and nails and se#ual desire

/ Marrow Blumpness, strength, splendor of the %ody, depth and softness of (oice and largeness of the eyes >ones Garge head and shoulders, firm teeth, &aws, %ones and nails Aat 7ool urine and perspiration, soft (oice, large %ody and capacity to %ear hardships Muscle A %ody without opening or crac0s in it, deep$seated %ones and &oints and muscular %uild >lood Smooth copper$colored nails, eyes, palate, tongue, palms and soles S0in +he luster and softness of the s0in A person should %e e#amined %y the test of his essence ( sra). +his pre(ents a physician from arri(ing at an erroneous conclusion %y a sight of the %ody alone of the patient. Such conclusions should ne(er %e formed as that one is endued with strength %ecause his %ody is large or another is of little strength %ecause his %ody is lean, et. It is seen that men whose %odies are of small dimensions or are lean are still possessed of strength. As regards e#amination of the patient %y o%ser(ation of his %ody, that %ody can %e called firm or compact which consists of symmetrical and well$formed %ones, well$0nit &oints, and well$placed flesh and %lood. +hose men who are possessed of firm and compact %odies are endued with strength. As regards e#amination of the patient?s dimensions, certain standards are laid down in the medical classics. +he entire foot is 1* fingers in length, the lower leg 13 fingers, the thigh '! fingers, the two together %eing -6 fingers in length. +he distance %etween the penis and the na(el, that %etween the na(el and the chest, that %etween the chest and the throat, and that %etween the two %reasts measure 1! fingers each. the length of the arm from the shoulder tot he el%ow is 1/ fingers. +he forearm including the hand measures !* fingers. +he circumference of the chest in females is e)ual to the circumference of the waist in males. the %readth of the chest in females is 13 fingers, which is the %readth of the waist in males. the height of the male is altogether 1!6 fingers. +he male and female attain their full de(elopment at the ages of !- and 1/ respecti(ely. If their %odies measured %y their own fingers at these ages correspond with the measurements gi(en a%o(e they attain long life and riches. If the measurements are of moderate length their li(es and riches will %e moderate, and if (ery short, then their li(es will %e short. 7apacity for food$$eating and digestion. Strength and longe(ity are %oth dependent on food. 7apacity for e#ercise$$capacity for action, for %earing weights and for the time he can perform la%or. +ime, +wo 0inds, the year and its di(ision into (arious seasons and the age of the patient. Ac0nowledge of the seasons is of special importance in connections with the administration of medicines and correcti(es. the age of the patient is of (alue in ascertaining his life e#pectancy. (7.S. III. 3). *he methods o' diagnosis (pramnas) 1. +he instructions of the inspired or wise (ptopadesa) !. o%ser(ation (pratyaka) '. inference (anumna)

1 1. Instruction of the wise @ne should first fully e#amine a disease %y means of these three. +he 0nowledge from the inspired is the most important. !. @%ser(ation (pratya0a) Susruta lays particular stress upon the interrogation of the patient in the ascertainment of certain facts a%out the disease, +he time or season of its first appearance2 the caste to which the patient %elongs,2 things or measures which tend to %ring a%out a manifest amelioration or pro(e comforta%le to the patient (s.tmya), as well as the cause of the disease the aggra(ation of pain2 the strength of the patient2 this state of digestion and appetite2 the emission of stool, urine and flatus or their stoppage2 and maturity of the disease in regard to time. 7hara0a adds to this list the dreams of the patient. '. Inference (anumana) +he two principal 0inds in practical use were the inference from cause to effect and that form effect to cause. 7hara0a mentions a third 0ind, inference of disease from its early prognostications (pur(a$rupa). +hat similar things produce similar effects and opposite things opposite effects are two of the accepted postulates of the law of s.manya and (isea. :ow applying these two principles, it is held that if the application of any particular 0ind of element increases an effect ( a particular 0ind of disease) and the application of its opposite decreases it, then that particular element may %e regarded as the cause of the effect. (concomitant (ariation) (upasaya and anupasaya) 7hara0a says diagnosis is %ased on nid.na (causes), p9r(a$r9pa (premonitory indications), r9pa (symptoms), upasaya (administration of drugs and diet), and sampr.pthi (fullness or de(elopment). :id.nas are the causes of the which e#cite the doas and induce disease B9r(a$r9pa implies those indications which manifest themsel(es %efore the appearance oft he disease 9pa are those symptoms which manifest themsel(es on the appearance of the disease Epasaya is the prescription, followed %y relief or reco(ery, of medicines, diet, and practices that are contrary to the con&ectured causes of the disease or to the disease itself as tentati(ely diagnosed or to %oth Sampr.pthi is the full de(elopment of the disease through the action, local or e#tending o(er the whole %ody, of the e#cited fault (doa) or faults (doas) which constitute the immediate nid.na of that disease. "istinguished %y considerations of sam0hya (num%er or enumeration), pradh.nya (predominance), (idhi(0ind), (i0alpa (solution of dou%t), %ala(strength), and 0.la(time) (7.S. II. 1.