Āyurveda and the Hindu Philosophical Systems

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Āyurveda and the Hindu Philosophical Systems Author(s): Gerald James Larson Source: Philosophy East and West, Vol. 37, No. 3 (Jul., 1987), pp. 245-259Published by: University of Hawai'i PressStable URL: http://www.jstor.org/stable/1398518Accessed: 16-11-2015 17:20 UTC

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Gerald James Larson Ayurveda and the Hindu philosophical systems

INTRODUCTION

An inquiry into the conceptual framework of traditional South Asian medicine is important not only from an anthropological and historical perspective-that is to say, from the perspective of uncovering archaic and ancient patterns of

symbolization with respect to notions of "health" and disease" together with the

development of these patterns synchronically and diachronically-but also, and

perhaps more importantly, from a philosophical and interpretive perspective. By the terms "philosophical" and "interpretive" I have in mind two distinct concerns: (a) a concern for "understanding" vis-a-vis them, or, in other words, the realization that millions of persons throughout South Asia and West Asia

currently utilize or practice some form of Ayurvedic medicine and that it is essential for us as modern researchers to grasp the indigenous conceptual systems with which these millions live, if we are to continue to make progress in "under-

standing" the nature of the multicultural world in which we live; and (b) a concern for "appropriating" vis-a-vis ourselves, or, in other words, the realization that our own modern conceptualizations of medical theory and practice may usefully be supplemented and enriched by taking seriously some of the insights and practices of traditional South Asian medicine. It is certainly no exaggeration to suggest that our modern notions of health care and the treatment of illness are

remarkably limited and in need of serious reform on the level of value orientation and conceptualization. Although important progress has been made in such fields as embryology, immunology, physiology, surgery, and so forth, ordinary health-delivery systems (in the United States, Western Europe, and elsewhere) regularly break down; the cost of medical research and training approaches outrageous levels; the doctor-patient relationship frequently becomes mechan- ical and callous; and, most important of all, the authentic benefits of modern medical science are largely available only in those areas of the world that are

technologically and economically advantaged-and even within these latter

areas, the inequities in medical care are staggering. This is not to belittle the

genuine contributions or the experimental methodology of modern medicine, nor is it to suggest that we should adopt traditional South Asian medicine as our own. Indeed, there appears to be little of scientific importance in traditional

medicine; or, to put the point somewhat less polemically, whatever is of scientific value in traditional medicine is handled in a more productive manner utilizing the

methodologies of modern science. What is of importance in traditional medicine, however, is a way of valuing and a way of conceptualizing "disease" and "illness" that is interestingly different from our own and that is not at all

incompatible with the rigorous precision of modern scientific methodology. It is with both of these concerns in mind, then, that I am undertaking this inquiry into traditional South Asian medicine.

Gerald James Larson is Professor of Religious Studies at the University of California, Santa Barbara.

Philosophy East and West, volume 37, no. 3 (July 1987). O by the University of Hawaii Press. All rights reserved.



246 Larson

I. THE HISTORY AND LITERATURE OF AYURVEDA

The term dyurveda means "knowledge" (veda) concerning the maintenance of "life" (dyus), and the origins of this "knowledge" are already evident in the A tharvaveda (the contents of which can be dated somewhere between circa 1500 and 1000 B.C.). To be sure, the treatment of disease (cikitsa) in the Atharvaveda is largely religious and ritualistic, emphasizing such practices as the articulation of "sacred utterances" (mantra), penances (niyama), sacred oblations (mahgala- homa), and purificatory rites (prdyascitta); but the Atharvaveda also contains material about human anatomy, herbal medicines (bhaisajya), and the classifica- tion of diseases (vyadhi). Reference is made to "wandering medical practitioners" (cdranavidya) and those who are "trained in medical science" (vaidya). Mytho- logically, the Ayurvedic tradition assures us that the first specialist in medical science was none other than the creator god, Brahma, himself. Brahma shared his

knowledge with Prajapati, who in turn passed on the tradition to the Asvins and Indra. Surgery (salya) was revealed by Indra primarily to the human school of Divodasa, the king of Kasi, who was also an incarnation of the divine Dhan- vantari, culminating finally in the classical Susruta tradition of Ayurvedic sur-

gery and medicine. Internal medicine (kdyacikitsa) was revealed by Indra primarily to the human school of Atreya Punarvasu, culminating finally in the classical Caraka tradition of Ayurvedic general medicine. Moreover, the Ayur- vedic tradition informs us that from ancient times specializations in eye, ear, nose, and throat disease (sadlkya), psychiatric disorders (bhutavidyd), pediatrics (kaumdrabhrtya), toxicology (agadatantra), geriatrics (rasdyana) and sexology (vdjfkarana) also developed. All of this traditional medical lore is encompassed by the general term ayurveda; and vis-a-vis the sacred, liturgical Vedas (namely, the Rg, Sdma, and Yajur collections together with the purely religious portions of the Atharva), the dyurveda is characterized as an updhga ("supplementary portion"), or as an upaveda ("supplementary Veda"), or even as a "fifth Veda."

