Chapter 1. Fundamental principles of Longevity - Deerghanjiviteeya Adhyaya
The title of Charak Samhita’s very first chapter, Deerghanjiviteeya Adhyaya, literally means the chapter on longevity. This is symbolic, because it implies that Ayurveda is not merely the science of life, but also a science of longevity. This chapter deliberates on the purpose of long life and health as the means of achieving purushartha chatustaya, or the four primary instincts of human beings (virtue, wealth, gratification and emancipation) – by way of explaining some of the basic tenets of Ayurveda and defining the scope of Ayurveda. The chapter introduces fundamental principles of Ayurveda, including its definition, objective, concept of three sharira (bodily) doshas and their qualities, and two manasa (mental) dosha and their treatment. The samanya(similarity) and vishesha(dissimilarity) theory, pharmaco-therapeutic aspects, classification of drugs, list of herbs and other animal products useful in purification and pacification therapies are highlighted. Through these deliberations, this chapter essentially lays the foundation for building the body of knowledge on life sciences and healthcare that Charak Samhita is known for.
Chapter 2. Dehusked Seeds of Apamarga and other medicines - Apamarga Tanduliya Adhyaya
Apamarga tanduliya or the “dehusked seeds of Apamarga”, is the second chapter within Bheshaja (medicinal treatment) Chatushka (tetrad constituting four chapters) of Sutra Sthana. After reading this chapter, the student of Ayurveda would understand the practical application of bio-purificatory drugs and dietary preparations for purificatory measures suggested for the preservation of health and treatment of diseases.
Chapter 3. Aragvadha(purging cassia) and other medicines - Aragvadhiya Adhyaya
While the preceding chapter (Apamarga Tanduliya) dealt with internal application of therapies in the form of Panchakarma, yavagu etc, this chapter deals with the external application of medications. Skin diseases such as kushtha are systemic disorders and considered a maharoga (major disease). They require internal cleansing and detoxification treatments prior to external treatments – and hence, the sequence of the chapters. Without prior internal treatment, local treatments have limited efficacy.
Chapter 4. The Classification of Six Hundred Types of Evacuatives - Shadvirechanashatashritiya Adhyaya
The fourth chapter, titled Shadavirechana Shatashritiyam, provides comprehensive information about herbs and their classification by their specific activity and utility, medicinal preparations for evacuation (or evacuatives), and specific therapeutic regimen such as samshodhana (cleansing regimen) and samshamana (pacification regimen). Ayurveda emphasizes upon removing body impurities, like metabolic waste products, toxins, and undigested foods from various tissues and organs before treating any disease or applying measures for preservation, protection, and rejuvenation of health. There are six hundred preparations used for cleansing the body by vamana (therapeutic emesis) and virechana (therapeutic purgation), five hundred herbs, and (fifty) mahakashayas (classes with similar activity profile) of herbs used in their preparations. An Ayurvedic physician should have complete knowledge of special/selective actions of various preparations meant for removal of impurities from the body. The fifty mahakashayas comprise of ten herbs in each of five classes of drugs. It also includes six virechana ashraya (types of plant-based evacuatives), five kashaya yoni (original sources as per tastes), and five kashaya kalpana (forms of medicine preparations).
Chapter 5. The proper quantity of food and daily regimen for preserving health -Matrashiteeya Adhyaya
Swastha chatushka , the health tetrad, deals with the preservation of health and prevention of diseases. The first chapter of this tetrad, entitled Matrashiteeya Adhyaya, covers two topics viz. various aspects of the proper quantity and quality of diet and various daily regimens that should be followed by a person for healthy living. The tenets of personal hygiene, oral hygiene and hygiene of sense organs are described in this chapter. The routine procedures to preserve health like abhyanga (massage), nasya (nasal errhines), kavala (mouth wash), gandusha (gargling), karnapurana (applying oil in ears), anjana (collyrium) etc. are described in this chapter with their methods of administration and positive health benefits.
