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Dr. Harbans Singh Wasir, MD, DM, FAMS,
Professor and head of Department of Cardiology,
All India Institute of Medical Sciences, New Delhi.

Disease-free condition is the best source of virtue, wealth, gratification and emancipation, while the diseases are destroyers of this (source), welfare and life itself
Charaka Samhita 4: 15-16

Unlike the various systems of medicine, like allopathy or homeopathy, Ayurveda is not a system of medicine but a science of life and longevity (Ayurveda= ayus: age, life, longevity, and veda: knowledge). The concept of Ayurveda is based on a combined study of body (sharira), sense organs (indriyas), mind (manas) and soul (atman). Equilibrium of these is related to health and their dysfunction is equated with death. Homeo-stasis of the internal milcu (dhatusamaya), or equilibrium of the various dhatus, is considered essential for absence of disease. The modern definition of health according to the World Health Organization (WHO) is 'the state of complete physical, mental and social wellbeing and not necessarily the absence of disease and infirmity'.

Ayurveda defines health as:

Abnormality (disorder) is disequilibrium of the dhatus and their equilibrium is normalcy (health) . Health is known as happiness while disorder is unhappiness (4)

Knowledge of Ayurveda is eternal, starting with creation; we do not know when it was not there. The origin of disease and disability must have been about the same time as the origin of life itself. The fight between the disease-creating elements and the disease-curing or disease-preventing systems must have been going on since Lord Brahma's day, as Brahma is considered to be the creator of the universe. The exact origin of Ayurveda cannot be dated precisely, but the original text is believed to have been written in ten million verses in one thousand chapters. The knowledge of Ayurveda then gradually descended through several sages, including Bharadwaja, Aitreya, Agnivastha, and finally Charaka and his students who compiled the text known as Charaka Samhita, which dates between 600 and 1000 B.C.

Charaka's description of Ayurveda is very systematic and in many ways it surpasses the modern system of medicine, because Ayurveda has a health-oriented approach, while modern medicine has largely had a disease-oriented approach. Modern medicine is only now stressing to some extent the role of mind in health and disease while in Ayurveda the basic approach incorporates body (sharira), mind (manas) and soul (atman).

Although the Rigveda and Atharvaveda are regarded as great treatises, Ayurveda is considered to be higher as it deals with life, health and longevity, and it is through the healthy body only that one can achieve all righteous tasks in life:

The approach in Ayurveda is wide and wholesome (holistic), while in modern medicine it is largely limited and materialistic (quick relief from disease and not much emphasis on promotive or positive health of mind and body). The mistake often made is when we equate Ayurveda with ayurvedic medicines. Although Ayurveda lays emphasis on both the preventive and curative aspects, its stronghold has been the former, its is clearly enunciated by Charaka. Therapeutics of two types have been described in the ancient Indian literature:

Therapeutics are of two hypes: (1) that which promotes strength. in the healthy (prevention of disease), and (2) that which alleviates disorders.
Charaka Samhita 3:4

One of the lengthiest chapters in Charaka Samhita is on longevity and the role of promotive health care:

From promotive treatment, one attains longevity, memory, intelligence, freedom from disorders, youthful age, excellence of lustre, complexion and voice, optimum strength of physique and sense organs, successful words, respectability and brilliance. Rasayana (promotive treatment) means the way to attain an excellent life.
Charaka Samhita 4: 7.8

Ayurveda is not just another system of medicine, but a science of total health care based on the strong pillars of positive health incorporating the role of the following four aspects: (i) character - achaar, (ii) thought or mind - vichaar, (iii) interpersonal relations - vyavahaar. and (iv) diet - altar.

Mind self and body these three make a tripod on which the living world stands The (living body) is purusha (person) sentient and location of this Veda (4yurveda). For him alone, this Veda is brought to light.
Charaka Samhita 6: 46-47

Charaka Samhita is the most complete text on health care and longevity, i.e. the Ayurveda contemporary surgical text has been dealt with separately in the Sushruta Samhita. A Charaka Club was established in New York in 1898, to honour the great Indian physician. Persian and Arabic translators of the Charaka Samhita had appeared in the 10th century A.D., and a first English translation appeared in the 19th century. Compared to the biblical human lifespan of 70 years (three score and ten), Ayurveda's figure for the human lifespan was given as 100 years, which was divided into four ashrams or phases of life: (i) brahmacharya: up to 25 years, (ii) grihastha: 25-50 years, (iii) vanaprastha: 50-75 years, and (iv) sannyasa: 75-100 years.

Charaka Samhita Contributions

The ten commandments propounded by Charaka for the study and advancement of medicine are as follows:

1. Advancement of basic concepts of life: physiological and pathological phenomena; dhatusamay - equilibrium of dhatus, homeostasis.

2. Rational attitude: treatment with knowledge and practical skills, not with blind belief. rukti (rational) approach was recommended instead of daivya (supernatural) therapy. The wise man, desiring health and long life, should not take any medicine prescribed by irrational physicians.

3. Organisation of symposium: presentation of works/papers on therapy. Lord Aitreya has been mentioned as presiding over one such meeting.

4. Psychosomatic approach: deha manasa (psycho-somatic) concepts of disease treatment of the purusha (person) were stressed instead of organic systems.

5 Individual constitution prakriti (individual psyche/nature) was considered important in the prescript ion of medicines; basis of anaphylaxis allergy idiosyncrasy.