From a historical-critical point of view the evidence indicates that Ayurvedic medicine is at least as old as the sacred brahmanical tradition and that systematic compilations of medical knowledge were prevalent before the time of Gotama, the Buddha (563-483 B.C.). Indeed, the very presentation of Buddhist notions in the older literature (for example, in texts such as the Dhammacakkappavattana- sutta of the Satiyutta-nikdya or the Mdlufkydputta-sutta of the Majjhima- nikdya, with their emphasis on existential disease or injury, its diagnosis, its prognosis, and treatment) suggests that some sort of systematic medical tradition(s) was widely known and respected. It is, however, in the first centuries A.D. that the older medical traditions were compiled and systematized into collections that have come down to us, namely, the Caraka-sathhitd (purportedly a revision of an old text on general medicine known as the Agnivesa-tantra, edited and revised by a certain Caraka who was possibly a court physician to king Kaniska in the first century A.D., and finally completed by a certain Drdhabala, circa A.D.



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500), and the Susruta-sathhita (purportedly an old tradition of surgical theory and practice, put into final form in the second or third century A.D. and later revised by a certain Nagarjuna either in the sixth or the tenth century A.D.). The basic commentary on Caraka-samhitd, the Ayurveda-dfpikd of Cakrapanidatta, was composed in the eleventh century, and the basic commentaries on the

Susruta-samhhita, namely the Bhdnumatf of Cakrapanidatta and the Nibandha- samhgraha of Dalhana, in the eleventh and thirteenth centuries, respectively. Other important texts include the Bhela-sathhitd (possibly earlier than Caraka), the Astdngahrdaya-sathhitd of Vagbhata (circa A.D. 600) and the Mddhavaniddna of Madhavakara (circa A.D. 700.) Numerous other texts on medicine were

regularly composed through the centuries, and the Ayurvedic tradition con- tinued as a vigorous scientific tradition down into the sixteenth century. More- over, in the last several decades of the present century the Government of India has been actively supporting research in ayurveda, and some of the leading research universities in modern India (for example, Banaras Hindu University) have established research programs in Ayurvedic studies. Thus, historically and

textually, we are dealing with a vast, ancient, and largely unbroken tradition, which ranges from the anatomical speculations and medical practices of the Atharvaveda (that is to say, from the latter half of the second millennium B.C.) to

present-day research programs in modern Indian universities.1

II. THE THEORY OF AYURVEDIC MEDICINE

Jean Filliozat, in his important work La Doctrine Classique de la Medicine Indienne (Paris, 1949), comments that Ayurvedic medicine is a "rational system" based on "experience" and that throughout conceptualization remains flexible and in almost every instance is easily adapted to usage.2 Filliozat's assertion can be readily documented in the two major classical medical texts (namely, Caraka- samhhita and Susruta-sathhita) and their commentaries, for it is obvious from the outset that the medical literature is oriented practically and operationally. The texts present a symposium-like format in which a practical symptom such as fever (jvara) or dysentery (atisdra), or a disease such as pulmonary consumption (rdjayaksman), is discussed, classified as to type, contextualized (with respect to

prodromes, syndrome, and prognosis), and finally dealt with therapeutically. In this respect the South Asian medical literature is much like a modern medical textbook-that is to say, overall theory is largely presupposed and attention is

given to symptomatology, diagnosis, and treatment. It is possible, however, to reconstruct (by comparing and piecing together occasional theoretical passages) an overall conceptualization of medical theory and to relate that conceptualization to the larger intellectual environment of classical Indian thought. It should be noted, though, that there is no one-to-one correlation. The dominant intellectual influences on Ayurveda are those of the Sarhkhya and Vaisesika

philosophies, although one also finds terms and notions from systems such as

Vedanta, Nyaya, Yoga, and early Buddhist and Jain reflection. It is difficult to



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determine whether Ayurvedic notions were shaped by classical Indian philosophical notions or if the latter were shaped by the former. Perhaps, therefore, the Weberian notion of "elective affinity" is the most appropriate characterization, a notion which allows for an ongoing exchange between the classical Indian

philosophies, on the one hand, and the practice of traditional Ayurvedic medi-

cine, on the other. In other words, it is probably not possible to suggest a causal relation one way or the other, but one can argue that there was a natural affinity between the naturalistic philosophical systems and Ayurvedic medical practice which generated a mutually influential pattern of ongoing interaction.

According to one important interpretation of Ayurvedic theory, "life" (ayus) arises because of the association (sathyoga) of body (sarTra), sense capacities (indriya-s), mind (sattva or manas), and self (atman) (Caraka 1.1.42), and it is further said that body (sarira) (including the sense capacities), mind (sattva), and self (atman) make up a tripod (tridandavat), which is the "person" (purusa) and which is the subject matter of dyurveda (Caraka I. 1.46-47). The body (sartra) is a

collocation of the atomic constituents (anu-s or bhuta-s) of wind (vdyu), fire

(tejas), water (ap), and earth (prthivT). The body exists in an all-pervasive environment or medium of space (dkasa) in which time (kdla) and extension or

place (dis) are the most important dimensions. Mind (sattva or manas) resides in the body as one more atomic constituent. The mind is considered to be atomic (a) because it can only attend to one apprehension at a time (that is to say, because it is not omniscient); and (b) because it can move (for example, it transmigrates), and only nonpervasive things can move. The self (atman) is an all-pervasive entity which comes into association with the atomic mind (sattva or manas), and this association (samtyoga) provides the environment for the rise of "consciousness" (cetana) and for the development of a karmic heritage, thus becoming an

important determinant (along with dharma and adharma or "virtue" and "lack of virtue") for future transmigrations. All of these items (namely, wind, fire, water, earth, space, time, extension, and self) are called "substances" (dravya-s). Wind, fire, water, earth, and mind are construed to be atomic "substances," and

space, time, extension, and self are construed to be all-pervasive "substances." All of these "substances" have certain properties (guna-s) or secondary attributes