Chapter 6. Seasonal Regimen or Qualitative Dietetics - Tasyashiteeya Adhyaya
Chapter Six of the Sutra Sthana, titled Tasyashiteeya Adhyaya, describes the time of the year (in solistices, or kala, and seasons, or ritu and the specific regimen to be followed in these ritus. Seasonal changes influence changes in the dosha, physical strength, as well as our digestive power and this influences every living creature, not just human beings. This chapter continues the study of dietary regimen from the preceding chapters by adding the dimension of time and seasonal variations to it.
This chapter describes preventive measures for endogenous and exogenous diseases. Emphasis is given to natural urges aimed at cleansing body channels. The text also emphasizes upon following a proper dietary regimen and exercising per the individual’s unique body constitution. Means for maintaining psychological and social well-being for prevention of psycho-spiritual disorders are described in detail. The methods of prevention of diseases by improving strength, by knowing one’s own body constitution, maintaining psycho-spiritual balance and following an ideal dietary and lifestyle regimen suited to one’s unique constitution have been provided here.
Chapter 8.The Disciplinary Protocol for Sense and Motor Organs - Indriyopakramaniya Adhyaya
This chapter describes how humans perceive the world surroundings by means of five senses (Hear, see, smell, taste, and touch), how a system of five senses called Indriya Pancha-Panchaka works and communicates with mind to perceive the surroundings and how a person can maintain health by using his/her senses properly (and therefore leading a tempered, ethical life) or suffer from disease by not using their senses properly. It also explains the role of mind, intellect and soul in the entire process of perception. This chapter describes the qualities of the mind based on the predominance of the three fundamental qualities, the triguna (sattva, rajas and tamas), including the illusions created by the mind that makes a common observer perceive through his/her senses, say, multiple minds instead of one. It further describes the spiritual elements (Adhyatma dravya guna sangraha) & their action. The principles of psycho-pathogenesis based on the excessive, deficient and perverted association of five senses with their objects along with the principles of preventing psychic disturbances and preserving the physical, mental and socio-spiritual health in the form of the principles of sadvritta has been elaborately described. This involves a broad range of ethical observances & moral practices for preventing psychosomatic disturbances. Broadly, the practices regarding code of general ethics, diet, natural urges, relationship with women, study, regarding self-control & related to worship have been elaborately described. General ethical practices related to individual, inter- personal & about maintenance of social relations have been included, which are extremely valuable for personal & social health.
Chapter 9.The four fundamental components of Healthcare Khuddakachatushpada Adhyaya
After completing the Swastha chatushka(tetrad on health), Charak draws attention of the student/reader to the components of Healthcare Management. Four components necessary for providing optimum healthcare are described in this chapter. These components are: Physician, Medicine, Attendant and the Patient. Further, qualities of these components are described in brief. Definitions of disorder, health, treatment etc, along with different types of physicians have also been described.
Chapter 10. The Four Important Components of Therapeutics - Mahachatushpada Adhyaya
In the preceding chapter, four important aspects of healthcare including the best qualities of physician, nursing staff, medicine and the patient were described. This chapter deals with guidelines for therapeutic management based on four types of prognosis of diseases. It is important to determine prognosis of a disease before starting the treatment to decide the quality of remaining life of the patient, and whether it will be diseased or disease free. Therefore, as the title suggests, the chapter is about four important components of management of diseases.
Chapter 11.The Three Desires of Life and important triads - Tistraishaniya Adhyaya
Having or expressing desires is a human trait, and only human beings aspire to fulfill them. This chapter, Tistraishaniya Adhyaya, tries to explain three basic desires in human beings, and the mode to fulfill them during one’s life – longevity, wealth (or material comforts), and a blissful afterlife. This chapter is described under Nirdesha Chatushka since it gives instructions to lead a healthy and righteous life. It also guides to treat a patient with physical and/or mental disease and describes a triad of eight vargas, or ashtatrikas, explaining the theories of reincarnation and creation of universe. Four parikshas (aptopadesha, pratyaksha, anumana and yukti) or means for getting correct knowledge and their role in establishing the theory of reincarnation are described in detail. Using these methods, a physician can get knowledge about roga (disease) and rogi (patient) and can choose appropriate courses of treatment, with suitable drugs.
