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THE DOCTRINE OF THE THREE HUMORS IN TRADITIONAL INDIAN MEDICINE AND THE ALLEGED ANTIQUITY OF TAMIL SIDDHA MEDICINE.

1. SIDDHA AND AYURVEDA

THIS STUDY REALLY BEGAN IN 1968 at the Second World Tamil Conference in Madras, where the organizers had arranged for an exhibit of traditional Tamil medicine, with a large number of Siddha(1) practitioners present. Theirs was obviously an ancient art, and attempts have been made in recent decades to give it wider currency.(2) Just how old is Siddha medicine and how does it relate to the better known Ayurveda, since one can immediately see that they have much in common and are practiced side by side in south India? My interest was aroused, as one who had strayed from the family profession of medicine, and I felt an urge to bring light to this mystery of medical history.

Almost from the beginning I was confronted with conflicting claims put forth in the strongest terms. Tamil practitioners tend to insist on the highest antiquity for their tradition, whereas V. Raghavan, the noted Sanskrit scholar, once told me years ago that Siddha medicine is nothing but a derivative of Ayurveda. If one views these claims against the background of tension persisting between the propagandists of Tamil culture, on the one hand, and brahmins (even Tamil brahmins), on the other, which has marked much of this century, one might be tempted to reject both claims as biased. But the claim of Ayurveda is backed by one obvious trump card: the terminology of Siddha medicine is overwhelmingly based on Sanskrit. Siddha texts speak of the three tatu or tocam, i.e., vata, pittam, and cilettumam, undeniably Tamil reflections of Sanskrit dhatu, dosa, vata, pitta, and slesman, as the basic constituents of the body; the same is true for much of the anatomical vocabulary: kayam 'body,' nadi 'nerve, artery,' nayana 'eye' are found even in the titles of various Siddha texts, such as Kaya-karpa, Nadi-nul, Nayana-viti.

One Siddha practitioner countered (in conversation) with the argument that it was fashionable for many centuries to replace old Tamil names and terms with more "prestigious" Sanskrit expressions, just as we see a replacement of the old place names Cirrampalam (frequently in the seventh-century Tevaram; e.g., at 1.1) or Tillai (Tiruvacakam 8.5) with today's Citamparam (Chidambaram)(3); older Kutantai and Kuta-mukku "Pot-nose" by Kumpakonam (i.e., Kumbha-ghona).(4) Still, it would be difficult to accept such a massive change of terminology in a medicine that--at least in minds and statements of contemporary practitioners(5)--prides itself in being distinctively Tamil.

Several authors have attempted to demonstrate the high antiquity of Siddha medicine by alleged references to Siddha practices in the old Sangam literature.(6) We can see that these references to human anatomy and certain treatments indicate that two thousand years ago the Tamils had knowledge of and names for certain parts of the human body (who would have doubted that?) and that they knew of some practices of treatment and healing. The word maruntu "medicine, medication" is common in the Sangam poems, and there are references to medical men maruttuvan (pl. maruttuvar); two poets have the word attached to their names: Maruttuvan Tamotaranar (i.e., Damodara)(7) and Maruttuvan Nallaccutanar.(8) Some form of medical practice can probably be found in any society; but there is nothing that points specifically to the practice of Siddha or of Ayurveda medicine in the time of the Sangam poetry.

The first reference to Ayurveda is found in Cilappatikaram V.44, where ayulvetar "experts in Ayurveda" are said to live in the center of town next to priests and astrologers.(9) The Cilappatikaram is one of the later Sangam texts and is now tentatively dated by K. Zvelebil to about A.D. 450.(10) Still later, probably, is the Tirukkural,(11) which states in stanza 941: "The three, having wind (vali) as first, as they (i.e., these three)(12) increase or diminish, will cause disease (noy)." This is an obvious reference to the wind, bile, and phlegm that play a crucial role in the pathology of both Siddha medicine and Ayurveda. But the poet used no comprehensive term for this triad--neither the word dosa nor any of its Tamil equivalents that we find in typical Siddha texts.

The oldest existing Siddha text is the Tirumantiram,(13) whose date scholars have tried to establish through elaborate investigations of who quotes or refers to whom. Does a reference in Tirumantiram 1646 (1619) to the five mandalas of the Tamil country point to an early date?(14) Does Sundaramurti (ninth century) in his Tiruttonda-ttokai (5.5) refer to the author of the Tirumantiram when he mentions a certain Tirumular? Based on how a scholar evaluates these references, the estimated date varies from the fifth century A.D.(15) to the eleventh century. A reference to the nine Nathasiddhas in Tirumantiram 3067(16) and the description of the concepts of the Buddhist Kalacakra school in section III, chapter 14(17) are taken by R. Venkatraman(18) as an indication that this text belongs to the tenth or eleventh century and that its author, Tirumular, must be distinguished from the Tirumular mentioned by Sundaramurti.(19) We must also consider the possibility that our text of the Tirumantiram contains later additions.(20) The earliest clear reference to the Tirumantiram is found in a twelfth-century work, Sekkilar's Tiruttondar Puranam.(21) A commentary (eleventh or twelfth century?) on the Yapparunkalam quotes Tirumantiram 204 (247), with slight variations.(22)

The exact dating of the Tirumantiram is of minor importance in the present context, because the text contains no specific references to Siddha medical doctrines.(23) There is no mention of diagnostics by feeling the pulse,(24) the pharmacological use of heavy metals,(25) or even the theory of the three toca, though wind, bile, and phlegm as the cause of trouble are known (see below).

The bulk of the texts associated with the thought and medicine of the Siddhas appears to be much later. Two Siddha scholars(26) readily admitted to me that the language of these rather voluminous texts is late, probably not older than the sixteenth century A.D., and R. Venkatraman's investigations of these works and the legends connected with the names of their presumed authors confirm this--but could these works be the written reflections of an oral tradition that goes back to a hoary past? Or, to put it in another way, between the two competing medical systems--Siddha and Ayurveda--which way did the borrowing go?

The key to the solution of this problem is, I think, the presumed role of the three faults or humors in man's physical well-being common to contemporary Siddha and Ayurveda medicines. In modern times we read and hear of tiridosam or tiritocam, simple adaptations of a Sanskrit tri-dosam to Tamil phonology. Muttocam replaces Sanskrit tri 'three' with the Tamil equivalent mu (with shortening of the /u/ in composition). Older--and more problematic--is mu-kkurram 'the three evils' of the soul in Naladiyar 190 (seventh century?), i.e., kamam 'desire,' vekuli 'anger,' and mayakkam 'confusion,'(27) which apparently have no medical connotations. The three blemishes (munrrula kurram) in Tirumantiram 2435f. (2396f.) are lust, anger, and ignorance--also ethical, not medical problems. Mu-kkurram would thus be similar to mu-mmalam 'three impurities' in Tirumantiram 343 (329), i.e., "egoity, karma, maya" in the words of B. Natarajan. Notice in contrast the different terminology, when in Tirumantiram 727 (707) yoga practiced at dusk is said to remove phlegm (ai);(28) at noon, the treacherous wind (vata); at dawn, bile (pitta)--allowing the yogin to escape old age. Here phlegm, wind, and bile are all seen as evils to be gotten rid of, as in some medical texts; and yet no general term, such as, e.g., "three evils," is used for phlegm, wind, and bile. Tirumantiram 458 (442)(29) refers to a balance of qualities that is beneficial for an infant, but I very much doubt that this is a reference to the "balance of the dosas." Only in more recent Siddha texts, it seems(30)--and in contemporary writings(31)--we are told that health is based on a balance of the three "faults" or "evils," i.e., wind, bile, and phlegm. In contemporary usage, these three, called tiri-tosam or mu-ttosam 'three faults' or mu-ppini 'three maladies'(32) are supposed to be balanced for good health. These three are often referred to in English writings (on both schools of traditional Indian medicine) as the three "humo[u]rs," as if this term(33) made their role in maintaining good health more acceptable. The introduction of the term is caused by an insidious side-glance at Greek medicine, where the four humors (the word used is xvuoi 'juices')(34)--blood, phlegm, yellow bile, and black bile(35)--play a central role in the texts of the hippocratic corpus (perhaps rather in the younger texts of this corpus). There is yet another reason why the term is ill-suited to Indian medicine as a common term for wind, bile, and phlegm: wind is obviously not a fluid or "humor" in the ordinary sense of the word. Use of the term in any discussion of Indian medicine creates the doubtful presumption of a similarity to or even a dependence on the Greek medical tradition, which could at best, perhaps, be established as a result of a thorough investigation.

It seems strange that positive well-being should be based on a balance of evils; one would at least like to see an explanation for this peculiar way of looking at things. A survey of the Tamil tradition fails to turn up convincing evidence of how the view evolved, but the late attestation of the tri-dosa theory in Tamil medicine may offer a clue. The seemingly odd expression could have been borrowed from a tradition where its evolution was more meaningful. In the following pages I shall try to show that this was, in fact, the case. The theory of the three "faults" as fundamental to health and illness evolves, as it were, under the influence of philosophical ideas that were current at the time the classical medical texts were composed or redacted. We shall now turn our attention to the north Indian tradition.

2. THE EVIDENCE OF THE BUDDHIST CANON

There are several references in the Buddhist canon to wind, bile, and phlegm as causes of illness; the term dosa is also found in the canonical texts, but wind, bile, and phlegm are, as such, never so identified, either individually or jointly, and no reference to a tri-dosa theory occurs. Since the illnesses and their cures described in the canon have been discussed in detail by Kenneth G. Zysk in a recent book,(36) I shall limit myself here to a short presentation of the relevant passages. At the risk of appearing repetitive, I will have to review some of Zysk's key evidence to show the use of important terms and to justify my critique of his translation of the term dosa in the Pali texts.

Anguttara-nikaya IV.320:

so mama assa antarayo, upakkhalitva va papateyyam,

bhattam va me bhuttam byapajjeyya, pittam va me

kuppeyya, semham va me kuppeyya, satthaka va me vata

kuppeyyum, manussa va mam upakkameyyum, amanussa

va mam upakkameyyum; tena me assa kalankiriya.

This may be my death: I may stumble and fall, the food

I have eaten may kill me, my bile may get angry, my

phlegm may get angry, my cutting winds may get angry,

men may attack me, demons may attack me; in this way

my end may come.

Anguttara-nikaya V.218 (cf. also V.219):

tikicchaka, bhikkhave, virecanam denti pitta-samutthananam

pi abadhanam patighataya, semha-samutthananam

pi abadhanam patighataya, vata-samutthananam pi

abadhanam patighataya.

O monks, physicians give a purgative as a cure for diseases

that arise from bile, as a cure for diseases that arise from

phlegm, as a cure for diseases that arise from wind.

Mahavagga VI.14.1 + 3f. (Vinaya I.205)

tena kho pana samayena ayasmato Pilindavacchassa

vatabadho hoti ...

Again, at that time the venerable Pilindavaccha had

affliction of wind ...

tena kho pana samayena ayasmato Pilindavacchassa

anga-vato hoti ...

Again, at that time the venerable Pilindavaccha had

wind in the limbs ... [rheumatism?]

tena kho pana samayena ayasmato Pilindavacchassa

pabba-vato hoti ...

Again, at that time the venerable Pilindavaccha had

wind in the joints ... [intermittent ague?]

Mahavagga VI.16.3 (Vinaya I.210; cf. also VI.17.1)

tena kho pana samayena annatarassa bikkhuno udaravatabadho

hoti.

Again, at that time a certain monk had affliction of wind

in the abdomen.

Samyutta-nikaya IV.230f. lists the eight determining causes, beginning with phlegm, bile, wind, and their combination:

pitta-samutthanani pi kho, Sivaka, idhekaccani vedayitani

uppajjanti, samam pi kho etam, Sivaka, veditabbam

yatha pitta-samutthanani pi idhekaccani vedayitani uppajjanti;

lokassa pi kho etam, Sivaka, sacca-sammatam

yatha pitta-samutthanani pi idhekaccani vedayitani

uppajjanti ...

semha-samutthanani pi kho ...

vata-samutthanani pi kho ...

sannipatikani pi kho ...

utu-parinama-jani pi kho ...

pittam semham ca vato ca, sannipata utuni ca /

visamam opakkamikam ca, kamma-vipakena atthami ti //

Now, Sivaka, in this connection, there are some

sufferings originating from bile. You ought to know by

experience, Sivaka, that this is so. And this fact, that

sufferings originate from bile, is generally acknowledged

by the world as true ...

Also originating from phlegm ...

Also originating from wind ...

Also originating from their combination ...

Also originating from changes of the season ...

