Healing from the Source-3: the Ancient approach to Treatment
------ © Dr. Satya Prakash Choudhary
The ancient Ayurvedic approach to treatment ( Cikitsa ) stems from its holistic approach to illness. Apart from Caraka's three-fold basic approach to the origin of illness that I have discussed in the earlier section, there is another interesting threefold classification of diseases followed by Vaghbhata ( Ashtanga Hrdayam : I. 12. 58-59)
Doshaja (arising from the doshas ): As the word ‘ doshaja ' itself indicates these illnesses are due to vitiation of the doshas . Since the disease can be traced to the doshas it can be treated by appropriate medicines which generally have the opposite tendencies of the causative doshas
Karmaja ( karmic in origin): Karmaja diseases are a result of our unwholesome or undesirable karmas (actions) done under the influence of Rajas and Tamas, the two psychological doshas . Such Karma maybe from this life or even past lives. Illnesses of this type cannot be treated by medicine. The remedial measures are psycho-spiritual in nature and ideally seek to address the root of karma or at least neutralize the negative karmas through positive karma such as atonement, charity, selfless service and penance.
Doshakarmaja (arising from both the doshas as well as karmas ): As the word indicates these illnesses are due to a combination of the doshas as well as karmas . Though pathogenesis involves vitiation of the doshas the effects of the diseases or illness are disproportionately higher than is normally anticipated. Karmic forces fuel an existing mild causative factor resulting in a more difficult situation. Obviously treatment includes both medicinal and psycho-spiritual remedies.
The above approach to illness straightaway reveals its inbuilt approach to treatment, albeit in a skeletal form. Now let us examine more elaborately the ancient Ayurvedic approach to Cikitsa or treatment. According to Caraka treatment is threefold ( Caraka Samhita : 1. 11. 58).
1. Daivavyapasrya (Spiritual intervention)
2. Yuktivyapasrya (Rational intervention or Empirical therapy)
3. Sattvavajaya (Psychological intervention or Psychotherapy)
Of the above three modes, modern medicine and modern psychotherapy employ the last two modes, but are yet to come to terms with Daivavyapasraya or spiritual intervention. Obviously this is due to an inherent disparity between contemporary western and ancient Indian approaches to illness. First I will briefly describe the last two modes.
Yuktivyapasrya (Rational intervention or Empirical therapy):
As the word indicates, Yuktivyapasrya is based on reason or logical analysis ( ‘yukti '). All the scientific systems of medicine largely deal with this type of treatment. The practitioner uses scientific rationale not only in diagnosing the illness but also in treatment planning. In other words the approach is objective, empirical and evidence-based. Among the three modes of intervention, it is only Rational or Empirical treatment that most modern medical practitioners (whether conventional western or modern Ayurvedic ) learn and practice. Whilst Ayurveda is quite good at this mode, it can benefit by integrating some important findings of modern medicine. Otherwise there is a danger of it remaining fossilized. Moreover reinventing itself in accordance with the latest scientific discoveries is fully in conformity to Ayurveda' s “rational” approach to treatment. However without undermining the tremendous importance of the rational approach, one has to bear in mind that in spite of its usefulness, exclusive adherence to the empirical approach is limited in its scope.
There is a chasm that exists between human reality and our desire for empirical certainty, between research on a population level and that of the individual and meaning. Moreover, the question arises as to what constitutes evidence and to what extent we agree on what is regarded as proper evidence. Is it not important to account for individual experience and the evolving and ongoing co-construction of meaning? Also, how do we decide on the relative worth of different forms of evidence? Another related question is the relationship that traditional, quantitative methodologies based on modernist assumptions can have to other research findings. Can all of the polemic and technology of modern medicine and science account for phenomena such as faith and hope?
