The science of Indian medicine is a good example of how knowledge is an integrated whole in the intellectual traditions. Indian medicine is also the earliest science that puts human psychology to service in the treatment of ailments. While major philosophical systems provide the theoretical framework for analysis of disease, its cause and cure, the world-view enshrined in those systems provides the governing philosophy of health and healing. It is also interesting to note that some of those theoretical categories, Ayurveda ^[1] shares with other disciplines such as Aesthetics. ^[2] In fact, Ayurveda and Art share the common goal of restoring human beings to good health, moral and physical ^[3]

Ayurveda is a science that enables a man to achieve a full life span. For a happy life, good health has to be sustained and if ailments afflict the body, the body has to be freed of them. Towards this end, this system of medicine, with two aspects of principles and practice, has been established by sages and seers. It has two ends – (i) freedom from illness and (ii) protection of good health through prevention. ^[4] Caraka and Sushruta are two celebrated thinkers of this science, one treating medicine in his Carakasamhita and the other dealing with surgery in his Sushrutasamhita.

The texts of science of medicine have attested history from 5^th century B.C. to modern times and has eight parts – surgery (for pain in the body), illnesses of the throat and above (including ENT), the main body (chest, stomach, heart, etc.), drives and obsessions (including nerves), pregnancy to child care, poisons, constituents/elements of the body (liquids, blood, fat, flesh, bones), energy (including reproductive functions).

Carakasamhita deals comprehensively with all the eight and is evidently a text that has come at the end of a long tradition of thought ^[5]. Caraka describes Ayurveda as the science of happy and useful life, classifies all ailments of the body into three types (intrinsic to the body, afflictions from external sources and those of the mind) and says that all ailments are ultimately rooted in what he calls pragyapradha, some failure of discriminating intellect and argues that to rid oneself of illnesses of the body and mind and to sustain good health, one must be or become sadavrtta, a person of affirmative, morally correct cognitions – “Who remains healthy?” he asks and answers, “One who eats in moderation and carefully, acts with discrimination, is not in bondage of the objects of senses, treats every one alike (samabuddhi), is truthful, is of forgiving disposition, and always follows  what the elders say.” ^[6]

Caraka’s theory of medicine is wholly embedded in the six principal darṥanas ^[7]and is founded on the shared conceptions of what constitutes ‘good’ life and what are the conditions of human happiness.

Caraka’s philosophy/theory of medicine is founded mainly in Sāmkhya-Yoga framework, though Vaiṥeṣika and Nyāya are also drawn upon in the definitions of ontological categories (such as manas). ^[8] The living human body, its afflictions and their cure is the subject matter of Ᾱyurveda. But this human body in its totality is much more than just its physical substance – it is also the internal organs, their disposition and their functions. This ‘totality’ is designated by the term puruṣa. What is a human being? What is his totality? This has to be understood. Only then one can study what the ailments are, what part(s) of the body they afflict, what is the nature and cause of those afflictions and what is their cure. Of the eight sthānas, divisions of Carakasamhitā, a whole division, ṥarirasthāna, is devoted is devoted to the human body – its constitution, its parts, its conception and its growth in the mother’s womb and its sustenance after birth. The first chapter of this division is devoted to suffering that afflicts puruṣa, the questions of sukha-duḥkha and vedanā, the cause and the role of the physician.

As we noted above, this exposition is primarily based in the Sāmkhya-Yogasystem. Puruṣa is defined in terms of the twenty-four Sāmkhya ontological primitives – the tattva. ^[9] This whole puruṣa is the substratum of suffering. The suffering is three-fold – ādhidaivika, ādhibhautika and ādhyātmika, ^[10]or nija: (engendered in the body), āgantuka: (received in the body from outside), manasa: (of the mind) in the Caraka framework. ^[11] Suffering is produced by a marked conjunction of six factors: failure of the intellect (dhi) to discriminate, of the faculty of restraint (dhṛti) to restrain, of memory (smṛti) in pertinent recall, of unrighteous experience of objects of senses or experience that is inimical for the self (asātmyārtha āgama). ^[12] Suffering, it is recognized, has as its substratum both the self (ātmā) and the body (ṥarīra). ^[13] Mind, mana, is, of course, the cognizer of joy and sorrow ^[14] regardless of where it is experienced. Further, suffering is not located in the present alone – it has a past and a future and therefore the physician treats suffering in its three temporal dimensions. ^[15]