(for example, touch, form, taste, smell, and so forth), and the atomic "substances" also possess motion (karman). Properties (guna-s) and motions

(karman-s) "inhere" (samavdya) in substances (dravya-s). Moreover, all things in the world that are constructed from the dravya-s can also be described in terms of their generic essence or class identity (sdmdnya) and in terms of their particularity or specificity (visesa). Thus, in addition to the basic "substances" which make up the world (namely, wind, fire, water, earth, space, time, extension, mind, and

self), there are six fundamental "categories" (paddrtha-s) by means of which

everything is apperceived, namely, substance (dravya), property (guna), motion

(karman), generality (sdmdnya), particularity (visesa), and inherence (samavdya). Such a theoretical account, of course, is clearly Vaisesikan in inspiration,



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although it should be noted that Ayurveda utilizes these Vaisesikan notions in ways that sometimes markedly diverge from the classical philosophical expo- sition. In any case, this general conceptualization is clearly implicit throughout the Sutra-sthdna portion of the Caraka-satzhitd (Caraka I, chapters 1-30).

According to another important interpretation of Ayurvedic theory (for example, in Caraka-samhhitd IV. 1 and Susruta-samthitd III. 1, and so forth), "life"

(dyus) is a product of the co-presence of "consciousness" (purusa) and primordial materiality (prakrti). Primordial materiality is made up of three material constituents (guna-s), namely, the subtle matter of pure thought or sattva, the kinetic matter of pure energy or rajas, and the reified matter of inertia or tamas.

(It is important to note, by the way, that the term guna is being used in a

fundamentally different way in this second theoretical elaboration. Whereas in Vaisesika a guna is simply a quality or attribute of substance (dravya), in this second theoretical elaboration guna is actually a material constituent of primordial materiality.) These material constituents (guna-s) dialectically interact with one another and generate the manifest world of subjective experience and objective existence. Subjectively, primordial materiality emanates into the forms of intellect (buddhi), ego (ahahimkra), mind (manas), the ten sense capacities (of cognition and action) and the five subtle elements (tanmdtra-s) or the generic essences of sound, touch, form, taste, and smell. Among these emanations, intellect, ego, mind, and the ten sense capacities are largely made up of sattva. The five subtle elements or generic essences are largely made up of tamas. That which impels or activates the process or transformation (parinama) of the emanation process is rajas. Finally, the five subtle elements or generic essences

(made up largely of the guna, tamas) generate the five gross material elements of

space (adkasa), wind (vdyu), fire (tejas), water (ap), and earth (prthivt). The gross, physical body is a collocation of these latter five gross elements, which are present throughout nature and which are transmitted genetically through the semen

(sukra) of the father and the ovum and blood (sonita) of the mother. Life, therefore, according to this interpretation, has several distinct supporting components, namely, (a) a general all-pervasive co-presence of consciousness (purusa) and primordial materiality (prakrti) (with its material constituents or guna-s of sattva, rajas, and tamas); (b) a subjective yet material subtle body (lihga- sarfra or siksma-sarlra), made up of intellect, ego, mind, the ten sense capacities, and the five subtle elements or generic essences, which transmigrates (samsdzra) from one life to another; (c) a gross organic body made up of the collocation of

space, wind, fire, water, and earth that is physically transmitted genetically through father and mother but which is separately enlivened by the transmigrating subtle body; and (d) collocations of gross inorganic elements. Running throughout nature on all levels (subjective and objective as well as microcosmic and macrocosmic), however, are the ongoing transformations (parindma) or transactions of sattva, rajas, and tamas. Such a theoretical account, of course, is

clearly Srahkhyan in inspiration, although here, too, it is to be noted that there



250 Larson

are a number of variations and divergences in the medical texts from the purely philosophical account of Samhkhya, but again, this general conceptualization is

clearly set forth in the SarTra-sthdna portion of Susruta-samthitd (III. 1.1-23). An allied but divergent Sahkhyan interpretation (albeit with a Vedantin overlay) can also be found in the first portion of the Sarlra-sthana section of Caraka- sathhitd (IV. 1.1-156).3

Although these two explanatory idioms (namely, Vaisesika and Samhkhya) are

clearly dominant in the medical literature, it is not the case that ancient Indian medical theorizing represents a "tight" or "hard" appropriation of these classical darsana-s. Medical practitioners undoubtedly knew their philosophies, and it is clear enough from the use of terminology that they understood the classical darsana-s in technical detail. It is also clear, however, that they utilized the technicalities of Indian philosophy for their own purposes even if that meant

stretching various conceptualizations beyond the parameters of precise philosophical usage. In discussions of "essence" (sdmdnya) and "particularity" (visesa), for example, in the Sutra-sthdna portion of Caraka (1.1.45 and the

following pages), these terms are not employed in their correct philosophical usage as categorical notions in ontology and epistemology, but, rather, as

organic notions having to do with homeostasis and the disruption of homoeostasis in a living body. Or, again, the discussion of imperceptibility in Caraka (at Suitra-sthdna I. 11.8), though almost a word-for-word quotation from

