The Charaka Samhita (Sanskrit: चरक संहिता, romanized: Caraka-Saṃhitā, lit. 'Compendium of Charaka') is a Sanskrit text on Ayurveda (Indian traditional medicine), attributed to Charaka (c. 1st–2nd century CE) and later revised by Dṛḍhabala.[1][2][3] It presents theories of physiology, diagnosis, anatomy, and tridosha (three humors of the body), and is considered one of the most authoritative texts on Indian medicine.[3] Along with the Sushruta Samhita, it is one of the two foundational texts of this field that have survived from ancient India.[4][5][6] It is one of the three works that constitute the Brhat Trayi.

The text is based on the Agnivesha Samhitā, an older encyclopedic medical compendium by Agniveśa. It was revised by Charaka between 100 BCE and 200 CE and renamed Charaka Samhitā. The pre-2nd century CE text consists of 8 books and 120 chapters.[7][8] It describes ancient theories on the human body, etiology, symptomology and therapeutics for a wide range of diseases.[9] The Charaka Samhita also includes sections on the importance of diet, hygiene, prevention, medical education, and the teamwork of a physician, nurse and patient necessary for recovery to health.[10][11][12]

Authorship

The ideal medical student

He should be of a mild disposition, noble by nature, never mean in his acts, free from pride, strong memory, liberal mind, devoted to truth, likes solitude, of thoughtful disposition, free from anger, of excellent character, compassionate, one fond of study, devoted to both theory and practice, who seeks the good of all creatures.

— Charak Samhita 3.VIII.6 (Abridged)[13][14]

The Charaka Samhita states that the content of the book was first taught by Atreya, and then subsequently codified by Agniveśa into the Agnivesha Samhita, which was later revised by Charaka into the Charaka Samhita and furthermore edited by Dṛḍhabala.[15] The manuscripts of the Charaka Samhita that survive into the modern era are based on one completed by Dṛḍhabala.[16] Dṛḍhabala stated in the Charaka Samhita that he had to write one-third of the book himself because this portion had been lost, and that he also re-wrote the last part of the book.[17]

Based on textual analysis, and the literal meaning of the Sanskrit word charaka, Chattopadhyay speculated that charaka does not refer to one person but a lineage or sect of people.[18] Vishwakarma and Goswami state that the text exists in many versions and entire chapters are missing in some versions.[19]

Date

Dates of composition of the Charaka Samhita are uncertain. Meulenbeld's History of Indian Medical Literature dates it to be between the 4th century BCE to the 2nd century CE,[8] with Charaka's compilation likely between 100 BCE and 200 CE.[20] The Dṛḍhabala revision and completion, the source of current texts, is dated to the 6th century CE.[21]

Roots

In Sanskrit, charaka is a term for a wanderer, sannyasi (ascetic), and sometimes used in the context of the ancient tradition of wandering physicians who transmitted medical knowledge along with ritual and therapeutic practices rooted in Vedic traditions from village to village.[22][23]

Surendranath Dasgupta states that the medical tradition of wandering physicians is traceable to the Atharvaveda, particularly the Caranavaidya shakha – one of the nine known shakha of Atharvaveda-based Vedic schools.[22] The name of this school literally means "wandering physicians".[22] Their texts have not survived into the modern era, but manuscripts from two competing schools – Paippalada and Saunakiya, have.[22]

The Atharvaveda contains chapters relating to medicine, surgery and ritualistic-therapeutic practices.[24] This Atharvaveda layer of text was likely compiled contemporaneously with Samaveda and Yajurveda, in about 1200–1000 BCE.[25][26] Dasgupta and other scholars state that the Atreya-Charaka school and its texts may have emerged from this older tradition, and he cites a series of Atharvaveda hymns to show that almost all organs and nomenclature found in Charaka Samhita are also found in the Vedic hymns.[27][28]

Contents

The aim of life science

Life is of four kinds: Sukha (happy), Duhkha (unhappy), Hita (good) and Ahita (bad).

Sukham-Ayuh is a life unaffected by bodily or psychic diseases is endowed with vigor, capabilities, energy, vitality, activity, knowledge, successes and enjoyment. The opposite of this is the Asukham-Ayuh.

