BOOK REVIEW OF "THE LEGACY OF CHARAKA"

LEGACY OF CARAKA – A REVIEW BY T.M.MUKUNDAN

(The Legacy of Charaka by M.S.Valiathan)

This work – a rearrangement of Charaka Samhita by a distinguished surgeon, is a welcome change in the attitude of the Allopathic medical establishment of India. For too long has the community of Allopaths in this country neglected the medical wealth contained in the Ayurvedic literature. This attitude, one can safely say, has only worked to the detriment of the health of the nation.

In this book, “The Legacy of Charaka”, there is a long introduction – running to 86 pages, which gives us some idea of the perspective of the author, the motivation for undertaking this work and his interpretation of the text. The author explains his work thus, “I was tempted to retell Charaka Samhita in a format which, I thought, would appeal to the students of Ayurveda, medicine and other sciences at the college level and all others interested in the history of science in India….instead of adhering to the sequence of sthanas in the original, I have retold the Samhita through thematically structured chapters. Although there has been some degree of restructuring and condensation,…no chapter in the eight sthanas of the original has been left out.” This book certainly is a massive effort, of going through an enormous text, the most important text of Ayurveda, and restructuring the contents. The introduction is followed by the translation of the text, running to about 600 pages.

The following are some of the mistakes this work suffers from:

(I) Mistakes arising from trying to understand and translate Ayurvedic terminologies to Western Allopathic terminologies

(II) Author’s lack of proper understanding of Ayurveda and lack of Ayurvedic clinical exposure

(III) The author’s preconceived notion that Ayurveda is not a legitimate independent system of medicine but is there only as an ancient cultural heritage. Its current use could be to strengthen the Allopathic medical knowledge, in particular, its pharmacopia.

(IV) Technical errors and improper translation

(V) Basis for some statements not clear

(VI) Printing errors

(I) The author judges ayurveda from the criteria and concepts of the Allopathic system. This is one major drawback of this work. Ayurveda has an independent, comprehensive and complete conceptual framework, based on the worldview of the Indian philosophical systems or Darshanas. Whether this framework is correct or not is to be judged only by the results – whether the Ayurvedic system is able to cure diseases today, and not if it is able to satisfy the criteria of the Allopathic system or those of modern Western science. Below we give some illustrations of some such errors.

COMMENTS (C)

From the Introduction:

1. (page vi) Mahasrotas is referred as trachea

(C) – Mahasrotas refers to the entire digestive tract and not trachea. (Ref : Caraka Nidanam, Chapter 3 on Gulmam, sloka 7)

2. (page vi) “As the chemical means for classifying drugs did not exist, its forerunner – rasa – became the basis for the choice of diet and drugs for treatment in Ayurveda.

(C) - This is an example of looking at Ayurveda through the perspective and understanding of modern science. This not only superimposes a Western understanding of science on Ayurveda, it betrays a wrong understanding of Rasa and its importance in the prescribing of a diet appropriate to a disease. The theory of Rasa is not just a “primitive” theory, which would ultimately lead to a “chemical” (presumably the modern biochemical) understanding.

3. (page xiv) “ Caraka was however ready to depart from tradition in the field of medicine, such as switching from faith-based (daivavyapasraya) to reason-based (yuktivyapasraya) practice or at any rate, endorsing the switch”.

(C) - Here, the author is applying a Western theory of development of a science and society from a “primitive” to a more “advanced” rational stage. But, Daivavyapasraya and Yuktivyapasraya are not two stages in medicine, the former gradually leading to and eventually being replaced by the latter. Treatment is classified into three categories – Daivavyapashraya, yukthivyapashraya and sattwavajaya chikitsa.

4. (page xxv) Various diseases are classified under two heads – infectious/non-infectious diseases.

(C) - This is entirely a modern classification and is of no relevance to Ayurveda.

5. (page xxviii) The four types of Vishama jwara are related to different organisms.

(C) - This is once again a modern classification.

6. (page xxx) “Smallpox is an ancient scourge which killed millions of people all over the world; the scant attention given to it by Caraka remains a mystery.”

