Pramāṇa · Search · About · API

History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c22: 4.5 Medical Techniques

History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c22

Language
English

Contents

4.5 Medical Techniques

v1.c22.1

Ayurveda, the ancient Indian Science of Life has its roots in antiquity. The early records about the medical techniques are seen in the Vedas, especially the *Atharvaveda*. But, most of these descriptions are in the form of terse aphorisms randomly scattered throughout the compendiums. In later days during ancient classical period the medical knowledge took a new organised shape and several schools of thought developed. Medical disciplines were developed from the ‘Atreya’ school of thought, which had been contributed by the chief disciples of Atreya, by compiling classics individually. Among these the *Agniveśa tantra* popularly known as *Caraka Saṃhitā* stands as the finest document of the creative period of ancient Indian Medicine with regard to the extent of its contents and to the state of its preservation. *Suśruta Saṃhitā* and *Vāgbhaṭa Saṃhitā* both have contributed much to the conceptual and therapeutic aspects of ancient medicine. In the course of development of the art and science of medicine in ancient India a number of medical techniques were evolved which reflect on the technical skill in this field.

v1.c22.2

These medical techniques can be categorised into three groups as mentioned below:

v1.c22.3

1. Diagnostic Techniques
2. Prognostic Techniques
3. Therapeutic Techniques

Diagnostic Techniques

v1.c22.s1.1

Diagnostic skill was the greatest achievement of ancient Indian Medicine. Caraka lays great emphasis on an early and correct diagnosis as the basis of any rational treatment. He devotes two complete *Sthānas*, the *Nidāna* and *Vimāna* in his ‘*Saṃhitā*’ to an exhaustive discussion of the subjects of different diagnostic techniques. Chapter 8 of the *Vimāna Sthāna* is perhaps the most comprehensive and complete discussion of the subject of diagnosis we possess in any ancient medical literature. The physicians conversant with this science, reflecting in all manner of ways, upon everything as far as possible, should then come to a conclusion about the diagnosis of the disease before him and the treatment that should be followed. The physician who fails to understand the constitution of the patient with knowledge and perceptual vision can never treat diseases (CS.VI. 4.13-15).

v1.c22.s1.2

The methods of approaching the patient to diagnose the ailment can be of two types.

v1.c22.s1.3

1.1. Examination of the patient

v1.c22.s1.4

1.2. Examination of the disease

v1.c22.s1.5

*Examination of the patient* (CS. VI. 7.94-122)

v1.c22.s1.6

Great emphasis was laid on the examination of a patient. This essentially involves the study of personality, strength and vitality of the patient. Caraka describes the following techniques for this purpose.

v1.c22.s1.7

(1) *Prakṛti* (Constitution), (2) *Vikṛti* (Morbidity), (3) *Sāra* (Excellence of *Dhātus* or tissue elements), (4) *Saṃhanana* (Compactness of organs),(5) *Pramāṇa* (Measurement of the parts of the body) (6) *Sātmya* (Homologation),(7) *Sattva* (Psychic condition),(8) *Āhāra Śakti* (Power of Intake and Digestion of Food), (9) *Vyāyāma Śakti* (Power of Performing Exercise), (10) *Vayaḥ* (Age).

v1.c22.s1.8

1. *Prakṛti*: Total constitution of the foetus is genetically determined by (1) Sperm and Ovum, (2) Seasons and Conditions of the Uterus, (3) Food and regimen of the mother and (4) Nature of the *Mahābhūtas* comprising the foetus. The foetus gets characterised with one or more of the *doṣas* which are dominantly associated with the above mentioned factors when they initially unite in the form of foetus.

v1.c22.s1.9

*Prakṛtis* are of seven types, three individual doṣic constitutions and three dual with combination of two *doṣas* and one with all *doṣas* in equal proportions. A detailed description of the qualities of individual constitutions is available in all major ancient classics of Indian Medicine. The *Doṣa Prakṛti* of an individual presents as the sum total of his physique, physiology and psychology and hence the *Acāryas* describe a comprehensive typology of human variation for determination of which an equally comprehensive technology is visualised.

v1.c22.s1.10

2. *Vikṛti* (Morbidity): Morbid manifestations are to be examined with reference to the specific causative factors *doṣas* and *dhātus* involved in the pathogenesis, *prakṛti* or constitution of the individual, habitat, season and strength and also the symptoms of the disease.

v1.c22.s1.11

Without determining the nature and strength of the causative factors etc it is not possible to know the nature of the disease. Moreover, morbidity helps in the assessment of the susceptibility and endurance pattern of an individual.