Samkhya discussions of imperceptibility (see Sdthkhya-karikd VIII), does not address the well-known Srmkhya problem. Srahkhya philosophy has the problem of accounting for the existence of purusa and prakrti, even though both

principles are imperceptible. Sahkhya proceeds, then, by a series of inferences to show that existent things need not be perceived. In the Caraka discussion, however, the discussion of imperceptibility concerns the existence of a trans-

migrating entity-admittedly, an interesting problem, but very definitely not the more general philosophical problem as set forth in philosophical Srahkhya traditions. Even more revealing in this regard is the discussion of the pramdna-s or "means of knowledge" in the Caraka-sathitd (I. 11). Four are listed as being authoritative, namely, reliable testimony (dptopadesa), perception (pratyaksa), inference (anumdna), and what might be called heuristic reasoning (yukti). The first three are discussed in what one might call a "tight" or "hard" philosophical manner characteristic of the classical darsana-s. Heuristic reasoning (yukti), however, is a much more flexible or "soft" means of knowing. It is described in Caraka-samhitd 1.11, at verses 23 and 24:

Heuristic reasoning is the other source of knowledge. Examples include the growth of crops on account of appropriate irrigation, properly ploughed land, good seed, and the determination of the correct season. Or again, the develop- mental stages of the embryo on account of the appropriate combination of the five gross elements together with the Self or atman; or yet again, the production of fire on account of the correct use of implements and an appropriate drilling technique, or the cure of diseases on account of the fourfold therapeutic tech-



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niques. Heuristic reasoning is a source of general knowledge-that is to say, it encompasses past, present, and future-that arises when one attends to the multiple causal factors that operate among things in the world...." (Translation mine)

Here reasoning functions as a set of regulative ideas that are pragmatically and empirically employed for purposes of getting a useful heuristic grasp on the complexities of the natural world (not unlike the heuristic use of reasoning in Kant's third critique). Many interpreters have suggested that heuristic reasoning can be reduced to inference (anumdna), but such a reduction misses the genius of what the medical practitioners are trying to get at with their notion of yukti, namely, an empirical and, indeed, experimental scientific (in the modern sense) approach to reality and experience. Perhaps the most revealing example, however, of how the medical tradition functions vis-a-vis the more technical philosophical schools can be found in Caraka-sathhitd 1.25.1-32, wherein a symposium is described on the subject of the "origin of man and his diseases." Various

philosophical positions are described which deal with the subject of the symposium, including the dtman school, the sattva school, the rasa school, the six- dhdtu school, the mdtd-pitr school, the karman school, the svabhdva school, and the Prajdpati-Kala school. Not enough is said about each school to determine its

precise historical identification, but one has the impression that these schools represent, respectively, an older form of Veddnta, an old form of Vaisesika or

Nydya, an old school of materialism, the old Samhkhya school, an old naturalist school, older Mimahsaka-s and Buddhists, possibly Carvaka-s (Svabhava- vadins), and one or another variety of theistic schools. Punarvasu Atreya, the leader of the symposium and the chief theoretician in the medical tradition, then enters the discussion with the following concluding remarks on the symposium topic:

Punarvasu then spoke to the experts who had been discoursing on the problem of the origin of man and his diseases. "Do not let yourselves become embroiled in complex arguments and counter-arguments nor let yourselves pretend that truth is obvious and easy to attain if one adheres to a single philosophical position (paksasamsraya). By your clever argumentation you will all end up going in circles, like a person sitting on an oil press that moves round and round. Free yourselves from simplistic biases and search for the truth dispassionately. (In- deed, such a dispassionate inquiry will show that) the very same factors which under some circumstances lead to health and well-being, under other circumstances bring about various diseases. (Translation mine)

Punarvasu Atreya then begins a long discourse on the importance of food in

maintaining health, but this need not concern us for purposes of my present point. What is interesting in the passage is the explicit rejection of any one

philosophical position as an adequate conceptualization of the human condition.

Philosophy, to be sure, has an important role to play in generating heuristic

interpretations that may be useful under certain circumstances, but primary emphasis is placed on empirical and experimental dimensions of everyday life.



252 Larson

Philosophy for the medical tradition, in other words, is always the "hand- maiden" of natural observation and experimental usage.

It is neither an accident nor a contradiction, therefore, to find more than one

philosophical position set forth in the medical literature. Nor is it an accident that the Vaisesika and Sramkhya should frequently find favor with the medical theore- ticians, for these systems appear to be most congenial to a naturalistic and commonsense approach to ordinary life and experience. Moreover, given the

pragmatic and usage-oriented perspective of Ayurvedic medical theory, it can be

argued that in an important sense both theoretical elaborations-that is to say, that inspired by Vaisesika and that by Sarhkhya-are remarkably alike in their fundamental postulates-fundamental postulates that probably represent a pro- tean Urphilosophie of South Asia that predates as well as underlies the later more sophisticated darsana-s. These fundamental postulates appear to include at least the following:

(a) The genetic body born of father and mother is a collocation of gross physical constituents, either "atoms" (anu-s as dravya-s) or gross elements (mahdbhuita-s).

