Caraka Samhita

Scope note. This encyclopaedia treats Traditional Western Medicine as its primary subject. Ayurveda is not a standalone subject here. This page is retained as context for Western medicine’s encounters with Ayurveda — chiefly through the Greek-Arabic translation movement, where Indian medical and pharmaceutical knowledge entered the Arabic corpus that was later translated into Latin, and through European colonial and scholarly contact from the eighteenth century forward. For comprehensive Ayurvedic scholarship readers should consult specialist references in that field; this page does not aim to replicate that scholarship and will not be expanded as a primary subject.

The Caraka Samhita is a Sanskrit medical compendium that became the standard textbook of internal medicine in classical ayurveda. Compiled in stages from roughly the third or second century BCE through the fifth century CE, it presents itself as a transmission from the sage Atreya to the pupil Agnivesa, edited by a later figure named Caraka, and finally completed by Drdhabala. Its eight sections cover medical theory, disease causes, clinical examination, anatomy and embryology, prognosis by signs, therapeutics, pharmacy, and treatment success. The work establishes a model of the physician as ethical practitioner bound by oath, frames disease causation in terms of “violation of good judgement” (prajnaparadha), and gives one of the earliest detailed prescriptions for an organized clinical facility in world literature. Together with the Susruta Samhita and Vagbhata’s Heart of Medicine, it forms the brhattrayi or “great threesome” of ayurvedic literature.

Title and Composition

The text is named after Caraka, but Caraka’s name appears in the body of the work only in the chapter colophons, which describe the book as “the system (tantra) of Agnivesa, edited (pratisamskrta) by Caraka.”(Wujastyk, 1998) The body of the compendium is cast as a teaching from the sage Atreya to his pupil Agnivesa, with both figures whose history is lost in legend.(Wujastyk, 1998) Current scholarship places the composition of the earliest version of the compendium in approximately the third or second centuries BCE, although the text does not begin to be quoted widely in other parts of Sanskrit literature until the period of the Gupta dynasty (320 to about 480 CE).(Wujastyk, 1998) Even Caraka’s redaction was not the end of the textual history. Drdhabala, who probably lived in the fourth or fifth century CE, contributed large parts to the text, “completing” the work which he apparently found in a fragmentary state.(Wujastyk, 1998) Drdhabala is named in the chapter-endings as the author of parts seven and eight of the compendium, and of many chapters of the sixth part.(Wujastyk, 1998)

The proper way to read the title, then, is not as the work of an individual author but as a stratified compilation. Debiprasad Chattopadhyaya argues that the Caraka Samhita in its original form was not the work of one person but the compilation of medical knowledge of ancient roving physicians; the word caraka itself, a masculine noun from the Sanskrit root car (to wander), means a wanderer or ascetic, and aptly fits members of the sramana groups who were the repositories of ancient medical lore.(Zysk, 1991) On this reading, the title might be rendered “Compendium of the Wanderers.”(Zysk, 1991)

Place in the Ayurvedic Canon

Wujastyk identifies the Caraka Samhita and Susruta Samhita as the absolutely fundamental starting places in ayurvedic literature, traditionally taken together with Vagbhata’s Heart of Medicine as the brhattrayi or “great threesome” of ayurveda; a “lesser threesome” (laghutrayi) consists of the more recent works of Madhava (c. 700 CE), Sarngadhara (c. 1300 CE), and Bhavamisra (16th century).(Wujastyk, 1998) The compendium emerged from a period in which a plethora of medical practices and ideologies was in circulation, but only one set of ideas was eventually adopted as the basic curriculum for the organized teaching of medicine in scholarly families and schools — ayurveda, “the science of longevity” (ayus + veda).(Wujastyk, 1998) An ancient etymological definition runs: “It is called ‘ayurveda’ because it tells us (vedayati) which substances, qualities, and actions are life-enhancing (ayya), and which are not.”(Wujastyk, 1998)

Contents and Structure

The Caraka Samhita is organized into eight parts (sthanas) — Sutra (general principles), Nidana (causes of disease), Vimana (specific determinations), Sarira (anatomy and embryology), Indriya (sensory prognostic signs), Cikitsa (therapeutics), Kalpa (pharmacy), and Siddhi (treatment success). The work treats internal medicine in much greater depth than its surgical counterpart in Susruta. Brief surgical descriptions occur, but the centre of gravity is on disease aetiology, regimen, diet, prognosis, and pharmacology.(Wujastyk, 1998)