Hitam-Ayuh is the life of a person who is always willing to do good to all living beings, truthful, non-stealing, calm, self-restrained, taking steps after examining the situation, virtuous, achieve Dharma-Artha-Kama, without conflict with others, worshipping whatever is worthy, devoted to knowledge-understanding-serenity of mind, and to charity and peace. The opposite of this is the Ahitam-Ayuh.

The aim of Ayurveda is to teach what is conducive to these four kinds of life.

— Caraka Samhita Chapters 1.1, 1.30 (Abridged)[29][30]

The extant text has eight sthāna (books), totalling 120 chapters. The text includes a table of contents embedded in its verses, stating the names and describing the nature of the eight books, followed by a listing of the 120 chapters.[31] These eight books are[7]

  1. Sutra Sthana (General principles) – 30 chapters deal with general principles, philosophy, definitions, prevention through healthy living, and the goals of the text.[32] It is divided into quadruplets of 7, making it 28 with 2 concluding chapters.
  2. Nidana Sthana (Pathology) – 8 chapters on causes of diseases.[33]
  3. Vimana Sthana (Specific determination) 8 chapters contain training of a physician, ethics of medical practice, pathology, diet and nourishment, taste of medicines.[34]
  4. Śarira Sthana (Anatomy) – 8 chapters describe embryology & anatomy of a human body (with a section on other living beings).[35]
  5. Indriya Sthana (Sensory organ based prognosis) – 12 chapters elaborate on diagnosis & prognosis, mostly based on sensory response of the patient.[33]
  6. Cikitsa Sthana (Therapeutics) – 30 chapters deal with medicines and treatment of diseases.[36]
  7. Kalpa Sthana (Pharmaceutics and toxicology) – 12 chapters describe pharmacy, the preparation and dosage of medicine, signs of their abuse, and dealing with poisons.[33]
  8. Siddhi Sthana (Success in treatment) – 12 chapters describe signs of cure, hygiene and healthier living.[33]

Seventeen chapters of Cikitsā sthāna and complete Kalpa sthāna and Siddhi sthāna were added later by Dṛḍhabala.[37] The text starts with Sūtra sthāna which deals with fundamentals and basic principles of Ayurveda practice. Unique scientific contributions credited to the Caraka Saṃhitā include:

  • a rational approach to the causation and cure of disease
  • introduction of objective methods of clinical examination

Physician, nurse, patient and medicines

The text asserts that there are four important parts to medical practice – the patient, the physician, the nurse and the medicines.[11] All four are essential to recovery and return to health, states the text. The physician provides knowledge and coordinates the treatment. He is who can "explore the dark interior of the body with the lamp of knowledge", according to the text and Valiathan's translation.[11][38] The physician must express joy and cheer towards those who can respond to treatment, masterfully avoid and save time in cases where the patient suffers from an incurable disease, while compassionate towards all.[11] The nurse must be knowledgeable, skilled at preparing formulations and dosage, sympathetic towards everyone and clean.[10] The patient is responsible for being positive, have the ability to describe how he or she feels, remember and respectfully follow the physician instructions.[10][11]

The Charaka Samhita, states Curtin, was among the earliest texts that set a code of ethics on physicians and nurses, attributing "moral as well as scientific authority to the healer".[39][40] The text, in chapters 8 and 9 of the Vimana Sthana dedicates numerous verses to discussing the code. It mandates that the physician must seek consent before entering a patient's quarters, must be accompanied by a male member of the family if he is attending a woman or minor, must inform and gain consent from the patient or the guardians if the patient is a minor, must never resort to extortion for his service, never involve himself in any other activities with the patient or patient's family (such as negotiating loans, arranging marriage, buying or selling property), speak with soft words and never use cruel words, only do "what is calculated to do good to the patient", and maintain the patient's privacy.[41]

There is no end in the knowledge of medical science, claims verse 3.8.12 of the Charaka Samhita, and the physician must constantly learn and devote himself to it.[42] The text asserts that a physician should discuss his findings and questions with other physicians because "when one discusses with another that is possessed of a knowledge of the same science, such discussion leads to increase of knowledge and happiness".[43] The verses that follow an outline that discussions can be hostile or peaceful, the former are unproductive, the latter useful; even if one faces hostile criticism, one must persuade with gentle words and manner, asserts the text.[44]