Bile, phlegm, and wind, their combination and the

seasons, mishaps and foreign impact, together with the

ripening of one's karma: that is eight.(37)

The same list of eight causes is found also in Anguttaranikaya II.87 and III.131. Note that sannipata 'combination' implies a close connection of the preceding three items: bile, phlegm, and wind. As these three are not identified in canonical texts as the three dosas, there is no justification for Demieville to speak of a "theory of four humors--wind, phlegm, bile and the combination of the three."(38)

In Mahavagga VIII.1.30-33 (Vinaya I.278f.) Buddha's body is said to be flooded with dosas:

atha kho Bhagavato kayo dosabhisanno hoti ...

At that time the body of the Blessed one was flooded with

faults ...

The famous physician Jivaka Komarabhacca gave him a mild purgative. The same affliction is apparently meant in Mahavagga VI.14.7 (Vinaya I.206):(39)

tena kho pana samayena annataro bhikkhu abhisanna-kayo

hoti.

Again, at that time a certain monk had a flooded body.

He, too, is given a purgative. His body was flooded, we may assume, with faults--as in the previous quotation. The phrase has a parallel in Caraka-samhita, Kalpasthana, 12:8:

pibet gulmodari dosair abhikhinnas ca yo narah

go-mrgaja-rasaih panduh krmi-kosthi bhagandari

A man with an abdominal tumor and one attacked by the

faults, one who is pale, who has a belly of worms, one

who has a fistula-in-ano should drink [ ... ] with juice of

cow's, deer's or goat's [meat]

with a variant reading abhisyannas ca yo narah, which would correspond well with Pali abhisanna. Forms of the root syand with the prefix abhi are well attested, whereas there is no trace of any other form of the root khid with abhi.

The faults or corruptions (Pali dosa, Sanskrit dosa) refer, in the classical medical texts, usually to wind, bile, and phlegm as the cause of illnesses. The same might be presumed to be the case here, too; but there is no clear instance of such usage in the Pali texts.(40) It is also not known whether abhisanna-kayo is an abbreviated version of dosabhisannna-kayo or the latter an elaboration based on later ideas. The relative chronology of the Pali passages quoted cannot at present be ascertained, and the whole Kalpasthana of the Carakasamhita is the work of the redactor Drdhabala (eighth century?).

I have to take issue here with Zysk's translation of dosa from the canonical passages (and from Caraka) as "'peccant' humors."(41) Not only is the expression "humor" misleading, as I pointed out earlier, but the qualification "peccant" surreptitiously affirms the negative aspect required by the context. If the word dosa 'humor' is value-neutral, why do we not see any "good" dosas in the Pali canon (or in Caraka, for that matter)? Zysk rightly stresses the continuity between early Buddhist and early Ayurvedic medicine, in that wind, bile, and phlegm--or a combination of these--are causes of many ailments, though in several instances ailments are not traced to any of these three.(42) But he treads on thin ice when he concludes that the textual evidence "does not imply the absence of humoral etiology at this time.(43) In fact, it doesn't imply its presence either, as R. Muller pointed out many years ago.(44) Dosa in these cases rather seems to denote something that should not normally be there in the body, a "fault," possibly referring to abnormal conditions of wind, bile, and phlegm. Still, this would be far from what is usually understood by a "humoral etiology."

In a few other occurrences of the word, dosa is used in a more general sense,(45) In Mahavagga VI.14.7 (Vinaya I.206)

tena kho pana samayena annatarassa bhikkhuno chavi-dosabadho

hoti

Again, at that time a certain monk had an affliction of

skin corruption.

chavi-dosa corresponds to classical tvag-dosa 'corruption of the skin, skin disease' found in Caraka, Sutra-sthana, 3.29; Bhela, Sutra-sthana, 6.17; and Susruta, Sutra-sthana, 24.10 and Cikitsita-sthana, 9.1f.

There are several lists of body parts in the Buddhist canon and in the preceding Vedic literature(46) that include, besides the more obvious bones and organs, bile and phlegm. The oldest detailed lists are probably those found in the brahmana sections of the samhitas of the Black Yajurveda: Taittiriya-samhita V.7.11-23 (14 prana 'breath'; 20 dusika 'rheum of the eyes'; 23 pitta 'bile'); cf. Maitrayani-samhita III.15.1ff. (2 prana, 8 dusika, 9 pitta) and Kathaka-samhita 53 (10 dusika, 12 pitta). A similar list is found, in the White Yajurveda, in Vajasaneyi-samhita XXV.1-9 (2 pranah, 7 pitta, 9 dusika).

In the Buddhist canon, Digha-nikaya II.293f. has the following list:(47)

puna ca param, bhikkhave, bhikkhu imam eva kayam,

uddham padatala adho kesa-matthaka, taca-pariyantam

puram nanappakarassa asucino paccavekkhati: atthi imasmim

kaye kesa loma nakha danta taco mamsam nharu atthi

atthiminjam vakkam hadayam yakanam kilomakam pihakam

papphasam antam antagunam udariyam karisam

pittam semham pubbo lohitam sedo medo assu vasa khelo

singhanika lasika muttam ti ...

puna ca param, bhikkhave, bhikkhu imam eva kayam

yathathitam yathapanihitam dhatuso paccavekkhati: atthi

imasmim kaye pathavi-dhatu, apo-dhatu, tejo-dhatu,

vayo-dhatu ti.

Furthermore, O monks, the monk views this body, from

the feet upward and from the hair and the head downward,

up to the skin filled with various impurities: In this

body there are hair of the head, hair of the body, nails,

teeth, skin, flesh, sinews, bones, bone marrow, kidneys,

heart, liver, pleura, spleen, lungs, bowels, intestines,

stomach, excrement, bile, phlegm, pus, blood, sweat, fat,

tears, grease, saliva, mucus, serous fluid, and urine ...

Furthermore, O monks, the monk views this body as it

stood, as it was put together from elements: There is in

this body earth element, water element, fire element, and

wind element.

To sum up: it is clear that bile and phlegm were considered in Buddhist doctrine as part of the human body--even (unexpelled) feces and urine. Breath, however is not included.(48) Dosas cause illness, but nothing more is said about them.

3. THE EVIDENCE IN THE MAHABHASYA(49)

Panini V.1.38 [18 TH[a.sup.n] tasya nimittam samyogotpatau "[The suffix -ika is attached to denote that this is] its effective purpose, provided that a conjunction or an omen is meant." [E.g., if one associates with a rich man in order to borrow a hundred rupees (sata), that man may be termed 'worth a hundred' (satika).]

Katyayana wants to expand the rule:

tasya-nimitta-prakarane vata-pitta-slesmabhyah

samana-kopanayor upasamkhyanam

Under the topic "its effective purpose," [the meanings]

"calming" and "riling," must be additionally enumerated,

[when the suffix] follows [the words] vata 'wind', pitta

'bile', or slesman 'phlegm'.

Patanjali paraphrases the varttika and exemplifies it:

vatasya samanam kopanam va vatikam; paittikam; slaismikam.

[A medicine or procedure] that serves to calm or rile wind

(vata) is termed a 'wind-calmant' or a 'wind-rilant' [procedure]

(vatika); one that serves to calm or rile bile is

termed a 'bile-calmant' or 'bile-rilant' [procedure]; one

that serves to calm or rile phlegm is termed a 'phlegm-calmant'

or 'phlegm-rilant' [procedure].

Katyayana further expands the rule:

samnipatac ca

And [when the suffix] follows [the word] samnipata.

Patanjali explains:

samnipatac ceti vaktavyam: samnipatikam

[A medicine or procedure] that serves to calm or rile a

combination (samnipata) of wind, bile, or phlegm] is

termed a 'combinatory-calmant' or a 'combinatory-rilant'

[procedure] (samnipatika).

This passage of the Mahabhasya shows the same group of wind, bile, and phlegm plus their combination, called samnipata, that we found in the Pali canon as causes of illness and, as in that canon, they are not linked to the term dosa.(50) In the Pali text it is said that wind/bile/ phlegm kupyate 'gets angry'; Katyayana speaks of riling them (kopana). The adjectives vatika, paittika, and slaismika for illnesses caused by vata, pitta, and slesman are common in medical texts; but there are no unambiguous instances where they mean 'riling vata, pitta, or slesman', and only rarely do we find vatika 'removing/calming wind.'(51) Since Katyayana can be dated to around 250 B.C. and Patanjali to 150 or 120 B.C., they are roughly contemporary with the works of the Buddhist canon, and their expressions are compatible with those found in the canon. Though Katyayana and Patanjali share the expressions vatika, paittika, slaismika, and samnipatika with the classical medical texts, the meanings of these terms do not match exactly those found in the medical texts and may represent a different strain of tradition, showing perhaps a regional/dialectal difference.

To sum up: the evidence is similar to that of the Buddhist canon, but dosa is not mentioned. The terms vatika, paittika, slaismika and samnipatika are similar if not identical in meaning with those in the classical medical texts.

4. THE BOWER MANUSCRIPT AND CONTEMPORARY BUDDHIST TEXTS

The Bower manuscript,(52) found in eastern Turkestan, has been placed, for paleographical reasons, in the time between the fourth and sixth century A.D.; current research favors the period between the beginning and the middle of the sixth century.(53) The manuscript contains several Buddhist texts, three of them dealing with medicine, which may be considerably older than the surviving manuscript.

The first text deals with the medicinal use of garlic, which "removes the strength of wind" (15 pavana-balaharah), "calms bile" (15 pitta-prasamanah), and "defeats the strength of phlegm" (15 kapha-bala-vijayi), i.e., "it removes the triad of faults" (15 dosa-traya-harah).(54) Sometimes the expressions are stronger: garlic "kills the wind" (16 pavanam vinihanti), certain drinks "remove bile and phlegm" (49 pitta-kaphapahah), a certain medicine "removes bile, blood, and wind" (85 pittasravatapaham) or just bile and blood (80 vata-raktapaham), wind and phlegm (82 vata-kaphapaham), or the faults (92 dosapahan, 120 dosa-harah). These expressions might be explained as merely emphatic exaggerations, or by attraction in mixed formulations like this: garlic "kills tumor [caused] by wind if joined with [other] wind-killers" (38 hanyad yukto maruta-gulmam pavana-ghnaih). Killing a tumor is unobjectionable; killing one's wind, however, is questionable.

These actions against wind, bile, and phlegm are important because the three cause illness. We learn about "eye disease caused by wind" (70 vata-krte 'ksi-roge), "eye diseased caused by bile or blood" (73 paitte 'ksi-roge rudhiratmake ca), and "eye disease caused by phlegm" (76 slesma-krte 'ksi-roge), and "coughing caused by wind" (121 maruta-kasinam, 124; vata-kasa- 129-31) as well as "coughing caused by bile" (132 paittike [kase]).

The role of blood in this context is curious, as it seems to join wind, bile, and phlegm as a cause of illness that has to be removed.(55) While one might argue that phlegm and wind are undesirable intruders (phlegm was not listed as part of the body in the older Vedic ritual texts, though it was in the Satapatha-brahmana and in Buddhist texts), this cannot be said about bile, which has always been considered part of a healthy body (only healthy animals(56) could be part of a Vedic sacrifice), and certainly not about blood. The ambiguous role of blood--often lining up with the dosas while frequently listed as one of the bodily elements (dhatu)--has been discussed by several later Ayurvedic authors.(57)

"Phlegm together with wind ... goes into anger" (101 slesma sa-vayuh ... prakopam yati), and garlic "calms phlegm that is not long established" (16 kapham apy acirad uditam samayet); there is a "calming of the illnesses caused by phlegm, blood, bile, and wind" (108 kaphasra-pittanila-roga-santau). The contrast of prakopa and samayet/santi reminds us of Katyayana's varttika kopana-samanayoh. The combination of two such causes is called samsarga; of all three (blood was probably not included), probably (*)sarva-samutthana; thus diseases caused by two are called samsarga-ja and those caused by all sarva-samutthita (78).

The ideal state is "the balance of the elements" (44 dhatunam samyam), for "health derives from the balance of the elements" (45 dhatu-samyad arogyam). What are these elements? One might think of the four elements earth, water, fire, and wind that we found in the list in the Buddhist canon. But it is more likely that the elements meant here are the seven elements listed in the classical medical texts (Car Sa 6.10; Sus Su 14.10f.): chyle, blood, flesh, fat, bone, marrow, and semen. Or, they could be the three elements wind, bile, and phlegm.