v1.c22.s1.12

3. *Sāra*: Patients are to be examined with reference to *sāra* or the excellence of their *dhātus* and body tissues with a view to determining the specific measure of strength. They are classified into qualitative categories depending upon the *sāra* or excellence of their *dhātus*:

v1.c22.s1.13

(1) Tvak (Skin, contextual meaning Rasa Dhātu), (2) Rakta (Blood), (3) Māṃsa (Muscle tissue), (4) Medas (Adipose tissue), (5) Asthi (Bone tissue), (6) Majjā (Marrow), (7) Śukra (Semen), (8) Sattva (Mental faculties).

v1.c22.s1.14

The detailed description of the qualities of above types are mentioned in Caraka Saṃhitā with brief mention of the technique of determination of the Sāra.

v1.c22.s1.15

4. Saṃhanana: A compact body is characterized by the symmetrical and well divided bones, well knit joints and well bound muscles and blood. An individual having a compact body is very strong, otherwise he is weak. When the body is moderately compact, the individual is possessed of moderate strength.

v1.c22.s1.16

5. Pramāṇa: A patient is also to be examined with reference to pramāṇa or the measurement of his bodily parts. This is determined by measuring the height, length and breadth of different parts by taking finger breadth of the individual as the unit of measurement. This is called Aṅgula Pramāṇa.

v1.c22.s1.17

The normal measurements of individual (all) body parts in Aṅgula Pramāṇa are described in all the three Saṃhitās. A body possessed of organs having proper measurement is endowed with longevity, strength ojas, happiness, power, wealth and virtues. If the measurements are not at par with standard norms the individual is considered weak and inferior.

v1.c22.s1.18

6. Sātmya: Stands for such factors as are wholesome to the individual even if used continuously. Individual for whom ghee, milk, oil and meat soup as well as the drugs and diets having all the six tastes are wholesome, are endowed with strength, the power of facing difficult situations and longevities. Those who are accustomed to unctuous things and drugs and diets having only one particular taste, are mostly possessed of less strength, less power (or resistance) to face difficult situations, are of smaller life-span and of meagre accessories like drugs for the treatment of his diseases. If there are combinations of both these types of homologation, individuals are possessed of moderate strength. Sātmya-asātmya is determined in terms of Rasa, Guṇa etc.

v1.c22.s1.19

7. Sattva is mind and it regulates the body functions to a great extent of its association with the soul. Depending upon its strength it is categorised to be of three types viz. 1) Superior, (2) Medium, (3) Inferior. Sattva Parīkṣā is essentially the Manobala Parīkṣā i.e. examination of mental stamina.

v1.c22.s1.20

8. Āhāra Śakti: One's capacity for food can be examined from two angles viz. (1) power of engestion, (2) power of digestion. Both these strengths and life-span are determined by giving a particular diet and by watching its digestion.

v1.c22.s1.21

9. Vyāyāma Śakti: The patient should be examined with reference to his capacity for exercise in the fixed exercise endurance. Strength of individuals is classified into three categories depending upon the ability to perform works/exercise, viz. (1) Pravara, (2) Madhyama, (3) Avara.

v1.c22.s1.22

10. Vayaḥ: The age of the patient represents the state of his body depending upon the length of the time that has passed since birth with a view to ascertaining the life span of an individual, and the rate of ageing process. A schedule of symptoms are described in the Indriya sthāna of Caraka Saṃhitā.

v1.c22.s1.23

*Examination of the disease*

v1.c22.s1.24

The ancient classical methods of investigation of disease are described under the following headings (CS. Ni. 1.7-11)

v1.c22.s1.25

1. *Nidāna*: *Nidāna* essentially refers to the aetiology of disease. One finds extensive description of a wide variety of causative factors, viz. biological, psychosocial and environmental. The basic technique of detection of aetiology is interrogation and observation.

v1.c22.s1.26

2. *Pūrva Rūpa*: This refers to the prodromate of the disease. By analysing this, the intensity and character of the disease can be ascertained at the earliest. It is also helpful in the prognosis. This description of prodromal symptoms and signs are seen in the texts while describing the features of the individual diseases.

v1.c22.s1.27

3. *Rūpa*: The knowledge of the manifested characteristic features of different diseases is very important for the diagnosis and to assess the intensity of the disease. These descriptions are also seen in all major classics either in the Nidāna Sthāna or in the context of Cikitsā.

v1.c22.s1.28

4. *Upaśaya*: It is a technique of diagnosis by utilising therapeutic test usually applied in cases where the etiology and symptomatology of a disease do not give conclusive clue to the predominance of *doṣa*. This diagnostic therapy is used in the form of diet, drug and or any other remedial measure to find out the original nature of disease.