(b) The mind or psychic apparatus is of the same nature as the gross body, although it is a more subtle manifestation of material reality (either as a dravya or as a product of the material constituent, sattva).

(c) The psychic apparatus transmigrates from one life to the next, enlivens the genetic, physical body born of father and mother but is construed to be quite separate from genetic inheritance. That is to say, in any given life an organism is determined both (1) by its genetic, physical heritage and (2) by its psychic heritage.4

(d) Nevertheless, there is a fundamental ontological uniformity throughout nature-that is to say, the gross, physical body and the psychic apparatus are both manifestations of subtle matter (either as dravya or as the guna, sattva)-which thereby encompasses our conventional Western polarities of subjective/objective, mind/body, or microcosm/macrocosm.5

(e) Finally, the self or soul (purusa or dtman) is clearly distinguished from the psychic apparatus so that the notion of "self" or "soul" has nothing to do with notions of mind, ego, intellect, personal identity, and so forth.

The two theoretical elaborations (namely, Vai§esika and Samikhya) differ mainly in the heuristic explanatory models they construct to account for the basic postulates just mentioned. Whereas Vaisesika prefers a mechanistic, atomistic ontology and epistemology of pluralistic realism, Samhkhya prefers an organismic, structuralist model based on the dialectical manifestations of sattva, rajas, and tamas (both on the level of subjective experience and objective existence). Overall, for purposes of medical theorizing, one has the impression that the Samhkhya explanatory model was superior in its subtlety, elegance, and explanatory power, and even from a modern point of view, the Samrkhya approach resonates interestingly to systems theory, semiotics, structuralism, and other contemporary explanatory models. Vaisesika atomism always had the problem-a problem, it should be noted, that plagues any theory of atomism, ancient or modern--of explaining



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how that which has no extension (namely, atoms) can generate a world that has extension, whereas the Samhkhya notion of an all-pervasive prakrti with its continuous transformation (parindma) and combination (samtghdta) of sattva, rajas, and tamas and with its inherent capacity for manifestation (pravrtti) and dissolution or disappearance (pralaya) was a powerful theoretical concept that

obviously avoided the atomistic dilemma. Similarly, the Vaisesika invariably had

problems with its theory of discontinuous causation-namely, that the effect is different from the cause-which always threatened to deny significant relations between entities in the real world and required a complicated (and frequently lame) notion of inherence (samavdya), whereas the Sramkhya notion of continuous causation-namely, that the effect is a manifestation or a reordering of what is already present in a cause-was a more useful conceptualization and was

especially attractive to medical practitioners working with the complex networks of causal factors that operate in the generation of illness and disease. Both Vaisesika and Sarhkhya, however, proved to be heuristically useful in Ayurvedic contexts, and it can be argued that Ayurvedic medicine unfolds within the

parameters of these two overall theoretical constructions. That which Ayurveda adds to these overall theoretical elaborations is a specific

account of gross, physical life-that is to say, ordinary biological existence-and the manner in which everyday existence interacts with the overall theoretical constructions. Caraka comments (in Caraka-sarhhitd 1.11.3), for example, that whereas the purpose of the religious systems is to attain moksa or "release," the

purpose of Ayurveda is to encourage the three ordinary, worldly desires for (a) long life (prdnaisana), (b) reasonable wealth (dhanaisana), and (c) patterns of behavior that will bring about a good rebirth (paralokaisana).

Both Srahkhya and Vaisesika carry their analyses to the level of the physical body, but the focus of attention in Vaisesika and Sarhkhya qua philosophical systems is largely on categorial issues, philosophical psychology, and soteriology (moksa). Ayurveda, as it were, moves in the opposite direction. It begins with the gross, constituent components and moves immediately into everyday biological life. Of the five gross elements (namely, space, wind, fire, water, and earth), the most important from a biological point of view are the middle three: wind (vayu), fire (tejas), and water (ap). Space (dakda), being all-pervasive, is simply a medium for biological life and, hence, not a great deal can be said about it other than its being an appropriate medium.6 Earth (prthivT) is largely a composite of the other elements and represents, therefore, the level of sheer immediacy. Again, not a

great deal can be said about it other than to refer to its composite structure and to classify its various modalities.

Wind (vdyu), fire (tejas), and water (ap), however, are fundamental for Ayur- vedic biological theory, for they are the principal components for life and movement. Taken together (and assuming, of course, the larger theoretical frameworks already discussed), they generate a nutrient fluid (rasa), which is sometimes construed to be the lymphatic chyle fluid from the small intestine or



254 Larson

the more general notion of nutrient fluid that nourishes the body as a whole. This nutrient fluid (rasa) is the first of the seven manifest constituents (dhatu-s) of the

body, namely:

1) nutrient fluid (rasa) 2) blood (rakta) 3) flesh (mdrisa) 4) fat (medas) 5) bone (asthi) 6) marrow (majjd) 7) semen (sukra)

These dhatu-s derive one from the other, starting with rasa, and, therefore, rasa is the primordial manifest substance of the living, physical organism. Sometimes this rasa is correlated with the notion of tejas or "liquid energy," sometimes with the notion of water (ap) as the basic nutrient of life. Thus, the rasa as nutrient fluid is related to both water (ap) and fire (tejas), and this primordial substance is taken to be the "life force" or "vital juice" (ojas) of the functioning organism.