The second text in the Bower manuscript is the Navanitakam "Made from Butter," essentially an Ayurvedic formulary for the treatment of various illnesses. We read about "tumor caused by wind" (79 vata-krtam ca gulmam), "tumor [caused] by an excess of wind or phlegm" (32 gulme vata-kapholbane), "tumor [caused] by bile" (154 pitta-gulma-), and so on. Diseases in general can be "caused by any of these: wind, blood, bile, phlegm, and their combination" (308f, vata-jan rogan, rakta-jan, pitta-jan, slesmikan, samnipatotthan). Such "diseases caused by a combination [of causes]" are called roga ye samnipatikah (250), using a term already demanded by Katyayana and made explicit by Patanjali. Note that here samnipatika seems to include diseases caused by blood as if it were a fourth fault or cause.

It is not clear what is meant by the expression "when the elements are broken apart by wind" (358 vata-bhagnesu dhatusu); the elements (dhatu) should again be the classical constituents of the body, which are disturbed in some way. The opposite process is obviously envisioned in the phrase "when the fault is removed [and] the elements settled" (385 hrte dose viprasannesu dhatusu). Here the "fault" (dosa) is clearly not among the "elements" (dhatu).

As illness is caused by the three (or even four?) faults, the cure consists in combatting the faults and their effects. A certain medical powder "pushes off the combination [of the faults]" (58 samnipata-nud); another treatment "pushes off phlegm and wind" (156 kapha-vata-nud), another "strikes down wind" (185 vatam nihanti). The cure is often seen as the calming of the disease or the causal fault: "calming of all diseases" (288 sarva-vyadhi-prasamanam), "calming of wind and blood" (vata-sonita-prasamanam, the colophon after 405, refers back to vatarakta-haram "removing wind and blood" in 405), "calming of all fevers" (501 sarva-jvaranam samanah). This text seems to use samana and prasamana without distinction; the former matches Katyayana's usage, the latter the usage of the classical texts.

The third medical text of the Bower manuscript offers little for our study except some medical terms postulated by Katyayana and exemplified by Patanjali: 47 vatika vrsana[h] ('testes with wind') and 50 slesmika roga vatikah paittikas ca ('illnesses caused by phlegm, wind, and bile'). But the adjectives vatika, etc., do not have quite the meaning envisioned by Katyayana, i.e., "riling/ calming wind, etc."(58) There is also a slight deviation in the form slesmika found here and in the Navanitaka; the correct form should be slaismika with vrddhi in the first syllable, as demanded in the Mahabhasya.

There is also a two page fragment of a medical text from Turkestan, edited by H. Luders(59) and dated around A.D. 200 on palaeographical grounds. It contains several references to wind, bile, and phlegm, and may perhaps represent a development of medicine similar to that found in the Bower manuscript.

In Asvaghosa's Buddhacarita III.42f. the charioteer explains the shocking appearance of a sick man to the young prince Siddhartha: "Friend, a great misfortune called disease has grown, arisen from the anger of the constituents (dhatu-prakopa-prabhavah), by which even this strong man is made helpless."(60) The young Siddhartha asks further: "Has this fault (dosa) come into being separately for him alone, [or] is there a general danger of disease for [all] men?" It looks as if dhatu here refers to wind, bile, and phlegm as constituents of the body, and dosa probably refers to any one of these as it has been riled; it is not impossible, though, that dosa could refer to the man's diseased state itself.

In Buddhacarita X.20, in a formal exchange of courtesies, the king inquires about [his guest's] "evenness of constituents" (dhatu-samyam). The guest, in turn, asks with equal kindness about the king's "mental well-being and his (physical) health" (manah-svasthyam anamayam ca). The same formalities are expressed thus in Buddhacarita XII.3:

tav ubhau nyayatah prstva dhatu-samyam parasparam

After both had properly asked each other about their

evenness of constituents [i.e., their health] ...

In Suvarnaprabhasasutra 16.3f., Jalavahana asks his father, the medical doctor Jatimdhara:

How is medicine to be practiced in order to cure a disease

when it has arisen due to wind, bile, phlegm, or a combination

(of these)? At what time is wind disturbed, at

what time is bile disturbed, at what time is phlegm disturbed,

so that men are oppressed?

From his father's response, note stanza 9:

Illnesses due to excess of wind occur in the rainy season.

Disturbance of the bile takes place in autumn. Likewise,

(illness) due to a combination (arises) in winter-time. Illnesses

due to excess of phlegm arise in the hot season.(61)

Although the term dosa is not found in this chapter, phlegm, bile, and wind are referred to as the "triad of elements" (dhatu-tritaya) in stanza 11, and their being angered (dhatu-tritaya-prakopah) is a sequential affair: "Excess of phlegm erupts as soon as one has eaten. Excess of bile erupts during digestion. Excess of wind erupts as soon as one has digested."(62)

To sum up: we found in this group of texts a "triad of faults" (dosa-traya), a "triad of elements" (dhatu-tritaya), and good health defined as the "balance of the elements" (dhatu-samya). The elements (dhatu-) are settled or serene when the faults (dosa) are removed; these faults appear to be various states of wind, bile, and phlegm.

5. THE CARAKA-SAMHITA

The Caraka-samhita presents itself as Caraka's redaction(63) of Agnivesa's work, but the bulk of book VI (Cikitsa-sthanam) and the books VII (Kalpa-sthanam) and VIII (Siddhi-sthanam) were added much later by Drdhabala (approximately eighth century A.D.) as a replacement for lost portions of the text.(64) It is probable that the whole text has been subjected to some amount of rewriting by Drdhabala.(65) I shall first take up the material found in book one (Sutra-sthanam).

The goal of medicine is defined thus in Sutra-sthana 1.53:

.... karyam dhatu-samyam ihocyate

dhatu-samya-kriya cokta tantrasyasya prayojanam

In the present context, the effect is the equilibrium of

[body] constituents. The very object of this science is the

maintenance of the equilibrium of [body] constituents.

A similar statement is offered in Sutra-sthana 16.34:

yabhih kriyabhir jayante sarire dhatavah samah

sa cikitsa vikaranam karma tad bhisajam smrtam

Such actions by which balanced constituents arise in the

body--these constitute treatment of diseases; that is considered

the duty of physicians.

What are these constituents? They could be the seven dhatu mentioned in Sarira-sthana 6.10, but they could also be wind, bile, and phlegm, as the following stanzas suggest (Sutra-sthana 7.39-41):

sama-pittanila-kaphah kecid garbhadi manavah

drsyante vatalah kecit pittalah slesmalas tatha

tesam anaturah purve, vataladyah sadaturah

dosanusayita hy esam deha-prakrtir ucyate

viparita-gunas tesam svastha-vrtter vidhir hitah

sama-sarva-rasam satmyam sama-dhatoh prasasyate

Some persons have the equilibrium of bile, wind, and

phlegm from the very time of conception; some are dominated

by wind, some by bile, some by phlegm. Of these,

the first are healthy, those dominated by wind, etc., are

always bound to get sick; their body constitution is named

after the fault [that afflicts them]. A prescription [of diet

and regimen] for their healthy life is laid down that has

the opposite qualities [of the dominant constituent that

gives them trouble]. For persons having balanced constituents,

habitual intake of diets consisting of all tastes

in proportionate quantity is prescribed.

Here wind, bile, and phlegm are called dhatu 'constituent' in stanza 41; ideally they are in balance.(66) If one of them is found in excess, it is called a dosa, and the person thus afflicted is called vatala 'dominated by wind,' pittala 'dominated by bile,' or slesmala 'dominated by phlegm.' All three are permanent parts of the human body (Sutra-sthana 18.48):

nityah prana-bhrtam dehe vata-pitta-kaphas trayah

vikrtah prakrti-stha va ton bubhutseta panditah

Wind, bile, phlegm--these three are always present in

the body of creatures. A physician should try to find out

whether they are in their natural state or transformed.

The distinction between natural and transformed states is important, as Sutra-sthana 20.9 explains:

sarva-sarira-caras tu vata-pitta-slesmanah, sarvasmin

charire kupitakupitah subhasubhani kurvanti; prakrtibhutah

subhany upacaya-bala-varna-prasadadini, asubhani

punar vikrtim apanna vikara-samjnakani.

Wind, bile, and phlegm, in fact, move throughout the

whole body and bring about in the whole body good and

bad results according as they are riled or not; in their

natural state [they bring about] good results like growth,

strength, [good] complexion, happiness, etc., but when

they have undergone acts of transformation, [they bring

about] bad results, i.e., what are called transformations

(viz., illnesses).

Wind, bile, and phlegm are also listed among the waste products of the body in Sutra-sthana 28.4:

tatrahara-prasadakhyo rasah kittam ca malakhyam abhinirvartate.

kittat sveda-mutra-purisa-vata-pitta-slesmanah

karnaksi-nasikasya-loma-kupa-prajanana-malah kesa-smasru-loma-nakhadayas

cavayavah pusyanti, pusyanti

tu ahara-rasad rasa-rudhira-mamsa-medo'sthi-majja-sukraujamsi ...

When this [food is digested], chyle, also known as food

essence and refuse, called waste, evolve. From the refuse

prosper sweat, urine, faeces, wind, bile, phlegm, excreta

of the ear, eye, nose, mouth, hair follicles, and the sex

organs, as well as the [body] parts: hair of the head, beard,

body hair, nails, etc. From the food essence prosper chyle,

blood, flesh, bones, marrow, semen, vital strength ...

The inclusion of the human waste products, presumably those not yet expelled, among the parts of the body (cf. the Buddhist lists) may surprise us, but it has its parallel in the Indian theory of the state that included the ally and sometimes even the enemy among the constituents of a polity.(67) The whole functioning unit is visualized. A small output of feces and urine is not described as the consequence of a medical problem but as a symptom, if not a cause, of it in Sutra-sthana 17.70f.

ksine sakrti cantrani pidayann iva marutah

ruksasyonnamayan kuksim tiryag urdhvam ca gacchati

mutra-ksaye mutra-krcchram mutra-vaivarnyam eva ca

pipasa badhate casya mukham ca parisusyati

And if the stool is diminished, wind squeezes, as it were,

the intestines; lifting the abdomen of the dehydrated

[person], the wind goes sideways and upwards.

If urine is diminished, dysurea and discoloration of the

urine [is found], and thirst afflicts [a person], and his

mouth gets dry.

Wind, bile, and phlegm can become riled and, in consequence, cause illness. The primary cause for this is faulty nutrition, as Sutra-sthana 18.7 spells out:

ayam tv atra visesah:

sita-ruksa-laghu-visada-sramopa-vasatikarsana-ksapanadibhir

vayuh prakupitas tvanmamsa-sonitadiny

abhibhuya sopham janayati; sa

ksiprotthana-prasamo bhavati ...

usna-tiksna-katukaksara-lavanamlajirna-bhojanair

agny-atapa-pratapais

ca pittam prakupitam tvan-mamsa-sonitadiny abhibhuya

sotham janayati; sa ksiprotthana-prasamo bhavati ...

guru-madhura-sita-snigdhair atisvapnavyayamadibhis ca

slesma prakupitas tvan-mamsa-sonitadiny abhibhuya

sotham janayati; sa krcchrotthana-prasamo bhavati ...

There is this difference: Riled by [the intake of] cold,

non-unctuous, light, non-slimy [food], by exertion, fasting,

excessive emaciation and elimination, wind afflicts

the skin, flesh, blood, etc., and causes swelling; this

[swelling] appears and calms down quickly ... Riled by

[the intake of] hot, pungent, bitter, alkaline, saline, sour,

and heavy food and by [exposure to] the heat of fire or

the sun, bile afflicts the skin, flesh, blood, etc., and causes

swelling; this [swelling] appears and calms down

quickly ... Riled by [the intake of] heavy, sweet, cold,

and unctuous [food], by excessive sleep, lack of exercise,

etc., phlegm afflicts the skin, flesh, blood, etc., and

causes swelling; this [swelling] takes a long time to

appear and to calm down (i.e., to be cured) ...

Besides food, the seasons are a major factor that can rile wind, bile, and phlegm. Sutra-sthana 6.33f. says:

adana-durbale dehe pakta bhavati durbalah

sa varsasv aniladinam dusanair badhyate punah

bhu-baspan megha-nisyandat pakad amlaj jalasya ca

varsasv agni-bale ksine kupyanti pavanadayah

In the body, weakened by dehydration (during summer),

the power of digestion is [also] weakened; during the

rains (which follow summer) [the power of digestion] is

further afflicted by the vitiations of wind, etc. When the

power of digestion during the rains is reduced due to vapors

coming from the soil, rainfall, and increase of acidity

in water, wind, etc., become riled.

varsa-sitocitanganam sahasaivarka-rasmibhih

taptanam acitam pittam prayah saradi kupyati (Su 6.41)

When the limbs that are used to rain and cold are suddenly

heated by the rays of the sun, the accumulated bile

usually becomes riled in the fall.(68)

caya-prakopa-prasamah pittadinam yathakramam

bhavanty ekaikasah satsu kalesv abhragamadisu

gatih kala-krta caisa cayadya punar ucyate (Sa 17.114f.)

