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Definition of health and disease
Dhatus consist of vata, pitta and kapha; rasa, rakta, mamsa, medas, asthi, majja and sukra; and upadhatus like rajas, etc. Any deficiency or excess in the normal quantity of the dhatus causes vikara or disease. Equilibrium of these dhatus, on the other hand, is prakrti, that is health.
Absolute equilibrium of the dhatus, in fact, is not possible. For example, kapha invariably gets vitiated in the first part of the day and night, immediately after taking food and during childhood. In the similar other circumstances, pitta and vata also invariably remain vitiated. To this extent, an absolute equilibrium of the dhatus is never possible. So arogya, that is health, can be defined as happiness. Happiness again is a relative term to be construed depending upon the conditions varying from individual to individual. For, no worldly happiness can ever be called happiness in absolute terms. All the worldly conditions are tinged with an element of misery, a slight disturbance in the equilibrium of dhatus does not cause any distinct uneasiness in the body and as such it can be called a state of happiness or so. In other words, equilibrium of dhatus even includes such conditions where there is only a slight deviation from normalcy. To sum up: health is a state of happiness or pleasure; vikara or disease, on the other, hand, is the cause of misery or pain. Misery itself is not the disease. If it were so, jvara (fever), etc. which are only the causative factors of misery would not be regarded as diseases.
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Definition of therapeutics
The entire effort of the four, viz., physician, medicament, attendant and patient, possessing requisite qualities, for the revival of the equilibrium of dhatus in the event of their equilibrium' being disturbed, is known as therapeutics.
Effort of a physician includes his judgement about his duties and otherwise; that of the medicament includes therapeutic action when administered; an attendant's action includes preparation of medicaments and nursing; the effort of the patient lies in following the instructions of the physician and in giving the correct history of his disease.
Qualities of Physician
Excellence in medical knowledge, an extensive practical experience, dexterity and purity — these are the four qualities of a physician.
Excellence in knowledge can be had by attending on preceptors and studying scriptures. Purity in a physician helps the patient by dint of its spiritual force. Reputation as infallible in prescribing medicines is also one of the qualities of a physician which is included in the four qualities mentioned above.
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Examination of disease
The disturbance of the equilibrium of dhatus is the source of action. The disturbance of the equilibrium of dhatus is invariably indicated by the onset of the disease. This state of health can be ascertained from the appearance of specific symptoms in the smaller or greater degrees due to the dosas responsible for the causation of the disease and also from the specific characteristics of the disease e.g. curability, incurability, mildness, seriousness etc..
Examination to ascertain if the disease is cured
The equilibrium of dhatus represents the "action itself." It is invariably associated with the alleviation or absence of the disease. This state of health can be ascertained from the following:
1. alleviation of pain;
2. appearance of normal voice and complexion;
3. nourishment of the body;
4. increase in strength;
5. desire for taking food;
6. appetite for food during meal-time;
7. proper digestion of the food taken during meal-time;
8. getting sleep at the appropriate time;
9. absence of dreams indicating morbidity;
10. happy awakening;
11. proper elimination of wind, urine, stool and semen; and
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12. unimpairement of mind, intellect and senses and association of all healthy symptoms therewith.
Signs of normalcy
Attainment of spiritual happiness is the result of therapeutic action. It is characterized by the pleasure or satisfaction of the mind, intellect, senses and the body.
Signs of ayus
Anubandha or subsequent manifestation is the maintenance of life (longevity). It is characterized by its union with prana type of vayu.
Examination of the land to ascertain particulars about the patient
Both the land as well as the patient constitute desa or habitat. Nature of the land is examined with a view to ascertaining the specific features of individual patients as well as the medicinal plants in different localities. The following points are to be examined with reference to the patient:
1. place of birth, growth and affliction with the disease;
2. specific features concerning food, exercise, customs, strength, mental condition, homologation by habit, dominance of one or the
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other of the dosas, liking, manifestation of diseases and things which are useful and harmful.