Now cikitsā, Caraka says, is of two kinds – symptomatic (upadhā cikitsā) and fundamental (naishathiki cikitsā). ^[16] The first is directed at the attributes of the ailment and is complete when the external symptoms disappear. The second is directed at the ultimate cause(s) of the ailment, which it seeks to eliminate. The ultimate cure for all bodily suffering and suffering of the spirit is stabilizing one’s mind in the sattvika guṇa ^[17], freeing oneself from the objects of senses ^[18], overcoming desire (tṛṣṇā) ^[19]. In other words, all vedanā, suffering, ceases in the state of mokṣa which is but the Yogic state of citta-vṛtti nirodha ^[20] in which mind, manas, with all its vṛttis, tendencies of the mind, is under complete control of the Self. Caraka defines Mokṣa ^[21] as dissolution (viyoga) of attachment (sambandha) with all that binds and, hence, torments the Self. In the next four verses ^[22], he lays down the rules of conduct that help attain this state: seek and serve the good and avoid the bad human beings; be happy in the happiness of others; live a life of restraint and discipline niyama); do you duty without attachment; keep evenness of mind and intellect; control the ‘waves’, cognitions, of the mind. These values are ingrained in the ordinary, average Indian mind, which unquestioningly accepts them and follows them in the lived life. He sums up these rules – there is no liberation, mokṣa, without knowledge. This is right knowledge as it leads to liberation.

This philosophy of health and happiness has over a period of time sedimented into the Indian mind, programmed the Indian mind as the only means of ārogya, disease-free-state. Ᾱyurveda is the science that deals with life. With what kind of life, one may ask? A life of ārogya, freedom from disease, and of good health ^[23], so that one is able to perform the enjoined duties and attain the four ends of life – dharma (righteousness), artha(material ends), kāma (desires) and mokṣa (freedom of the self from all this pursuit). Ᾱyurveda, Indian medicine, is thus not concerned merely with āyu, long life. It asks – why must one live long and what kind of long life, we should aspire for? Ᾱyurveda is not concerned with ensuring long life, dirgha āyu – it seeks to promote, sukha āyu and hitāyu ^[24], a happy life and a useful life. Caraka defines happy life as one:

“…free of bodily or mental ailments, able to do all work, endowed with strength and with energy to do [his] duty, possessed of knowledge, able to use and enjoy all his senses, ornamented with virtues, able to fulfil/achieve his tasks, blessed with different sukha…” ^[25]

And hitāyu, useful life, is defined as the life of one:

“…who in all his life-time thinks of the well-being of others, considers others’ wealth as tuccha, of no consequence, is possessed of acknowledged virtues, sadguṇa, such as truth-telling, acts thoughtfully, respects those who are worthy of respect, is indifferent (udasīna) to others, serves, devotedly the learned and the aged, controls his passions, is constantly involved in sharing his knowledge, his wealth, sees all beings in his own self, accepts good advice.” ^[26]

Roga, disease, takes away from life both happiness (sukha) and usefulness (hita). Hence Ᾱyurveda is the science of medicine that enables cikitsā ^[27],restoration to the pre-affliction state of the body. ^[28] Afflictions are of three kinds, as we noted above, but it is the third group of ailments, mānasa vyādhi, afflictions of mind and spirit which, besides medicine, Caraka says need for their treatment darṥana, philosophy.

The nature, properties and functions of manas, mind, have been established by Caraka with exactness and thoroughness with the help of ideas drawn from the six philosophical systems. ^[29] Mind is an ontological primitive and has the function of selecting objects for cognitive focus (saṅkalpa/vikalpa). Mind in this sense is the presiding sensory organ. The mind’s functions are identified as:

i. grasping/cognizing the sense-object contact,

ii. self-regulation for that knowledge(under i. above),

iii. analysis of and reflection on cognitions.

After this, the intellect, buddhi, takes over. It is the intellect presided over by the self (ātmā) that programs the Mind to select, control and cognize the sense object conjunction. Mental ailments have roots in a deviant program that sets up goals for the mind that are extreme, undesirable or inappropriate and generate, in terms of conduct, acts that are described by Caraka as prajňparādha ^[30] – inordinate desire and jealousy ^[31], for example. What you desire you do not get and what you dislike continues to be present and the result is illness. Those who are sāttvika of disposition, predominantly good (sattvaguṇa pradhana), are not prone to acts, mental or physical, that are violative of wise intelligence. Desire and hate are so classified because they harm the one who nurses them more than those who are their objects. As Caraka says elsewhere ^[32] jealousy, grief, fear, anger, pride) and rivalry are products of failure of true intelligence, failure to see what is bad or good for one’s self. Prajňparādha are those volitive acts that are not approved by intellect (buddhi), tolerance faculty (dhairya) and memory (smṛti). Caraka lists such acts ^[33] that may lead to ailments as serious as paralysis – exerting beyond one’s capacity, sexual indulgence, abandoning civil behavior, insulting those worthy of respect, indulging knowingly in wrong doings, befriending wrong people, be susceptible to jealousy, fear, anger, greed, indulging in despicable, disgusting deeds with one’s body – these are all ‘crimes of intellect’ and show complete absence of discriminating faculty (viveka buddhi).