Taken separately (that is to say, taking vdyu, tejas, and ap individually), vdyu or wind manifests itself as the motorsystem (vata or prdna) of the organism (including the motor activities of respiration, swallowing, speaking, digestion, excretion, ejaculation, the labor activity of childbirth, circulation, and motor activity generally). This is the vdta-dhdtu (or motor constituent) of the body which includes prdna (the breath of the mouth for respiration), uddna (the "breath" of the vocal cavity for speaking), samdna (the "breath" of the stomach which aids digestion), apdna (the "breath" of the lower extremities for excretion, sexual activity, and the labor activity of childbirth), and vydna (the "breath" in all the limbs for circulation). Both the rasa or nutrient fluid and the prdna or the principal process of the motor system reside primarily in the heart (hrdaya) and flow to other parts of the body through various arteries, veins, capillaries, and channels (dhamani-s, sird-s, srota-s, and ni.d-s). Tejas or fire manifests itself as the energy system of the body (pitta, literally "bile" because it shows itself in the bilious secretions of the liver, and so forth) (including the actual "cooking" or pacaka in the digestion of food, the coloring agent in blood and complexion, the energizer of desire, the presupposition of vision, and the sensory-nervous apparatus generally). Ap or water manifests itself as the integrating system of the body (kapha or slesman, literally "phlegm," for it shows itself in mucus, plasma, and so forth) which holds together the limbs and tissues and maintains the organism in a kind of steady state or homeostasis. Vdta, pitta, and kapha (or wind, bile, and phlegm), then, are the overall respiratory, digestive, and integrative components of the biological system, which provide the homeostatic environment in which the previously mentioned seven nutrient constituents (rasa-s) function.7 When vdta, pitta, and kapha are in balance and harmony, they are referred to as the tri-dhdtu ("three systemic constituents"), which one might, therefore, call organismic "health." When vdta, pitta, and kapha are not in



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harmony or are unbalanced, they are referred to as the tri-dosa ("three systemic problems"), which one might, therefore, call organismic pain or "illness." Vdta, pitta, and kapha are also used typologically so that, according to Ayurveda, every person tends to be a vdta type or a pitta type or a kapha type. The task of the

physician (vaidya, bhisaj) is to be able to diagnose the imbalances that occur in

persons or in specific illnesses, and Ayurvedic medicines (bhaisajya) are pre- scribed to counteract these imbalances and, hence, to restore the healthy balance of vdta, pitta, and kapha that is characteristic of a given patient. Moreover, because the nutrient fluid (rasa) is so basic both in the anatomy and in the

chemistry of the body, a concern for food and "tastes" (rasa-s) plays a crucial role in the maintenance of organismic health. It is essential for health that

persons maintain a balanced diet of sweet (svddu), sour (amla), salty (lavana), pungent (katuka), bitter (tikta), and astringent (kasdya) "tastes" (rasa-s), which

represent the fundamental nutrients of the functioning organism. According to Caraka (at 1.26.40), "tastes" (rasa-s) derive from the mahdbhuta-s as follows: the sweet taste (svddu-rasa) derives from water (jala or ap); the sour (amla) from earth (prthivl) and fire (agni); the salty (lavana) from water (ap) and fire (agni); the pungent (katuka) from fire (agni) and wind (vdyu); the bitter (tikta) from wind

(vdyu) and space (dkasa); and the astringent (kasdya) from wind (vdyu) and earth

(prthivT). Among the sense capacities those of touch and taste were of particular interest to the medical practitioners. The tactile sense would, of course, be the most important (see Caraka 1.11.38), since every sensation and perception presupposes some kind of contact and involves, therefore, some sort of tactile

apprehension. Feeling or touch, therefore, is basic to symptomatology, and this is undoubtedly one of the primary reasons why the feelings of "pain" (duhkha) and "pleasure" (sukha) are so fundamental in Indian thought and culture. Almost as important, however, is the sense capacity of taste (rasa), for more than

any other of the sense capacities, the sense of taste functions at the intersection of transaction between the natural world and the organism. Taste would, therefore, be a crucial measuring or determining faculty with respect to what the organism imbibes, digests, assimilates, discharges, and, of course, becomes! To control taste is to get a handle on the larger transactional environment in which the

organism functions. Hence, it is no accident that Ayurveda, and Indian culture

generally, is preoccupied (even obsessed) with "wholesome" food (hitdhdra- upayoga) and "unwholesome" food (ahitdhdra), which, respectively, are equiva- lent to "health" and "disease" (see Caraka 1.25.33 and pages following) and which likewise become the operational definitions of the "pure" and the "im-

pure." Moreover, when fundamental themes such as these are then combined with the equally fundamental theme of transmigration and rebirth, one begins to understand more clearly why birth and caste come to play such a significant role in everyday life in South Asia. Obsessive attention is given to food, season, habitat, lifestyle, and social interaction in Ayurvedic diagnoses and thereapies, for the notions of "health" (tri-dhdtu) and "disease" (tri-dosa) are but compo-



256 Larson

nents in a much larger, holistic, systemic, and transactional network of patterned interaction that structures the apprehension of traditional South Asian culture.

