Review Article International Ayurvedic Medical Journal ISSN:2320 5091

CONCEPT OF ETIOLOGY IN AYURVEDA AND WESTERN MEDICINE Komatineni Surendra J. S. R. A. Prasad Dept. of Sanskrit Studies, School of Humanities, University of Hyderabad, Hyderabad, Andhra Pradesh, India

ABSTRACT Disease is as old as mankind itself. Man has always tried to understand natural phenomena and attempted to give his own explanation to it. The Indian system of medical thought has its origin in the vedas dated about 5000 years ago. Later Charaka samhita (1200B.C.), Sushruta samhita (1000B.C.) and Ashtanga sangraha (600B.C.) scientifically documented the bequeathed medical concepts. Disease or roga was described as an imbalance of the three humors of the body vata, pitta , and kapha . The western perspective on disease is recorded around 400 BC. Hippocrates has been considered the father of western medicine, which is otherwise known as biomedicine. He proposed the four humeral theories in which the Black bile, Yellow bile, Phlegm and blood are the governing factors of health or disease. Prior to Hippocrates, disease was thought of as the handiwork of witches and sorcerers over which humans had no control. During Renaissance in Europe, scientific thought grew by leaps and bounds and rational explanations were sought for every phenomenon. This situation gave rise to many discoveries in medicine too. Unlike Ayurveda , whose theories are founded on universal and holistic principles, and remained the same for over 5000 years, the western theories of philosophy of health and disease etiology have a relatively short history. Modern theories on disease etiology like the germ theory and the genetic theory were described in Ayurvedic scriptures in Sanskrit language. The notion that these theories were already proposed in Ayurveda is increasingly being recognized after the translation of Ayurveda books into English and other languages. Lifestyle disorders are gained utmost attention in recent times. In this regard Ayurveda attributes three prominent factors as the basic disease etiology. They are asatmendriyarthasamyoga, prajnaparadha and parinama . In this paper, we tried to trace the ancient Indian concepts of disease etiology. Keywords: Etiology , Disease , prajnaparadha, Ayurveda

INTRODUCTION world gives the earliest information on Ancient civilization in the east or diseases, their etiology and treatment 2. the west applied its rational to understand While Rgveda contains details of three the etiology of disease. Each civilization energies namely vata, pitta, and kapha 3, had its own interpretation of what causes Atharvaveda (1500 BC) goes into disease or the different factors that steer considerable details on aspects related to the course of a disease. The Vedas put disease etiology and treatment 4. Etiology forth three humeral theories as a possible is a clearly defined science in the explanation for the state of either health or samhitas, Caraka , Sushruta and Kashyapa disease 1. The Rgveda (3000 B.C.) which is and in the Ashtanga sangraha . The regarded as the oldest scripture in the samhitas tried to offer a rational and Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine indigenous explanation for disease. From rationalistic evolution of the concept of this front, it can be argued that concept of etiology in both systems. disease etiology has its roots in Vedic The tridosha vs the humoral theory scriptures and samhitas, much before the The tridosha theory modern medicine spoke anything about Vata, Pitta, and Kapha are called this. Tridoshas in Ayurveda 7. Tridosha theory is Disease etiology has been the foundation of Ayurvedic concepts of discussed in different ways in the west too. health and disease. Further, there is an Historically, before the advent of inherent link between Tridosha and Hippocrates (450-380B.C.) 5 and Galen Panchamahabhuta (five gross elements) (130-200A.D.) 6 it is believed that disease theories. All material substances in the is caused by the action of God. Further, universe, animate or inanimate, are the such divine action is often described as a manifested form of the punishment for human sin. In idolatrous Panchamahabhutas, viz. Akasha (Sky), cultures disease was associated with gods, Vayu (Air), Agni (Fire), Ap (Water) and demons, witchcraft, curses and astrological Pruthvi (Earth) 8. Graph 1 shows the influences. It was Hippocrates, (considered conglomeration of the five gross elements. as the father of medicine) who first Man is no different from the universe attempted to offer a rational explanation of where he inhabits, and actually is a disease in the west. Later, Galen tried to microcosm of the macrocosm called explain and correlated the anatomy of universe 9. Human body is the humans by performing anatomical manifestation of the said gross elements dissections on animals, as human wherein the Tridoshas can be said as the dissection was prohibited during those bio-energies. Amongst the Tridoshas , Vata days. is the outcome of the wind and earth This paper attempts to correlate the elements, Pitta is the manifestation of fire humeral theory in Ayurveda and Western element and Kapha is the result of the Medicine while trying to trace the water and earth elements in the human body 10 .

