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Caraka, the extraordinary physician and the author of Caraka Samhita, an ancient treatise of Ayurveda, is believed to have lived during the time of the Kushan empire that flourished in today’s north India between 200 BC and AD100. Being one of the three foundational texts of Ayurveda (the other two being the treatises authored by Sushruta and Vagbhata), Caraka Samhita is a creative revision of its forerunner, “Agnivesa Tantra”, the teachings of the great saint Atreya on Ayurveda.

Ayurveda traces its origin to the Atharva Veda, which is also known as Brahma Veda. Even though many of its hymns (mantras) are concerned with philosophical and spiritual ideas, a substantial part of the six thousand hymns and one thousand prose lines deals with the human body, its disorders and their cure. The curative hymns were chanted to induce faith in patients with frightful dreams and illness of sinful origin.

Even though Caraka urged the votaries of Ayurveda to be loyal to the Atharva Veda, his idea of medicine and treatment was different. “Atharva veda was faith-based in which an illness is awarded as a punishment by the god. Each and every illness has a god associated with it. Propitiating the god through various rituals and hymns was part of curing a disease. Caraka replaced these elements with reason, and brought in a reason-based medicine,” said Dr M S Valiathan, a renowned cardiac surgeon and the author of “The Legacy of Caraka”, “The Legacy of Sushruta” and “The Legacy of Vagbhata” among others.

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What makes Caraka different from other physicians of today? Caraka was not just a physician. He would check a number of things associated with a patient during diagnosis. He would ask him about his neighbours and the surroundings. He would check whether any death occurred in the neighbouring houses or in the case of animals nearby. The environment also mattered. “Caraka believed that to treat a patient, he needed to diagnose him thoroughly and it was this quality that made him an extraordinary physician,” said Valiathan, while speaking on “Caraka Samhita”: An ancient treatise of Indian Medicine” as part of the monthly lecture organised by the Chennai-based Varahamihira Science Forum on Saturday.

Dr M S Valiathan

Valiathan is a former President of the Indian National Science Academy and National Research Professor of the Government of India. After obtaining an MBBS from University of Kerala, he also received his Master’s degree from the University of Liverpool, England and later underwent training in cardiac surgery at Johns Hopkins and George Washington University hospitals. He returned to India, first serving at Safdarjung Hospital, Delhi then as a teacher at Indian Institute of Technology, Madras. The Government of Kerala invited him to set up a hospital facility for cardiac surgery and a research centre at Sri Chitra Tirunal Institute, which was later designated an Institute of National Importance. His team developed an indigenous heart valve called the Chitra valve. Being an expert in modern allopathic medicine, Valiathan also developed an interest in Ayurveda. There was a reason.

Way back in the 1990s, inside an operating theatre in Thiruvananthapuram a heart surgery was being performed on a patient. Even though such surgeries were common in the professional career of Valiathan, this one made him think about his country and its tradition. Barring the heart on which the surgery was being performed, every other thing was foreign. The medicine, surgical tools and the methods…etc. “We have been using the British system of medicinal practice for long despite making our own progress in various fields. Raman spectroscopy is an example. There are many. But why are we sterile when it comes to our own tradition? I asked myself. This realization helped me get into the world of Caraka, and our traditional medicine system,” he said.

Many diseases of today existed centuries ago as well. If that was the case, how did they treat them? Valiathan tried to find the answer to the question. Caraka’s manual of medicine appealed to him. He started studying the Ayurveda system with the help of Raghavan Thirumulpadu, a scholar in the field. “I have learnt modern medicine from masters. But if I believe that’s the end of the world, then I am wrong. I am making a mistake. We need humility to accept other views as well. I was 65 when I started learning Ayurveda,” said Valiathan, who was awarded a fellowship by the Homi Bhabha Council to study Caraka and his work in 1999. The study not only resulted in the translation of Caraka Samhita into English titled “The Legacy of Caraka” but also in the publication of “The Legacy of Sushruta” and “The Legacy of Vagbhata” in the coming years.

Caraka believed that to treat a patient, he needed to diagnose him thoroughly and it was this quality that made him an extraordinary physician,” said Valitathan

Caraka Samhita was different mainly due to its philosophical content when it comes to the manual for surgery and medicine. One of the fundamental concepts of Ayurveda is that everything in the universe is composed of ‘Panchabhuta’ (earth, water, fire, air, space). But Caraka, according to Valiathan, didn’t stop here. “He (Caraka) said there was an indefinable inexorable, which couldn’t be defined. Caraka gave supreme importance to air (vayu). He pointed out that vital breath (prana) follows blood in its course. The functions of ‘vayu’ constituted the basis of respiratory function in humans,” he said. “The head and brain were distinguished from each other in the Atharva Veda and Caraka Samhita, but neither connected the brain with consciousness or brain-based disorders such as mental illness or epilepsy. Caraka’s predecessor Bhela was the only one who located the seat of consciousness between the top of the head and palate,” he added.

Valiathan said it “is intriguing that the Ayurvedic authorities took no note of the tantric views on the levels of consciousness and their correlation with the centres in the spinal cord and the brain. It is unlikely that Tantra did not exist when the Caraka Samhita and its revision by Drdhabala were written.” Caraka noted pulsations in the neck arteries, but he didn’t not connect them to the function of the heart. “Tissues receiving blood were clearly mentioned when Caraka noted the supply of blood from the heart to the maternal surface of the placenta. The distribution of blood from the heart was known but not its return. Caraka had a comprehensive knowledge of the internal organs in the main cavities of the body,” he said.

The study of human skeleton on the basis of cadaveric dissection was a major achievement of Indian medicine. If you look at modern anatomy, the human skeleton is made up of 200 bones. Caraka, however, totalled 360 bones. How? The discrepancy, according to Valiathan, occurred largely because he included all hard tissues – teeth, cartilages and prominences of bones – in the skeleton for computation purposes. Caraka’s total exceeded Susrutha’s (300) mainly because he included tooth sockets and nails in his list of bones.

“Caraka was not averse to accepting ideas from Buddhist philosophy despite its denial of vedic authority. The concept of the momentary nature of sense perception and the permanent relief from suffering by giving up covetousness appealed to his catholic mind. He saw no conflict between his adherence to vedic rituals and gods and an eclectic approach to philosophy,” he said. “People today think Ayurveda is full of vegetarian products. It is not true. Animal products and drinks like wines were used as part of treatment. Ayurveda means a cheerful and healthy life,” he added.

Caraka Samhita was different mainly due to its philosophical content when it comes to the manual for surgery and medicine.

Despite having a great tradition of Caraka, Sushruta and Vaghbhada, why does Ayurveda take a back seat in our country today? “Caraka had a great system of teaching where discourses between the master and his students were common. Unfortunately, Ayurveda is taught in colleges not the way it is to be taught,” said Valiathan. Drug regulation in India is hopeless, according to him. “The Ministry of Ayush has published 500 compositions of medicines, but there are more than 1500 available in the market. Most medicines you get in the market are made without proper tests and analysis and that’s the tragedy,” he said. While big Ayurveda institutes have laboratories to conduct tests, the smaller ones lack such a facility. “The government needs to support small units because they don’t have laboratories to conduct tests and analysis. Most medicinal plants, barring a few, function in a very unscientific way. You can’t check the purity of a medicine. The government should bring in more laboratories and regulations. Otherwise, our markets will be flooded with substandard Ayurvedic products,” he said.

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