These acts are analogous of vṛttis, tendencies of Mind. When a person is afflicted by some ailments, he has to exercise control over his mind. Caraka says:

“In all ailments, the responsibility is of a physician, but in the mental ailment, it is the patients’ own responsibility. A wise man keeping in mind his own welfare, acts with great care in respect of dharma, artha and kama. It is these three that are the cause of internal sukha or duḥkha…Such a patient should discipline himself, respect the physician and recognize the truth about himself, the maryāda or limits of his family honour and conduct, the nature of time and place and social and economic strength (/weakness)…” ^[34]

It is advised that mental ailments can be cured or removed by cultivating sada-vṛttis, the positive or righteous cognitions and attitudes. He should not “seek his own sukha alone…” ^[35]. Sadavṛtti is the conduct of ‘good people’ (sajjana), those who are at peace, pure, truthful and guided by righteousness in all their acts. By following their examples, a person regains good health and also conquers his senses. This is considered so crucial for a happy, healthy life that Caraka declares that he is laying down in detail the sadavṛttis. ^[36] A study of these shows that great value is put on cleanliness of the body and of mind, generosity of spirit, kindness to others, respectful to elders, parents, teachers and guests, restraint in speech and movement, control over senses, absence of jealousy, worry, fear, possessed of humility, faith in God, devotion to those who excel in learning and arts, thoughtfulness and carefulness. We have listed only some of the properties upheld by Caraka. The whole list is a comprehensive enumeration of what will be agreed by all is list of virtues of a pious, goodman’s life. Evidently, these sadavṛttis are the same as the daivisampada elucidated in The Bhagavad Gītā ^[37]. Four of these – maitrī, karuṇā, mudita and upekṣā get mentioned in the Yogasūtra as the means of purifying the citta. ^[38]

The science of medicine thus recognizes the there is a deep connection between the body and the mind and that for good health, mind must be at peace with itself and this peace of mind is born of, to use one word, moral cognitions and conduct. The thinking itself emanates from a world-view which considers controls of the self as the highest conquest, and a deliverance from the limitations of a narrow self as mokṣa, the final state in which there is a cessation of suffering. In making a rigorous analysis of properties and affliction of body and mind, Caraka, the celebrated exponent of Ayurveda, not only draws upon the major philosophical systems, the ontology of Sāṁkhya and the epistemology of Yoga but also transforms their constructs into practical rules of conduct that will ensure a long, happy, useful life to the people.

References

[1] Based on this paper, a talk was given at Belfast on 11 April, 2005 to an audience that included physicians.

 [2] The categories of rasa (‘aesthetic experience’ and ‘chemical or substance’) and anand(‘joy’ of art experience and of life), for example.

 [3] In fact plays had actually been composed such as Prabodhacandrodaya and Jivanandanam., one of them as late as 18th century, to dramatise the whole event of falling ill and recovery and ending in  joy or bliss (anand) born of good health resulting from the cultivation of moral values.

 [4] Sushrutasamhita, 1.12,

 [5] It is said that Caraka, an Afghan resident of Gandhara the Kingdom ruled by Nagnajit, was a contemporary of the great Persian King Daryus (Darius), 6th century B.C. and a teacher at the University of Taxila.

 [6] CS, 4.2.46

 [7] In the first chapter of the fourth division of Carakasamhitā, Caraka seeks to define sorrow and suffering, analyze their cause and their cure. Here, we only note that the vocabulary of his discussion is the vocabulary of the six systems

 [8] Carakasamhita (henceforth, CS), 4.1.16-18

 [9] CS,4.1.16-38, 63

 [10] Samkhysastra

 [11] CS, 1.11.45

 [12] CS, 4.1.98

 [13] CS, 4.1.84-85,136

 [14] see, Vaisesikasastra

 [15] CS, 4.1.86

 [16] CS,4.1.94-97

 [17] CS,4.1.94

 [18] CS, 4.1.95

 [19] CS, 4.1.134

 [20] Yogasutra, 1.1.2

 [21] CS, 4.1.142

 [22] CS, 4.1.143- 146, 154

 [23] It protects and promotes the health of the healthy and cures the ills of the ailing.

 [24] CS, 1.1.41

 [25] CS, 1.30.23

 [26] CS, 1.30.26

 [27] Cikitsa is a key concept of Indian thought in grammar, philosophy, medicine and art. The word made up of the prefix ci- and the verb root kit followed by the -sa affix means ‘to systematically act almost as an act of devotion to restore or cure or elevate/purify’.

 [28] CS, 1.16.34

 [29] CS, 1.8.4,5,12; 4.1.18-23

 [30] CS, 4.1.21

 [31] CS, 4.1.102

 [32] CS,1.7.52

 [33] CS, 4.1.103

 [34] CS, 1.1.46

 [35] CS 1.8.26

 [36] CS 1.8.18-25

 [37] Bhagavadgita, 16.1-3

 [38] Yogasutra, 1.33