6. Expansion of discipline: (i) nidana - etiology, (ii) samprapti - pathologenesis, (iii) purvarupa - prodroma, (iv) rupa - signs and symptoms, and (v) upasaya - therapeutics.

7. Scientific method of diagnosis: first study the patient, then study the suitable drug, and watch for interactions, results and side effects.

8. Importance of nature: drugs and dietetic measures used to aid nature to fight/prevent disease:

swanbhavoparama - recession of disease by nature.

9. Emphasis on promotive and preventive aspects: Charaka Samhita starts its first chapter on the longevity of life in which the practice of rasayana (promotive health care) , aachar (conduct) and lifestyle are given importance.

10. Scientific study of drugs: analytical study of medicinal plants in the vedic period. The Rigveda and Atharvaveda mention aushadhi sukta drugs which are divided into 50 groups, according to their pharmacological action, based on: rasa, guna, virya, vipatka and prabhava (effects).

Charaka's quadruple

Fully realising the importance and contribution of the physician, the attendant (nurse), the patient and the drug, in the treatment of the sick, Charaka defined all the four as follows:

Physician, drug, attendant and patient, this is the quadruple which, if endowed with proper qualities, leads to time alleviation of disorders (3)

Physician:
Excellence in theoretical knowledge, experience, dexterity and cleanliness - this qualities of a physician. (6)

Attendant (nurse):
Knowledge of attendance, dexterity, loyalty and cleanliness:
these are the four qualities of an attendant. (8)

Patient:
Memory, obedience. fearlessness and providing all information about time disorder - these are the qualities of a patient (9)

Drug:
Abundance, effectively, various pharmaceutical forms and normal composition - these are the four qualities of drugs. (7)

Employment of all the excellent four - physician, attendant, patient and drug. in case of disorder of the dhatus, with the object of (re-establishing) their equilibrium, is said to be therapeutics. (5)

Preventive approach to positive health

This is only a glimpse of what Ayurveda offers, and if this is what Ayurveda is, then it certainly is much more than just a system of medicine. Dr. Dean Ornish, a well-known American cardiologist, has recently propounded that it is possible to reverse atherosclerosis (narrowing of the blood vessels) by the following regime:

1. Balanced diet, consisting mainly of vegetables and fruits;
2. Regular physical exercise, and
3. Practice of mental relaxation through Yoga and meditation.

This approach may be new for the Americans, but it is certainly not new for India, where Ayurveda has described three types o diet: sattwic, rajasic and tamasic. The sattwic diet, containing fresh fruits, vegetables, honey, curd etc., is considered to be superior. The rajasic diet was prescribed for those engaged in heavy physical work, and it contains high protein foods such as various types of meats, beans etc. The tamasic diet which contains highly spiced and refined foods was considered to be harmful to the health. Regular, moderate physical exercise and practice of Yoga are of course mentioned repeatedly in Ayurveda as the essential components of the preventative approach to positive health.

The major thrust in Ayurveda is on prevention of disease through diet, physical exercise and Yoga which includes several ways of mental relaxation. Drugs prepared from herbs, plants and animal products, including the milk of various animals, ghee and honey, have been used in Ayurveda for the treatment of different diseases. In the chapter on heart disease, the Charaka Samhita mentions at several places the reasons for cardiac problems and the means of prevention.

Cardiac disease of the kapha is born from the intake of fatty meals, overeating, and also from excessive indulgence in sleep, sedentary habits and carelessness.

Even wholesome food taken in proper quantity does not get digested due to anxiety, grief, fear, anger, uncomfortable bed and vigil.
Charaka Samhita 311 :9

The person desiring to protect himself from adverse ejects upon the heart) coronary blood vessels and the contents thereof should particularly avoid all the causes of mental affliction.
Charaka Samhita 30:53

In the present times, most deaths and disabilities occur from diseases of the cardiovascular system, cancer, psychosomatic problems, degenerative disorders like diabetes, gout and the modern scourge of AIDS. There is no permanent cure for any of these diseases, and their palliative treatment is becoming very expensive, which many families and even some states cannot afford. Modern medicine has provided excellent tertiary care treatment in the form of very effective drugs, angioplasty procedures, radiotherapy and sophisticated advanced surgical techniques to tackle some of these diseases where treatment could be beneficial for variable lengths of time. There is, therefore, an urgent need on a global level, and more so in the poor nations, to evolve preventive strategies on a war footing, to contain the emergence of epidemics of coronary disease, cancer and AIDS. Concepts and ways and means, as enunciated in Ayurveda, should be revived to supplement and augment the achievements of modern medicine.

As a city manager is cautious in the duties of the city and a charioteer in those of time chariot, a wise person should be cautious in the duties relating to his own body. An axle fitted in a vehicle which is endowed with all the essential qualities, carries on and perishes with time by depreciation of its normal limit.

Similarly, the lifespan of the body of a person comes to an end after the normal limit Such death is known as timely. Just as the same axle gets destroyed on the way, due to overload, uneven road, want of road, breaking of wheels, defects in the vehicle or driver, separation of the bolt, lack of lubrication, and throwing about, similarly, the lifespan of a person comes to an end in the middle due to over exertion, diet which is not in accordance with one's nature, and irregular meals

Samhita, sixth century B. C.

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