Accumulation, anger, and calming of bile, etc., happen in

due order one by one in the seasons beginning with the

monsoon, and this process, i.e., accumulation, etc., is said

to be caused by the seasons.

But such aggravation of the bile can also be the consequence of bad treatment (Su 14.14): pitta-prakopo, murccha ... atisvinnasya laksanam "Anger of the bile, fainting ... are the sign of over-fomentation." Due to various activities, from the suppression of natural urges to practices incompatible with the location or season "wind, etc., become riled, and the blood in the head vitiated; hence illnesses with various symptoms arise in the head" (Su 17.11).(69) By excessive acts, from loud speech to long walks and emaciation, "the increased wind enters the vessels in the head and gets riled;(70) then a sharp pain arises in [the head] from the wind" (Su 17.18).(71) "By [the consumption of food having] acrid, sour, or saline [taste], alkalies and alcohols, by anger, by [exposure to] sun and fire, the bile in the head becomes vitiated and causes illness in the head" (Su 17.22).(72) "By the comforts of sitting, the comforts of sleep, excessive consumption of heavy and unctuous [food], the phlegm in the head becomes vitiated and causes illness in the head" (Su 17.24).(73)

The symptoms differ, depending on which of the three causes is involved. All three causes may be involved at the same time, and the sum of the symptoms can be attributed to the power of each of these causes: "Because of wind there is pain, giddiness, shaking of the head; because of bile there is a burning sensation, intoxication [and] thirst; because of phlegm there is heaviness and drowsiness [all this together] in an illness of the head born from [all] three faults" (Su 17.26):

vatac chulam bhramah kampah, pittad daho madas trsa

kaphad gurutvam tandra ca siro-roge tri-dosa-je

In this last stanza the symptoms caused by the wind, bile, and phlegm alone are repeated in abbreviated form, as they occur jointly when all three causes are involved. Wind, bile, and phlegm--riled and causes for an illness--are here referred to as "the three faults."

Diseases are generally cured by attacking the underlying cause. "[Medicines that are] sweet, sour, and salty defeat wind; [those that are] astringent, sweet, and bitter [defeat] bile; [those that are] astringent, pungent, and bitter [defeat] phlegm" (Su 1.66):

svadv-amla-lavana vayum, kasaya-svadu-tiktakah

jayanti pittam, slesmanam kasaya-katu-tiktakah

A certain medicated enema is called "wind-killing" (Su 7.19 vata-ghnam; cf. 24 vata-ghnyas and 13.15 marutaghnam); "sweet taste ... kills bile, poison, and wind" (Su 26.43/1 tatra madhuro rasah ... pitta-visa-maruta-ghnas); "for these fats are prescribed as knocking off wind, bile, and phlegm" (Su 1.88 sneha hy ete ca vihita vata-pitta-kaphapahah); "ghee removes bile and wind" (Su 13.14 ghrtam pittanila-haram). Such strong expressions are also found in sentences where wind, bile, and phlegm as targets of medication are parallel to diseases: a certain concoction "knocks off cough, hiccup, dyspnoea, and phlegm" (Su 2.27 kasa-hikka-svasa-kaphapaha), "bamboo seed ... kills phlegm and bile and kills fat, worms, and poison" (Su 27.20 kapha-pitta-ha medah-krimi-visa-ghnas ca ... venu-yavo matah). Among other benefits, "destruction of faults and increase of the digestive power is born from physical exercise" (Su 7.32 dosa-ksayo 'gnivrddhis ca vyayamad upajayate).

The direct contrast to the "riling" of wind, bile, and phlegm is their "calming down." "[Urine] when drunk, calms bile" (Su 1.98 slesmanam samayet pitam) "and the wind is calmed" (when oil is massaged into the feet) (Su 5.91 marutas copasamyati); note also the passage quoted above from Sutra-sthana 18.7: vayuh prakupitas ... ksiprotthana-prasamo bhavati, where prakupita and prasama contrast.(74) When all three, wind, bile, and phlegm, were riled and caused illness, they are referred to as the three faults: "The black-bucks (i.e., their meat) ... calm the three faults" (Su 27.77 tri-dosa-samanah). "Killing the three faults" tri-dosa-ghnam)(75) and "calming the three faults" (tri-dosa-samani) are used as parallel expressions in Su 27.89. Combatting "faults" can be expressed as "killing" them, e.g., Sutra-sthana 1.100f. where "goat's [urine] strikes down faults; a cow's [urine] is fault-killing" (ajam ... dosan nihanti; ... gavyam ... dosa-ghnam). A stanza, apparently quoted from another source, stresses the importance of removing a fault altogether (Su 26.85):

bhavanti catra slokah:

yat kincid dosam asravya na nirharati kayatah

ahara-jatam tat sarvam ahitayopapadyate

And there are stanzas:

All drugs and diets that liquefy a certain fault but do not

remove it from the body are ultimately unwholesome.

Cakrapani's commentary suggests that this total removal is achieved through emetics and purgatives; this interpretation is consistent with the teaching of Sutra-sthana 16.20:

dosah kadacit kupyanti jita langana-pacanaih

jitah samsodhanair ye tuna tesam punar-udbhavah

Sometimes faults that are defeated by fasting and digestive

drugs are riled [again]; but those that are defeated

by elimination therapies do not recur.

A disease is easy to cure (sukha-sadhya) if the fault (dosa) is of a different quality than the affected constituent of the body or if there is only one fault (dosas caikah).(76) A disease is difficult to cure (krcchra-sadhya) or merely palliable (yapya) if it is caused by two faults (dvidosa-jam; 16f.), but one should refuse (pratyakhyeya) treatment for a disease caused by three faults (tri-dosa-ja; 19).(77) It may be for metrical reasons that here the terms samsarga and samnipata for the combination of two and three faults are not used; they do occur in Sutra-sthana 17.41f.(78) and are defined in Vimana-sthana 6.11.

At this time we should take a closer look at how do.sa 'fault' is used in relation to wind, bile, and phlegm. "Wind, not riled, ... dries up the faults ... ; but riled in the body it afflicts the body with various types of transformation (i.e., diseases)" (Su 12.8 vayur ... dosa-samsosanah ... bhavaty akupitah; kupitas tu khalu sarire sariram nanavidhair vikarair upatapati); this implies that wind, which is not riled, is not itself a fault (dosa). This fact can explain the contrast of do.sa and dhatu in Sutra-sthana 1.67:

kimcid dosa-prasamanam kimcid dhatu-pradusanam

svastha-vrttau matam kimcit tri-vidham dravyam ucyate

Medication is said to be of three kinds: some calms down

faults, some vitiates elements, some is meant for maintenance

of positive health.

Here it is the fault that must be calmed down, whereas an element can be vitiated (until it becomes a fault).(79) It is therefore not legitimate (as far as Caraka and other old medical texts are concerned) to introduce the notion of "fault" in a discussion of the healthy body, as is often done in modern translations. I shall give one example of this practice. Sutra-sthana 5.4 yavad dhy asyasanam asitam anupahatya prakrtim ... jaram gacchati ... should be translated: "The amount of food which, without upsetting the physique, gets digested.... "Cakrapani's commentary explains the word "physique" of the text with "equilibrium of wind, etc., and chyle, etc." (prakrtim vatadinam rasadinam ca samyavastham). This gloss, which seems unobjectionable, is incorrectly reflected in the modern translation of the Caraka-samhita by R. K. Sharma and Bh. Dash as "without disturbing the equilibrium (of dhatus and dosas of the body)."(80) Since wind, etc., are not yet disturbed, they are not "faults." A modern Siddha author(81) still preserves the old distinction. He writes: "When these thridhatus become abnormal or when their mutual harmony is disturbed (in which role they are called thridosha) they bring about ill health."(82)

"Wind, bile, and phlegm when spoiled become spoilers of all these,(83) because that is the nature of a fault" (tesam sarvesam eva vata-pitta-slesmano dusta dusayitaro bhavanti, dosa-svabhavat Sa 6.18). A contrast develops between wind, bile, and phlegm that have become faults (dosa)--and hence spoilers--and the elements of the body (dhatu) that are going to be spoiled (dusya). Thus we read in Ci 6.8

kaphah sa-pittah pavanas ca do.sa

medo sra-sukrambu-vasa-lasikah

majja rasaujah pisitam ca dusyah

pramehinam, vimsatir eva mehah

Phlegm with bile, and wind, are the faults; and fat, blood,

semen, water, lymph, marrow, chyle, vitality, and flesh

are the [elements] to be spoiled [in the bodies] of diabetics;

there are twenty [kinds of] diabetes.

And in Ci 21.15 we read about the skin disease visarpa:

raktam lasika tvan mamsam dusyam dosas trayo malah

visarpanam samutpattau vijneyah sapta dhatavah

Blood, lymph, skin, flesh are what is to be spoiled, the

three faults are the impurities; seven elements should be

recognized in the origin of visarpa.

Here the three faults seem to be included together with the four named elements (dhatu) to bring the number of dhatus up to seven. A strict equation dhatu = dusya, however, is only found in later texts (Astanga-samgraha and Astanga-hrdaya-samhita; see below, p. 628).

The worldview of the Samkhya philosophy, including its ontology of the three "strands" (guna), dominates the general thinking in the Caraka-samhita, even though notions current in other philosophical schools are also used wherever convenient. Sutra-sthana 1.57f. displays key terms of Samkhya:

vayuh pittam kaphas coktah sariro dosa-samgrahah

manasah punar uddisto rajas ca tama eva ca

prasamyaty ausadhaih purvo daiva-yukti-vyapasrayaih

manaso jnana-vijnana-dhairya-smrti-samadhibhih

Wind, bile, phlegm are called the corporeal sum of faults;

the mental [sum of faults] again is taught as rajas and

tamas.(84) The former [sum of faults] is calmed down by

therapies relying on divine intervention and rational remedies;

the mental [sum of faults is calmed down] by knowledge,

insight, steadfastness, memory, and meditation.

These notions are expanded in Vimana-sthana 6.5:

rajas tamas ca manasau dosau; tayor vikarah

kamakrodha-lobha-mohersya-mana-mada-soka-cintodvega-bhaya-harsadayah.

vata-pitta-slesmanas tu khalu sarira

dosah; tesam api ca vikara jvaratisara-sopha-sosa-svasa-meha-kusthadayah

rajas and tamas are the mental faults; their transformations

are desire, wrath, greed, delusion, envy, conceit, intoxication,

grief, mental excitement, fear, arousal, etc. Wind,

bile, and phlegm, however, are corporeal faults; and their

transformations are fever, diarrhea, swelling, dryness,

dyspnoea, urinary disorders, skin diseases, etc.

The attempt to link the three faults of medical theory(85) and the strands of Samkhya(86) remains superficial: the numbers do not match, since the three faults are paired with only two of the three strands. While it is doubtful that rajas and tamas were called "faults" in classical Samkhya texts, preclassical texts like Mahabharata XII.212.25-31 do contrast the "good" sattva with the comparatively "bad" rajas and tamas.

sattviko rajasas caiva tamasas caiva te trayah

tri-vidha vedana yesu prasuta sarva-sadhana |25|

praharsah pritir anandah sukham samsanta-cittata

akutascit kutagcid va cittatah sattviko gunah |26|

atustih paritapas ca soko lobhas tathaksama

lingani rajasas tani drsyante hetv-ahetutah |27|

avivekas tatha mohah pramadah svapna-tandrita

kathamcid api vartante vividhas tamasa gunah |28|

tatra yat priti-samyuktam kaye manasi va bhavet

vartate sattviko bhava ity apekseta tat tatha |29|

yat tu samtapa-samyuktam apritikaram atmanah

pravrttam raja ity eva tatas tad abhicintayet |30|

atha yan moha-samyuktam kaye manasi va bhavet

apratarkyarn avijneyam tamas tad upadharayet |31|

[ ... the state] based on sattva, the one based on rajas, and

the one based on tamas, these three, in which threefold

feeling is born that effects everything. Thrill, love, pleasure,

happiness, peace of mind, ... is the quality based on

sattva. Dissatisfaction, anguish, sadness, greed, and

impatience, these are perceived as the signs of rajas,

whether caused [by it] or not. Lack of distinction and delusion,

carelessness, sluggishness of sleep, somehow are

the various qualities of tamas. This being so, what there

is in body or mind that is joined with love, that is based

on sattva; thus one should see it. What the Self has that is

joined with anguish [and] creates displeasure, that is rajas

in action; thus one should hence consider it. But what is

joined with delusion in body or mind, can not be figured

out [and] can not be known, that one should consider

tamas.(87)

Caraka espouses similar views in Sa 1.36:

rajas-tamobhyam yuktasya samyogo 'yam anantavan

tabham nirakrtabhyam tu sattva-vrddhya nivartate

This connection [with the senses and their objects] is

unending for one who is linked with rajas and tamas;

with these two done away, it ceases through the growth

of sattva.