The above information is generally obtained by the examination of the land. The term desa meaning habitat includes both the patients as well as healthy individuals. Individuals of the latter category are included here because they are also susceptible to the attacks of diseases. They are required to be examined with a view to administering such regimens as would keep them healthy.
Examination of Patient
A patient constitutes the karyadesa or the site for the administration
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of therapies with a view to bringing about equilibrium of dhatus. He should be examined so as to obtain knowledge regarding the span of life, strength and the intensity of morbidity. Here, the purpose of examination is to obtain the knowledge relating to the strength of the individual and the intensity of morbidity, because it is on the basis of the intensity of morbidity that the dosage of the therapy is determined and the latter is dependent upon the strength or the power of resistance of the individual. If strong things are immediately administered without proper examination to a weak patient, this might result in his death. Weak patients are incapable of resisting strong therapies like medicaments dominating in agni and vayu mahabhutas, application of alkalise and heat (cauterization) and surgical operations. These therapies cause immediate death of the patient because of their very sharp action which are too strong for the individual. Thus a weak patient should be given such mild and tender therapies as are not injurious to the body and the mind. Stronger therapies which are neither distressing during their digestion nor associated with serious complications may be administered slowly and gradually. Such therapies are specifically needed for ladies because they are by nature unsteady, light (not deep) and of sensitive or weak temperament and also because they are mostly tender and subordinate to others. Similarly, if weak therapies are administered to a strong individual having a serious disease without proper examination, the disease does not get cured. Therefore, the patient should be examined with reference to his prakrti (physical constitution), vikrti (morbidity), sara (excellence of dhatus, or tissue elements), samhanana (compactness of organs), pramana (measurement of the organs of the body), satmya (homologation), sattva (psychic conditions), aharasakti (power of intake and digestion of food), vyayamasakti (power of performing exercise) and vayas (age) in order to ascertain his strength and the intensity of the malady.
The dosage in which a therapy is to be administered depends upon the intensity of morbidity as well as the strength of the patient. A strong patient with a serious disease needs the therapy in a stronger dose. Mistakes like giving strong therapies to weak patients and vice versa can be avoided if patients are duly examined beforehand. Even if a weak person is suffering from a serious disease which requires a strong therapy for cure, he should not be given a strong therapy all of a sudden. Such a patient should be given strong therapy slowly and gradually, depending upon his strength and power of resistance gained..
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Prakrti
Now we shall explain the characteristic features of prakrti (physical constitution etc.,). Prakrti or physical constitution of the foetus is determined by the following factors :
1. sperms and ovum;
2. season and condition of the uterus;
3. food and regimens of the mother; and
4. nature of the mahabhutas comprising the foetus. The foetus gets afflicted with one or more of the dosas which are dominantly associated with the above mentioned factors. The physical constitution of an individual is determined on the basis of these dominant dosas in the above mentioned factors when they initially unite in the form of foetus. Therefore, the physical constitution of some is dominated by kapha (slesmala), of some others by pitta (pittala) of others by vata (vatala) and of some others by the combination of two dosas (samsrista). In some other cases, however, the equilibrium of dosas (samaprakrti) is well maintained. We shall now expound their characteristic features one after the other.
Dosas dominating the sperms and the ovum during the time of conception and also those inhabiting the uterus at that time determine the prakrti (physical constitution) of the individual. Food and regimens of the mother which aggravate dosas at that time also determine the physical constitution. The dosa(s) which ultimately emerge as dominant factors actually determine the prakrti or the physical constitution. Season etc., also indirectly serve as important factors for the determination of prakrti inasmuch as they also aggravate dosas in the sperms and ovum.
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Characteristics of slesmala individual
Kapha is unctuous, smooth, soft, sweet, firm, dense, slow, stable, heavy, cold, viscous and clear.