-L/). +he first pro%lem for diagnosis is the presence of dh.tu$(aiamya , that is the increase or decrease of some of the dh.tus, i.e., the se(en dh.tus, the doas and the malas. 7hara0a and Susruta gi(e in detail the causes, signs and symptoms of the decrease, increase and (itiation of each dh.tu, doa and mala. +he ne#t pro%lem is the stage of dh.tu$(aiamya. Susruta enumerates fi(e stage in its de(elopment$$cherry, por0pie, pras.ra, p9r(a$r9pa and r9pa. +he disease has to %e diagnosed in all these stages. After ha(ing diagnosed a disease, the ne#t thing to %e done is to ascertain whether it is a primary or independent one or merely an accessory or sympathetic one or the premonitory indication of an incipient one. "iseases at first remain as principal ones. +hey then %ecome causes of other diseases. C#ample from e#cessi(e heat of fe(er arises %lood$%ile, and from %lood$%ile springs fe(er and from these two springs consumption.

3 +here are endless (arieties of symptoms and (arieties of diseases. +here is no a%solute difference %etween a cause and an effect, and that which is a cause may %e an effect and that which is an effect may also in turn %e a cause. 7hara0 thus sums up the whole pro%lem of diagnosis, ,8ithout dou%t, ha(ing carefully noticed the particulars relating to the inducing causes (nid.na), premonitory indications (p9r(a$r9pa), symptoms (r9pa), applica%ility of medicine, diet, course of conduct (upasaya), the (arieties of diseases (sam0hya), the predominance of (.ta, pitta and 0apha in diseases (pradh.na), the class under which the disease falls ((idhi), the precise measure in which the faults ha(e %een e#cited ((i0alpa),s strength, and age or season, the physician with concentrated mind, should specially attend to the 0nowledge (analysis ) of the tastes, articles, faults, derangements, medicine, country, season, strength, %ody, diet, predominance of constituent elements (of the %ody, such as s0in, %lood, et.),assimilation, mind, constitution, and age, %ecause of the dependence of curati(e operations on a con(ersant with such analysis of the tastes etc.I (7.S. III. 1.1.). B
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Susruta HMen die from their actions in a former life, from improper treatment, and from the uncertainty of human life. 8hen life is a%out to depart, spirits, ghosts, infernal imps, and demons approach the dying and, from their desire to 0ill, pre(ent the action of medicine2 hence no treatment is effecti(e with persons whose li(es are at an end.I (S.S. 1.'1). +he physician on approaching a patient should first test his longe(ity and see if he has any (itality in him. Susruta 7hara0a at the commencement of &ndrya-sthna mentions se(eral items that should %e e#amined and attended to %y the physician desirous of ascertaining what the patient?s life e#pectancy is. +he following characteristics indicate long life, large hands, feet, sides, %ac0, nipples, teeth, face, shoulders, forehead, &oints, fingers, eyes, and arms2 e#tended eye%rows, %road space %etween the %reasts, long %reath, short legs, penis and nec0, deep intellect, low (oice and na(el, firm %reasts, large hairs growing on the ears, the top of the head %eing %ehind the median line2 the %ody commencing to dry from the head downwards after inunction of oil and %athing, the region of the heart %eing the last to dry. A patient possessing the a%o(e characteristics should %e 0nown as long$ li(ed and should %e treated (S.S. I. '-). Any symptom from which he nearness of death is inferred is called an arita. Seems to hear a noise or confounds (arious noises with each other, if he gets irritated at the (oice of a friend and re&oices at that of an enemy, feels cold as hot and heat as cold, feels %urning heat in chil%lains, does not feel a %low or e(en a cut on a lim%, thin0s he sees the stars and moon %y day and the sun at night, if his eyes are remar0a%ly restless or motionless, if %rown, red, %lue or yellow shadows follow him, if his teeth ha(e %ecome %rown or ha(e suddenly fallen out, if his tongue is white, or %rown, dry, hea(y, num%, coated or rough, his mouth smells %adly, his lim%s %ecome suddenly hea(y or remar0a%ly light, if his (eins stand out on his forehead when they did not pre(iously, if his snee;ing, cough, et., sound differently from usual, if strong perspiration occurs without cause, if the patient cannot sleep or sleeps continuously, if his feet and hands are cold, his %reathing la%ored, et.2 these are all considered ominous signs foretelling death. If any part of the %ody changes its natural color, consistency, dimensions, position, li0e an erect part hanging down or a hanging part %ecoming erect, if any part of the %ody suddenly %ecomes cold, hot, dry, oily, discolored or ener(ated, then that part has changed its usual character. Bage 16'$16* different symptoms and diseases which are fatal.