And Sa 1.142: mokso rajas-tamo 'bhavat "Liberation [derives] from the absence of rajas and tamas."(88) Sattva is placed on a different level from rajas and tamas also in Sa 4.34-36:

tatra trayah sarira-dosa vata-pitta-slesrmanah, te sariram

dusayanti; dvau punah sattva-dosau rajas tamas ca, tau

sattvam dusayatah, tabhyam ca sattva-sarirabhyam dustabhyam

vikrtir upajayate, nopajayate capradustabhyam.

tatra sariram yoni-visesac caturvidham uktam agre trividham

khalu sattvam suddham, rajasam, tamasam iti ...

There are three faults of the body, [i.e.] wind, bile,

phlegm, they spoil the body; then there are two faults of

the sattva 'mind,'89 [i.e.] rajas and tamas, they spoil sattva

'mind.' With these two, [i.e.] sattva and body spoiled,

a deviating transformation occurs, and it does not occur

when they are not spoiled. Now, the body has been said

at the beginning to be of four kinds due to different

origins.(90) The sattva is of three kinds: pure, admixed

with rajas, admixed with tamas ...

It will be necessary to examine a few other occurrences of the term do.sa in the Caraka-samhita, where it has been taken to denote "humor." The stanzas Sutrasthana 17.41-62 go through the various combinations, where one, two, or all three of the causal elements, i.e., wind, bile, and phlegm, have grown in excess to various degrees or are diminished; there are further combinations, where one or two of them are grown in excess, while the remainder is diminished. In this context the word dosa 'fault' is used twice:

yatha vrddhais tatha ksinair dosaih syuh pancavimsatih

vrddhi-ksaya-krtas canyo vikalpa upadeksyate |43|

As there are with the increased [faults], thus there would

also be twenty-five [combinations] with the diminished

faults; and the other condition [of twelve more combinations]

will be taught as effected by growth and diminution.

dosah pravrddhah svam lingam darsayanti yathabalam

ksina jahati lihgam svam samah svam karma kurvate |621|

The much increased faults show their mark in accordance

with their strength; those that are diminished abandon

their mark, those that are even, do their proper work.

A strict interpretation might suggest that here wind, bile, and phlegm, even in their normal and healthy state, are called faults. But one should also notice that the expression dosa is used in immediate proximity to ksina and pravrddha, terms that indicate pathological deviation, i.e., a fault. In the intervening stanzas all references are to vata/maruta/vayu/anila/samirana, pitta, and kapha/ slesman, not to dosa.(91)

The prose sentences Sutra-sthana 12.8-12 attempt to place wind, bile, and phlegm in a correspondence of microcosmos versus macrocosmos, possibly in a reprise of ideas found in the upanisads. In the beginning, wind is described as a constituent of the body, first in its natural state, i.e., non-riled (akupita), then riled (kupita); subsequently, it is detailed as a force in the outside world (loke), first in its natural state involving the kindling of fire, the showering of rains, etc., then in its riled form involving the uprooting of trees, causing earthquakes, etc. Finally, Lord Wind (Vayu) is the eternal cause of the universe; he is Lord Visnu. "It is Agni (the god of fire) alone, represented by bile in the body, which brings about good or bad effects according to its being non-riled or riled, i.e., digestion or indigestion ... " (Su 12.11 agnir eva sarire pittantargatah kupitakupitah subhasubhani karoti tad yatha paktim apaktim ...). Similarly Soma, the moon as the receptacle of water, is represented in the body by phlegm.

The dominant position of wind is also evident in Sutrasthana 17.115-18. In the preceding stanzas, 112ff., we read about the threefold way of faults (dosa): they may be diminished, stay as they are, or they may grow. It is not certain that the word do.sa continues in the following stanzas:

gatis ca dvi-vidha drsta prakrti vaikrti ca ya |115|

pittad evosmanah paktir naranam upajayate

tac ca pittam prakupitam vikaran kurute bahun |116|

prakrtas tu balam slesma vikrto mala ucyate

sa caivaujah smrtah kaye sa ca papmopadisyate |117|

sarva hi cesta vatena sa pranah praninam smrtah

tenaiva roga jayante tena caivoparudhyate |118|

And there is a twofold way, viz., natural and transformed.

From bile is born men's digestive force of heat;

and that bile, if riled, effects many transformations (i.e.,

illnesses). Natural phlegm is called "strength," transformed

[phlegm is called] "refuse": the one is remembered

as vital force(92) in the body, the other is taught to

be evil. All movement, indeed, is [caused] by wind;

[wind] is remembered as the vital breath of living

beings; by the very same [wind, if riled], diseases are

born, and by it one is led to one's death.

If dosa is understood in these stanzas as a referent, this should strictly only apply to the "transformed way" (vaikrti gatih), when wind, bile, and phlegm have become "faults," not the natural way when they carry on with their beneficial functions.

Two passages will clarify the relation of wind, bile, and phlegm with the body elements (dhatu). Sutra-sthana 17.63:

vatadinam rasadinam malanam ojasas tatha

ksayas tatraniladinam uktam samksina-laksanam

Diminuitions occur of wind, etc., chyle, etc., waste products

and vitality. Regarding this, the characteristics of

diminuition of wind, etc., have [already] been told.

In the following stanzas the diminuition of chyle, blood, flesh, fat, bone, marrow, semen, i.e., the elements (dhatu), and of faeces, urine and "other waste products" are described. It is clear, therefore, that wind, etc., were not counted among the chyle, etc.--i.e., the elements (dhatu). Sutra-sthana 19.5 deals with the relation of wind, etc., and the elements.

sarva eva nija vikara nanyatra vata-pitta-kaphebhyo

nirvartante, yatha hi sakunih sarvam divasam api paripatan

svam chayam nativartate, tatha sva-dhatu-vaisamyanimittah

sarve vikara vata-pitta-kaphan nativartante.

vata-pitta-slesmanam punah sthana-samsthana-prakrtivisesan

abhisamiksya tad-atmakan api ca sarva-vika-rams

tan evopadisanti buddhimantah.

All the endogenous diseases occur only [in connection]

with wind, bile, or phlegm; for as a bird cannot transgress

its own shadow even though flying throughout the day,

so also all endogenous diseases caused by an imbalance

of one's body elements cannot transgress wind, bile, and

phlegm. Again, considering the specific location, symptoms

and causes of wind, bile, and phlegm, the wise teach

all these transformations (i.e., diseases) as having that

(i.e., wind, bile, or phlegm) as their identity.(93)

To sum up: the older parts of the Caraka-samhita consider wind, bile, and phlegm in their natural state as elements (dhatu) and only in their riled condition as faults (dosa). Health is the balance of the elements (dhatu).(94) The three faults (do.sa) are put in an awkward relation with the two less valuable strands/qualities (guna).

6. THE SUSRUTA-SAMHITA

I shall first present the evidence found in the Sutrasthana. The presentation of Ayurvedic theory is strikingly different from that in the Caraka-samhita, but some peculiarities of Susruta's teaching--I would call them innovations(95)--have received little attention so far. The reasons for this shall be discussed later. The three faults (dosa) are always part of the human body. Sutra-sthana 15.3:

dosa-dhatu-mala-mulam hi sariram

For the body is rooted in faults, elements, and waste

products.

Sutra-sthana 15.37-41:

vailaksanyac chariranam asthayitvat tathaiva ca

dosa-dhatu-malanam tu parimanam na vidyate |37|

esam samatvam yac capi bhisagbhir avadharyate

na tat svasthytad rte sakyam vaktum anyena hetuna |38|

dosadinam tv asamatam anumanena laksayet

aprasannendriyam viksya purusam kusalo bhisak |39|

svasthasya raksanam kuryad asvasthasya tu buddhiman

ksapayed brmhayec capi dosa-dhatu-malan bhisak

tavad yavad arogah syad etad samyasya laksanam |40|

sama-dosah samagnis ca sama-dhatu-mala-kriyah

prasannatmendriya-manah svastha ity abhidhiyate |41|

Because the bodies vary [from one person to another] and

because they are not static, an exact measure of the faults,

elements, and waste products is not known. And their balance

that is ascertained by physicians cannot be told by

any other reason except on the grounds of perfect health.

But a skilled physician would by inference characterize

an imbalance of the faults, etc., when he observes a man

whose faculties are unsettled. The physician shall protect

the healthy [man], but shall weaken and strengthen [as the

case demands] faults, elements, and waste products of an

unhealthy one, until he is healthy; that is the mark of balance.

A person with balanced faults, balanced digestive

fire, balanced actions of the elements and the waste products,

whose self, senses, and mind are settled, is called

healthy.

Sutra-sthana 21.7 lists the organs where wind, bile, and phlegm are primarily located; it concludes: etani khalu dosanam sthanany avyapannanam "These are the locations of the faults when they are not afflicted."

The role of wind, bile, and phlegm is comparable to that in the treatises discussed earlier, but is more powerful and exclusive. Sutra-sthana 21.3 tells us:

vata-pitta-slesmana eva deha-sambhava-hetavah. tair

evavyapannair adho-madhyordhva-sarnnivistaih sariram

idam dharyate 'garam iva sthunabhis tisrbhir, atas ca tristhunam

ahur eke. ta eva ca vyapannah pralaya-hetavah.

tad ebhir eva sonita-caturthaih sambhava-sthiti-pra-layesv

apy avirahitam sariram bhavati.

Wind, bile, and phlegm(96) alone are the causes for the

constitution of the body. By them alone, if they are unimpaired,

occupying [respectively] the lower, middle,

and upper [parts of the body] is this body held up like a

house with three supporting poles; hence some call [the

body] "three-pillared."(97) Impaired, these same are the

cause of dissolution. This body is not separated from

these same [three], with blood as the fourth, in its origin,

stay, and dissolution.

Certain medicinal plasters remove swelling caused by wind, by bile, by phlegm, and by a combination of all three of them (Su 37.3-7 pralepo vata-sopha-hrt; ... pralepah pitta-sopha-hrt; ... pralepah slesma-sopha-jit; ... lepo 'yam sannipatika-sopha-hrt). "Wind, bile, and phlegm alone are the root of all diseases" (Su 24.8 sarvesam ca vyadhinam vata-pitta-slesmana eva mulam). Blood sometimes joins the other three causes as a fourth, as in Sutra-sthana 1.24: sariras tv anna-pana-mula vata-pitta-kapha-sonita-sannipata-vaisamya-nimittah "But bodily [diseases], rooted in food and drink are caused by an imbalance of wind, bile, phlegm, blood,(98) or their combination." Imbalance (vaisamya) of wind, bile, and phlegm as the cause of illness was not found in the texts studied earlier; the closest is the statement of Caraka, Sutrasthana, 7.39 that people with balanced (sama) congenital wind, bile, and phlegm have the best constitution. We read in Susruta's work of the riling (prakopa) and calming (prasama) of the faults (Su 1.34f.). Sutra-sthana 15.36 describes the impact of a riled fault:

dosah prakupito dhatun ksapayaty atma-tejasa

iddhah sva-tejasa vahnir ukha-gatam ivodakam

A riled fault destroys the bodily elements by its own

glare, as a kindled fire [evaporates] water in a pot with its

own flame.

Therefore a fault must be calmed down (Su 18.7):

avidagdhesu sophesu hitam alepanam bhavet

yathasvam dosa-samanam daha-kandu-rujapaham

A medical plaster of the alepana class would prove

beneficial in swellings that suppurated, inasmuch as it

calms the faults [and] pushes off (= removes) burning,

itching, and pain [the typical consequences of bile,

phlegm, and wind].

Since the balance of faults, bodily elements, and excreta is essential for a person's well-being, any diminution of these must be countered and corrected. Sutra-sthana 15.29:

dosa-dhatu-mala-ksino bala-ksino 'pi va narah

sva-yoni-vardhanam yat tad anna-panam prakanksati

A man deficient in faults, bodily elements, and excreta,(99)

and deficient in strength desires food and drink

that will strengthen their respective procreation.

This desire of the patient is not a morbid wish to be discouraged but considered medically proper in Susruta's Cikitsita-sthana 33.3f.

dosah ksina brmhayitavyah, kupitah prasamayitavyah,

vrddha nirhartavyah, samah paripalya iti siddhantah, pradhanyena

vamana-virecane vartete nirharane dosanam.