(C) - In India there seems to be no basis for this statement. Obviously, during Caraka’s time it was not a scourge. If it was, it would have definitely been mentioned by Caraka. In India a system of inoculation was prevalent for centuries, and since most people seem to have received the inoculation and since inoculation gave 100% protection, it is understandable that Caraka treats it like just another disease. (Ref: Dharampal: Indian Science and Technology in the 18^th Century; J. Holwell (FRS), 1767).

7. (page xxxi) Rajayakshma is translated as “pulmonary tuberculosis”.

(C) - It may not correspond completely to what is understood today as “pulmonary tuberculosis”. It is important, particularly for Ayurvedic physicians, to understand each disease as it is described, without forcing it to conform to some modern equivalent. Only then can an Ayurvedic physician tackle the disease successfully.

8. (page xliii) “As in most branches of medicine, therapeutic action was always ahead of the understanding of a disease in Caraka’s time. This is not untrue even in today’s context.”

(page xlvii) “… treatment received the higher priority of physicians who were obliged then, as now, to act before a disease is fully understood in terms of etiology, pathogenesis and natural history.”

(C) - It is not clear on what fact this statement is based. In Ayurveda, Chikitsa (treatment) is always based on the understanding of the disease – in terms of Nidana (cause), Poorvarupa ( symptoms prior to the occurrence of the disease), Lakshana (actual symptoms of the disease) etc. Nidana is always known in terms of the doshas.

In fact Charaka says, in a famous statement,

“Vikaaraanaam akusalo…” (Ch. Sutram 18/44-47)

i.e. “if a physician is not able to name a particular disease he should not feel ashamed on that account because, it is not always possible to name all types of diseases in definite terms. When aggravated, one and the same dosha may cause manifold diseases depending on the various etiological factors and the sites of manifestation. So a physician should try to comprehend the nature of the disease (dosha), the site of its manifestation and etiological factors and should then initiate the treatment. A physician who so initiates the treatment after having full knowledge of the therapeutic properties of these three aspects would never fail in his attempt to cure the disease”.

This is why an Ayurvedic physician is able to diagnose and treat successfully even when confronted with a (new) disease, not known before.

On the other hand, in the Allopathic system most diseases are said to be of “unknown etiology” and most often, the medicines/treatment take care of the symptoms without curing the underlying disease.

9. (page xlvi) “In terms of epidemiology, a society passes, over time, from an age when infectious diseases cause the heaviest mortality and morbidity to another when infections decline and non-infectious diseases take over as the major killers. The change from one phase to the other is known as the epidemiologic transition.”

(C) - (a) This theory is once again based on the linear, progressive view of development of societies, from a “primitive” to a more “advanced” stage. It should not be applied to Ayurveda.

(b) As mentioned above, infectious vs. non-infectious classification of diseases is a modern classification. To divide Caraka’s list of diseases according to this classification seems fairly arbitrary.

(c) The author has based his analysis by counting the number of times a disease is mentioned in the text. Ayurvedic drug/medicine has multiple effects and uses. Therefore, counting the number of references to a particular disease in the Chikitsa Sthana, for instance, will not give the correct picture of the incidence of a disease.

________________________________________________________________

(II & III) Errors due to incorrect understanding of Ayurveda

There are several errors in this work, which seem to arise from the author’s lack of understanding of Ayurvedic concepts and lack of familiarity with Ayurvedic practice. Below we give some illustrations.

From the Introduction:

1. (page xxv – under grahani) “The treatment of grahani consisted of general measures for lightening the digestive system (samana)…”

(C) - This means langhana and not samana.

2. (page xxvii – under jvara) “The perturbed dosa was believed to acquire the digestive heat of chyle upon entering the stomach…” This is the author’s summary of samprapti of jvara. (see Caraka, Nidana, chap. 1, sloka 20 onwards).

(C) - There are some errors in this summary. The heat is from the agni (digestive fire) and not the “chyle”. (Ref: commentary of Chakrapani in Caraka, Nidanasthana, 1/20) The author uses chyle to mean ahara rasa. However, in jvara samprapti, it is the rasa dhatu which is involved. And the phrase “was believed to” suggests that perhaps the author does not believe this to be relevant now. However, ayurvedic physicians use this samprapti to treat and cure various fevers even now.

3. (page xl) Under Hrdroga, it is said “According to Caraka, heart disease originates from conventional causes such as dietary indiscretion, emotional disturbance, excessive exposure to sun and too much or too little activity. When vata consequently gets perturbed, it enters the heart…to produce heart disease.”