v1.c22.s1.29

5. *Samprāpti*: It is the description, in detail of all the morbid processes that take place in different diseases or in different stages of the same disease. The accumulation of *doṣas*, their movements and the particular form which the disease takes, are included in *Samprāpti*. *Dosa*, *Duṣya*, and *Adhiṣṭhāna* are the main *Ghaṭakas* or components of the *Samprāpti* of a disease.

v1.c22.s1.30

These five techniques are useful to ascertain the character and strength of a disease.

v1.c22.s1.31

*The Four Pramāṇas of Ayurveda*

v1.c22.s1.32

According to *Darśanas* i.e. the systems of Indian Philosophy, the means of obtaining true knowledge are mainly three, viz.

v1.c22.s1.33

(1) *Pratyakṣa* (perception)

v1.c22.s1.34

(2) *Anumāna* (Inference) and

v1.c22.s1.35

(3) *Āptavacana* (revelation, oral evidence or valid testimony).

v1.c22.s1.36

These three, known as *pramāṇa* provide within themselves for a thorough investigation of all the material and abstract aspects of the universe. Hence they have been accepted as the methods of examination by all ancient Hindu Sciences including Ayurveda.

v1.c22.s1.37

*Caraka Saṃhitā* (Su. 11.17) enumerates the above three *Pramāṇas* and adds one more, the *Yukti* as the fourth. In fact it is included in *Anumāna* itself but it has been given an independent status in view of its importance in practical application.

v1.c22.s1.38

*Three other techniques of examination*

v1.c22.s1.39

1. *Darśana Parīkṣā (Inspection)*: Under this technique the physician has to inspect the *Varṇa* (colour), *Chāyā* (lustre and complexion), *Saṃsthāna* (shape, quality, external appearance features), *Pramāṇa* (number and proportion), *Prakṛti-Vikāras* (the normal and abnormal appearance of the body) and *Anuktam* which ever else not mentioned here but comes within the perview of the eyes like *saṃkhyā* (number, counting) *ceṣṭāgati*, *spandana* (movements, pulsations, throbing etc.) (*CS Vi* 4.7).

v1.c22.s1.40

2. *Sparśana Parīkṣā (Palpation)* (CS. In. 3.3.): It is the hands of the physician that are essential for this examination. Through this technique physican can get the knowledge regarding ‘Gunas’ like *Śīta*, *Uṣṇa*, *Mṛdu*, *Kaṭhina* etc. (qualities such as heat, cold, soft, hard and many other *spandanas* or pulsations); *sat* and *asat* *bhāvas*. (Ca. Indriya 3/4).

v1.c22.s1.41

3. *Praśna parīkṣā*: This is the technique of obtaining knowledge regarding the etiology and symptomatology of a disease by interrogation. This is an important technique which is ultimately helpful in the diagnosis and prognosis of a disease.

v1.c22.s1.42

As a matter of fact *Praśna* or interrogation is the basic technique of all other clinical investigations. When the patient is in unconscious state, the well wishers and attendants of the patient (*Āptas*) are to be interrogated. This gives the first hand knowledge about the disease.

v1.c22.s1.43

*Nāḍī Parīkṣā*: Examination of pulse is another important diagnostic technique. The description about the *Nāḍī Parīkṣā* is not available in the major ancient classics of Ayurveda. However, this technique appears to have been introduced during the medieval period by Sārangdhara in the context of *Aṣṭavidha Parīkṣā* i.e. eightfold clinical examination namely *Nāḍī* (Pulse), *Mūtra* (urine examination), *Mala* (stool examination), *Jihva* (tongue), *Tvak* (skin), *Dṛṣṭi* (eyes), *Śabda* (speech), *Ākṛti* (appearance) are described in details in *Yoga Ratnākara*.

v1.c22.s1.44

The *Nāḍī* (pulse) is examined at the root of the hand i.e. at the wrist in a relaxed state. A pulse of very high rate with low pitch and volume gives the feeling of a serpentine movement which is characteristic of *Vātika Nāḍī*. A moderately rapid pulse with high pitch gives the feeling of a movement simulating jumping movement of a frog which is characteristic of *Paittika Nāḍī*. A pulse which is relatively slow in rate but high in volume gives the feeling of the movement of a swan which is characteristic of *Kaphaja Nāḍī* (*Sāraṅg.S.* 3. 1-8)