Disease aetiology

Caraka identifies three sources of disease: overuse, underuse, and abuse (atiyoga, ayoga, mithyayoga) of sense-objects, of action (body, speech, and mind), and of time (the seasons).(Wujastyk, 1998) At the root of these stands prajnaparadha — “violation of good judgement” — which Caraka treats as the most fundamental concept of disease causation, the source of mental defects (envy, grief, fear, anger, pride, hatred), of invasive ailments arising from possession, poison, fire, and assault, and of the unrighteousness that produces epidemics.(Wujastyk, 1998) In the chapter on epidemics (janapadoddhvamsa), Caraka explains that diseases striking many people at once arise from corruption in four shared conditions — air, water, locale, and time — and lists mosquitoes, rats, earthquakes, and bad water as features of unwholesome terrain.(Wujastyk, 1998) The ultimate root of such epidemics is moral: when leaders transgress virtue, populations follow, the gods withdraw, the seasons fail, the herbs become denatured, and corruption of touch and food spreads disease.(Wujastyk, 1998)

Disease aetiology in classical ayurveda turns more on misplacement and inflammation of the dosas (humours) than on simple imbalance. Wujastyk warns that “disease is caused by an imbalance of the humours” — the platitude repeated in secondary literature on Indian medicine — is not adequate to the original ayurvedic texts. Disease arises when a humoral substance collects in the wrong part of the body and becomes irritated or inflamed (Skt. prakupita, “angered”); the exclusive focus on imbalance is largely a reading back into Indian medicine of Hippocratic and Galenic thinking.(Wujastyk, 1998)

Therapeutics and regimen

The Sutrasthana enunciates the principle of allopathy in its strict sense — treat a condition with its contrary. Cold soothes diseases caused by heat; heat treats diseases caused by cold; depletion is met with a supplement.(Wujastyk, 1998) Wujastyk notes that this is a strict sense of “allopathy” distinct from contemporary Indian English usage, in which the word means Western biomedicine.(Wujastyk, 1998) The compendium also teaches gradual habit change in quarter-portions over successive days — replacing unwholesome barley with wholesome red rice in measured steps — as the earliest explicit ayurvedic teaching on behavioural self-improvement.(Wujastyk, 1998) Natural urges (urine, faeces, semen, wind, nausea, sneezing, yawning, hunger, thirst, tears, sleep, panting) must not be suppressed; mental urges of greed, grief, anger, pride, envy, and the impulse to harm must be.(Wujastyk, 1998)

Caraka recommends seasonal catharsis: at the start of spring, the rainy season, and autumn, the body should be oiled, sweated, and cleared above and below by emetics and purgation, followed by enema and nasal treatment.(Wujastyk, 1998) The therapeutic toolkit includes meat and alcoholic preparations, presented without apology as ordinary medical resources; later commentators such as Cakrapanidatta defend this practice against ahimsa concerns by separating medical health from religious virtue (dharma).(Wujastyk, 1998)

Three kinds of physician, three kinds of medicine

Caraka divides physicians into three kinds: imposters with the trappings of medicine, the merely sponsored, and the truly accomplished.(Wujastyk, 1998) The three corresponding kinds of medicine are the sacred (daivavyapasraya — mantras, amulets, oblations, vows, fasts, pilgrimage), the rational (yuktivyapasraya — diet, drugs), and the triumph of good character (sattvavajaya), which means turning the mind away from things that are not good for one.(Wujastyk, 1998) The daivavyapasraya category preserves a magico-religious therapy resembling the medicine of the Atharvaveda fire priests, and Zysk argues that its retention in the Caraka Samhita reflects the older sramanic medical tradition’s coexistence of empirical and magical strands.(Zysk, 1991)