(C) - Here the first sentence refers to the causes for all 5 types of hrdroga, i.e., vataja, pittaja, kaphaja, tridoshaja and krimija hrdrogas. For example, while too much activity may lead to vataja hrdroga, too little activity may lead to kaphaja hrdroga.

However, the second sentence is relevant only in the case of vataja hrdroga and not for the other types. (Ref :Caraka, Sutrasthana, chap. 17, sloka 30 onwards).

4. (page xl) “Diseases of moderate severity caused by perturbed kapha and pitta such as …should be treated with appetizers in the early stage of the disease.”

(C) - Appetizers generally refer to “Deepana” substances. But Caraka (Sutrasthana, chap. 22, sloka 21) says drugs that promote digestion (Pachana) should be used here.

5. (page xli) “The heart happened to be one of the cluster of targets in Caraka’s category of heart disease”.

(C) - It is difficult to understand this statement and there seems to be a confusion. Each Ayurvedic medicine has more than one effect. Most medicines can be used for more than one disease. So also treatments, like enemas. This does not mean that the heart is only “one of the cluster of targets” in Caraka’s category of heart disease.

6. (page xliii) “As in most branches of medicine, therapeutic action was always ahead of the understanding of a disease in Caraka’s time. This is not untrue even in today’s context.”

(page xlvii) “…in other words, treatment received the higher priority of physicians who were obliged then, as now, to act before a disease is fully understood in terms of etiology, pathogenesis and natural history.”

(C) - (a) It is not clear on what these statements are based. It may be true in today’s context of allopathic practice, that physicians act “before a disease is fully understood” since many important diseases are said to be “of unknown etiology”. However, In Caraka, treatment (chikitsa) is always based on the understanding of the disease – in terms of causation (Nidana), clinical features (Lakshana), Samprapti, etc.

(b) Etiology is always known in Ayurveda, in terms of the doshas. Caraka says “Vikaaraanaamakusalo na jihreeyat kadacana…” (refer to point 8 in the previous section)

7. (page xlviii) Under the heading “Why study disease burdens of the past?” the author talks about “clinical conditions that received attention long ago, but are no longer easy or possible to identify.” As an example he mentions “Urustambha”.

(C) - The author may not have had any occasion to come across this disease. The fact is, this disease is even today diagnosed as “Urustambha” and treated quite successfully by Ayurvedic physicians.

8. (page liii) Speaking about Rasa (taste) it is said, “…basic qualities such as smell and sound of the other bhutas did not receive the same attention because they were regarded as unimportant in indicating the composition of substances.”

(C) - It is not clear what is meant here. Smell and sound are unimportant only from the point of view of substances as food and medicine. It is taste (Rasa) which is important in understanding the action of substance as food and medicine, since it has to act by undergoing digestion.

9. (page liii) Explaining Prabhava (“specific effective action”) the author says, “Specific effective action resembles the power attributed to amulets in the Atharva Veda. The mechanism of specific action belongs more to the domain of psychoneuropharmacology than to therapeutics.”

(C) - This seems to be a misunderstanding of Prabhava. Prabhava has nothing to do with the mysterious (like “amulets in Atharva Veda”). Prabhava is an action of a drug, which is observed but cannot be explained by analysing all the other properties of the drug, like rasa, guna, virya and vipaka. For example, ghee is sweet in taste (rasa), cold in potency (virya) and heavy to digest (vipaka). However, it possesses the quality of Deepana, i.e. it stimulates the digestive fire. Many such examples can be given. Hence, Prabhava does not belong more to the domain of “psychoneuropharmocology” as has been suggested by the author but belongs very much to therapeutics.

10. (page lv) “The properties and functions attributed to vata, pitta and kapha would suit all organic substances that have respectively to do with movement and breakdown, digestion in the gut and the dhatus, and the building of the dhatus. In other words, the balance of the substances that constitute vata, pitta and kapha is equivalent to the balance of their distinct functions.”

(C) - It is not clear what is the point being made here. It would have been helpful to elaborate, with some illustrations.

11. (page lvi) “The importance of tridosa grew so greatly over centuries that Vagbhata even identified dosasamya and dosavaisamya as the basis of health and disease.”