5 Susruta says, Hthe physician should not %e called in the following lunar asterisms, K Ktti0a, 4rdra, Aslesh., Magh., M9la, B9r(aph.lguni, B9r(.shada, B9r(a%h.drapada, or >harani and on the following days of the moon, the fourth, si#th and ninth and the day of the new moon.I Susruta says, H+he appearance, address, dress and action of the messenger sent to call a physician, the star, hour and lunar day on which he is called, the %irds seen at the time, the residence, speech and mental and %odily actions of the physician, all afford omens from which a fa(ora%le or unfa(ora%le prognosis may %e formed of the patient?s illness.I It was counted as a happy omen if the messenger sent to fetch the physician was clean, dressed in white, of the same caste as the sufferer and came riding in an o#$cart. it was inauspicious if the messenger was of a higher caste, a eunuch or a woman, himself sic0 or afraid, if he ran, if he wore sha%%y or dirty clothes, rode on an ass or a %uffalo, came at mid$night or mid$day or at a time of an eclipse of the moon or if he arri(ed when the physician was asleep or lay unclothed upon the ground. @mens on page 16*$16Auspicious (isions in dreams are, gods, %rahmins, H+wice %ornI people of the three upper castes, li(ing friends and 0ings2 a %rightly %urning fire, or flawless clear water promises luc0 and the (anishing of disease, Meat, fish, fruit, white garlands and clothes purport financial success and the (anishing of disease. if the dreaming person ascends stately terraces, clim%s trees laden with fruit, mounts elephants, A patient who sees auspicious dreams of his 0ind may %e diagnosed as possessed of long life (drghyus) and the doctor should accept the treatment of the case. Materia Medica Bhysicians should loo0 upon the four factors of food, conduct, earth, and time as the accumulators, aggra(ators and pacifiers of the deranged %odily doas and of the diseases resulting form them. +he term medicine signifies drugs and their (irtues, tastes, potency, inherent efficacy (prabhva) and reactionary properties (vikalpa). (S.S. I. 1). +he action of medicines is called karma, its potency vrya, the place where it operates di-kra+a, the time of operation, kla, the mode of operation, upya, and the result achie(ed, phala. -ravya is a su%stance which is independent %y itself. .una )ualities Susruta +he su%stance (dravya) e#erts its medicati(e influence through its )ualities, rasa, vipka, and vrya. +his %eing so, the )ualities or gu+as may %e considered the sakti (power) %y which the dravya) e#erts its action. Dence rasa, vrya, vipka must %e considered the sakti (potency) of the su%stance (dravya). Also the dra(ya has its influence called prabhva. 7hara0a, Vrya in its general sense means the potency or power of medicines to produce effects and as such includes within it %oth rasa and vipka, %ut since these ha(e special names the term (irya is not applied to them. "isease is the result of the increase or decrease of the dhatus and the main aim of Ayur(eda is the restoration of the ingredient dhatus of the %ody to their normal state. +he main tas0 of the Indian Materia Medica was, therefore, to in(estigate how this aim could %e attained %y the use of diet and medicines. +hese ha(e an effect on the dhatus of the %ody and on their dise)uili%rium through the influence of rasa, (ipa0a, (irya and pra%ha(a. "ra(ya, rasa, (ipa0a and (irya, each e#erts an action on the dosas. Samanya and <isesa, Su%stances ha(ing similar constituents or characteristics will increase each other, while those ha(ing dissimilar constituents or characteristics will decrease each other.