Diminished faults must be strengthened, riled [faults]

calmed, increased [faults] removed, balanced [faults] protected:

that is the authoritative doctrine. Most prominently,

emetics and purgatives are used to remove the faults.

This intentional strengthening of the "faults" (do.sa) is a new element in Susruta's work; all previously discussed works sought only to calm or remove and destroy the faults. Such expressions are even still found in the Susruta-samhita. In Sutra-sthana 11.3 we read that "alkali is most important.., because it kills the three faults" (... ksarah pradhanatamah ... tri-dosaghnatvad ...); "rainwater kills the three faults" (Su 45.26 gaganambu tri-dosa-ghnam), and among the benefits of a medicinal plaster called alepana or kalka, applied to an ulcer, is anantardosata "absence of faults inside" (Su 18.6). In Sutra-sthana 45 (madhu-vargah), v. 141 we learn that:

dosa-traya-haram pakvam, amam amlam tri-dosa-krt

Mature [honey] removes the three faults, raw [and] sour

[honey] creates the three faults.

What could have caused a development such that the balance of the faults becomes an ideal to be preserved and that diminished faults must be increased? Or the notion that the three faults are an essential, even beneficial, part in the make-up of the human body? Actually, Susruta is quite explicit about his thoughts on this subject. He says in Sutra-sthana 24.8:

sarvesam ca vyadhinam vata-pitta-slesmana eva mulam;

tal-lingatvad drsta-phalatvad agamac ca. yatha hi

krtsnam vikara-jatam visva-rupenavasthitam sattva-rajas-tamamsi

na vyatiricyante, evam eva krtsnam vikara-jatam

visva-rupenavasthitam avyatiricya vata-pitta-slesmano

vartante, dosa-dhatu-mala-samsargad ayatana-visesan

nimittatas caisam vikalpah, dosa-dusitesv atyartham dhatusu

samjna: rasa-jo 'yam, sonita-jo 'yam, mamsa-jo 'yam,

medo-jo 'yam, asthi-jo 'yam, majja-jo 'yam, sukra-jo 'yam

vyadhir iti.

Wind, bile, and phlegm alone are the root of all diseases,

because [the diseases] carry their distinguishing mark,

because the fruit [of wind, bile, and phlegm] is seen, and

because the tradition [says so]. For as [the three strands]

sattva, rajas, and tamas are not separate from the universe,

[which is] nothing but a transformation [of the

three strands], [and] established with all phenomenal

appearances; thus wind, bile, and phlegm exist without

being separate from everything that is a transformation

(i.e., illness) [and are] established with all phenomenal

appearances. Because of the contact of faults, bodily elements,

and waste products, because of the difference of

locations, and because of their causation, there are different

forms [of disease]. As bodily elements are exceedingly

aggravated by the faults, a term [viz., a technical expression,

as in the following] is created: "this illness is born

from chyle, this from blood, this from flesh, this from

fat, this from bone, this from marrow, this from semen."

There is no doubt that the Samkhya philosophy played a major role in the medical texts; the five elements with their qualities are important notions in the medical man's view of the body and the world. The discovery of a homology between the strands (guna) that make up the physical world and the three faults (dosa) that move and eventually destroy the body must have been overwhelming, especially when we consider that the word guna had expanded from its earlier meaning of three strands in a braid--or the strands of the physical world--to the meaning of "quality, good quality, virtue," the antonym of dosa, "fault." This homology is superior to Caraka's clumsy attempt to link the two systems: rajas and tamas (the somewhat "inferior" gunas) leading to mental illness, on the one hand; wind, bile, and phlegm as the three faults causing corporeal illness, on the other. In Susruta's view the correspondence is symmetrical: just as the three strands of Samkhya transform themselves into the world through the subtle and gross elements (tan-matra, bhuta), the three faults cause illnesses through the bodily elements (dhatu). This is the main intellectual achievement of Susruta, which has had a lasting effect on later authors,(100)

The author of the Uttara-tantra ("Supplementary Chapter"), apparently a later addition to the main text of the Susruta-samhita,(101) is commonly dubbed Susruta the Younger or Susruta II. In Uttara-tantra 66.9 he seems to identify the three dosas and the three gunas; this is made explicit by the commentator Dalhana.

vyasatah kirtitam tad dhi bhinna dosas trayo gunah

dvisastidha bhavanty ete bhuyistham iti niscayah

For this has been proclaimed in detail: these faults, the

three gunas, are mostly divided sixty-two-fold; that is

the doctrine.

According to Dalhana, wind consists mostly of rajas, because it promotes all beings, bile of sattva, because of its light and illuminating (fiery) nature, phlegm of tamas, because of its heavy and covering nature.(102)

As long as the three gunas are in balance, they are not perceived;(103) the gunas are mutually repressive.(104) Gaudapada on Samkhya-karika 16 says: "The Prime Materia is the state of equilibrium of sattva, rajas, and tamas" (sattva-rajas-tamasam samyavastha pradhanam). The late compendium Sarva-darsana-samgraha (chapter 14) describes the evolution of the world as the move from samyavastha "state of equilibrium" to vaisamya "imbalance, inequality."(105)

To sum up: Susruta's intellectual achievement is the establishment of a homology of the three medical dosas with the three ontological gunas of Samkhya; now the dosas are permanent and necessary elements of a healthy body.

7 ASTANGA-SAMGRAHA AND ASTANGA-HRDAYA-SAMHITA

These two works ascribed to Vagbhata (often spelled Vahata)(106) may actually be the work of two authors, according to some scholars,(107) dubbed Vagbhata I and Vagbhata II. Of these the former would have flourished at about A.D. 600,(108) while the work of the latter(?) was quoted by an Arab author in A.D. 849/850 and must hence be earlier (perhaps seventh century).(109) Vagbhata is commonly counted as the third in the triad of great medical authorities--Caraka, Susruta, Vagbhata.

AS Su 1.40-42 gives the basic definitions of health and illness:

kalartha-karmanam yogo hina-mithyatimatrakah

samyag-yogas ca vijneyo rogarogyaika-karanam

rogas tu dosa-vaisamyam dosa-samyam arogata

nijagantu-vibhagena rogas ca dvi-vidha matah

tesam kaya-mano-bhedad adhisthanam api dvidha

rajas tamas ca manaso dvau ca dosav udahrtau

Diminished, wrong, or excessive application of time

(season), objects or actions and the correct application

[of these] is the only cause of illness and health.

Illness is the imbalance of the faults, health the balance

of the faults. And the illnesses are twofold by the division

of being innate(110) or accidental.(111)

Of these [illnesses] the location is also twofold by the

division of body and mind; and rajas and tamas are listed

as the two faults of the mind.

These stanzas occur with only a minor variation(112) in AHS Su 1.19-21, but the preceding line of the AS (39 cd) is omitted:

sattvam rajas tamas ceti trayah prokta mahagunah

sattva, rajas, and tamas: the three are called the great

gunas.

This line in the AS marks the transition from a discussion of various concepts of the gunas (such as heavy, soft, smooth, etc.) to the causes of health and illness, putting the three gunas of Samkhya in close proximity to the three dosas of medicine. But it is awkward that rajas and tamas, which have just been called "great gunas" in stanza 39, are called the dosas of the mind in stanza 42. The author of AHS avoided the awkwardness by simply omitting the reference to the "great gunas."

S. Dasgupta(113) and P. Kutumbiah(114) noted correctly that Vagbhata's definition of health as dosa-samya and illness as dosa-vaisamya replaces the definitions dhatu-samya and dhatu-vaisamya, but they overlooked the antecedents in the Susruta-samhita Hence, Kutumbiah attributed this development to "advancement in medical thought" rather than to the influence of philosophical speculation.

The three gunas of Samkhya are compared to the three dosas of medicine in AS Su 21.32

arambhakam virodhe 'pi mitho yad yad guna-trayam

visvasya drstam yugapad vyadher dosa-trayam tatha

As the triad of gunas in spite of their mutual opposition

is seen to set the universe in motion simultaneously, thus

the triad of dosas [sets] disease [in motion]

and in AS Su 22.5

dosa eva hi sarva-rogaika-karanam, yathaiva sakunih

sarvatah paripatan divasam svam chayam nativartate,

yatha va krtsnam vikara-jatam vaisva-rupyena vyavasthitam

guna-trayam apy atiricya na vartate, tathaivedam

api krtsnam vikara-jatam dosa-trayam iti ...

The faults are the only cause of all illnesses. As a bird

flying all over for a day does not go beyond its own

shadow, (115) or as the transformed universe, established in

all its forms does not exist beyond the three gunas, thus

also all this that is transformed (i.e., illnesses) [does not

exist beyond] the three dosas.(116)

Susruta II and Dalhana came close to identifying the three dosas with the three gunas; Vagbhhata was satisfied with a homology that cemented the role of the dosas as basic constituents of the body.

"The body is based on the dosas, the elements, [and] the secretions," say both authors.(117) "The dosas, if spoiled, spoil the elements through the tastes, both [spoil] the secretions." (118) The elements can therefore be defined as dusya "to be spoiled": "The elements chyle, blood, flesh, fat, bone, marrow, [and] semen are the seven dusyas, and also the secretions, i.e., urine, faeces, sweat, etc."(119) The "non-transformed," i.e., healthy dosas have their natural locations in the body: iti prayena dosanam sthanany avikrtatmanam (AHS Su 12.18). Caraka would have spoken of the natural location of wind, bile, and phlegm instead.(120)

To sum up: Vagbhata (and it does not matter whether he was two authors or one) presents the definite shape of the tri-dosa theory. The three dosas are constant elements of the body; their equilibrium constitutes health, their imbalance illness.

8. CONCLUSION

We have traced the semantic development of dosa in the (essentially) North Indian tradition where it first means an affliction--especially a pathological affliction of wind, bile, and phlegm--and then is a common term for these three components of the body. This happened under the influence of a perceived homology with the three gunas of the Samkhya philosophy, at a time when the two Sanskrit words had become antonyms in general usage: guna "quality, virtue," versus dosa "fault." Beginning with Susruta, and henceforth, three "faults" are the basis of health. Indian medicine, rooted in popular observation and folk remedies, as we can still see in the earliest Buddhist canonical texts, had become a dogmatic system linked with a prestigious ideology. Caraka made a first (almost playful) attempt to link medicine with philosophy which had no major impact on his presentation of medicine; Susruta perfected the homology and applied it rigorously to medical theory. Some formulations of Vagbhata became standard expressions in later texts. The commentators of the classical medical texts have worked hard, as was to be expected, to create a consistent system of Ayurvedic theory that neglects the changes that happened over time. For all their efforts they have trouble defining what exactly constitutes a dosa.(121)

We find, on the other hand, no trace of an evolution in the Tamil tradition that would explain the odd concept of health being based on a balance of faults. We must conclude, then, that the medicine of the Tamil Cittars is based on the later development found in the works of Susruta and Vagbhata, at least as far as their theory of the three faults is concerned. The discussion of cultural exchanges between Sanskritic and Tamil traditions must be removed from the highly charged atmosphere that has too often dominated such discussions over the past decades and should resort to the investigation of technical details. The present study is meant as a step in that direction, and it is my hope that my Tamil friends also will find its logic compelling. If it could elucidate at the same time the evolution of Ayurvedic theory, I would consider this a bonus.

(1) There can be little doubt that Tamil cittar is derived from Sanskrit siddha, with the Tamil suffix -r to denote plurality or respect. However, already the Tevaram poets connected the word with Sanskrit cit or citta 'thought': R. Venkatraman, A History of the Tamil Siddha Cult (Madurai, 1990), 2f., with reference to Tevaram 6.46.3 and 5.76.5. This connection was very suggestive inasmuch the distinction of /tt/ and /ddh/ in the original Sanskrit was lost as these words were accepted as loans in Tamil.

(2) There are government-supported institutions now in Madras and Palayamkotta and elsewhere for teaching, research, and treatment of patients, based on Siddha doctrine.

(3) The Tamil Lexicon derives the (earlier) form Cirrampalam from Skt. cit. This can hardly be correct; Cirrampalam must contain the word for 'small' as in cirrarivinar 'having little wisdom' (Nalatiyar 329.4). Cirramparam and Citambaram occur together in Tirumantiram 886 (866); for ref. see note 13. B. Natarajan, Tirumantiram, 141f., takes Cirrampalam as a "Tamilized form of Chidambaram."