Religious ideas

The Charaka Samhita, like other ancient Hindu literature, the text presents its knowledge within a traditional framework in which divine figures such as Indra are described as sources of medical wisdom, reflecting the integration of spiritual and medical knowledge in early Indian thought.[9] The Charaka Samhita mentions Bharadvaja learning from god Indra, after pleading that "poor health was disrupting the ability of human beings from pursuing their spiritual journey", and then Indra provides both the method and specifics of medical knowledge.[9][45] The method, asserts the text, revolves around three principles: etiology, symptomology and therapeutics.[9] Thus, states Glucklich, the text presumes proper goals to include both spiritual and physical health.[9]

The Charaka Samhita, in addition to initial recitations, uses the foundational assumptions and values embedded in various layers of the Vedas. These assumptions include the Vedic doctrine that a human being is a microcosmic replica of the universe,[9] and the ancient Hindu theory of six elements (five Prakriti and one Brahman),[9] three humors (Vata, Pitta, Kapha),[46] three Guṇas (Sattva, Rajas and Tamas) as constituent forces innate in a human body,[47] and others.[48] The text in Charak Samhita is based on philosophical concepts found in Hindu thought, including the idea of Atman(self), it is immutable and views health as a balance between bodily, mental, and existential factors, and hence thereafter the text defines physical and mental diseases as caused by a lack of correlation and imbalance in body, or mind, or both, because of external factors (Prakriti, objects of senses), age or a want of correlation (appropriate harmony, equilibrium) between the three humors or the three Gunas.[49]

The Sushruta Samhita and Charaka Samhita have religious ideas throughout, states Steven Engler, who then concludes, "Vedic concepts play a central role in shaping the theoretical foundations of the text.".[50][51][52] The text integrates empirical observations with philosophical and spiritual concepts, reflecting a holistic approach in which physical, mental, and spiritual aspects of health are interconnected.[50]

There is a close relationship between the philosophic presuppositions and the approach to medicine in Caraka Samhita. The Charaka Samhita is notable for its systematic approach to medicine, including detailed discussions on diagnosis, preventive care, ethics, and the importance of individualized treatment.[53][54][55]

Nutrition and diet

Diet and health

Innumerable diseases, bodily and mental, have for their root Tamas (stupefaction, darkness). Through fault of the understanding, one indulges in the five injurious objects, suppresses the urgings of nature and accomplishes acts that are highly rash. The man of Ignorance then becomes united with conditions for disease. The man of Knowledge, however, purified by knowledge avoids those conditions. One should never take any food, acting only from a desire for it or guided by ignorance. Only food that is beneficial should be eaten, after proper examination. Verily, the body is the result of food.

— Caraka Samhita, 1.XXVIII.41-48[56][57][58]

Charaka Samhita dedicates Chapters 5, 6, 25, 26 and 27 to "Aharatattva" (dietetics), stating that a wholesome diet is essential for good health and to prevent diseases, while unwholesome food is an important cause of diseases.[59]

— Charaka Samhita, 3.I.3-4[60][61]

The text suggests that foods are source of heat, nutritive value as well as physiological substances that act like drugs inside human body. Charaka identifies the three humors in the human body: Vata (linked with motion), Pitta (linked with metabolism), and Kapha (linked to structure). Imbalances or displacements of these three is the root of all diseases and malfunctions of the human body.[15] Furthermore, along with medicine, Charaka Samhita in Chapters 26 and 27, states that proper nutrition is essential for expedient recovery from sickness or surgery.[59]

Meat for diebetics and medicine

The Charaka Samhita suggests a regimen of Mamsa Rasa (meat soup) during pregnancy from the 6th month onwards.[62]

Freshly cut meat is also recommended by the text for treatment of poison: the cut meat is pressed against the affected part or spot of insect or reptile bite to absorb the poison.[63]

Ray et al. list medicinal substances from over 150 animal origins that are described in Charaka Samhita, and the chapters these are found in.[64] These range from meat of wild animals such as fox and crocodile, to that of freshly cut fish, fish oil, eggs of birds, bee's wax.[64] Additionally, the text describes hundreds of formulations (gruel) it asserts to be of medicinal value from a mixture of animal products and herb or plant products,[65][66] as well as inert minerals such as various salts, soots and alkalis.[67][68]