v1.c22.s1.45

*Mūtra Parīkṣā*: Urine examination has been an important technique for clinical diagnosis. Besides the physical examination in terms of colour, consistency, turbidity, taste etc the technique of *Taila Bindu Parīkṣā* (oil drop test) is described in later texts. In this technique a drop of oil is left on the surface of the patient’s urine and the movements of the oil drop in different directions and its rate of spread and change in colour etc are interpreted in terms of a number of chemical and physical properties of urine such as ph, specific gravity, surface tension etc. and also in terms of *Pañca Mahābhuta* and *Tridoṣa* (*YY*. 1, *Bās*. 3):

v1.c22.s1.46

*Mala Parīkṣā*: Examination of faeces is described as an important technique for diagnosis of a disease and disease state. Besides routine physical characteristics of stool such as colour, consistency appearance etc, an important consideration is the Sama-Nirāma Parīkṣā (M.Ni. 3, Ma.K, vs 12-13). For this a known amount of the faecal matter is dropped in water and if it floats on the surface of water it is inferred that the Mala is in Nirāma Avastha. If it dips in water it is considered Sama. The degree of Amavastha can be measured quantitatively by measuring the degree of dipping of the stool in depth of water. It is a very useful technique which can be interpreted in a variety of ways giving significant information on digestive and metabolic state of a patient.

Prognostic Techniques

v1.c22.s2.1

The art of prognosis was highly developed in ancient Indian Medicine. The origin of the art of prognosis has to be traced to the inherent desire of the physician to know with some certainty what would be the outcome of his treatment and the course which the disease he was treating would take. In pre-vedic times when the cause of disease was attributed to external agencies the modest physician looked to these agencies for some guidance as to the outcome of the disease. But as magic and witchcraft were replaced by empiricism and reason, prognosis assumed a different aspect. It was common experience that some patients died inspite of adequate treatment. As Caraka remarks, there are patients that meet with death not withstanding the application of treatment in its entirety. Not all patients by obtaining treatment obtain recovery. The reason is that not all diseases are capable of cure. The great problem therefore was to discover what were the factors that influenced the course of treatment for good or ill and how to ascertain them before hand i.e. before the treatment was commenced ‘Men die’ says Suśruta from their action of former life, from improper treatment, and from the uncertainty of human life. When life is about to depart, spirits ghosts and demons approach the dying and from their desire to kill, prevent the action of medicine hence no treatment is effective with persons whose lives are at an end (SS. Sū 31. 31).

v1.c22.s2.2

That is why such great emphasis was laid on the ascertainment of the period of life expectancy. The physician on approaching a patient should first test his longevity and see if he has any vitality in him says Susruta. So also Caraka at the commencement of Indriya-Sthāna mentions several items that should be examined and attended to by the physician desirous of ascertaining what the patient’s life expectancy is.

v1.c22.s2.3

Caraka in Indriya Sthāna deals with the subject of prognosis on the same lines which he employed in the study of diseases. To find out what are the indications for ascertaining the life expectancy, he proposes to conduct this examination by means of direct perception, inference and the instructions of the wise, the same three methods he employed in connection with the study of diseases, viz., Pratyakṣa, Anumāna and Āptopadeśa.

v1.c22.s2.4

These prognostic symptoms and signs can be classified into two categories.

v1.c22.s2.5

1. Puruṣa Samsraya: Those fatal features which are actually found in the body of the patient.

v1.c22.s2.6

2. Puruṣa Anasraya: Those which are outside the body of the person. These are the features seen in the family members of the patient and surroundings. Of these two, it is the former which is given more importance and not the latter. Further, the former is again sub-divided into three groups.

v1.c22.s2.7

1.A. Lakṣaṇa Nimitta: There are certain feature present since the birth of the person such as hasta rekhā (lines in the palms), padarekhā (lines of the soles), auspicious and unauspicious features of different parts of the body. This branch of knowledge known as Sāmudrika Śāstra (physignomy) has its own separate literature. It’s detailed description is not seen in ancient Ayurvedic classics.

v1.c22.s2.8

1.B. Laksya Nimitta: These are fatal features appearing in the course of various diseases affecting human beings. The elaborate descriptions of these features are seen in the classics which is very relevant to medical science.

v1.c22.s2.9

1.C. Nimittānurūpa: These are fatal features which invariably appear in every person prior to his death without any reason except death. There are definite features heralding death and so are the real fatal signs in the real sense of the term.

v1.c22.s2.10

Observing these, death can be predicted if the physician is well experienced in recognising them. Ayurvedic classics have also described these features to some extent.

v1.c22.s2.11

The Ancient Indian prognostic skill displays, on one side wonderful perception and power of observation, while on the other hand it literally abounds in evidence of primitive superstition. In this connection may be indicated their belief in dreams and the ominous influence of purely fortuitous occurrences previous to visiting the patient. Great stress was laid on the occurrences of celestial phenomena, Susruta says, “the physician should not be called in the following lunar asterism Kṛttikā, Ārdrā, Āśleṣā etc. and the following days of the moon viz., the fourth, sixth and ninth and the day of new moon”. In addition to celestial phenomena, all events of note, encounters etc. assume the role of portents, affording an insight into the future fate. Particular attention was paid to the dreams of the patient. Both Caraka and Suśruta describe such dreams and their importance in detail. Indian Medical texts give lists of omens that indicate prognosis. In these both good and bad prognostic omens are narrated in all the three major classics.

