Chapter 32 Ayurveda
The Science of Life and Mother of the Healing Arts
The Major Schools and Specialties
Ayurveda is one of the most ancient systems of medicine known today. The origins of this science of life (Ayu—life and Veda—knowledge), although difficult to pinpoint, have been placed by scholars of ancient Indian Ayurvedic literature somewhere around 6000 BC.1
Ayurveda is a holistic science of health and a balance in lifestyle. Disease is seen as an imbalance, and its treatment involves diverse strategies to restore optimal function and balance. Using dietary alterations, yoga, and exercise, along with elaborate surgical techniques and complex, integrated herbal formulas, the Ayurvedic physician treats the whole person, removing disease completely by ending the imbalance that created it.
In ancient India, it was custom for a teacher’s instruction to be recorded by his students, who would eventually repeat the same information orally to their own disciples. Thus, according to the different interpretations given by various disciples of Ayurveda, a number of treatises were written. Although specific instructions differed, the basic principles remained the same.
Ayurvedic teachings were orally transmitted for thousands of years and then written down in melodious Sanskrit poetry. The contents of a number of Sanskrit verses, or shlokas, although written many centuries ago, still sound a note of familiarity in today’s scientific environment. Ayurveda, in its first recorded form (vedas: the world’s oldest literature), is specifically called Atharveda.
The Development of Ayurvedic Medicine
Hindu legend holds that, after seeing the suffering of human beings, Lord Brahma, the god of creation, elaborated ways to ease that suffering to Daksha, who, in turn, taught them to the Ashwin twins. Figure 32-1 presents the chronology of Ayurveda’s development.
Dhanvantari and Bhardwaj separately developed the surgical and medical aspects of Ayurveda around the ninth century BC. Their students recorded these principles in great detail in compendia that are called Samhitas.
The Sushruta Samhita, one of the most widely accepted Ayurvedic texts, emphasizes the surgical aspects of therapy. Its author, Sushruta, is considered the father of surgery (particularly of plastic and reconstructive surgery). The medical teachings of Charak were a synthesis of earlier work. His material has become a classic text of the nonsurgical medical wisdom of Ayurveda. Successive generations have modified his work, the Samhita.
The Major Schools and Specialties
School of Physicians (Atreya Sampradaya)
Charak wrote a complete text on Ayurvedic medicine in which he revised the work of Agnivesh. Charak’s text described the Tridosh physiology (Vat, Pit, and Kaph), seven Dhatus (tissues), and three Malas (excretions). His text covered the pathophysiology and treatment of diseases, human constitution (Prakriti), classifications and preparations of drugs, diet, “right conduct,” medical ethics, and many other aspects of medicine.
School of Surgeons (Dhanvantari Sampradaya)
Sushruta wrote the first comprehensive works on surgery. These were later revised by Nagarjuna in the second century AD. The major subjects in his texts were the following:
Sushruta described 141 types of instruments and listed 40 types of surgeries and surgical techniques for treating cataracts, hemorrhoids, hernias, and bone problems, for cosmetic and plastic purposes, and for the removal of kidney stones and gallstones.
Branches of Ayurveda
Ayurveda encompasses eight specialties or branches. They comprise a system developed to prevent and cure disease, as well as achieve and maintain excellent health. Table 32-1 lists the branches.
|AYURVEDIC NAME||ENGLISH NAME|
|Shalya Tantra||General surgery|
|Shalkya||Ophthalmology and otorhinolaryngology|
|Kumar-Bhritya||Pediatrics, obstetrics, gynecology|
|Agada Tantra||Toxicology and jurisprudence|
|Vajikaran||Fertility and sterility|
Ayurvedic philosophy is based on the Samkhya philosophy of creation. It has influenced major strains of philosophy in both Eastern and Western civilization. The word Samkhya is derived from the Sanskrit words Sat (truth) and Khya (to know). The Rishi Kapila (Rishi means realized beings or seers of truth) realized the Samkhya philosophy of creation. They perceived the following:
• The close relationship between humans and the universe (that humans are a microcosm, a universe within themselves, whereas the external environment is the macrocosm).