CONCLUSIONS

Returning now to the "philosophical" and "interpretive" concerns that I ex-

pressed at the beginning of this article, let me briefly conclude by drawing attention to three aspects of the conceptual basis of Ayurvedic medicine, as I have outlined it, that could be productively pursued (both in empirical research and in theoretical reflection) in our own modern medical science.

(1) Ayurvedic theory (with its Vaisesika-cum-Sahkhya theoretical basis and its systemic notions of "illness" and "disease") calls into serious question our conventional modern notions of the individual person and our modern notions of isolating a sick patient. Of course, contagious disease must be isolated and

antisepsis and asepsis rigorously pursued in view of modern discoveries in

pathology and bacteriology. Ayurvedic theory in its modern form fully recog- nizes this. For Ayurveda, however, the "individual" is really "dividual" (to use McKim Marriott's idiom)-that is to say, the "individual" is a kind of fictional construct, a heuristic residue, as it were.8 What is more basic or important is the "dividual" transactional environment within which culture occurs, and notions of "health" and "disease" come to have much richer connotations and implications in such a transactional, "dividual" conceptualization. The exchange of

food, the larger social reality, and the notion of a regulated homeostasis within and outside of the body come to have greater importance. Health care, or health

delivery, is no longer an ad hoc response to acute disease (although sometimes, of

course, it must be that) but becomes a much broader conceptualization that

encompasses the totality of the "life" of a culture.

(2) Ayurvedic theory interprets the "dividual" transactional modalities of the life of culture in terms of a "reductive materialism" in which our conventional notions of the polarity or duality of mind/body, subjective/objective are no

longer relevant. Ayurveda stresses not only what we would call psychosomatic medicine, but even more than that, what might be called a "sociobiological" medicine.

(3) Finally, Ayurvedic theory poses the possibility of a "holistic" medicine that encompasses more than one life. That is to say, Ayurveda assumes that we are much more than a genetic heritage of father and mother. We possess in addition psychic components that may reach back over many lives and may be projected many lives hence. Ayurveda, of course, uses the traditional South Asian idiom for talking about a holistic medicine that encompasses more than one life (in terms ofkarman, rebirth, transmigration, and so forth). One wonders, however, if it might be possible to translate this ancient idiom into a modern



257

format for research and study. If such could be accomplished, we might be

surprised at the new vistas for philosophical anthropology that would be opened, and we might be surprised to discover that in an important sense the ancient wisdom of traditional South Asian culture has been quietly waiting to be "re- born" and to reveal again its mysteries to us.

NOTES

1. For useful and recent discussions of the history of the literature of Ayurveda, see the Introduc- tion and Appendix Two in G. J. Meulenbeld, ed., The Mddhavaniddna and Its Chief Commentary, chapters 1-10; Orientalia Rheno-Traiectina (Leiden: E. J. Brill, 1974), pp. 1-27, 389-436; also, see the Introduction in Claus Vogel, ed., Vdgbhata's Astdhgahrdayasarhhitd (The First Five Chapters of Its Tibetan Version), Abhandlungen fur die Kunde des Morgenlandes, XXXVII, 2 (Wiesbaden: Deutsche Morgenlandische Gesellschaft, 1965), pp. 1-43.

2. Filliozat's classic study has been available for some years in a good English translation, namely, J. Filliozat, The Classical Doctrine of Indian Medicine, trans. D. R. Chanana (Delhi: Munshiram Manoharlal, 1964).

3. This divergent interpretation of Srmkhya has been carefully described by Surendranath Das-

gupta in A History of Indian Philosophy (Cambridge, 1963 printing), vol. 1, pp. 213 ff, and, hence, need not be repeated here. I also have discussed this interpretation of Srahkhya vis-a-vis other forms of preclassical Sramkhya in Gerald James Larson, Classical Samkhya, 2d rev. ed. (Delhi, Motilal Banarsidass, 1979), pp. 103 ff. Dasgupta argues that this Caraka form of Srakhya is an early Samrkhya that is later reworked by the classical Samhkhya thinkers. A. B. Keith and some others have

argued, on the other hand, that the Caraka form of Sramkhya is a later, syncretistic form of Srmhkhya, clearly under Vedanta influence. My own view of the problem has changed in recent years. For many years I was convinced by Dasgupta's discussion, but now that I have been reading the medical texts with greater care I am convinced that the Caraka material in the SarTra-sthdna is clearly a Vedan- ticized Sriakhya, and not at all an early form of pure Sarhkhya.