16 All articles or o%&ects in the world may %e classified as medicines, and if they are endowed with energy and other properties and are employed according to reason and necessity, they pro(e ser(icea%le in the cure of diseases. A 0nowledge of the composition of articles and the predominance of a particular %huta or %hutas in them is of great help in the selection of drugs for use as medicine. Articles containing an e#cess of the %hutas earth and water are hea(y and owing to their weight they ha(e a tendency to fall downwards. it would seem, therefore, that they act as purgati(es owing to their tendency to go downwards. Articles containing an e#cess of the %hutas of air and fire are light, as %oth air and fire are light, and owing to their lightness they ha(e a tendency to ascend. It would seem, therefore, that they cause emetics from their tendency to ascend. Articles which posses in a%undance %oth property of going upwards and downwards act %oth as emetics and purgati(es. Articles which posses in a%undance ether$$alternati(es. Air$$astringents Aire$$digestion Air and fire$$a%sor%ents or li)uefacients Carth and water$$nutrition +he primary cause of disease is dhatu$(aisamya that is the increase or decrease of the dosas, (ata, pitta and 0apha, either singly or in com%ination. +he chief use of medicines is for their action on the dosas. Sweet (madhura) increases the dhatus of the %ody, impro(es comple#ion, strengthens the %ody, heal wounds and ulcers, and purifies the rasa and the %lood. +he acid (sour$$amla) carminati(e and digesti(e, e#pels wind from the %owels, accumulates secreti(e impurities n the tissues. +he saline group (la(ana) purifies tissues, is digesti(e and rela#ing, separates impurities, accumulates e#cretions in the system, causes the %ody to lose its tone, i.e., rela#es it, clears the outlets of the system and produces softness of all the structures of the %ody. +he pungent group (0a=u) increases digesti(e power, purifies the %ody, pre(ents corpulence, causes rela#ation of ligaments of the &oints and of the system in general2 diminishes formation of mil0 ,semen and fat. +he %itter group (ti0ta) separates the doshas, is appeti;ing, digesti(e and purifying, impro(es secretion of %reast mil0, and reduces the )uantity of faeces, urine, perspiration, fat, marrow and pus. +he astringent group (0a.ya) is styptic (ser(ing to contract organic tissue2 astringent2 %inding. !. ser(ing to chec0 hemorrhage or %leeding, as a drug2 hemostatic.) and fa(ors the healing of ulcers, chec0s all discharges, separates impurities from tissues, reduces corpulence and superfluous moisture. Some authorities held that this potency (irya was only of two 0inds, hot (una) and cold (s ta). 7hara0a and Susruta held that it is of eight 0inds, hot cold moist dry mo(ing slippery soft and sharp. 7hara0a writes that the articles called Flight? contain largely the properties of air and fire, while those called Fhea(y? contain largely those of earth and water. Susruta says that the sastras mention two sorts of digestion, sweet and hot. @f these, the sweet digestion is hea(y and the hot is light.