(C) - Does this mean Vagbhata makes it more important than Caraka? Caraka (Sutrasthana, chap. 12, sloka 13 and chap. 20, sloka 9) talks about the importance of the three dosas.

12. (page lvii) “After all, a cause cannot produce disease except by disturbing dosasamya, and if dosasamya is restored the cause would take care of itself.”

(C) – Cause does not take care of itself without ‘Nidana parivarjanam’. It is an important step in the treatment of diseases. It means, giving up the causative factors which are responsible for causing the disease. The Nidana would not ‘take care of itself”.

13. (page lvii) Under Dosas and constitution, “…the dosa constitution has more to do with the status of digestive fires and less with dosas. The connection between the dosa constitution and dosas is, at best, indirect…”

(C) - There seems to be a misunderstanding here. The relationship between dosas and dosa constitution is clearly indicated in Caraka, Vimanasthana, chap. 8, sloka 95.

14. (page lviii) Under Rtucarya, “The rules of conduct are essentially based on the role of the body fluid which fluctuates in the body with changing seasons.”

(C) - What is this body fluid? Rtucarya is based on the fluctuating dosas ( and not on body fluid) with changing seasons.

15. (page lxi-lxiii) Section on “Natural Urges (Vegas)”:

(C) - This concept seems to be completely misunderstood. It is not merely an equilibrium of matter that is important, as it is explained here, but the role of vayu as the agent responsible for the Vegas.

16. (page lxxii)- “To make the formulations acceptable to patients…”

(C) - Each form of medicine in Ayurveda such as powder, pill, decoction of herbs, etc. has a different action and different application. That is why such a diversity of forms and anupana are specified.

17. (page lxxix) “Caraka was careful to suggest an alternative vegetable preparation whenever he prescribed a meat formulation for treatment.”

(C) - This is not true. The properties of vegetables and meats are very different . In some treatments (like the treatment of Rajayakshma or some Vata Roga) it would not be possible to substitute vegetables for meat.

From the Text:

18. (page 11) “The physical properties of dosas notwithstanding, in practice, the choice of drugs opposed to them is made on the basis of taste that indirectly reflects the physico-chemical properties and holds the key to therapeutic choices.”

(C) – This is not true. The most important medicine for Vata is oil (tailam). Oil opposes the Rooksha (non-oily) property of Vata and not taste.

19. (page 73) “Vata gets perturbed by many unrelated agents such as loud and excessive talk, suppression of natural urges, fasting, excessive vomiting and purgation, weeping and exhaustion from physical labour.”

(C) - It is not clear why these factors are termed ‘unrelated’. These are not ‘unrelated’ agents, they are related to vata in a significant way.

(VI) Technical errors and improper translation

1. (page 23) “…weekly use of rasanjana (mercurial collyrium) to the eyes is beneficial because it promotes secretions and controls kapha which dominates the sense of vision.”

(C) - (a) Rasanjana is not “mercurial collyrium”. It is prepared from Daru Haridra.

2. (page 23) “kapha…dominates the sense of vision”

(C) – This is a wrong translation of “Cakshustejomayam…” (Caraka, Sutrasthana, chap. 5, sloka 16). It means tejas / pitta dominates the vision.

3. (page 24) “(smoking controls) …vata and kapha which dominate the regions of the head, neck and chest.”

(C) - Only kapha dominates this region. But smoking ensures that vata and kapha diseases do not afflict this region.

4. (page 26) “A practical policy is to restrict the intake of heavy items to a third or half of the point of satiety; this applies equally to light articles in order to maintain the digestive power at the right level.”

(C) - This is not correct. Caraka (Sutrasthana, chap. 5, sloka 7) says “laghunaam api cha na ati sowhityam”, light articles should not be taken beyond the point of satiety.

5. (page 30)- “Summer solstice…when the sun progresses north of the equator. And winter solstice … when the sun moves south of equator”.

(C) - Beginning in Sisira, the sun starts moving northwards from its southern most point. This northward movement is called Uttaraayana, which corresponds to the Adaana Kaala. Similarly, beginning in Varsha, the sun starts its southward movement. This movement is called Dakshinaayana, which corresponds to the Visarga Kaala.

6. (page 31) “In spring, the rising heat of the sun perturbs body fat.”