4. I use the ambiguous phrase "psychic apparatus" deliberately, for the Indian philosophical schools differ considerably as to the precise characterization of that which transmigrates. Sirakhya and Vedanta argue for a subtle body, Sarhkhya suggesting that the subtle body is made up of intellect, ego, the eleven indriya-s (including mind), and the five subtle elements, Vedanta suggesting various "sheaths" (kosa-s) that accompany the transmigrating entity. Nyaya, Vaisesika, and Yoga, on the other hand, argue against the notion of a subtle body. The Nyaya-Vaisesika notion of manas as atomic eliminates the need for any vehicle, for an atomic entity has no extension to begin with. The

Yoga notion of citta being all-pervasive likewise eliminates the need for a subtle body, since citta has, as it were, no place to go! It is already there at the moment of conception. It is interesting to observe in this regard that Ayurveda clearly sides with Srmhkhya and Vedanta-that is to say, there is a subtle

body that transmigrates from life to life. 5. In modern philosophical discourse such a view is referred to as "reductive materialism"-that is

to say, intellect, ego, mind, and so forth are viewed as manifestations of subtle materiality. Ordinary awareness (antahkarana-vrtti or citta-vrtti), therefore, is simply a reflection or manifestation of material stuff (prakrti or dravya, and so forth). Indian thought generally, however, makes one additional (and crucial) claim, namely, that consciousness (as purusa, dtman, and so forth) is to be

clearly distinguished from awareness. Nyaya-Vaisesika realism, of course, tends to see consciousness as an attribute that emerges because of the contact between Self and mind (and thus comes

dangerously close to a thoroughgoing materialism, although most Nyaya-Vaisesika thinkers hesitate to go all the way on this issue), whereas Sramkhya, Yoga, and Vedanta argue for a fundamental difference in kind between consciousness and awareness. It is interesting to observe in this regard that

Ayurveda tends to side with Nyaya-Vaisesika. 6. The materialistic bias is undoubtedly also a reason for the absence of discussions of akdsa in the

medical literature. The materialists accepted such notions as wind, fire, water, and earth and largely ignored the notion of adkda.



258 Larson

7. It is perhaps tempting to correlate vdta, pitta, and kapha with the three guna-s of Srhkhya philosophy (namely, sattva, rajas, and tamas), and indeed, Dalhana, the commentator on Susruta- samihitd, makes just such a correlation, arguing that vdta can be correlated with rajas, pitta with sattva, and kapha with tamas. His attempted correlation is understandable, given the generally Sarhkhya bias of Su§ruta both in its earlier portions as well as in the later Uttara-tantra portion. From a theoretical point of view, however, such a correlation is simplistic and unconvincing. Technically speaking, vdta, pitta, and kapha are tamasic manifestations since they emerge from the mahdbhauta-s, which themselves are derived from the tamasic form of aharhkdra, namely, the five subtle elements or tanmdtra-s. It could hardly be the case, therefore, that there is any kind of simple one-to-one correlation between vdta, pitta, and kapha and sattva, rajas, and tamas. If one wishes to suggest some kind of correlation, it is possible to work it out, but the procedure is much more complicated than Dalhana's commentary suggests. One would have to move in the following fashion and develop a scheme of symbolic notations: In Srhkhya philosophy, the divine realm is sattvic (S), the human realm is rajasic (R) and the animal realm is tamasic (T). The human realm is a collocation of the three guna-s, therefore, with a rajasic predominance, or R(s + r + t) = prakrti (as apprehended from a human perspective). Ego (or aharhkdra) in its tamasic mode (or, in other words, as it shows itself in the five tanmdtra-s) would have the following notation: R(t(s1,rl,tl) (sr)), which means that in the overall human rajasic realm, when a second-level tamas is dominant and the second-level forms of sattva and rajas and latent, and when third-level forms of sattva, rajas, and tamas begin to interact dialectically (namely, si, r1, t1), one has reached the level of a subtle element or tanmdtra. If one then takes the subtle element rasa, for example, and its correlates water (ap) and its dhatu or dosa form, namely, kapha, a reasonably correct guna correlation would be the following: R(t(t1rl[sl]) (sr)). Needless to say, it is hard to imagine that Dalhana had any such approach in mind when he naively suggested a correlation between vdta, pitta, and kapha and the three guna-s of the Srhkhya. (I might add, parenthetically, that the use of symbolic notations in trying to work out the implications of the Sahkhya philosophy is not as far-fetched as it may seem at first glance. Sarhkhya enumerations tend to focus on the sequence of prime numbers (namely, 2, 3, 5, 7, 11, 13, and 17). If one then combines the sequence of prime numbers with 1 (= prakrti) and 0 (= purusa), one is able to generate all composite numbers. If one also correlates derived quotients with various "entities" (for example, buddhi, manas, mahdbh;ita, and so forth), one soon finds oneself working on a kind of mathematical physics, a physics not unlike the kind of theoretical physics one finds in ancient Pythagoreanism.)

8. For a systematic discussion of Marriott's notions of "dividual," "transactional," and so forth, see McKim Marriott, "Hindu Transactions: Diversity without Dualism," in Transactions and Meaning: Directions in the Anthropology of Exchange and Symbolic Behavior, ed., B. Kapferer, ASA Essays in Social Anthropology, I (Philadelphia, Pennsylvania: ISHI Publications, 1976), pp. 109-142.

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Series Office, 1963. Caraka and Drdhabala, ancient editors. The Caraka Satihita, comp. by Agnivesa and redacted by

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Āyurveda and the Hindu Philosophical Systems