Chapter 12.The merits and demerits of Vata - Vatakalakaliya Adhyaya
This last chapter of the Nirdesha Chatushka is based on the findings of an assembly of expert practitioners of Ayurveda, headed by Atreya, that analyzed the normal and abnormal functions of tridosha. Among the three doshas, the vata dosha has been discussed in more detail, considering its supremacy as the initiator of all functions in the body. The important normal and abnormal functions of Vata in environment are also mentioned. Consequently, shorter descriptions of pitta and kapha dosha’s normal and abnormal functions have been provided.
Chapter 13. Oleation therapies - Snehadhyaya
Thirteenth chapter of Charak Samhita describes details of oleation therapy including the sources of lipids, types, properties, administration method, time, dose, alternative methods of administration in the form of recipe (vicharana), indications, contraindications, symptoms of proper, inadequate and excess oleation. Lipids are essential components of body as the meda dhatu (lipids) provides lubrication to all viscera and other interstetial spaces due to its snigdha (unctuous) qualities. Meda dhatu (lipids) is an integral part of cell membrane that allows entry of lipid soluble substances/drugs into the cells. The selection of lipids for oleation therapy depends upon the specific integrity of gut, severity of the disease, and specific indications of lipids. Those contra-indicated for use of natural fat as in diabetes or skin diseases, can consume medicated lipids. Properly done oleation results in proper downward movement of vata, increase in digestive power, softening of (hard) feces, and making the body supple and soft. Improper implementation of methods or violation of guidelines results in complications such as skin diseases, itching, haemorrhoids, ascitis, fainting, indigestion etc. Oleation and sudation are pre-requisites or pre-treatment procedures for shodhana (purification) therapies to aid in moving vitiated dosha to gut (for an eventual expelling out of the body and achieve purification). The present chapter can be considered as a first step in purification therapies described.
Chapter 14. Sudation Therapies - Swedadhyaya
Swedana (sudation) is a process in which the individual is subjected to therapeutic sweating. It is considered an essential prerequisite to Panchakarma (purification therapy involving five procedures) in Ayurveda and is secondary to snehana (oleation) in importance. When done without snehana, it is called ruksha sweda (dry fomentation). Swedana is intended to remove excessive vata and kapha dosha and is contraindicated in pitta disorders. The extent and severity of swedana depends upon various factors such as physical strength, amount of dosha, season, site, age etc. There are specific indications and contraindications for swedana karma and the optimal signs should be strictly followed for the procedure. There are many agents to induce sweating which can be broadly divided into sagni sweda (sweating induced with the help of fire) and niragni sweda (induced without using fire). Bolus fomentation, steam fomentation, tub fomentation and poultice fomentation are some of the very common types of swedana procedures. There are thirteen varieties of fomentations (prevalent in the olden days) that involve direct usage of heat derived from fire, and ten methods without fire. Swedana is an effective therapeutic method in Ayurveda and is the focus of study in this chapter.
Chapter 15. The Guidelines for Hospital Management and Purification Treatment- Upakalpaniya Adhyaya
The fifteenth chapter, Upakalpaniya Adhyaya continues the discussion on purification procedures (samshodhana karmas) from the preceding sections, but also focuses on the pre-requisites for construction of a well-equipped hospital facility suitable for administration of Panchakarma therapies. Pre-procedure, main procedure and post-procedure guidelines have been described in detail in this chapter, along with descriptions of dosages of drugs for vamana and virechana therapies as well as signs and symptoms of inadequate, proper and excess purification. Dosha afflictions, complications, dietetic regimen during the therapy and after the therapy (samsarjana karma) have also been clearly elaborated.
Chapter 16. Duties and Responsibilities of a Qualified Physician - Chikitsaprabhritiya Adhyaya
Chikitsaprabhritiya Adhyaya is the last chapter of the Kalpana Chatushka tetrad and describes the traits of a physician proficient in therapeutics, besides the consequences of appropriate as well as incorrect administration of therapeutic procedures, along with corrective interventions wherever applicable. This chapter also describes various indications for therapeutic intervention and their benefits, and questions and answers related the applicability of svabhavaparamvada (i.e. theory of natural destruction of causative factors of disease).