(4) R. Manickavasagam gives further examples in "Contribution of Agasthiyar to Siddha System of Medicine," Heritage of the Tamils: Siddha Medicine, ed. S. V. Subramanian and V. R. Madhavan (Madras, 1983), 582.

(5) R. Venkatraman, History, 114, 179f. Cf. K. Zvelebil, The Smile of Murugan (Leiden, 1973), 223.

(6) T. G. Ramamurthi Iyer, The Hand Book of Indian Medicine: The Gems of Siddha System (Erode, 1933; repr. Delhi, 1981), 13-15; A. Ramalingam and G. Veluchamy, "Elements of Medical Science in Sangam Literature," in Heritage of the Tamils: Siddha Medicine, 44-53; K. and L. Palanichamy, Heritage, 550-67.

(7) Akananuru, ed. South India Saiva Siddhanta Works Publishing Society (Madras, 1946; repr. 1959), nos. 133, 257; Purananuru, ed. SISSWPS (Madras, 1947-51; repr. 1959-62), nos. 60, 170, 321.

(8) Paripatal, ed. tr. E Gros (Pondichery, 1968), colophons of Paripatal 15 and 19.

(9) Cilappatikaram, ed. SISSWPS (Madras, 1942; repr. 1966).

(10) Lexicon of Tamil Literature (Leiden, 1995), 146. The reference to king Gajabahu of Ceylon is often taken as an indication that the work may have been composed around 200 A.D.; the historicity of Gajabahu has been denied by G. Obeyesekere, most recently in his The Cult of the Goddess Pattini (Chicago, 1984), 361-80, but defended by K. Zvelebil, Tamil Literature (Leiden, 1975), 38f., and Lexicon, 145f. The final redaction of the text may, however, be somewhat later.

(11) The Tirukkural of Tiruvalluvar is dated by K. Zvelebil about 450 to 550 A.D.: Lexicon, 669: cf. The Sacred Kurral, ed., tr. G. U. Pope (London, 1886; repr. New Delhi, 1984).

(12) Some interpreters have mistakenly assumed that it is food and work that increase or decrease: Tirukkural, tr. G. U. Pope, W. H. Drew, John Lazarus, and F. W. Ellis (Madras, 1958); A. Ramalingam and G. Veluchamy, Heritage, 50.

(13) Tirumantiram: A Tamil Scriptural Classic by Tirumular, tr. B. Natarajan, 2nd ed. (Madras, 1994); Tirumantiram, ed. SISSWPS (1942; 8th ed., Madras, 1989). The numbers of the latter edition are added in parentheses.

(14) R. Manickavasagam, Tirumantira araycci (Madras, 1982), 74f.

(15) R. Manickavasagam, Tirumantira araycci, 91; Encyclopaedia of Tamil Literature, I: 296 (J. Parthasarathi: sixth century); K. Zvelebil, Tamil Literature, 138; Lexicon, 677, suggests the late sixth or early seventh century.

(16) I could not verify this reference in the editions of B. Natarajan or the SISSWPS, which contain only 3047 and 3001 stanzas, respectively.

(17) Stanzas 740-69 (720-49).

(18) History, 45-48.

(19) R. Venkatraman assumes the existence of two men named Tirumular: one referred to in a ninth-century text, who may have been one of the sixty-three nayanmar; the other, the author of the Tirumantiram in the tenth or eleventh century. A similar suggestion was already made by S. Vaiyapuri Pillai, History of Tamil Language and Literature (Madras, 1956), 108 n. 3.

(20) S. Vaiyapuri Pillai, History, 108 n. 3; T. P. Meenakshisundaran, A History of Tamil Literature (Annamalainagar, 1965), 67; K. Zvelebil, Tamil Literature, 138.

(21) R. Venkatraman, History, 45.

(22) In the commentary on Yapparunkalam 93, ed. M. V. Venugopala Pillai (Madras, 1960), 288: S. Vaiyapuri Pillai, History, 108; R. Venkatraman, History, 193.

(23) There are references, though, to beliefs and practices found in a wider field, as R. Venkatraman, History, 145f. points out:

The beliefs of the Siddhas in immortality, rejuvenation, finding God within the body through Yoga, the doctrine of vanural (somarasa or "nectar in the body"), urine therapy, the eight great siddhis, sorcery and astrology are all traceable to the Tirumandiram.

(24) R. Venkatraman, History, 118f.

(25) R. Venkatraman, History, 116.

(26) R. Manickavasagam in Madras and S. Prema in Tanjore. This is also the opinion of T. P. Meenakshisundaran, according to K. Zvelebil, The Poets of the Powers (London, 1973), 71.

(27) Thus the Tamil Lexicon under mukkurram, with reference to the Pinkalanikantu. A group of six evils (ari-sad-varga) is frequently encountered, e.g., Arthasastra, ed. R. P. Kangle (Bombay, 1960), 1.6.1: kama-krodha-lobha-mana-mada-harsa. K. and L. Palanichamy seem to assume that mu-kkurram refers here to the three humors vali, azhal, and iyam: Heritage, 560 n. 1.

(28) R. Venkatraman, History, 113, quotes the term as nancu instead of ai, apparently by mistake.

(29) R. Venkaraman, History, 118, quotes Tirumantiram 480 for the imbalance of humors; this stanza is probably the same as the one quoted here as 458, which may contain a vague allusion to the three gunas of Samkhya but none of the terms denoting humors. The three gunas (mu-kkuna) are clearly mentioned in Tirumantiram 615 (595).

(30) It is a pity that R. Venkatraman, History, 117, does not give references from the medical Siddha texts.

(31) E.g., several contributors to the volume Heritage of the Tamils, 172, 185, 219; Encyclopaedia of Tamil Literature, I: 335.

(32) Cf. pini 'disease' in Tirukkural stanzas 949 and 1102.

(33) Cf. the critical remark made by R. Muller, Sudhoffs Archiv fur Geschichte der Medizin und der Naturwissenschaften 32 (1939): 291.

(34) In the title of the hippocratic text IIepi xvuwv "Humours": The Loeb Classical Library: Hippocrates, vol. IV, tr. W. H. S. Jones (Cambridge, Mass., 1931; repr. 1998), 62.

(35) E.g., in the hippocratic text Nature of Man, ch. 4f.; Hippocrates, 10-13.

(36) Asceticism and Healing in Ancient India (New York, 1991).

(37) There seems to be some corruption in the second line of this sloka: both quarters have nine syllables, and the feminine form atthami is out of place; shall one emend to visamam, opakkamikam, kamma-vipako atthamo 'ti?

(38) P. Demieville, "'Byo' from Hobogirin," tr. M. Tatz (Lanham, Md., 1985), 71. Several passages discussed by Demieville on pp. 65-76 point to a struggle to reconcile a Buddhist doctrine of four constituent elements of the body (earth, water, fire, wind) with the concept of the three causes of illness, i.e., bile, phlegm, and wind.

(39) Also Cullavagga V.14.1 = Vin II.119.

(40) R. Muller, Janus 38 (1934): 80.

(41) K. G. Zysk, Asceticism, 108f., 124f.

(42) The "sickness of the hot season" (saradika-abadha-MV VI.1 = Vin I.199, where only the much later commentator Buddhaghosa suggests bile as the cause), the "disease of thick scabs" (thulla-kacchabadha MV VI.9 = Vin I.202), "disease of the eyes" (cakkhu-rogabadha MV VI.11 = Vin I.203), "heat in the head" (sisabhitapa MV VI. 13 = Vin I.204), boils (gandabadha MV VI. 14 + Vin I.205), constipation (duttha-gahanika MV VI.14 = Vin I.206), jaundice (pandu-rogabadha, ibid.), skin disease (chavi-dosabadha, ibid.), fistula-in-ano (bhagandalabadha MV VI.22 = Vin I.215).

(43) Asceticism, 76; cf. also p. 110.

(44) See n. 40.

(45) Cf. G. J. Meulenbeld, "The Characteristics of a Dosa," Journal of the European Ayurvedic Society 2 (1992): 1.

(46) Cf. K. Zysk, "The Evolution of Anatomical Knowledge in Ancient India, with Special Reference to Cross-Cultural Influences," JAOS 106 (1986): 689.

(47) This list is found also in Majjhima-nikaya 1.57 and III.90f. (with further elaboration on the following pages) and, without reference to the dhatus, in Anguttara-nikaya III.323f. A bare list is found in Khuddakapatha 3 (Khuddaka-nikaya, PTS ed., I.2); cf. also Sutta-nipatha I.195-201 (Khuddaka-nikaya, PTS ed., p. 34f.).

(48) The relative frequency of wind as a cause of illness in the texts quoted by Zysk does not support F. Zimmermann's theory that wind was "grafted onto the humoral theory at a later stage" while "its core concepts, bile and phlegm, stem from cosmology," Review of K. Zysk, Asceticism, JAOS 113 (1993): 322. But bile and phlegm at the root of Hippocratic nosology (i.e., in the presumably older texts) offer, indeed, a remarkable parallel.

(49) Ed. E Kielhorn, 3rd ed. (Poona, 1965), II: 351.7-14.

(50) J. Filliozat, The Classical Doctrine of Indian Medicine, tr. Dev Raj Chanana (Delhi, 1964), 192, goes too far when he asserts that Katyayana's varttika "fully assures us that the pathological theory of the tridosa ... had been fully constituted in Katyayana's time."

(51) R. P. Das, "Miscellanea de Operibus Ayurvedicis (II)," Journal of the European Ayurvedic Society 2 (1992): 27-29.

(52) The Bower Manuscript, ed., tr. A. F. R. Hoernle (Calcutta, 1893-1912). Quotations refer to the stanzas of the texts.

(53) Lore Sander, in Investigating Indian Art, ed. M. Yaldiz and W. Lobo (Berlin, 1987), 313-23; and similar already, A. H. Dani, Indian Palaeography (Oxford, 1963), 151.

(54) R. Muller, Grundsatze altindischer Medizin (Copenhagen, 1951), 120, rightly criticizes Hoernle's translation of dosa as "humour" rather than "Fehler" in the texts of the Bower Manuscript.

(55) J. Jolly, ZDMG 53 (1899): 379; idem, Indian Medicine, tr. C. G. Kashikar (Poona, 1951), 60f.

(56) At least some of the Vedic evidence deals with the body of the sacrificial animal.

(57) This ambiguity may reflect a phase in the development of Ayurveda when the role of the three faults in nosology was not yet fixed, as G. J. Meulenbeld has suggested: "The Constraints of Theory in the Evolution of Nosological Classifications: A Study on the Position of Blood in Indian Medicine (Ayurveda)," in Medical Literature from India, Sri Lanka, and Tibet, ed. G. J. Meulenbeld, Panels of the VII[supth] World Sanskrit Conference (Leiden, 1991), 8-9: 91-106.

(58) Cf. above, p. 615.

(59) H. Luders, Philologica Indica (Gottingen, 1940), 586-88; a new edition and translation is found in R. Muller, Grundsatze altindischer Medizin, 40f.

(60) Buddhacaritam, ed. E. H. Johnston (Lahore, 1936; repr. Delhi, 1984). Asvaghosa, the author of the Buddhacarita, is usually assumed to have lived in the first or second century A.D.

(61) The Sutra of Golden Light, Being a Translation of the Suvarnabhasottama-sutra, (by) R. E. Emmerick (London, 1970), 75f. The Sanskrit text was not available to me. Emmerick (p. ix) dates the text approximately at the beginning of the fifth century A.D. (when it was translated into Chinese). The compilation of the text stretched over several centuries, and there are numerous versions. J. Nobel proposes A.D. 300 as the approximate date of the nucleus of this medical chapter: Ein alter medizinischer Sanskrit-Text und seine Deutung, supplement to JAOS 71 (1951), 34.

(62) J. Nobel, Ein alter medizinischer Sanskrit-Text, 11.

(63) In its present form the text contains some expressions that can hardly be earlier than the early centuries A.D. In Su 12.8 we find the poetic expression an-oka-ha "tree" (lit. "not leaving its home"), which is otherwise attested only in Kalidasa's Raghuvamsa 2.13 and a version of the Sakuntala (so PW); an-oka-sari "not living in his home, beggar" is found in Mahabharata I 86.5; mrdvika "grape" (Su 25.49) is a wrong sanskritization of a loan word from Iranian madvika (literature in H. Scharfe, Investigations in Kautalya's Manual of Political Science [Wiesbaden, 1993], 88). Such late words may point to insertions or reformulations of the text.

(64) Car Ci 30.289f. and Si 12.36-40.

(65) A. F. R. Hoernle, JRAS 1908: 997-1028; G. J. Meulenbeld, The Madhavanidana (Leiden, 1974), 411; Debiprasad Chattopadhyaya, Science and Society in Ancient India (Calcutta, 1977), 31-33; H. Scharfe, "The Language of the Physician," in Fs. G. Cardona (forthcoming).