• The source of all existence is cosmic consciousness, manifest as male (Shiva or Purusha) and female (Shakti or Prakriti) energy.
Purusha is formless, colorless, and beyond attribute. Prakriti has form, color, awareness, and choice. Prakriti creates all the forms of the universe and has three attributes (Gunas): Satva (essence), Rajas (movement), and Tamas (inertia). It is also represented by Brahma (the god of creation), Vishnu (god of protection), and Shiva (god of destruction), which together comprise a cycle active in this universe.
In Prakriti, the three attributes are in balance. Whenever this balance is disturbed, they interact to bring about the evolution of the universe, yielding the cosmic vibration of Aum. The cosmic intellect (the Mahad) manifests itself as ego (Ahamkar), which, through the help of Satva, manifests the five senses and five motor organs, which together constitute the “organic universe.” Ego further manifests into the five basic elements (space, air, fire, water, and earth), which, under the influence of Tamas, create the “inorganic universe.”
Satva is a creative potential (Brahma), Rajas is a kinetic protective force (Vishnu), and Tamas is a potentially destructive force (Mahesh). These three—Brahma, Vishnu, and Shiva—are constantly operating in the universe.
Five Basic Elements and the Universe (Panchbhuta Philosophy)
The Rishis perceived that consciousness consists of these five basic elements: ether (space), air, fire, water, and earth. At the beginning of the world, consciousness was without form, existing as the subtle vibration of the cosmic “soundless” sound Aum.
Within these vibrations appeared the element ether. Ether started to move, creating air. The movement of ether also produced friction and, through friction, generated heat, then fire. From the heat of the fire, ethereal elements dissolved and liquefied into water. Water then solidified to form molecules of earth. Thus, all matter was born from the five elements. These five elements exist in energy forms.
Five Elements and the Senses
The five elements also connect with the five senses: ether—hearing, air—touch, fire—vision, water—taste, and earth—smell, and they are present in certain physiologic functions. Expressing the functions of the sensory organs are five actions (Table 32-2). In this manner, the elements are directly related to humans’ abilities both to perceive the external environment in which they live and to respond to it:
• Ether is the medium through which sound travels. The ear is the organ of hearing, expressing its action through the organ of speech, which creates meaningful sound.
• Air is related to skin and the sense of touch. Its organ of action is the hand, which is especially sensitive. The hand performs the actions of holding, giving, and receiving.
• Fire produces light, heat, and color, and is thus related to vision and direction. Its organ is the eye.
• Water relates to the organ of taste. The tongue is also related to the action of the genitals, the penis, and clitoris. In Ayurveda, the penis and clitoris are called the lower tongues. By controlling the upper tongue, one naturally controls the lower tongue.
• The earth element relates to the sense of smell, and the nose is its organ.
The five elements manifest within the body as the Tridosha (Dosha means protective or, when out of balance, disease producing). The Tridosha are the three humors, or basic principles, described earlier—Vat, Pit, and Kaph.
From the bodily combination of ether and air comes the bodily air principle, Vat Dosha. Likewise, fire and water combine as Pit Dosha, or fire principle, and earth and water produce the Kaph Dosha, or water principle.
These three control all biological, psychological, and physiopathologic functions of the body, mind, and consciousness. They produce natural urges and individual tastes in food, flavor, and temperature. They govern the maintenance and destruction of bodily tissue and the elimination of waste products. They also are responsible for psychological phenomena, including the emotions of fear, anger, and greed, as well as the highest order of emotions: understanding, compassion, and love.
Properties of Dosha
Vat, Pit, and Kaph control all human biological, psychological, and physiopathologic functions and have subtle properties, as shown in Box 32-1.
BOX 32-1 Properties of Dosha