Unlike the modernist, the ancient physician seems to have a more integrated and open approach to illness and its treatment. The ancient Ayurvedic approach was neither modernist nor postmodernist. It was humane, integrated and wholistic. While Caraka recognizes the importance of rational intervention or scientific medical treatment, his approach is truly holistic and integrated unlike the modern university trained Ayurvedic physician. He accords equal validity to the other two modes of treatment- namely psychological and spiritual.
Sattvavajaya (Psychological intervention or Psychotherapy)
This is the Ayurvedic equivalent of psychotherapy. Though the Ayurvedic classics haven't dealt with this very elaborately, the very inclusion of psychotherapy in a basic threefold classification of treatment modalities indicates that psychotherapy was an integral part of the Ayurvedic approach. Though the Ayurvedic classics themselves do not deal with this topic except for a brief reference, an excellent template can be fleshed out from the classics based on Samkhya-Yoga, Ayurveda and Vedanta bearing in mind that Ayurveda shares common ground with the Darsanas as is evident even from Caraka's writings. Such a template can not only complement modern approaches to psychotherapy but also rival them as full-fledged schools of psychotherapy. Samkhya-Yoga, Vedanta and Buddhist psychology have a full-fledged working model of the mind that can lend itself to the clinical practice of counseling.
While rational interventions work well with predominantly somatic illnesses (not withstanding the oneness of the mind-body gestalt), wherever the psychological ( manasika ) doshas are involved, psychological interventions are required. ‘ Sattva ' refers to the ‘mind' or ‘consciousness', while ‘ avajaya ' means ‘overcoming' or ‘subjugating'. In other words Sattvavajaya means the process of overcoming or subjugating the mind. Here it refers to overcoming the two psychological doshas ( rajas and tamas ) that lead to various other afflictions. Apart from being a synonym for the mind, ‘Sattva' is one of the three gunas, in fact the one and only wholesome guna . In its most wholesome state ideally the mind or manas is in the state of sattva . That is why ‘Sattva' is a synonym for the mind. But what could have been a sattvic (calm and clear) state is often clouded by the other two afflicting gunas - reactivity ( rajas ) and delusion ( tamas ). This results in distorted thinking or lack of discernment ( ‘prajnaparadha' ). It works both ways. Distorted thinking can allow reactivity and delusion to prevail just as reactivity and delusion can lead to erroneous judgment or lack of discernment.
Either ways when the two psychological doshas predominate, they cause various psychological/emotional afflictions like lust ( kama ), craving/greed ( lobha ), delusional thinking ( moha ), jealousy/envy ( irsya ), conceit ( mana ), arrogance ( mada ), grief ( soka ), anxiety ( cittodvega ), and fear ( bhaya ). Ayurveda views these afflictions too as mental afflictions though conventionally they are not considered as mental diseases. These afflictions can lead to mental illness once they cross a threshold. Hence the psychologically afflicting rajas and tamas have to be overcome. The aim of psychotherapy ( sattvavajaya cikitsa ) is to restore or augment sattva . Thus ‘sattvavajaya' is nothing but the restoration of sattva by overcoming rajas and tamas .
Sattvavajaya is achieved through a variety of Yogic practices some of which are partly similar to modern cognitive behavioral techniques. Yoga (whether Hindu or Buddhist ) reorients the individual's values and attitude to life in general by working on the klesas . The klesas are inherent psychological hindrances that obstruct clear thinking by deepening reactivity ( rajas ) and delusion ( tamas ). That is why the klesas are more important than even rajas and tamas . Strictly speaking rajas and tamas are also innate to all things in nature just as the wholesome sattva . Their natural presence is not really the problem. They become afflictions or doshas under the deepening influence of the klesas . Hence removing the klesas leads to a restoration of sattva and the subordination of tamas and rajas . There are five klesas or hindrances that afflict the mind. They are:
avidya : ignorance of the true nature of things
asmita : preoccupation with ‘self' or ‘ego' (sense of ‘I', ‘mine') this leads to much subjectivity
raga : passion
dvesa : aversion
abhinivesa : clinging to one's beliefs, thoughts, emotions etc, inability to let go
The psycho-spiritual practices of Yoga facilitate the removal of the klesas thereby ending the inner psychological conflict of the gunas . This in turn enables the individual to let go and accept life and its dualities with equanimity ( upeksha ). This return to the lost harmony and peace is the restoration of ‘s attva ' or the ‘overcoming of the mind'.