11 De is regarded as a physician that is con(ersant with the tastes (rasas), all articles of (food and drin0), the dosas, and diseased, in respect of their potency (or (irtues),and that 0nows (the (irtues of ) place and time, as also of the %ody (i.e., the elements that constitute it and their respecti(e unctions) (7.S. III.1.'-). Medicines are employed in treatment for the purpose of restoring the deranged dosas and dhatus to their normal state. +he only logical and rational classification is that %ased on the action of drugs on the doshas and dhatus. +he dosas may collect and then get e#cited and then %egin to spread. Gater they increase in amount %eyond the normal measure. In the first case, they ha(e to %e %rought to their normal state and in the second case, they ha(e to %e got rid of from the system. Accordingly, Susruta di(ides medicines into two classes, (i;., samsamana and the samsodhana. the former are medicines which rectify the deranged state of the dosas and calm their e#cited action without promoting their e#cretion +his class is su%$di(ided into three orders, (.tasamsmana (arga, pittasamsamana (arga and slemansamsanana (arga. +he latter are medicines which remo(e collections of deranged dosas from the %ody %y promoting their e#cretion. +his class of drugs include emetics, purgati(es, errhines, depuratories. +reatment 7hapter <II +he sole aim of Ayur(eda is to ad(ise diet, medicine and a regimen of life, such that, if properly followed, a normal healthy person may maintain the %alance of the dhatus and one who has lost this may regain. +reatment is adopted with a (iew to perpetuate the harmony of the dhatus, pre(ent their disharmony and %ring them and the dosas %ac0 to their normal state of e)uili%rium when their harmony is distur%ed %y any cause. (7. S.I. 1/.-1 and -!). 8hen persons in health conduct themsel(es improperly, in respect of diet and deportment, forgetting considerations of measure and season, diseases are generated. @ne endued with intelligence and desirous of maintaining health should %estow great care upon e(erything connected with food, deportment and practices. (7.S. I. 1. *' L --). Ender tucharya 7hara0a descri%es the dietetic regulations to %e followed in the (arious seasons. In hemanta (1- :o(em%er to 1- Nanuary) one should eat fat, sour and salt, sauce, flesh of watery and marshy animals, goats, etc. %ecause cold increases the digesti(e power which ena%les one to digest hea(y and rich food. @ne should ta0e li)uor, mil0 preparations, sweets, fats, oils, new rice and hot water. he also recommends the use of ointments, massage, anointing the head with oil, staying in a warm room, in the sunshine, in a warm underground place or an inner room., etc. Similar rules are gi(en for sisisra (1- Nanuary to 1- March). @nly one should loo0 for a still %etter and warmer room protected from the wind, and a(oid pungent, light, cold and similar food and drin0. In %oth these cold seasons man is at his %est strength. In vasanta (Spring, 1- March to 1- May) the accumulated 0apha pro(o0es many diseases2 therefore emetics etc. should %e ta0en and hea(y, sour, oily and sweet food, as well as sleep %y day should %e a(oided. C#ercise, massage, inhalations, water$gargling, ointment, washing, and %athing in cold water are li0ewise recommended. As for food and drin0, %arley and wheat and the flesh of the stage, hare, antelope and )uail and certain 0inds of li)uor are recommended. In grma (summer, 1- May to 1- Nuly) one should eat tasty, cold, fluid, oily things, cold preparations of %arley with mil0 and sugar, flesh of deer, ghee, mil0 and rice. Spirituous drin0s should %e ta0en only in small )uantities or not at all or mi#ed with plenty of water. Salt, sour, pungent and hot things, as well as physical e#ercise, coha%itation and sleeping %y day in a cool place should %e a(oided. At night one should sleep in a place which has %een cooled %y rays of the moon, particularly on the windy roof of the house, should anoint oneself with cooling sandal$ointment, etc. In vara (rainy season, 1- Nuly to 1- Septem%er) the digesti(e system is wea0ened2 therefore, one should 0eep to a diet, should a(oid sleeping %y day, physical e#ercise, coha%itation, sun$heat, etc., should eat %arely, wheat and old rice and drin0 medicinal li)uor in small doses with honey, rain$