The various manifestations in the human body having slesmala type constitution are given below :
Attributes of Slesma
1. unctuous;
2. smooth:
3. soft:
4. sweet:
5. firm:
6. dense:
7. slow:
8.stable:
9.heavy:
10. cold:
11. viscous:
12. clear:
Specific manifestations in the body of the individual having slesmala type of constitution.
unctuousness of organs.
smoothness of organs.
pleasing appearance, tenderness, clarity of complexion.
increase in the quantity of semen, desire for sex-act and number of procreations.
firmness, compactness and stability of the body.
plumpness and roundedness of all organs.
slow in action, intake of food and movement.
slowness, in initiating actions, in getting irritated and in morbid manifestations.
non-slippery and stable gait with the entire sole of the feet pressing against the earth.
lack of intensity in hunger, thirst, heat and perspiration
firmness and compactness in joints.
happiness in the look and face; happiness and softness of complexion and voice.
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By virtue of the above mentioned qualities, a man having slesmala type of constitution is endowed with the excellence of strength, wealth, knowledge, energy, peace and longevity.
Characteristics of pittala individual
Pitta is hot, sharp, liquid, of fleshy smell, sour and pungent. Various manifestations due to these attributes in the human body having pittala type of constitution are as in the table given below :
Attributes of pitta
1.hot:
Specific manifestations in the body of the individual having pittala type of constitution.
intolerance for hot things, having hot face, tender and clear body of port-wine mark, freckles, black mole, excessive hunger and thirst; quick advent of wrinkles, greying of hair and baldness; presence of some soft and brown hair in the face, head and other parts of the body.
2. sharp:
sharp (demonstration of) physical strength, strong digestive power, intake of food and drink in
large quantity, inability to face difficult situations and glutton habits;
3. liquid:
4. fleshy smell:
55. pungent tastes:
looseness and softness of joints and muscles; voiding of sweat, urine and feces in large quantity.
putrid smell of axilla, mouth, head and body in excess;
insufficiency of semen, sexual desire and procreation.
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By virtue of the above mentioned qualities, a man having pittala type of constitution is endowed with moderate strength, moderate span of life, moderate spiritual and materialistic knowledge, wealth and the accessories of life.
Characteristic of vatala individual
Vata is ununctuous, light, mobile, abundant in quantity, swift, cold, rough and non-slime. Various manifestations due to these attributes of vata in a body having vatala type of constitution are given below :
Attributes of vata
1. Ununctuous:
Specific manifestations in the body of the individual having vatala type of constitution
ununctuousness, emaciation and dwarfness of the body; longdrawn, dry low, broken, obstructed and hoarse voice; always keeping awake;
2. light:
3. mobile:
4.abundance:
5. swift:
light and inconsistent gait, action, food and movement;
unstable joints-eyes, eye brows, jaws, lips, tongue, head, shoulder, hands and legs;
talkativeness, abundance in tendons and veins;
quick in initiating actions, getting irritated and the onset of morbid manifestation; quick in affliction with fear, quick in likes and dislikes; quick in understanding and forgetting things;
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6. cold:
7. rough:
intolerance for cold things; often getting afflicted with cold, shivering and stiffness;
roughness in the hair of the head, face and other parts of the body, nails, teeth, face, hands and feet.
8. non-slime:
cracking of the limbs and organs, production of cracking sound in joints when they move.
Because of the above mentioned qualities, individuals having vatala type of constitution are mostly possessed of strength, span of life, pro creation, accessories of life and wealth in lesser quantity.
Individuals having constitution dominated by the combination of two dosas are characterized by the combination of the manifestations of respective dosas.
A samadhatu type of individual who has all the dosas in the state of equilibrium is endowed with the good qualities of all the three types of individuals. Thus an individual should be examined for his constitution.
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Examination of sara (Excellence)
Patients are to be examined with reference to sara or the excellence of their dhatus. With a view to determining the specific measure of strength they are classified into eight categories, depending upon the sara or excellence of their dhatus, viz. tvak (skin), rakta (blood), mamsa (muscle tissue), medas (adipose tissue), asthi (bone tissue), majja (marrow) sukra (semen) and sattva (mental faculties).