(C) - This is not correct. It is the kapha that is perturbed. (Caraka, Sutrasthana, chap. 6, sloka 22).

7. (page 32) “When the body accustomed to rain and cold is suddenly exposed to the heat of the sun in autumn, pitta gets perturbed.”

(C) - However, Caraka (Sutrasthana, chap. 6, sloka 41) says “Taptaanaam aaacitam pittam … kupyati”. In other words, the pitta which gets accumulated during the rains gets perturbed.

8. (page 36) “Calibrating the riddance of an unwholesome habit as well as the uptake of a good habit is conducive to stable results.”

(C) - This is apparently a translation of Caraka, Sutrasthana, chap. 7, sloka 38, “Kramena apacita doshah …” It is confusing. Could have been made simpler by saying “Gradual riddance of an unwholesome habit as well as gradual uptake of a good habit…”

9. (page 37) “Increase or decrease in the level of malas from food (ahara malas) are indicated by signs such as a sense of heaviness and constipation on the one hand and a feeling of lightness and easy passage of stools on the other.”

(C) - This seems to be a statement about faeces. However, Sutrasthana, chap. 7, sloka 43, is about malas in general and not only about faeces.

10. (page 42) “…the qualities of dosa and dhatus assailed by dosa (dusya) are unequal in the body constitution to the advantage of dusya…”

(C) - This is apparently a translation of Sutrasthana, chap. 10, sloka 11 “Na ca tulyaguno dusyo na dosah prakrtirbhavet”. The translation is confusing and not helpful.

11. (page 42) “Kaalaprakrtidusyaanaam saamaanye anyatamasya ca” (Sutrasthana, chap. 10, sloka 14) is translated as: “any one of the qualities of dosa and dusya is equal to the detriment of dusya at the time of illness”.

(C) - Once again translation is not only confusing, it also seems to be wide off the mark.

12. (page 74) “As a result, water tends to dominate blood, kapha and the muscles.”

(C) - In Sutrasthana, chap. 17, sloka 27, the word ‘kleda’ is used, which may be better translated as ‘stickiness’ and not as water.

13. (page 74) “… the chyle derived from food becomes water-laden …”

(C) - In Sutrasthana, chap. 17, sloka 37, the word Rasa is used, which means Rasadhatu. Chyle as used by the author seems to imply ‘ahara rasa’ which is not the appropriate translation, the context being heart disease. And again the word ‘samkleda’ has been translated as water-laden. ‘Stickiness’ would have been a more appropriate word here.

14. (page 78) (Sutrasthana, chap. 18, sloka 6) Siro Virecana has been translated as “nasal irrigation”.

(C) - It should be “nasal purgation” or purgation of the head.

15. (page 79) Describing Pitta Sotha (swelling due to Pitta) (Sutrasthana 18/7) says “…na ca sparsamushnam ca sushooyata…”. This has been translated as “application of heat to the swelling brings comfort.”

(C) - It actually means “application of heat does not bring comfort”. This is not only a wrong translation but also seems to be a serious misunderstanding of Pittaja disease.

16. (page 85) “Summer is the best season for building up therapy; therefore it should include a diet containing fish or the meat of healthy adult animals…”

(C) - Sutrasthana chap. 22, slokas 25-28 adds an important qualification to the diet, i.e. the meat soup … made light for digestion (“laghavo rasah”). Summer is a season for building up therapy. However, the diet should be laghu (light) and not guru (heavy). This important point seems to have been missed altogether in the translation.

17. (page 89) In the context of treatment for obesity (sthaulya), the author mentions “rough massage with oil”.

(C) - Sutrasthana chap. 21, sloka 21 uses the term “…rookshaani udvartanaani”. Rooksha udvartana is not a rough massage with oil, but a massage with medicated powders.

18. (page 90) In the context of day sleep, the author has said that day sleep “is also harmful for the obese who suffer from disorders of Kapha and toxins”.

(C) - This is a wrong interpretation / translation. In Sutrasthana chap. 21, sloka 45, it is said that day sleep is harmful “for the obese AND for those who suffer from disorders of Kapha and toxins.” These are three different categories of patients and not one (obese) as appears from the translation

19. (page 182) In the context of time (kaala), the author says “looked from the patient’s angle, time refers solely to the appropriate and inappropriate periods for performing a procedure during the course of his illness. It does not refer to a drug being preferable to another at a particular time.”