Embryology, lifespan, and rebirth

Book Four (Sarirasthana) argues that the embryo is created by the conjunction of six causes — mother, father, self, compatibles (satmya), nutritive juice (rasa), and mind — each contributing distinct features to the developing body.(Wujastyk, 1998) Whichever of three qualities (sattva, rajas, tamas) is dominant in a man’s mind becomes what he is associated with in a subsequent birth, connecting embryology to rebirth and karma.(Wujastyk, 1998) On lifespan, Caraka rejects the strict view of total predetermination: timely death follows the body’s inherent measure, but untimely death follows from misuse, accidents, mistreatment, and refusing food or medicine. The argument turns on the practical observation that a strict fatalism would render preventive medicine, prayer, and regimen pointless.(Wujastyk, 1998)

The clinical facility

The Vimanasthana describes a clinical facility with strict architectural, staffing, and supply requirements — among the earliest detailed prescriptions of an organized medical institution in world literature.(Wujastyk, 1998) The building should be strong, out of the wind, partly open to the air, easy to move about in, and clear of smoke, sunlight, water, dust, and unwanted noise; it should have a water supply, pestle and mortar, lavatory, bathing area, and kitchen.(Wujastyk, 1998) Staff should include cooks, bath attendants, masseurs, herb grinders, and patient-assistants, all good-natured, clean, well-behaved, loyal, practical, and pious.(Wujastyk, 1998) Read against Fa Hsien’s early-fifth-century report of charity-and-medicine houses in Pataliputra, the Caraka Samhita’s specification suggests that India may have been the first part of the world to evolve an organized civic system of institutionally-based medical provision.(Wujastyk, 1998) Fa Hsien recorded that the peoples of his journey — including Bahlikas, Pahlavas, Cinas, Yavanas, and Sakas — each maintained distinct dietary customs, a cosmopolitan awareness of regional difference that the Caraka Samhita reflects in its prescriptions for medicines suited to the dietary affinities of each region.(Wujastyk, 1998)

Medical ethics and the oath of initiation

Caraka’s “Oath of Initiation” for medical students, often compared with the Hippocratic Oath, requires celibacy during training, truthfulness, vegetarian diet, freedom from envy, never carrying arms, full submission to the teacher except where this would conflict with higher ethical values, day-and-night care of patients without desertion or sexual exploitation, refusal to treat enemies of the king and women without male attendance, and absolute confidentiality regarding the patient’s household.(Wujastyk, 1998) The compendium also identifies categories of patient who should not be treated, including the violent, the slanderous, those who fancy themselves doctors, the dying, and (controversially) the poor — Susruta’s commentator Dalhana glosses the latter restriction by noting that a poor patient cannot afford the medicine prescribed and so cannot benefit from medical advice.(Wujastyk, 1998)

Reception and Transmission

The Caraka Samhita was studied at the great Buddhist monastic centre of Taxila, where the lay physician Jivaka Komarabhacca is said to have studied for seven years under the semilegendary Atreya whose teachings underpin the compendium.(Zysk, 1991) Zysk notes that Caraka’s standardization of physician-patient-attendant qualities into clean fourfold lists is closer in style to Buddhist Vinaya formulations than to the looser brahmanic terms (satya, dharma, astika) used in the Susruta Samhita — pointing to a shared sramanic substrate underlying both texts.(Zysk, 1991) In comparative materia medica, Caraka enumerates a fivefold list of salts (saindhava, sauvarcala, vida, audbhida, samudra) that is essentially identical to the Pali Vinaya’s medicinal salts.(Zysk, 1991) But Caraka’s classification of fats not by source (bear, fish, alligator, swine, donkey) but by ecological habitat — wetlands (anupa) versus drylands (jangala) — represents what Francis Zimmermann identifies as a brahmanic systematization superimposed on the older sramanic source-classification.(Zysk, 1991)

Textual State

Wujastyk warns that none of the texts of the brhattrayi has been subject to the proper attention of a text-critical editor. The printed editions on which all twentieth-century scholarship rests, including his own translations, are vulgate texts — books printed on the basis of a small number of manuscripts from a local region, normally Bombay or Calcutta, where the publishing industry was strong.(Wujastyk, 1998) In the absence of critical editions, “we cannot really say that we know the foundations of ayurveda. Our impression of the tradition is partial, fuzzy, out of focus.”(Wujastyk, 1998)

See Also

• Charaka
• Susruta Samhita
• Susruta
• Ayurvedic Medicine
• Tridosha
• Prajnaparadha
• Hippocratic Oath
• Atharvaveda
• Buddhist Monastic Medicine

Sources

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Editorial Notes

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Reception and Transmission