Graph 1 11 Graph 2 12

The equilibrium between these elements of in-equilibrium in humors, it is the same (rather the energies represented by them) that constitutes the etiology of the disease. signifies health and in-equilibrium constitutes disease. Whatever is the cause Hippocratic theory

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Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine In ancient Greece and Rome, numerous philosophy, the universe has been believed scholars, right from Hippocrates to Galen to be evolved of four gross elements - tried to render rationalistic explanation on 'earth', 'air', 'fire' and 'water'. These disease affliction. The primary factors elements possess various combinations of were considered to be four basic qualities like moisture, dryness, hot and substances or humors called 'blood', cold. The four humors also acquire these 'phlegm', 'yellow bile' and 'black bile'. qualities in different ratios and human Hippocrates developed a naturalistic body is the outcome of these. approach to medicine that contrasted Each of these humors is associated with a sharply with the dominant religious views major organ of the body. that preceded him. His four humeral theory • Blood- liver was held in high esteem as the promoter of • Phlegm- lungs etiological concepts of disease, until the • Yellow Bile- spleen advent of the germ theory by Louis Pasture • Black bile- gall bladder in sixteenth century. Foundational principles of tridosha and Hippocrates proposed that the four Hippocratic theories fluids blood, phlegm, yellow bile and The following table shows the black bile makes up one's constitution. foundational principles of the Tridosha Health is a state in which these fluids are theory in Ayurveda and the four humeral said to be in equilibrium. As per Greek theory of Hippocrates. Table 1: Foundational principles of humors Sl no Tridosha Theory Hippocratic Theory Stems from five elemental theory Theory stems from four elements theory 1. (Akasha, vayu, Agni , Jala and Pruthvi) (Wind, Fire, Water and Earth) Is the energy represented by 2. Are basically liquid body substances conglomeration of respective elements Constitutes the entire body though there Humors are liquids emanating from a vital 3. are specific seats for individual doshas organ Tridoshas are metaphysical, cannot be 4. seen by naked eye but can only be Not the case here understood by their way of functioning Though foundational principles are seemingly different in both systems, there are certain commonalities in the theories. Commonalities are correlated as per the following table. Table 2: Commonalities in humeral theories Sl no Three Humeral theory Four Humeral theory A right proportion of four elements is An equilibrium of Tridoshas constitute 1. health, Disproportion of any is health, in-equilibrium is disease disease Represent the five elements and understood Represents the four elements and 2. by the properties (smell, cold, touch, sound, understood by 4 properties, moisture, hot) of the 5 elements and dryness, hot and cold.

Thus, in spite of differences in the anyone. Irrespective of the number of foundational concepts of the Ayurvedic humors proposed in both the medical and Hippocratic theories, commonalities systems, it is common that health is a state observed are a matter of interest for of the homeostasis of the humors, and 3 www.iamj.in IAMJ: Volume 1; Issue 4 ; July – Aug 2013

Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine disease a state in which the balance in the etiology was dominant until the arrival of humors is deranged. In turn, the “Germ Theory”. derangement gives rise to disease. The germ theory Therefore, it is contextual to discuss about Until the 16 century, the dis- the etiologies of disease in the western and proposition between the four humors was eastern systems. This discussion may bring the only rational explanation given to about the intricacies in both systems. disease etiology in the west. The discovery The importance of etiology of fermentation technique and the analogy Disease etiology is a crucial between disease and fermentation led to concept that facilitates proper treatment. the transition between humeral theories to Diagnosing the root cause of disease the germ theory. This transition removes from the mental or physical pain. represented a major conceptual revolution After all, removing the root cause of of etiology. When we look at the disease is the first step towards proper continuum of this transition, Fracastoro treatment, and sometimes, is the only step (1478-1553) an Italian physician wrote the that is essential. Medical tradition in the first important work 'On Contagion' in west has paid considerable attention to 1546. The modern germ theory of disease etiology due to its valuable stake in the developed with the research of Pasteur, treatment process. Lister, Loch and others in 1860’s and Western thought on disease etiology 1870’s. 14 Other radical changes happened In the west, Hippocrates has in the 20 th century with the discovery of observed instances of hereditary traits in genetic, nutritional and immunological diseases. According to him, the phlegmatic causes of disease. Of late, infectious nature is hereditary. Later, the first diseases are typically classified as assertion of the genetic basis of a disease bacterial, viral, protozoal and fungal. was discussed in Archibald Garrod’s work When we look back to Hippocrates, he has on Alkaptonuria in 1901. 13 Many other emphasized only on humoral imbalances genetic disorders were identified further. with sketch knowledge of anatomy. The Hippocrates considered poor diet doctrine ‘De Sedibus et Causis Morburum also as one of the prime factors of disease. Per Anatomen Indagatis’ states that However, he did not refer to the dietary 'disease has specific seats in particular supplements like vitamins, minerals etc. body organs' that was developed by which is a recent phenomenon in 20th Morgagni. He has been considered as the century. father of modern anatomical pathology in Hippocrates has also added that the the 18 th century. 15 seasonal variations can alter the heat, cold, Disease concept in the 21 st century moisture and dryness like qualities thereby Concepts of Disease, based on etiology in affecting humeral homeostasis. contemporary times can be summed up as: On the other hand, Galen had 1. Infectious diseases - caused by germs focused mainly on circulatory system, eg: malaria, typhoid nervous system, respiratory system and 2. Genetic diseases - caused due to other anatomical structures. hereditary factors eg: heart disease After Hippocrates and Galen, for a 3. Nutritional disorders - deficiency of long time, no new theory on disease certain nutrients can be the cause for disease eg: Anaemia 4 www.iamj.in IAMJ: Volume 1; Issue 4 ; July – Aug 2013

Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine 4. Immunological disorders - disease 2. Prajnaparadha - Is intellectual arising from attacks by the immune blasphemy. Improper understanding of system on the body’s own organs eg: objects by intellect will result in adverse Rheumatoid Arthritis. actions such as, negative thinking, 5. Metabolic disorders - A hampering of misbehavior with noble people, lack of metabolism causing disease eg: knowledge controlling mind, lack of good Diabetes conduct are some of the reasons for 6. Cytological diseases - study of intellectual errors. structure and function of cells. For eg: 3. Kala - Is seasonal variation. Improper like in growth of Cancers intake of food such as untimely Indian thought on disease etiology consumption of eateries while ignoring Sushruta stated that 'duhkha ' (grief) seasonal changes etc., are due to is the root cause of diseases- kalaviparinama . Improper intake of food “taddhukhasamyoga vyadhaya ucyante 16 also causes lot of life style disorders such /” (association of miseries is called as stress etc. As an effect, people also 'duhkha' ). That means, if one avoids suffer with stress/anxiety disorders, work duhkha, there would be no disease. In tensions and so on and so forth. order to avoid, the removal of causes that DISCUSSION are attributed with duhkha, needs attention. More or less, the five elemental Charaka has listed the causes for duhkha. theory is common to Hippocratic and Dhīdhrtismrtivibhramsha samprapti Ayurveda systems. Humors make up one's kalakarmanam | constitution in Hippocratic and Ayurveda asatmyarthagamashceti jnatavya systems though respective constitutive dukhahetava || 17 members of humors vary in character, “Derangement of intellect, restraint and except the phlegm. In fact, the concept of memory, advent of time and action and 'phlegm' has been intended differently by contact with unsuitable sense objects Charaka as its scope is much wider than in should know as the cause of misery”. Hippocratic system. Even though tridosha s Charaka samhita has discussed three main pervade the entire body, specific regions reasons for disease: are attributed as their seats. Phlegm is said “...asatmyendriyarthasamyoga, to occupy the upper part of the body prajnaparadha, parinamashceti consisting head, neck, thorax, chest, upper trayastrividhakalpa hetavo vikaranam stomach, fat tissues, lymph glands and samayogayuktastu prakrtihetavo joints 19 . Further, it can be postulated that bhavanti 18 ” the tridoshas are not measurable using 1. Asatmyndriyartha samyoga - Is extreme scientific equipment, whereas the use, under use and abuse of sense organs Hippocratic four humors are. while aligning with their objects . That Factors listed in Charaka were said means indulging cognitive organs, viz., to produce disease due to the in- eyes, nose, ear, tongue and skin, in equilibrium of doshas . Charaka and contrary methods cause disease. For Hippocrates agreed upon the root cause of instance, listening music in high decibels hereditary diseases. Also, both believed triggers ear related diseases, which is that poor diet and seasonal variation called ' aindriyaka '. affects the equilibrium of humors. But the threefold etiology of Charaka is unique in 5 www.iamj.in IAMJ: Volume 1; Issue 4 ; July – Aug 2013

Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine many ways compared to western medical Looking again at the modern system. theories of disease it is apparent that Astamyendriyarthasamyoga is Ayurveda addressed the issue of the related to incompatibility senses with their genetic theory and Lifestyle disorders or objects. Most professional hazards like metabolic disorders gout, obesity etc. in continuous peering into computer the texts. monitors, listening high decibel sounds Cancer ( karkatarbuda ) was through various means, looking at high explained as an abnormal and unexplained beam lights, exposure to extreme heat or growth of Cells and tissues. Nutritional cold temperatures, smelling of chemical deficiencies too were considered a reason pollutants are the ' asatmya' for disease. The best example for that (incompatibility) of objects to being Pandu or Anaemia. Lohatatwa or corresponding sense organs. Abusing the iron was advised for this right from the sense of taste or its excessive usage could samhita times. Although vitamins and be termed as overeating which is the essential minerals were not explicitly instigator for lifestyle disorders like named in those times, certain foods were Diabetes Mellitus. considered healthy and certain to be Prajnaparadha carries a greater unhealthy. Diet was a major factor behind relevance in contemporary times. health or sickness. Committing errors willfully is nothing but Immune disorders are described in an intellectual blasphemy. Errors like Charaka . Immunity is known as ' ojas' and smoking, alcoholism, abusing elders and 'balam' . The impression that the body’s noble people, drug abuse and sedentary immune system kills its own cells and life style with faulty food habits results in tissues is an invention of the twentieth Prajnapar ādha. Humans have no control century which was not known earlier. It is over seasonal variations. Hence, Ayurveda a matter of issue that auto immune advocates Ritucarya and pancakarma disorders respond positively to Ayurvedic therapy for prevention and treatment immune modulators like guduchi purposes. (tinospora cordifolia ) etc. Sushruta did consider Amongst the study of most divine/supernatural origin of disease important aspect of all these theories the amongst the other types. But in germ theory leads to interesting findings. 'adibalapravrutta' 20 type of diseases Although Ayurveda , the Indian system of 'genetic disorders' were discussed for the medicine, lays emphasis on the tridosha first time in indigenous medicine. This disturbance being the cause of disease in concept speaks of the disorders that can as much they cause the in-equilibrium or take place in the seed of the male and the the tridoshas . Germs were recognized and female that leads to genetic disorders in called with different names such as, Bhuta, the progeny. A concept on Krimi etc. Charaka has enumerated about 'Janmabalapravrutta' 21 speaks about twenty such germs/microbes. Graharogas disease occurring due to problems during (epidemical) mention isolating patients to pregnancy and child birth. For instance, avoid the spread of disease from person to long labor and hypoxia during child birth person. can lead to mental retardation of child. In Charaka Samhit ā, a chapter called ' janapadodhwamsavimanadhyaya' 22 6 www.iamj.in IAMJ: Volume 1; Issue 4 ; July – Aug 2013

Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine discusses epidemic breakouts and lists out www.arogyabhawan.com/about polluted air, water and earth as its reasons. āyurveda.html So, germ theory is entirely not unknown 2. www.arogyabhawan.com/ [Home page yet not overtly emphasized in the Indian on Internet]; Available from school of medical thought. All factors of http://www.arogyabhawan.com/about- etiology were examined for the āyurveda.html disturbance they could cause to doshas . 3. www.arogyabhawan.com/ [Home page In addition to these Ayurveda went on Internet]; Available from ahead of its times to describe the http://www.arogyabhawan.com/about- psychological component of disease āyurveda.html etiology. Phobias and grief could cause 4. www.intratext.com/ [home page on disease. When Charaka spoke about the Internet] Available from strong body-mind link and physical http://www.intratext.com/ixt/ENG0042/ diseases causing psychological 5. iep.utm.edu/ [Home page on Internet]; disturbances and psychological diseases (ISSN 2161-0002); 1995. Available from causing physical disturbance, he was in http://www.iep.utm.edu/hippocra/ fact speaking about psycho-somatic and 6. iep.utm.edu/ [Home page on Internet]; somato-psychic diseases. This demands (ISSN 2161-0002); 1995. Available from preventive or healing measures to mind http://www.iep.utm.edu/galen and body. 7. Charaka, Charaka Samhita (text with CONCLUSION English translation) Editor and Translator- The origin of the modern concepts P. V. Sharma, Chaukahamba Surabharati of etiology was already laid in Indian Prakashan, Varanasi, Re-print, 2010.p. 8 system of thought ( Ayurveda ) in context of 8. Sushruta, Sushruta samhita (Text, disease. The four humeral theory from the English Translation, Notes, Appendices time of Hippocrates paved the way for and Index) Vol.III, Translater Prof. K. R. other concepts of etiology like the germ Srikantha Murthy, Chaukhambha theory and the genetic theory in the Orientalia, Varanasi, Re-print, 2012.p. 8 modern times. The tridosha theory is as 9. Charaka, Charaka Samhita (text with relevant to Ayurveda today as it was 5000 English translation) Editor and Translator- years ago. The significant concepts of P. V. Sharma, Chaukahamba Surabharati etiology in Ayurveda need a thorough Prakashan, Varanasi, Re-print, 2010.p. 440 revisit from the modern perspective. 10. Vagbhata, Ashtanga Samgraha (text ACKNOWLEDGEMENT with English translation) Editor and Authors are thankful to the inputs Translator P. V. Sharma, Chaukhambha provided by Dr. Vinaya P. N. and Dr. Surabharati Prakashan, Varanasi, Re-print, Srikanth K.Y., of University of 2011.p.15 Hyderabad. 11. www.indianetzone.com/ [Home page on Internet] Available from http://www.indianetzone.com/20/panchabh REFERENCES uta_in_ayurveda.html 1. www.arogyabhawan.com/ [Home page 12. www.bbc.co.uk/ [home page on on Internet]; Available from http:// Internet] Available from http://www.bbc.co.uk/schools/gcsebitesize

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Surendra and Prasad: Concept of Etiology in Ayurveda and Western Medicine /history/shp/ancient/greekknowledgerev1.s 18. Charaka, Charaka Samhita (text with html English translation) Editor and Translator- 13. Thagard, P. (1996). The concept of P. V. Sharma, Chaukahamba Surabharati disease: Structure and change. Prakashan, Varanasi, Re-print, 2010.p. 77 Communication and Cognition, 29: 445 - 19. Maya Tiwari, The Path of Practice, 478. HTML (Article on Internet). [cited Motilal Banarasidas, New Delhi 2000, 2013 Mar 15]; [about 26p.]. Available P.334 from: 20. Sushruta, Sushruta samhita (Text, http://cogsci.uwaterloo.ca/Articles/Pages/ English Translation, Notes, Appendices Concept.html and Index) Vol.III, Translater Prof. K. R. 14. Thagard, P. (1996). The concept of Srikantha Murthy, Chaukhambha disease: Structure and change. Orientalia, Varanasi, Re-print, 2012.p. 75 Communication and Cognition, 29: 445 - 21. Sushruta, Sushruta samhita (Text, 478. HTML(Article on Internet). [cited English Translation, Notes, Appendices 2013 Mar 15]; [about 26p.]. Available and Index) Vol.III, Translater Prof. K. R. from: Srikantha Murthy, Chaukhambha http://cogsci.uwaterloo.ca/Articles/Pages/ Orientalia, Varanasi, Re-print, 2012.p. 76 Concept.html 22. Charaka, Charaka Samhita (text with 15. http://www.historylearningsite.co.uk/ English translation) Editor and Translator- [home page on Internet] Available from P. V. Sharma, Chaukahamba Surabharati http://www.historylearningsite.co.uk/giova Prakashan, Varanasi, Re-print, 2010.p. 314 nni_morgagni.html CORRESPONDING AUTHOR 16. Sushruta, Sushruta samhita (Text, Dr. SURENDRA KOMATINENI English Translation, Notes, Appendices Research Scholar of Sanskrit Studies and Index) Vol.III, Uttara Tantra, School of Humanities, University of Translater Prof. K. R. Srikantha Murthy, Hyderabad, Hyderabad, (A.P) India Chaukhambha Orientalia, Varanasi, Re- E-mail: [email protected] print, 2012.p. 7 Source of support: Nil Conflict of interest: None Declared

17. Charaka, Charaka Samhita (text with English translation) Editor and Translator- P. V. Sharma, Chaukahamba Surabharati Prakashan, Varanasi, Re-print, 2010.p. 406 8 www.iamj.in IAMJ: Volume 1; Issue 4 ; July – Aug 2013