(C) - It is not clear what the second sentence means and what it seeks to clarify.

20. (page 206) In Table 31.1 (under Antenatal care), it is indicated that from 4^th to 8^th month, butter / ghee should be used.

(C) – It is important to note that all the butter/ghee are those taken directly from the milk (ksheera navaneeta, ksheera sarpih). (Sarirasthana chap. 8, sloka 32). This distinction is important, since butter and ghee taken directly from milk have an important role in antenatal care.

21. (page 251) “…diseases are considered under different stages of their evolution. These are nidana, purvarupa, linga, therapeutic evaluation including therapeutic trial (upasaya) and the full blown stage (samprapti).”

(C) – Nidana, purvarupa, linga, samprapti and upasaya are not different stages of evolution of a disease. In addition, the author calls samprapti as “the full-blown stage”. This is wrong. Samprapti means pathogenesis, i.e. it is the actual pathological process through which the perturbed dosa causes the disease.

22. (page 258) Under “Treatment” for fever, it is said “Reducing measures include fasting, liquid diet, milk diet, ingestion of ghrtas…”

(C) - Reducing measures given in the initial stage of fever, can never include milk and ghrtam. Both these are contra-indicated in the initial stage of fever.

23. (Page 258) Under “Reducing measures” for fever, it is said “Except for fevers caused by emotions, wasting diseases and overexertion, reducing measures, as a rule, are administered in the beginning”.

(C) - However, Chikitsasthana, chap. 3, sloka 139 also includes “anila” to the above group. That is, fevers caused by Vata are also to be included to the above list. This is a serious omission.

24. (page 258) “They (reducing measures) act by stimulating gastric juice…”

(C) - Chikitsasthana, chap. 3, sloka 140 says “sandhukshite anale” which is better translated as “stimulating the agni”.

25. (page 259) “After six days … the patient should be given extracts of herbal medications …If these drugs are administered early or prematurely they may bind the dosas and produce intermittent fever.”

(C) – Here “extracts of herbal medications” seems to mean a kashaya preparation. However, Chikitsasthana (chap. 3, slokas 161,162) states that only Kashaya as a rasa (taste) is not to be given in early stage of fever, and not kashaya as a preparation.

26. (page 262) Under “Ghee-processed extracts” it is said “This group becomes useful when fever does not respond to extracts, emesis and reducing and dietary measures”.

(C) - However, in Chikitsasthana chap. 3, sloka 216, the word ‘rookshitasya’ is used, i.e. one who has been made ununctuous (dried up) by the fever. This qualification is important.

27. (page 322) the phrase “dehaagni” has been translated as “body heat”.

(C) - The phrase actually means body and agni (digestive fire) (Nidanasthana, chap. 8, slokas 36-38).

28. (page 355) “Bleeding piles are caused by the disturbance of kapha or vata.

(C) - Bleeding piles are actually caused by pitta or rakta. Kapha and vata are only anubandha (secondarily aggravated) in bleeding piles (Chikitsasthana, chap. 14, sloka 170).

29. (page 359) “body fire” has been used to mean jatharaagni.

(C) - The term ‘agni’ could have been retained or the term “digestive fire” could have been used.

30. (page 359) “It is this material (food) which forms the substrate of the digestive fire …”

(C) - It is not clear what is meant here by the term ‘substrate’. Substrate normally means something that is underneath or a basis (for another thing). Food is not the substrate of digestive fire, since the agni is underneath the food. (Chikitsasthana chap. 15, sloka 8, says “evam rasamalaaya ……. adhahsthitah”).

31. (page 359) “The initial stage of the cooking of food by the digestive fire from below… is reminiscent of rice grains in a pot being cooked by fire …”

(C) - Instead of the term “reminiscent of” it would have been better to use the term “like”, since this is a drshtantah (simile) (Chikitsasthana, chap. 15, sloka 8).

32. (page 361) “… the effect of obstruction reminds one of a downpour …”

(C) - “is like a downpour” would have been better.

33. (page 361) “… in the absence of ama, the stool floats as it does also in the presence of liquidity, solidity, coldness and involvement of kapha.”