(a) Tvak-sara (Excellence of skin):
Individuals having the excellence of tvak or skin are characterized by unctuous, smooth, soft, clear, fine, less numerous, deep rooted and tender hair and lustrous skin. Such individuals are endowed with happiness, good fortunes, power, enjoyment, intellect, knowledge, health, excitement and longevity.
(b) Rakta-sara (Excellence of blood):
Individuals having the excellence of rakta or blood are characterized by unctuousness, red colour, beautiful dazzling appearance of the ears, eyes, face, tongue, nose, lips, sole of the hands and feet, nails, forehead and genital organs. Such individuals are endowed with happiness, great genius, enthusiasm, tenderness, moderate strength and inability to face difficulties. Their body remains hot.
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(c) Mamsa-sara (Excellence of muscle tissue):
Individuals having the excellence of the mamsa or muscle tissue are characterized by stability, heaviness, beautiful appearance and plumpness of temples, forehead, nape, eyes, cheeks, jaws, neck, shoulder, abdomen, axillae, chest and joints of upper and lower limbs being covered with flesh. Such individuals are endowed with forgiveness, patience, non-greediness, wealth, knowledge, happiness, simplicity, health, strength and longevity.
(d) Medah sara (Excellence of adipose tissue):
Individuals having the excellence of medas or adipose tissue are characterized by the abundance of unctuousness in complexion, voice, eyes, hair of the head and other parts of the body, nail, teeth, lips, urine and feces. Such individuals are endowed with wealth, power, happiness, enjoyment, clarity, simplicity and delicate habits.
(e) Asthi-sara (Excellence of bone tissue):
Individuals having the excellence of asthi or bone tissue are characterized by robust heels, ankles, knees, forearm, collarbones, chin, head, Joints, bones, nails and teeth. Such individuals are very enthusiastic and active, and are endowed with strong and firm bodies as well as longevity.
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(f) Majja-sara (Excellence of marrow):
Individuals having the excellence of majja or marrow are characterized by softness of organs, strength, unctuous complexion and voice" and robust, long and rounded joints. Such individuals are endowed with longevity, learning, wealth, knowledge, progeny and honour.
(g) Sukra-sara (Excellence of semen):
Individuals having the excellence of sukradhatu or semen are characterized by gentleness, gentle look, having eyes as if filled with milk, cheerfulness, having teeth which are unctuous, round, strong, even and beautiful, clean and unctuous complexion and voice, dazzling appearance and large buttocks. Such individuals are loved by women, they are strong and endowed with happiness, power, health, wealth, honour and children.
(h) Sattva-sara (Excellence of mental faculties):
Individuals having the excellence of mental faculties are characterized by good memory, devotion, gracefulness, wisdom, purity, excessive enthusiasm, skill, courage, valour in fighting, absence of sorrow, proper gait, depth of wisdom and sincerity in actions and virtuous acts. (These characteristic features represent the qualities of such individuals.)
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Individuals having all saras
Individuals possessed of the excellence of all the above mentioned dhatus including mental faculties are endowed with great strength and happiness, resistance to difficulties, self-confidence in all enterprises, virtuous acts, firm and well built body, correct gait, resonant, melodious and high pitched voice, happiness, power, wealth, enjoyments, honour, slowness of aging process, resistance for diseases, large number of children with similar qualities and longevity.
Need for examination of sara
It is fallacious to consider an individual to be strong or weak either from his plumpy or emaciated body or from the large or small size of his body. Some people having a small sized and emaciated body are seen to be strong. They are like ants who have a small body and look emaciated but can carry too heavy a load. Thus one should examine the individual with reference to the excellence of his dhatus.
Samhanana
A patient is to be examined with reference to his samhanana or
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compactness of the body. Samhanana, samhati and samyojana — these three terms are synonymous. 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.