Therapeutic Techniques

v1.c22.s3.1

If we see the chronological evolution of therapeutic skills in ancient India, the major developments took place in the classical period. In the pre-vedic and vedic period the cause of disease was attributed to evil forces and supernatural beings, hence the therapeutic measures were also directed to pacify those powers. In later years of classical era the intellectual development of man made roads to develop newer diagnostic sills to ascertain the cause and nature of disease. The establishment of Tridoṣa theory was an impetus for the comprehensive development of systematic medicine in ancient India. The diseases were thought to be due to derangement of Śārīrika and Mānasika doṣas. The therapeutic methods were also rationalised and directed to bring normalcy in the initiated doṣas. Three dimensional approach towards human entity, considering soul (Ātmā), mind (Mana) and body (Śarīra) as the three basic components of living entity was another development by which ancient Indian Medicine reached its zenith by evolving holistic approach towards the patient.

v1.c22.s3.2

All the three major classics in general and *Caraka Saṃhitā* in particular contributed much to the development of rationalised therapeutic skill.

v1.c22.s3.3

Several classifications regarding therapeutic measure are seen in different contexts of the three major classics. The widely accepted classifications are quoted with brief descriptions. For the detailed study of these techniques the original classics may be referred.

v1.c22.s3.4

Three major branches of therapeutics (*CS.Sū.*11. 54-55) are recognised in the ancient Indian system of medicine.

v1.c22.s3.5

1. Daiva Vyapāsraya Cikitsā
2. Yukti Vyapāsraya Cikitsā
3. Sattvāvajaya Cikitsā

v1.c22.s3.6

1. Daiva Vyapāsraya Cikitsā: This is one of the three major methods of treatment that goes back to a hoary past, and finds mention in *Ṛgveda* as well as in the *Atharvaveda*. This method relies on divine intervention (*Daiva*) (*CS. Sū.*11.54). In life, the divine or unseen element (*Daiva*) comprehends past actions and their depositions *Devaḥ* (Gods) and human effort (*Puruṣakāra*) are together involved in health as well as in disease. When the former is weak, human effort can surely counteract it, in any case, human effort is able to minimise the severity of diseases caused by ‘*Daiva*’ factors (*CS. Vi* 3. 33).

v1.c22.s3.7

Diseases such as *Unmāda* (insanity), *Apasmāra* (epilepsy) *Kuṣṭha* (certain skin diseases) and *Bāla graha* (childhood maladies) all of which cannot be ascribed to physical or mental causes are included in this category.

v1.c22.s3.8

The techniques of therapy include the employment of incantations (*Mantra*), precious stones and sacred gems (*Maṇi*), auspicious rituals (*Maṅgala*), oblations (*Bali*), gifts (*Upahāra*), sacrifices (*Homa*), penances (*prāyaścitta*), fast (*Upavāsa*), benediction (*svastayana*), bowing before elders and divine beings (*Praṇipāta*) and visits to sacred spots (*Gamana*) etc. all of which are intended to counteract the force of unfavourable past action (*Daiva*) and to secure divine influence in order to eliminate the diseases.

v1.c22.s3.9

Most of these techniques are inherited from *Atharvaveda* while Ayurveda in theory considers the curative value of these practices. It attaches importance to rational methods like proper medicine, beneficial diet and favourable habits.

v1.c22.s3.10

2. Yuktivyapāsraya: Treatment of diseases by the employment of reason viz. clinical examination (*Parīkṣā*), diagnosis (*Nidāna*) and employment of drugs, prescriptions of diet etc. in terms of the basic doctrines of Ayurveda viz. *Pañca Mahābhuta*, *Tridoṣa* etc. is called Yukti Vyapāsraya Cikitsā. It broadly includes three varieties of treatment, viz. -

v1.c22.s3.11

2.A. *Antaḥ Parimārjana* (Internal Cleansing) 2.B. *Bahiḥ Parimārjana* (External Cleansing) 2.C. *Śastra Praṇidhāna* (Surgical Intervention)

v1.c22.s3.12

2.A. *Antaḥ Parimārjana*: diseases caused by improper diet, etc are eradicated by medicines meant for internal cleaning. This method consists of two main procedures (i) *Saṃśodhana* - general cleansing of the entire physical constitution through *pañca karma* therapy utilising the techniques of *Vamana*, *Virecana*, *Vasti*, *Sirovirecana* and *Raktamokṣaṇa*. (ii) *Samśamana* - general palliation of the constitution through drugs, diet, and exercise etc.

