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History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c22.s3: Therapeutic Techniques

History of Technology in India, Vol. I: From Antiquity to c. 1200 A.D. v1.c22.s3

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English

Therapeutic Techniques

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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.

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

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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.

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

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

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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).

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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.

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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.

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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.

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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. -

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

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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.

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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.

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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.

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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.

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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.

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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).

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

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1. *Samśodhana Cikitsā*

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2. *Samśamana Cikitsā*

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*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.

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

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*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.

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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.

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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).

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This line of treatment has five major procedures viz.,

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(1) *Vamana* (Emesis),

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(2) *Virecana* (Purgation),

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

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

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

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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

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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).

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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.

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*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).

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*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)

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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.

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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.

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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.

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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)

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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.

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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).

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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).

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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.

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