Pramana
The patient is also to be examined with reference to pramana or the measurement of his bodily organs. This is determined by measuring the height, length and breath of the organs, taking the finger breadth of the individual as the unit of measurement.... Thus the measurement of individual organs of the body are described. A body possessed of organs having proper measurement is endowed with longevity, strength, ojas (energy), happiness, power, wealth and virtues. If the measurement is either on the high or low side, the individual possesses qualities contrary to what are mentioned above.
Satmya
A patient is also to be examined with reference to his satmya or homologation. Satmya stands for such factors as are wholesome to the individual even when continuously used. Individuals 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
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situations and longevity. Those who are accustomed to ununctuous 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 is combination of both these types of homologation, individuals are possessed of moderate strength.
Sattva
The patient is again to be examined with reference to his sattva or mental faculties. Sattva is mind and it regulates the body because of its association with the soul. Depending upon its strength, it is of three types, viz. superior, mediocre and inferior. Thus human beings are classified into three categories depending upon the superiority, mediocrity or inferiority of their mental faculties. Individuals having mental faculties of superior type are possessed of the excellence of these faculties and the characteristic features of such individuals are described above. Even if possessed of weak physique, such individuals, because of the specific manifestations of sattva qualities in them, tolerate serious exoganous and endogenous diseases without much difficulty. Individuals having mediocrity of mental faculties tolerate the pain themselves when they realize that others can also tolerate it, then they at times gain strength from others. Those having Inferior type of menial faculties, neither by themselves nor through others can sustain weir mental strength and even if possessed of plump or big physique, they cannot tolerate even mild pain. They are susceptible to fear, grief, greed, delusion and ego. When they hear even stories describing
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wrathful, fearful, hateful, terrifying and ugly situations or come across visions or flesh or blood of an animal or man, they fall victims to depression, pallor, fainting, madness, giddiness or falling on the ground, or such events that may even lead them to death.
Capacity for food
A patient is further to be examined with reference to his aharasakti or the capacity for intake of food.
One's capacity for food can be examined from two angles, viz. the power of ingestion as well as the power of digestion. Both the strength and life-span are determined by the diet of the individual. Digestion of food when taken in large quantity is indicative of one's capacity for food. Digestion of food when taken in small quantity does not do so.
Capacity for exercise
The patient should be examined with reference to his capacity for exercise which is determined by one's ability to perform work like lifting weight etc. Strength of individuals is classified into three categories, depending upon their ability to perform work.
Span of life
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The patient should be examined with reference to his age which represents the state of his body depending upon the length of the time that has passed since birth. Age is broadly of three types, viz. young age, middle age and old age.
Young age is again of two types, viz. (i) immature stage lasting upto 16th year of age and (ii) maturing stage lasting upto the 30th year of age. During immature stage various organs of the body are not well developed, there is tenderness, the individual cannot tolerate difficulties, there is incomplete strength and the dominance of kapha dosa in the body. During the second stage i.e. the stage of maturing lasting upto 30th year of age, the mental faculties are not properly developed.
During the middle age lasting upto the 60th year of age, there is well manifested strength, energy, manliness and valour, power of understanding, retention, memorizing, speech and analyzing facts and the qualities of all dhatus; there is the dominance of pittadosa.
Thereafter during old age lasting upto 100th year of age, there is diminution of the dhatus (tissue elements), strength of sense organs, energy, manliness, valour, power of understanding, retention, memorizing, speech and analyzing facts. There is gradual diminution in the qualities of dhatus and dominance of vata during this age.
During this kali age, the span of life is hundred years. Of course, there are people who live for a longer or shorter period than this. This age should be classified by determining the life-span with the help of factors described above, viz. prakriti (physical constitution) etc. excluding morbidity and also with the help of characteristic features of individuals having various categories of life-span.
Extracts from Caraka Samhita, edited by R.K Sharma & V.B. Dash,
Chowkhamba Sanskrit Series Office, Varanasi 2002
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