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The philosophy of healing in Indian medicine

Kapil Kapoor

Indian medicine is a good example of how knowledge forms an integrated whole in the intellectual traditions. While major philosophical systems provide the theoretical framework for an analysis of disease, its causes and cure, the world-view enshrined in those systems provides the governing philosophy of health and healing. It is also interesting to note that Āyurveda shares some of those theoretical categories with other disciplines such as Aesthetics.¹ In fact, Āyurveda and Art share the common goal of restoring human beings to good health, both moral and physical.²

Āyurveda is a science that enables a man to achieve a full life-span. Good health has to be sustained in order to lead a happy life, and the body has to be freed of the ailments afflicting it. It is towards this end that this system of medicine, with its 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.³ Caraka and Suśruta are two celebrated proponents of this science, one dealing with medicine in his Carakasaṃhitā and the other with surgery in his Suśrutasaṃhitā.

Texts pertaining to the science of medicine have attested to a history from the 5^th century B.C. to modern times and are divided into eight parts—surgery (for bodily pain); 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); and energy (including reproductive functions). Carakasaṃhitā deals comprehensively with all eight and is evidently a text that has emerged at the end of a long tradition of thought.⁴ Caraka describes Āyurveda as the science of a happy and useful life. He classifies the 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 prajñāparādha, some failure of one’s discriminating intellect, and argues that to rid oneself of illnesses of the body and mind and sustain good health, one must be or become sadvṛtta, a person with 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’ (CS, 4.2.46).

Caraka’s theory of medicine is wholly embedded in the six principal darśanas,⁵ and is founded on the shared conceptions of what constitutes a ‘good’ life and what the conditions for human happiness are.　

Caraka’s philosophy and his theory of medicine are based mainly on the Sāṁkhya Yoga framework, although Vaiśeṣika and Nyāya are also drawn upon in the definitions of ontological categories (such as mana) (CS, 4.1.16−18). The living human body, its afflictions and their cure form the subject matter of Āyurveda. However, this human body is in its totality much more than just its physical substance—it also comprises the internal organs, their disposition and their functions. This ‘totality’ is designated by the term puruṣa. What constitutes a human being? What forms his totality? This needs to be understood; only then can one study what the ailments are, what part(s) of the body they afflict, what the nature and causes of those afflictions are, and what their cure is. Out of the eight sthānas, divisions of Carakasaṃhitā, a whole division, śarīrasthāna, is devoted to the human body—its constitution, its parts, its conception and growth in the mother’s womb, and its sustenance after birth. The first chapter of this division is devoted to the suffering that afflicts puruṣa, the questions of sukha-duḥkha and vedanā, the causes of suffering and the role of the physician.

As noted above, this exposition is primarily based on the Sāṁkhya Yoga system. Puruṣa is defined in terms of the 24 Sāṁkhya ontological primitives—the tattva (CS, 4.1.16−38, 63). This entire puruṣa is the substratum of suffering. The suffering is three-fold—ādhidaivika, ādhibhautika and ādhyātmika,⁶ or nija (engendered in the body), āgantuka (received in the body from outside) and mānasa (of the mind) in the Caraka framework (CS, 1.11.45). Suffering is produced by a marked conjunction of six factors: failure of the intellect (dhī) 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) (CS, 4.1.98). It is recognized that suffering has as its substratum both the self (ātmā) and the body (śarīra) (CS, 4.1.84−85,136). Mind, mana, is of course the cognizer of joy and sorrow⁷ 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 (CS, 4.1.86).

Caraka says that cikitsā⁸ is of two kinds, symptomatic (upadhā cikitsā) and fundamental (naishathiki cikitsā) (CS, 4.1.94−97). 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 suffering, both physical and that of the spirit, is stabilizing one’s mind in the sāttvika guṇa (CS, 4.1.94), freeing oneself from the objects of senses (CS, 4.1.95) and overcoming desire (tṛṣṇā) (CS, 4.1.134). In other words, all vedanā, suffering, ceases in the state of mokṣa, which is but the yogic state of citta-vṛtti-nirodha (Yogasūtra, 1.1.2) in which mind, manas, with all its vṛttis, tendencies of the mind, is under the complete control of the Self. Caraka defines mokṣa (CS, 4.1.142) as the dissolution (viyoga) of attachment (sambandha) with all that binds and, hence, torments the Self. In the next four verses (CS, 4.1.143−146, 154), he lays down the rules of conduct that help to 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 your duty without attachment; sustain an evenness of the mind and the intellect; and control the ‘waves’, cognitions, of the mind. These values are ingrained in the ordinary, average Indian mind, which unquestioningly accepts 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, and programmed it as believing this to be the only means of ārogya, a disease-free, state. Āyurveda is the science that deals with life, a life of ārogya, freedom from disease, and of good health,⁹ so that one is able to perform one’s enjoined duties and attain the four ends of life—dharma (righteousness), artha (material ends), kāma (desires) and mokṣa (freedom of the self from all pursuit). Āyurveda is thus not concerned merely with āyu, a long life. It asks, ‘Why must one live a long life, and what kind of a long life should we aspire for?’ Āyurveda is not concerned with ensuring a long life, dirgha āyu—it seeks to promote sukha āyu and hitāyu (CS, 1.1.41), a happy life and a useful life. Caraka defines a 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 …’ (CS, 1.30.23).