(66) Cf. Mahabharata XII.330.21f. In Car Vi 8.95 again "excessive dosas" cause the above mentioned unhealthy dispositions; those with balanced dhatus are endowed with all good qualities (Vi 8.100). Even centuries later, Astahga-hrdaya Su 1.10 retains the distinction of the ideal sama-dhatuh [prakrtih] and the undesirable disposition caused by faults (dosa); it is only Arunadatta, in his commentary on this stanza, who maintains that dosa here (!) is nothing but a synonym of dhatu: dhatu-sabdo 'tra dosa-paryayah.

(67) H. Scharfe, The State in Indian Tradition (Leiden, 1989), 2: 28 n. 18.

(68) The commentator, Cakrapani, explains that this problem can be avoided if measures are taken during the rainy season that prevent the build-up of bile.

(69) vatadayah prakupyanti sirasy asram ca dusyati tatah sirasi jayante roga vividha-laksanah |11|

(70) "Being riled, riles" is expressed in various similar ways: kupyati, prakupyanti, atikopayati (Su 26.84), etc.

(71) siro-gatah sira vrddho vayur avisya kupyati tatah sulam mahat tasya vatat samupajayate |18|

(72) katv-amla-lavana-ksara-madya-krodhatapanalaih pittam sirasi samdustam siro-rogaya kalpate |22|

(73) asya-sukhaih svapna-sukhair guru-snigdhatibhojanaih slesma sirasi samdustah siro-rogaya kalpate |24|

(74) In Sutra-sthana 1.59-61 we find side by side samprasamyati, prasamyati, and prasamam yanti. By metonymy an illness can also be "calmed": "by an oil-massage the body becomes one in whom the wind-disease is calmed" i.e., not susceptible to diseases due to wind (Su 5.86 sariram abhyahgad ... jayate prasanta-marutabadham).

(75) A certain "oil is killing the three faults" (tailam etad tridosa-ghnam): Su 5.70.

(76) Su 10.11, 13.

(77) tri-dosa-ja is also found in Su 17.26, but here it may refer to a headache caused by any of the three do.sas individually.

(78) samnipata also occurs several times in Su 19.4.

(79) In Su 5.6 dosa is not used in its technical sense: "light [articles of food] are of little harm (alpa-dosani) even if taken in excess ... heavy [articles of food] are exceedingly harmful (dosavanti)."

(80) Caraka Samhita, tr. Ram Karan Sharma and Vaidya Bhagwan Dash (Benares, 1976), I: 106.

(81) S. Chidambarathanu Pillai, Siddha System of Diseases (Madras, 1992), ii f.

(82) J. Filliozat (The Classical Doctrine, 28 and 187) also speaks of the three elements (tridhatu) which become the three troubles (tridosa) when they are disturbed; but he does not elaborate on the use of these terms in earlier and later Ayurvedic texts.

(83) According to Cakrapani, the reference is to faeces, etc., and chyle, etc.

(84) These almost untranslatable terms denote two of the three strands (guna) that make up the prime materia in classical Samkhya doctrine; rajas 'sky, dusk, redness, defilement, passion' denotes a restless, active element; tamas 'darkness' a dull, sluggish element. The third is sattva 'createdness, living being; goodness; an element of brightness, knowledge, and capacity of release: J. A. B. van Buitenen, JAOS 77 (1957): 88-107. One can define the three gu.nas functionally: "The subtle matter of pure thought or sattva, the kinetic matter of pure energy or rajas, and the reified matter of inertia or tamas," so G. J. Larson, Philosophy East and West 37 (1987): 249. Cf. R. Mailer, Janus 38 (1934): 77-93.

(85) The desire to find homologies is also noticeable in Car Su 12.13 where rata, pitta, and slesman in their proper and their disturbed states are compared to the proper and improper attendance to the three goals in life (dharma, artha, kama) and to the three seasons, whose "unseasonal' weather spells disaster.

(86) This passage invalidates the statement by R Kutumbiah, Ancient Indian Medicine (Bombay, 1962), 73, that "Caraka does not mention the gunas at all in connection with the dosas." On some linkage of the medical do.sas and the philosophical gunas of Samkhya, cf. Arion Rosu, Les Conceptions psychologiques dans les textes meddicaux indiens (Paris, 1978), 108, 118, 192.

(87) Cf. S. N. Dasgupta, A History of Indian Philosophy (Cambridge, 1922; repr. Delhi, 1975), I: 216; E. H. Johnston, Early Samkhya (London, 1937; repr. Delhi, 1974), 35; E. Frauwallner, WZKM 32 (1925): 188ff.; J. A. B. van Buitenen, JAOS 77 (1957): 99f.; G. Larson, Classical Samkhya, 2nd ed. (Delhi, 1979), 45, 112, 131, 162-64.

(88) Cf. S. Dasgupta, A History of Indian Philosophy, I: 126.

(89) Sattva is used in widely divergent contexts and meanings: van Buitenen, JAOS 77 (1957): 95-99.

(90) Some Indian traditions recognized four origins of life, lit. "wombs," viz., chorion, egg, sweat (insects, etc.), sprouts (plants).

(91) The absence of a common term for healthy wind, bile, and phlegm in the older texts necessitates frequent enumeration of all three (as in Su 7.39) or abbreviation (vatadayah Su 17.11, pittadinam Su 17.114).

(92) This vital force is considered to reside in the heart: J. Filliozat, The Classical Doctrine, 27f., 166f. with reference to Caraka, Su 30.6-11.

(93) Cf. Bhela-samhita, ed. V. S. Venkatasubramania Sastri and C. Raja Rajeswara Sarma (New Delhi, 1977), Su 26.34:

(94) The Bhela-samhita which had been eclipsed for a long time, has been recovered, though in imperfect textual condition (see n. 93). It is assumed to be of comparable antiquity with the works of Caraka and Susruta. A cursory study showed that ill-applied heat riles wind, which in turn agitates the dosas--all three dosas then spoil the blood (Ci 6.8f.); dysentery caused by mental anguish leads to a riled do.sa (Ci 10.42); undigested food leads to riled elements (dhatu), and the force of these dosas is increased by wind (Ci 10.51). Here Bhela seems to agree with Caraka in that vata, pitta, and slesman are only called dosas in their abnormal state. Only in a corrupt passage (Ci 20.3) do we find dosasatmya [sic] 'imbalance of faults.'

(95) J. Filliozat, The Classical Doctrine, 273, also considers the section on prognostics in Susruta, Sutra-sthana, chapters 29 to 33, as an improvement on Caraka's and Bhela's Indriya-sthana.

(96) H. Zimmer, Hindu Medicine (Baltimore, 1948; repr. New York, 1979), 134, is typical for the lax manner in which translators insert the term "humor" with no textual basis in works on Ayurveda: "The three humors, wind, bile, and phlegm are the basis of the existence of the human body."

(97) Cf. Astanga-samgraha Su 20.1. The closest parallel is found in Mahabharata V. 33.81, where the body is called tri-sthuna; in the Bower manuscript, Navanitaka 500, "fever is based on the three pillars" (tri-sthuna-gatam ... jvaram). I do not, so far, understand the image of a house resting on three poles.

(98) Blood is a cause of disease only as an intermediary; for it is itself "aggravated by wind ... aggravated by bile ... and aggravated by phlegm ... aggravated by a combination [of all three] or joined [by two of them] (Su 14.21 vatena dustam ... pitta-dustam ... slesma-dustan ca ... sannipata-dustam ... samsrstam). Cakrapani on Caraka Su 1.57 notes that the seeming inclusion of blood among the do.sas in Car Su 24.18 and Ci 5.27 does not make it a fourth dosa, as it itself is aggravated by wind, bile, or phlegm.

(99) Deficiency in faeces, urine, and sweat is, if not perhaps a cause, at least a symptom; measures are taken to produce more stool and urine and to stimulate perspiration in Su 15.11; cf. also Caraka Su 17.70f.

(100) G. J. Larson, Philosophy East and West 37 (1987): 258, seems to have overlooked this passage when he ascribed the postulation of this correspondence to Dalhana (comm. on Uttaratantra 66.9, numbered 66.6 in some editions, as in that quoted by Larson). There is a problem, as Larson points out, that vata, pitta, and kapha should all be derived from tamas since they emerge from the mahabhutas. The increasing emphasis on philosophical speculation in the medical schools and simultaneous de-emphasis or outright ban on experimentation led to stagnation in Indian medicine: Debiprasad Chattopadhyaya, Science and Society in Ancient India (Calcutta, 1977), 157f. The veterinary work Hasty-ayurveda localizes sattva in the phlegm, rajas in the wind, and tamas in the bile: Arion Rosu, Les Conceptions psychologiques, (118).

(101) J. Filliozat, The Classical Doctrine, 12; G. J. Meulenbeld, The Madhavanidana (Leiden, 1974), 431 f.

(102) rajo-bhuyistho marutah, rajo hi pravartakam sarva-bhavanam, pittam sattvotkatam laghu-prakasakatvat, rajo-yuktam va ity eke kaphas tamo-bahulah, guru-pravaranatmakatvad ity ahur bhisajah. The text is quoted from S. Dasgupta, A History of Indian Philosophy (Cambridge, 1932), II: 329 n. 3.

(103) E. Frauwallner, Geschichte der indischen Philosophie, 1: 308, 353.

(104) Samkhya-karika 12: anyonyabhibhavasraya-janana-mithuna-vrttayas ca gunah "The strands mutually domineer, rest on each other, produce each other, consort together, and are reciprocally present."

(105) Samkhya-karika 46 traces the varieties of ignorance, etc., to the "destructive influence of the imbalance of the strands (guna-vaisamya-vimarda)."

(106) C. Vogel (Vagbhata's Astangahrdayasamhita [Wiesbaden, 1965], 45) discusses the various attested forms of the name.

(107) C. Vogel (Vagbhata's Astangahrdayasamhita 1-10) and G. J. Meulenbeld (The Madhavanidana, 423-25) review the arguments for and against the assumption of one or two Vagbhatas, leaning towards a belief in only one author; the problem has little relevance for the present investigation, since both texts differ little concerning the topics under discussion. The AS is apparently the later work (or a later recension of the AHS), but not necessarily by another author.

(108) G. J. Meulenbeld, The Madhavanidana, 423-25.

(109) F. Filliozat, The Classical Doctrine, 14; G. J. Meulenbeld, The Madhavanidana, 425.

(110) I.e., caused by dosas linked to faulty nutrition or behavior.

(111) I.e., caused by external forces, such as a fall, an injury which brings about an imbalance of wind, bile, and phlegm (Car Su 20.7) resulting in illness.

(112) The last pada of AHS Su 1.20 differs in form, though not in content, from AS Su 1.41: tatra roga dvidha smrtah.

(113) S. Dasgupta, A History, II: 328.

(114) p. Kutumbiah, Ancient Indian Medicine, 60f.

(115) Cf. Caraka Su 19.5 and Bhela Su 26.34 (above pp. 624-25), where, however, there is no reference to the gunas of Samkhya! In AS and AHS krtsnam vikarajatam seems to be the agent, guna-trayam and dosa-trayam the object, which is similar to the construction in Car Su 19.5 (sarve vikara vata-pitta-kaphan nativartante); Su Su 24.8 has it the other way around: krtsnam vikara-jatam ... avyatiricya vata-pitta-glesmano vartante.

(116) Astanga-hrdaya Su 12.32-34 says essentially the same, except that it inserts the imbalance of the three elements (dhatu) as an intermediate cause:

tatha sva-dhatu-vaisamya-nimittam api sarvada

vikara-jatam trin dosan (supply: nativartate) ... /34/

(117) AS Su 19.1 dosa-dhatu-mala-mulo hi dehah and AHS Su 11.1 dosa-dhatu-mala mulam sada dehasya.

(118) AS Su 19.14 cd = AHS Su 11.35 cd dosa dusta rasair dhatun dusayanty ubhaye malan

(119) AS Su 1.29 = AHS Su 1.13

rasasrn-mamsa-medo-'sthi-majja-sukrani dhatavah

sapta dusya mala mutra-sakrt-svedadayo 'pi ca

(120) It is remarkable that AS Su 20.5 in this instance is closer to Caraka: evam amisu sthanesu bhuyistham avikrtah sakala-sarira-vyapino 'pi vata-pitta-slesmano vartante. We have to assume that these vast compilations incorporated elements from different periods and did not always achieve consistency.

(121) G. J. Meulenbeld, Journal of the European Ayurvedic Society 2 (1992): 1-5.
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