(C) - However, in Chikitsasthana (chap. 15, sloka 94), it is said that the stool associated with ama sinks in water due to heaviness, while that devoid of it floats except in cases of… compactness, coldness and derangement of kapha. i.e., the stool sinks and does not float in the presence of solidity, coldness and involvement of Kapha. The translation is wrong.

34. (page 371) Under Panduroga, it is said that pandu develops if (a) a person with a vatala constitution eats food which perturbs vata ….. (b) when pitta is disturbed in an individual with pittala constitution ….. (c) there is perturbation of kapha in a slesmala person …..

(C) - However, Chikitsasthana chap. 16, slokas 17-25, mentions only pitta aggravation in a person with pittala constitution developing pittaja pandu. In the other two cases (a) and (c), vatala and slesmala constitutions are neither mentioned nor implied in the text. (Refer also Chakrapani’s commentary to the above passage).

35. (page 371) “…(kamala) arises from accumulation of disturbed pitta in the gut and blood.”

(C) - Chikitsasthana, chap. 16, sloka 36 says “Koshtha saakhaasrayaa”. Saakha refers to the dhatus, rakta, mamsa, etc and not only blood.

36. (page 410) The author has translated visarpa as cellulitis.

(C) - Cellulitis already has some connotation in the Allopathic vocabulary and its use in the context of Caraka Samhita may be misleading. Hence, while translating the text, the word visarpa could have been retained.

37. (page 451) The phrase “Sarpisha satadhowtena” (Chikitsasthana, 25/64) has been translated as “applying (cold) ghee … (as irrigant) a hundred times.”

(C) - Satadhowta ghrta is ghee “washed a hundred times”. In other words, it refers to a particular processing of ghee.

38. (page 495) Vatasonita is translated as “disorders of perturbed vata and blood”.

(C) – Vatasonita is a single disease entity. However, the translation implies otherwise.

39. (page li-lii) “Perturbation involves the increase or decrease of dhatus, which are restored to the normal range by administering substances with qualities opposed to those of the relevant dhatus and dosas.”

(C) - This should be “…with qualities opposed to or homologous to, respectively …”

A few other errors

1. (page xxxv) Swelling is given as sodha. It should be sotha.

2. (page xl) Reference 19 is given as Chikitsa 26:70-73. It should be Chikitsa 26:78

3. (page lxvi) “Lubricant therapy” is referred to as Vicarana. It should be Snehana.

4. (page lxxvi) Sami dhanya should be Simbi dhanya.

5. (page 52) Godha in Sutrasthana (chap. 11, sloka 62) is translated as “alligator”. It should be “monitor lizard” (udumbu in Tamil).

6. (page 139) “… heavy vrihi turns light when fried and converted to lajja”. It should be “laaja” instead of “lajja”.

7. (page 379) The heading “Urdha svasa” should read “Urdhva svasa”.

8. (page 466) “… in the perturbation of vata, the heart feels obstructed with a heavy sensation…” This should have been “… in the perturbation of kapha …”

9. (page xv) “Conclusion: ….river of medicine, rising from an obscure past, ever-flowing, ever-growing, and racing to the floodwaters of today…” .

(C) - This conclusion is somewhat confusing. It is not clear whom it is addressed to. Is it addressed to the Ayurvedic community or the Allopathic community? In fact, there does not seem to be a single river of medicine. There are various streams. Consider two such streams, the Ayurvedic and Allopathic streams – they have different conceptual worlds. In effect, they can be considered two parallel streams. Therefore, to see the “river of medicine” as a single stream may not be correct. On the whole, if this exhortation (about knowledge vs. wisdom etc.) is addressed to the modern scientist or the Allopathic community, it would make more sense.

10. (page liv)“….whose views and interpretations differed. Caraka, Susruta and Vagbhata, for example, do not agree on every aspect of the doctrine.”

(C)-Between Caraka Susrutha and Vagbhata there is no disagreement on the basic doctrine. However, it would have been interesting if these specific differences noted by the author were elaborated.

11. All the tables provided by the author contain various yoga, compositions, under each disease. But under each of the yoga, the ingredients are not completely listed. It would have been better if all the ingredients had been given, so that the book can stand independently, without the reader having to go back to the original text.