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 (udāsīna) 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 (CS, 1.30.26).

Roga, disease, robs life of both happiness (sukha) and usefulness (hita). Hence Āyurveda, the science of medicine, enables cikitsā, a restoration of the body to its pre-affliction state (CS, 1.16.34). Afflictions are of three kinds, as we noted above, but according to Caraka, it is the third group of ailments, mānasa vyādhi (afflictions of mind and spirit), which needs for its treatment darśana, philosophy, apart from medicine.

The nature, properties and functions of manas, the mind, have been established by Caraka with exactitude and thoroughness with the help of ideas drawn from the six philosophical systems (CS, 1.8.4, 5, 12; 4.1.18−23). Mind is an ontological primitive and has the function of selecting objects for cognitive focus (saṅkalpa/vikalpa). In this sense, the mind is the presiding sensory organ. Its functions are identified as:

1. Grasping/cognizing the sense-object contact;
2. Self-regulation for that knowledge;
3. Analysis of and reflection on cognitions.

After this, the intellect, buddhi, takes over. It is the intellect presided over by the self (ātmā) that programmes the mind to select, control and cognize the sense-object conjunction. Mental ailments have their roots in a deviant programme that sets up extreme, undesirable or inappropriate goals for the mind, which generate, in terms of conduct, acts that Caraka describe as prajñāparādha (CS, 4.1.21)—inordinate desire and jealousy (CS, 4.1.102), for example. An inability to get what one desires and a continuing presence of that which one dislikes leads ultimately to illness. Those who are sāttvika of disposition, predominantly good (sattvaguṇa pradhāna), are not prone to acts, either mental or physical, that violate wise intelligence. Desire and hate are so classified because they harm the one who nurses them more than those towards whom they are directed. As Caraka says elsewhere (CS, 1.7.52), jealousy, grief, fear, anger, pride and rivalry are products of the failure of true intelligence, a failure to see what is bad or good for one’s self. Prajñāparādha are those volitive acts that are not approved by the intellect (buddhi), tolerance faculty (dhairya) and memory (smṛti). Caraka lists acts (CS, 4.1.103) that may lead to ailments as serious as paralysis—exerting oneself beyond one’s capacity, sexual indulgence, abandoning civil behaviour, insulting those worthy of respect, indulging knowingly in wrong-doings, befriending the wrong people, being susceptible to jealousy, fear, anger and greed, indulging in despicable, disgusting acts with one’s body—these are all ‘crimes of intellect’, and show a complete absence of a discriminating faculty (viveka buddhi).

These acts are analogous to vṛttis, tendencies of the mind. When a person is afflicted by certain 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 kāma. 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 (or weakness) …. (CS, 1.1.46).

It is said that mental ailments can be cured or removed by cultivating sadvṛttis, positive or righteous cognition and attitudes. He should not ‘seek his own sukha alone …’ (CS 1.8.26). Sadvṛtti is the conduct of ‘good people’ (sajjana), those who are at peace, are 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 and healthy life that Caraka declares that he is laying down in detail the sadvṛttis (CS 1.8.18−25). A study of these shows that great value is placed on cleanliness of the body and of the mind, generosity of spirit, kindness to others, respect for elders, parents, teachers and guests, restraint in speech and movement, control over one’s senses, absence of jealousy, worry and fear, possession of humility, faith in God, devotion to those who excel in learning and the arts, thoughtfulness and carefulness. We have listed only some of the properties upheld by Caraka. The whole list is a comprehensive enumeration of what everyone will agree are the virtues of a pious and good man. Evidently, these sadvṛttis are the same as the daivīsampada elucidated in The Bhagavad Gītā (16.1−3). Four of these—maitrī, karuṇā, mudita and upekṣā are mentioned in the Yogasūtra as the means of purifying the citta (1.33).　

The science of medicine thus recognizes the deep connection that exists between the body and the mind, and that to ensure good health, the mind must be at peace with itself. This peace of mind is born of moral cognition and conduct. This thought itself emanates from a world-view that considers control of the self the highest conquest, and a deliverance from the limitations of a narrow self as mokṣa, the final state in which all suffering ceases. In rigorously analysing the properties and afflictions of both body and mind, Caraka, the celebrated exponent of Āyurveda, 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 people a long, happy and useful life.

Classical texts quoted

Bhagavad Gītā

Carakasaṃhitā

Yogasūtra