v1.c22.s3.13

2.B. *Bahiḥ Parimārjana*: The cleansing therapy which has its curative effect by external contact with the body such as massage, fomentation, unction, affusion and kneading etc.

v1.c22.s3.14

2.C. *Śastra Praṇidhāna*: The surgical intervention involves the performance of eight surgical techniques like incision, excision, scarification, puncturing, probing, extraction, evacuation and suturing with the help of sharp instruments and blunt instruments. It also includes potential and actual cautery (*Kṣāra* and *Agni*), venesection and blood letting by leeches. This branch was developed from the Dhanvantari School of thought.

v1.c22.s3.15

The *Suśruta Saṃhitā* mainly deals with this branch, in addition to the other therapeutic skills. Surgical treatment was reserved for those diseases which do not come entirely under the category of medical treatment.

v1.c22.s3.16

3. *Sattvāvajaya Cikitsā*: The expression ‘*Sattva*’ has many meanings but in this context it means ‘mind’ (*CS. Sū* 1.46). Subjugation of mind has been prescribed as a special therapeutic technique to deal with psychic and psycho-somatic diseases. This has the import of psychotherapy and counselling for it is reduction of mind to restrain itself from unwholesome preoccupation. *Caraka* argues that most of our troubles are due to folly or errors of judgement (*Prajñāparādha*) and to avoid or eliminate the troubles one must live correctly (*Saḍvṛtta*). Correct living, according to Ayurveda, does not involve supernatural sanction or vedic authorities. It is a wholesome integrated living which adequately fulfills the three fundamental motivations i.e. urge for self preservation (*Praṇeṣaṇa*), the desire for material provisions which make life comfortable (*Dhaneṣaṇa*) and a longing for better state of existence, here and hereafter (*Paralokaiṣaṇā*). Ethics is thus judiciously subordinated to pragmatic considerations.

v1.c22.s3.17

The development of this dimension in the classical era fulfilled the lacuna of therapeutic skill and made the approach of Indian system of medicine towards the health demands of the society as a comprehensive and holistic one (*CS. Su.* 1.46 *CS. Śā.* 1.108).

v1.c22.s3.18

In principle, the Ayurvedic approach to the treatment of a disease consists of two major procedures (*CS. Vi*, 7.30).

v1.c22.s3.19

1. *Samśodhana Cikitsā*

v1.c22.s3.20

2. *Samśamana Cikitsā*

v1.c22.s3.21

*Samśodhana Cikitsā* is the radical treatment of a disease and is supposed to eradicate or eliminate the vitiated *doṣas* thus completely preventing and curing the disease. *Samśamana Cikitsā* is the conservative treatment which consists of conservative measures like *Laṅghana* (fasting) *pacana* (digestion) etc. by administration of appropriate drugs designed for subsiding or alleviating the vitiated *doṣas* thus preventing temporarily or subsiding a disease.

v1.c22.s3.22

*Pañca Karma* (literal meaning, five-fold therapeutic action)is a collective expression for the cleaning of the physical constitution (*Samśodhana Karma*).

v1.c22.s3.23

*Karma* in this context signifies specific action directed towards therapy, and therapy here is directed towards the elimination of the vitiated *doṣas* for the purpose of cleansing the constitution, and therefore all the therapeutic actions listed under this head are properly cleansing devices (*Śodhana*). They are also eliminative processes and are therefore generally called the *Laṅghana* treatment. The exception is the ‘*Anuvāsana Vasti*’ which is *Bṛṃhaṇa* in nature.

v1.c22.s3.24

These treatments are resorted to when the normal pacification treatment fails to correct the disturbed *doṣas*. Their main purpose is to eliminate the vitiated *doṣas* from the body, and thus cure the diseases. While they are curative in their import, they may also be employed as preventive and promotive measures, for they are also prophyllastic.

v1.c22.s3.25

Normal health is resultant of these treatments, and a resistance against the factors that are likely to upset the balance of the *doṣas* is built up; longevity is a side-benefit. Body metabolism is rendered efficient, and digestion normalized, sense-functions become alert, body strength is enhanced, and mind becomes clear and sharp. The degenerative processes in the body are effectively stalled or slowed down (*CS. Sū.* 10.17-19).