1! water or %oiled water. Massage, %aths, residence in dry places, etc., are also ad(ised. In summer and in the rainy season man is at his wea0est. In sarad (autumn, 1- Septem%er to 1- :o(em%er) one should eat in moderate )uantity things which are sweet, light, cold ,%itter and deficient in pitta,, as well as rice, %arley and wheat2 should use pure water from a spring, for washing, drin0ing and %athing, a(oid %itter drin0s, ghee, purgati(es, %lood$letting, fat and oil, and 0eep out of the east wind (7.S.1./) Along with the proper and well$controlled e#ercises of the moral functions, 7hara0a ad(ises one to ta0e to well$controlled physical e#ercise ((y.y.ma). 8hen moderately performed, this gi(es lightness, power of wor0, steadiness (sthairya) and fortitude (7.S. I 1.'6). A correct diagnosis is the foundation of rational treatment. +he indications for treatment are deri(ed from the diagnosis. >efore commencing treatment the physician should ascertain whether the disease is cura%le or not. Arom the point of (iew of treatment, diseases are di(isi%le into two classes, cura%le and incura%le. 7ura%le diseases may again %e regarded from three points of (iew, those that are capa%le of %eing cured %y easy means, those that are cura%le %y means neither easy nor difficult and lastly those that are cura%le %y difficult means. +he characteristics of diseases that are easily cura%le are, 1. the causes, premonitory indications and present symptoms are slight !. the derangement has no sympathy with the inducing causes of the disease, the derangement that has %rought a%out the disease is not capa%le of %eing aggra(ated %y the constitution of the patient. '. the inducing derangement is not sympathetic with the season in which the disease has appeared2 *. the place does not interfere with the treatment -. only one part of the %ody is affected %y the disease. /. the disease is new 1. there are no (iolent symptoms from the disease 3. the cause of the disease originated from the distur%ance of only one doa. 5. the %ody can tolerate all 0inds of medicine. 16. a good doctor, nurse medicine and patient are present. (7.S.I. 16.1!.1*). +he characteristics of diseases that are cura%le with difficulty are that the causes, premonitory indications, and present symptoms are neither slight nor (ery gra(e2 that any of these, that is, the season of the disease, its nature, and the character of those ingredients of the %ody which are 0now %y the name of d#ya is sympathetic with the derangement that induces the disease2 that the disease appertains to an elderly woman, an old man o an infant2 that it is not characteri;ed %y e#cessi(ely (iolent symptoms2 is such that is should %e treated with the aid of operations %y (surgical) instruments, %y caustic al0ali, or %y fire2 that it is chronic2 that it affects some (ital lim% or some &oint of the %ody or affects only one part2 that the four principal re)uisites of treatment are wanting in some particular and the disease affects two parts2 that the disease is not (ery old and lastly that the disease has %een induced %y a dou%le derangement2 such diseases should %e 0nown as cura%le with difficulty. C(en diseases that are incura%le, in conse)uence of the e#haustion of one?s allotted period of life, may %e 0ept in a suppressed state %y means of regulated diet and proper nursing (7.S.1.16 1-$13). 8hen the disease is deeply ingrained (in the marrow and such other constituents of the %ody) when it affects many of the constituent parts, when it is attached to the (ital lim%s and &oints of the %ody, when it manifest itself continuously, when it is chronic and (ery old, when it is %orn of the derangement of two of the three ingredients (of (at, pitta, 0apha) or of all the three, when it is %eyond the operation of treatment, when it affects all the organs, when the patient is thoroughly cheerless and despairing, when the disease is characteri;ed %y a stupefaction of the mind, when it wea0ens all the organs (of 0nowledge and action), when it has reached the highest limit of aggra(ation and the patient has %ecome entirely strengthless, and lastly, when it shows indications of

1' the patient?s dissolution, it should %e regarded as one that should not %e ta0en up for treatment (7.S. I 16.15$!1). 7hara0a and Susruta descri%e the four re)uisites of successful treatment. +hese are the physician, the patient, medicines and the attendant on the patient. Bhysician$$learned in the sastras, practical e#perience, sensi%le, furnished with instruments and medicines. Batient$$(itality, strength, and a cura%le disease, can procure all articles necessary for treatment, self$controlled, faithful and o%edient to the physician Medicine$$grown in pure soil, collected on an auspicious day, and administered in proper doses and times, which are pleasing, and endowed with their proper colors odors and tastes which can remo(e the disorders of the doas and cure diseases, which do not cause in&ury when gi(en under misapprehension, are said to possess their necessary )ualities. +he attendants should %e amia%le, capa%le of preser(ing secrets, strong in %ody and de(oted to the care of the patient. +hey should carry out the orders oft he physician and ne(er %e tired (7.S.I.'