SOME INTERESTING COMMENTS AND FEATURES

1.(page iv) “The study of human skeleton on the basis of cadaveric dissection was a major achievement of Indian medicine …”

2. (page xlviii) “ … the absence of the description of severe malnutrition – not emaciation due to diseases or iron deficiency anemia – in the Caraka Samhita.”

3. (page liv) “Tridosa was anticipated in the Atharva Veda, which referred to diseases caused by water, wind and fire. … The doctrine evolved over centuries and attained the present form through debate among schools…”

4. (page lxv) “… ayurveda recognizes no disorder as purely local…”

5. (page lxix) “The great emphasis placed on rejuvenant therapy contradicts the perception of Indians as a world-renouncing people haunted by fatalism.”

6. In each chapter, some of the important information is summarized in the form of tables, which are very useful and convenient to use as a quick reference. However, some Sanskrit names could have been retained. For example, in pages 16-19 the ten groups of Mahakashaya, the Sanskrit names like Jeevaniya, Brmhaniya could have been retained in addition to the English translations like vitalizing, bulk-promoting, etc.

7. Pages 360, 361 have a good summary of Dhatu Parinama. However, Sanskrit terms like Dhatu, Mala, etc. could have been retained, in addition to ‘constituents’, ‘excrements’ etc.

8. (page 454) The chapter “Trimarmeeyasiddhi” has been brought before the portion on chikitsa. This is a useful summary.

9. (page 520) Chapter 65 “Emetics and purgatives” is useful.

10. (page 540) “Guidelines for prescription” from Kalpasthana-12 is a useful summary.

_____________________________________________________________

MOTIVATION OF THE AUTHOR:

Under the sub-heading “Why study disease burdens of the past?” (page xlvii) the author gives us one of the motivations for the work. “…If the ancient disorders could be identified in contemporary terms or modern disorders discovered in ancient descriptions, the search for new chemical entities and potential drugs from the old plants would undoubtedly become better focused.”

In the context of Rasayana (rejuvenation) and Vajikarana (virility enhancing) therapies (page lxix) the author says: “ In the present context when the problems of ageing have become a major concern in social and economic terms in many nations, Caraka’s herbal formulations for rejuvenation demand a serious second look. There are experimental models already available for inducing DNA chain breaks and measuring the rate of repair. It has been shown that the rate of repair in the neonatal rat brain cells, for example, is faster than that of adult brain cells. A good question would be whether compounds from Caraka’s formulations would enhance the rate of repair of the DNA in the brain cells of adult rats. One could also design many other interesting experiments to evaluate formulas for rejuvenant and virile therapies.”

Under “Use of medicinal plants – ancient and modern approaches”, the author talks about the need to look through the wealth of plant material accessible through the Caraka Samhita: “Obviously, accessibility to a large library of compounds is essential for drug discovery from plants but the screening tends to become wasteful unless the numbers to be screened are reduced on a rational basis. It is in this context that the formulations in Caraka Samhita assume special importance. It describes clinical features of numerous disorders in terms of the disturbance of dosas. If diseases as recognized and known today could be disengaged from among the ancient descriptions, one would know the precise formulations that had been prescribed for those diseases and be in a position to prepare a purposeful shortlist of plant extracts for screening. The opportunities for developing drugs for treating a variety of diseases (particularly degenerative diseases) from the wealth of ayurvedic formulations and individual plants are vast.”

This quest as the author repeatedly mentions, would certainly help the Indian pharmaceutical firms and the Allopathic community. It is, however, not clear how this would help Ayurveda or Ayurvedic physicians.

In addition to using the Ayurvedic knowledge to help the development of western medical science, the author suggests using the modern scientific tools, the latest techniques of chemistry and biology, to understand Ayurveda. He says (page lxxvi): “Perhaps it would be rewarding to look for physico-chemical fingerprints that may distinguish the anti-dosa groups of plants from each other and from plants that have few anti-dosa effects. The fingerprints could be developed on the basis of a cluster of biological activities such as anti-oxidant, anti-neoplastic, anti-mitotic, anti-inflammatory and immunomodulatory. In this reverse approach may lie the key to the biochemical understanding of the perturbation of dosas and a new kind of therapeutics.” While such understanding may be indeed rewarding to a modern biologist/chemist, it is not clear how this would help an Ayurvedic physician or make Ayurveda serve the society better.