v1.c22.s3.26

This line of treatment has five major procedures viz.,

v1.c22.s3.27

(1) *Vamana* (Emesis),

v1.c22.s3.28

(2) *Virecana* (Purgation),

v1.c22.s3.29

(3) *Nirūha vasti* (Evacuation by Enema),

v1.c22.s3.30

(4) *Anuvāsana Vasti* (Unctuous Enema),

v1.c22.s3.31

(5) *Nasya* (Errhine Therapy or Nasal Insufflation).

v1.c22.s3.32

This is also the order in which the treatment is carried out. But before emesis, it is advisable to administer to the patient two preoperative treatments, (*Pūrva Karma*) namely *Snehana* (Oleation) and *Svedana* (Sudation).¹⁴

v1.c22.s3.33

There are five therapeutic operations according to the *Caraka Saṃhitā*; there is a slightly different list in the *Suśruta Saṃhitā*. The two ‘*Vastis*’, *Anuvāsanavasti* (called *Snehavasti* in the *Suśruta Saṃhitā*) and *Niruhavasti* or use of decoctions as enemata are in the *Suśruta Saṃhitā* under one head, and blood letting (*Rakta Moksana*) has been enlisted as the fifth (*SS. Ci.* 36 17). This is based on the idea that blood is the fourth *doṣa* and that a large number of diseases are caused by its vitiation (*SS. Sū.* 21.3).

v1.c22.s3.34

The two pre-operations (*Pūrva Karmas*) are helpful in loosening the vitiated *dosas* which are struck in the body tissues, releasing them for circulation and into the alimentary canal, so that they may be thrown out by the principal operation i.e. *Vamana, Virecana, Vasti* etc.

v1.c22.s3.35

*Snehana* (*Oleation*): The preparations containing fat i.e. oils, ghee, animal fat and bone marrow are administered internally and externally through food, massage, inhalation, enema and so on and render the body soft, disintegrate the accumulated *doṣas* and clear the accumulated and obstructing waste products from the channels of circulation (*CS. Sū.* 8).

v1.c22.s3.36

*Svedana* (*Sudation*): After the oleation therapy, application of sudation is done. These may be unctuous, for example with ghee, oils, vapour bath, or dry with heated sand, hot bricks, husks of cereals, sun-bath etc. Forms of sweating without the employment of heat (Niragni) that is by exercise, warm clothing, hunger, popultice bring out sweat which is an internal secreta of the body, and this liquifies or melts the doṣas held in the subtle channels of the body and also the waste products of metabolism (CS. Sū. 14; CS. Si. 1.7)

v1.c22.s3.37

These two snehana and svedana help bring the chief of the doṣas, fatal, under control, so that in the course of the principal operations (śodhana) the entirety of the vitiated doṣas can be thrown out.

v1.c22.s3.38

1. Vamana (Emesis): This is the first of the pañca karma series and consists in causing vomiting of the vitiated doṣas especially kapha from the upper parts of the body, by means of suitable recipes which possess repulsive, nauseating, indigestible and tending to move upward qualities. When this is properly administered, the emesis occurs; first salivation then the medicines taken, followed by kapha, pitta and vata in that order (SS. Ci. 33.22; CS. Si. 1-15). Channels of circulation are cleared, sense functions become effective; lightness in body and heart and clarity of mind are ensured. The emetic treatment is especially indicated in diseases when the vitiation of kapha figures prominently.

v1.c22.s3.39

2. Virecana (Purgation): The administration of purgatives the drugs which are pleasant/palatable, easily digestable, and tending to move downward in order to eliminate the vitiated doṣas especially the pitta from the lower regions of the body as taken from the stomach to the large intestine and expelled through the anal passage. When properly carried out, the expelled contents will be in this order, viz. faeces, urine, ‘pitta’, medicines taken and kapha (SS. Ci. 33.22). Clarity of mind, efficiency of sense organs, stability of the bodily constituents, vigour and good digestion are brought about by proper purgation (SS. Ci. 33.26). The treatment through purgatives is especially indicated in diseases where the vitiation of pitta along with initiative of kapha figures prominently.

v1.c22.s3.40

3. Anuvāsana Vasti: Enemate with unctuous substance i.e. the administration of unctuous drugs (oil, ghee, animal fat) into the rectum through enema, inorder to eliminate the vitiation of vāta, which is the chief among the doṣas. This is regarded as an extremely beneficient treatment, good for old and young alike, for the fat and the lean alike, it helps rejuvenation secure good health and prolongs life (CC. Si. 4.55; SS. Ci. 37-58)

v1.c22.s3.41

A variety of this unctuous enemata is known as Mātrā Vasti, which is harmless and involves no restriction of diet behaviour, time of the day or season of the year. It is suitable even for daily use by those who are emaciated, debilitated and overworked.