Chapter 17. Diseases of three vital organs including Head and other conditions - Kiyanta Shiraseeya Adhyaya
This is the first chapter of Roga Chatushka(tetrad on disease information) dealing with description related to diseases of the trimarma (three vital organs – the head, heart, and the urinary bladder (basti)). The etiopathogenesis of these diseases is detailed. Various diseases are caused due to permutations and combinations of dosha imbalances. The chapter describes signs of depletion of dhatu and mala. It also highlights the disorders of oja as well as madhumeha (diabetes mellitus), and carbuncles produced as its complications. This chapter also describes various types of dosha gati (movements of dosha). The comprehensive information about principles of basic Ayurvedic pathology is included in the chapter.
Chapter 18.Three Types of Swellings and other conditions - Trishothiya Adhyaya =
The preceding chapter (Kiyanta Shiraseeya) provided details on diseases of the vital organs with signs of swellings. This Trishothiya Adhyaya of Roga Chatushka (tetrad on diseases) describes various kinds of swellings/distension as well as causative factors for endogenous and exogenous swellings/distensions, their locations in the body and their modes of treatment. Further,the pathophysiology of various diseases along with their specific diagnostic criteria have been described in the chapter.
Chapter 19. Numerical Classification of Diseases - Ashtodariya Adhyaya
In continuation of the previous chapter, this chapter delves into classifications of various diseases. Diseases have been broadly classified here into two groups – one comprising of diseases manifesting as a result of involvement of two or more doshas (Samanyaja Vyadhi), while the other focusing on diseases caused due to a single dosha (Nanatmaja Vyadhi). Forty-eight diseases have been enlisted with their types from diagnostic perspective in this chapter. The role of doshas in etiopathogenesis of the diseases, difference between the exogenous and endogenous diseases and their coexistence has also been described. In modern medicine, classification and knowledge of these diseases differs. Some diseases described in this chapter can be exactly correlated with diseases of modern medicine whereas some cannot be.
Chapter 20. Dosha specific classification of diseases - Maharoga Adhyaya
This chapter focuses on diseases caused due to one vitiated dosha. Considering the fact that there are three distinct one-dosha families of diseases, and various exogenous (agantuja) diseases, there could be as many as eighty variants due to a vitiated vata, forty due to pitta, and twenty due to kapha. Any effective diagnosis or treatment of these diseases would need a detailed study of the doshas, their locations and characteristics. This has been provided in this chapter.
Chapter 21. Eight Undesirable Physical Constitutions - Ashtauninditiya Adhyaya
The Ashtauninditiyam is the first chapter of the Yojana Chatushka (tetrad on management protocol) within the Sutra Sthana. It deals with the interrelationships of diseases and drugs that depend upon the physical constitution of an individual. This chapter talks about eight undesirable physical constitutions that require special attention during any course of treatment and then focuses on features that are extreme and undesirable - morbid obesity and extreme emaciation. The reader of this chapter would expect to learn about these two conditions, their causative factors, signs and symptoms, and ways of effective management. A special emphasis has also been given to the merits of sleep, qualities or characteristics that define a “good sleep” and the demerits of sleep related disorders.
Chapter 22. Reduction and nourishing therapies - Langhanabrimhaniya Adhyaya
The courses of treatment for the sthula (obese) and the krisha (too thin/skinny/emaciated), and of various other diseases form the basis of Ayurvedic therapeutics and is the theme of the present chapter. Ayurvedic therapeutics are reducing (Apatarpana) or nourishing (Santarpana), and are of six types: Langhana (reduction), Brimhana (nourishing), Rukshana (drying), Stambhana (astringent/styptic), Snehana (oleation), and Swedana (sudation). Besides providing insights into these therapeutic measures, this chapter also describes specific qualities of these therapeutic procedures and their indications in detail. Finally, the reader would also expect to learn about features of optimally administered techniques while understanding the consequences of their over and under-application.