* and 1.5). "isease must %e treated in the earliest possi%le stage +hree seats of disease (s.0h.) the e#ternal the (ital parts (middle), the 0o=a the internal S.0h. includes the s0in and the dh.tus, e#cept rasa +he (ital parts are the arms, %rain and the li0e, the %one$&oints of the different %ones and the arteries and (eins attached to them 7hara0a considers that the disease is incura%le if it affects the (ital parts and 0o=a. As long as the disease affects only the three or four first stages into which the food$&uice or rasa of the organism is gradually transformed, %lood, s0in and flesh may %e cured. If it reaches the su%se)uent stages of meta%olism, the more (ital and su%tle transformations of rasa, namely the %ones, marrow and semen the disease is %eyond cure. 7hara0a descri%es si# processes which, as method of treatment, are sufficient for all diseases. langhana, %rimhana, r90shana, snehana, swedana and stham%ana. 1. Ganghana$$anything that lightens or attenuates the aggra(ated dhatus and dosas. !. >rimhana$$that which promotes nutrition and puts on weight '. 90shana$$that which %rings a%out dryness, roughness and paleness of the %ody *. Snehana$$that which leads to secretions of oily matter, softness of the %ody and increase of impurities -. Swedana$$anything that produces perspiration and destroys stiffness and hea(iness and sensation of cold /. Stham%ana$$that which constipates or stops the motion of such constituents of the %ody as are li)uid and restless and enduced with motion +he four 0inds of correcti(e process, administration of emetics, of purgati(es, or errhines or cere%ral purgati(es and dry enemata, as also the %earing of thirst, and winds and the heat of the sun, drin0ing of medicines called p.chana, fasts and physical e#ercise, are included under langhana. +reatment of (ata foremost is enemas +reatment of pitta foremost is purgati(es +reatment of 0apha foremost is emetics

1* Susruta di(ides medicines into two classes with reference to their action on the dosas Samsamana and samsodhana Samsamana class is comprised of medicines which rectify the deranged state of dosas and calm their e#citement without promoting the e#cretions. Samsodhana class is comprised of medicines which remo(e collections of deranged dosas and discharge them through the e#cretions. +he samsamana group of drugs HsuppressI the disordered dosas and the samsodhana group Hclear upI the accumulated dosas. 7hara0a di(ides treatment into two 0inds, santarpana and apatarpana Santarpana is the prescri%ing of food and practices that ha(e a soothing an nutriti(e effect on the system. Apatarpana is a course of treatment that dries up the dosas. 7ertain diseases were recogni;ed as produced %y o(er$indulgence in sedati(e and nutriti(e food and practices. 7ertain others were produced %y rigorous a%stinence from such 0ind of food and practices. Aor all diseases generated %y apatarpana, there is no alle(iation without purana or santarpana2 as for diseases generated %y purana or santarpana, there is no alle(iation without apatarpana. Atatarpana is of three 0inds, 1. langhana2 !. langhana$pachana and '. do.(asechana. Ganghana is to %e used for dosas slightly pro(o0ed. A dosa slightly pro(o0ed and of little strength %ecomes dried up through the increase of digesti(e fire and of (ayu %rought a%out %y langhana, &ust as a shallow pool is dried up %y heat and wind. A dosa that is pro(o0ed a little more than what would %e called slight and that processes medium strength is dried up %y the administration of %oth langhana and p.chana, &ust as a slightly larger pool is dried up %y the wind and the rays of the sun, as also %y dust and ashes falling upon it. B.chana are medicines which digest undigested food without increasing the appetite. In cases where the dosas ha(e %een e#cited to a great degree it is necessary to drain them out. this process is called a(asechana. +he means adopted for this purpose are the administration of correcti(es such as emetics and purgati(es and the application of swedana and snehana. @f these three 0inds of treatment, langhana and langhana$p.chana come under the heading of samsamana and do.(asechana under that of samsodhana (7.S. III.'. -1$/!). In the treatment of disease regimen of life and diet were considered at least of e)ual importance with drugs and more strictly therapeutic measures. 7hara0a considers diseases which re)uire treatment %y instruments and caustics to %e cura%le with difficulty (7.S.I 16. 1-$13). 7hara0a recogni;es three (arieties of mental disease, those produced %y the disorders of the %odily dosas, those produce %y the mental dosas, and those produced %y a com%ination of the two. +he disharmony of the dosas of the %ody is to %e treated in the rational way and the derangement of the mental dosas %y mantras an other theurgic practices. (7.S.II * and 7.S. <I.5). Surgery in Ancient India 1. A marma is a &unction or meeting place of the fi(e organic structures, that is, of ligaments, %lood (essels, muscles, %ones and &oints.