v1.c22.s3.42

4. Nirūha Vasti: Enemata with decoctions of drugs (kvatha), milk, juice is also meant to eliminate the vitiated vata. Many varieties of these Vastis are recognised, viz. Utkleṣaṇa which removes the vitiated doṣa from its location, ‘doṣāhara’ which actually expels the doṣa from its location and śamana which cools, soothes or ameliorates the doṣa after the vitiation is removed from it, ‘Lehana’ a mild variety of Nirūhavasti, Bṛmhaṇa - Nutritive in effect and ‘Piccha’ emollient in irritation of the colon (CS. Si. 3; SS. Ci. 35.18).

v1.c22.s3.43

5. *Nasya Karma*: Errhine therapy or nasal insufflation is described as a purgative to the head (*Śiro-virecana*). It consists in introduction into the nostrils, suitable medicines in liquid form (oils or *taila*) or powder form (*cūrṇa*) in order to throw out the vitiated *doṣas* from the parts of the body above the classic. The treatment is administered through the nose, because the nose is the gateway to the head. Three varieties of therapy are recognised purgative or eljminatory (*Recaka*) nourishing or cooling (*Tarpana*), and sedating or alleviating (*Sāmaka*) (CS.Si.9. 89-92).

v1.c22.s3.44

All these five therapeutic operations are considered major and special precautions regarding diet and regimen are prescribed before and after these procedures. Some ancilliary therapeutic techniques are also described in the Ancient Indian Medical Classics while dealing with some special diseases.

Ancillary Therapeutic Techniques

Dhūmapāna (fumigation in the nose or mouth)

v1.c22.s4.t1.1

According to *Caraka* the medicines to be used are powdered and kneaded into a ball which is fixed to the end of a seed-stalk.

v1.c22.s4.t1.2

When the ball is dry, the stalk is pulled out, the tube thus formed is put in pipe of metal, wood or ivoy, it is then kindled and the other end of the seed is put into the nose or mouth. According to *Suśruta*, there are five kinds of *Dhuma* (SS. Ci. 40; Aṣṭ Hṛ. Sū. 21.10).

v1.c22.s4.t1.3

*Kavalagraha* and *Gandūṣadhāraṇa*: (Mouth rinsing and gargling): The techniques are prescribed particularly for the diseases of mouth and teeth. The fluid is to be retained in the mouth until tears come out of the eyes and drops begin to fall down from the nose, then a new portion of the fluid is to be taken (SS. Ci. 40).

v1.c22.s4.t1.4

*Āścyotana*: Instilling of drop for the aliments of eye is prescribed.

v1.c22.s4.t1.5

*Pradeha*: softening popultices.

v1.c22.s4.t1.6

*Varti* or *Phalavarti*: Suppositories for use in narrow orifices of the body (*Kāś. S. Si. 6; CS. Si. 9.65-66*) etc.

References

v1.c22.s5.1

*Aṣṭāngahṛdaya*, of Vāgbhaṭa, edited with Sanskrit Introduction by Nandakishore Sarma, Nirnaya Sagara Press, Bombay, 1891.

v1.c22.s5.2

*Caraka Saṃhitā*, edited with English, Hindi and Gujarati translations (6 vols.) Gulal Kunverba Ayurvedic society, Jamnagar, 1949.

v1.c22.s5.3

*Kāśyapa Saṃhitā*, edited by Hemaraja Sharma, Kasi Sanskrit Granthamala No 154, Benares, 1953.

v1.c22.s5.4

*Mādhavanidāna*, edited with the commentary *Madhukośa* of Vijayarakṣita and Śrīkanthadatta and extracts from the commentary *Ātarikadarpaṇa* of Vācaspathi Vaidya by Vaidya Jadavji Trikumji Acharya, Bombay, 1939

v1.c22.s5.5

*Madhukośa* Commentary, See *Mādhavanidāna* *Sāraṅgdhara Saṃhitā*, edited by Jivānanda Vidyāsāgara, Calcutta, 1874

v1.c22.s5.6

*Suśruta Saṃhitā*, Chowkhamba Sanskrit Series office, 2nd edition, Varanasi, 1963

v1.c22.s5.7

*Yogaratnākara*, edited by Annamoreśvara Kunte, Anatasrama Sanskrit series No.4, Poona, 1889

Linked texts (10)