Daivavyapasrya (Spiritual intervention)
This form of therapy is the most misunderstood, highly marginalized, largely neglected mode of Ayurvedic treatment in our times. It is not currently popular partly due to the paucity of adepts in this form of therapy and partly due to the overall emphasis on modernist assumptions that value rational/scientific approaches while marginalizing other ways of approaching reality. Suffice it to say that Daiva chikitsa has been grossly neglected due to a combination of social, cultural, political factors. This is the area of biggest gap between ancient and modern Ayurvedic approaches. Even in its country of origin, a vast majority of the Ayurvedic physicians today are ignorant of this mode. Some modern Ayurvedic writers have tried to depict this as spiritual psychotherapy. Let me clarify that Daiva cikitsa is not a form of psychotherapy. Broadly speaking Sattvavajaya covers all forms of psychotherapy including spiritual. Daiva cikitsa is a unique and integral part of the ancient Ayurvedic approach.
Ayurveda being an upaveda of Atharva veda, it has inherited Daivavyapasrya (Spiritual intervention) or Daiva Cikitsa (Spiritual therapy) largely from the Atharva veda . In the Atharvaveda the word ‘ Daiva ' refers to the past acts or karmas of past lives. Thus Daivavyapasrya or Daiva Cikitsa seeks to address the karmic origins of illness ( karmaja roga ). Karmic illnesses cannot be treated by mere rational approaches. First let us understand the concept of ‘Karma' .
Karmic origin of illnesses
Along with Dharma, the concept of Karma is a distinctive part of the Indian world-view be it Hindu, Buddhist or Jain . Simply put, ‘man reaps what he sows'; if one reaps what one sows, then one ought to be careful about what one sows. This principle of causality is what makes the law of Karma unique. There is nothing fatalistic in the concept itself. K arma literally means ‘action' or ‘deed', in fact anything that you do. Thus Karma is the “Law of action”. In the traditional texts karma is often written as a compound word- karma-vipaka . Karma-vipaka means “action and result” similar to “cause and effect”. Everything you do is caused (at least in part) by what you have done in the past and in turn will cause your future actions. Thus every act is the result of some previous act which caused it. In the Upanishads , karma operates as a causal explanation for everything that happens, particularly to human beings. “As one does, so one becomes; by virtuous acts one becomes virtuous, by errant acts one becomes errant” ( Brihadaranyaka Upanishad 4.4.5).
In other words, all actions you take are the results of actions you have taken in the past; all actions you take are also the causes of future actions. Thus a proper understanding or insight into karma inspires a wise person to take responsibility for his or her own life. Most often we are victims of our own actions, both conscious and unconscious. What we do everyday determines who or what we are. As long as there is no change of nature from within, even the best healer or doctor cannot cure us completely. An occasional visit even to the most famous healer cannot substitute for a change of life style resulting from a change of consciousness. First we must have the ‘right will', the true resolve to live in harmony with natural order ( ‘Rta' ). One has to own responsibility for one's own life and health.
Now let us return back to Daiva cikitsa . Daiva cikitsa includes among other things spiritual interventions based on the karmic origins of illnesses, some of which do not yield to rational therapy. Karma and astrology figure prominently in this mode. Though most illnesses can be rationally traced to causes in our immediate life and environment, at times there are difficult cases that need a different approach. Here purva janmakrta karmas or previous lives' karmas are thought to be the cause. But how does one analyze the karma of previous lives? The physician-astrologer taps into the phenomenon of ‘synchronicity' which is behind why astrology works well. In the ancient days it was not uncommon for a physician to use astrology as part of his methodology. This is the most difficult and controversial part of the ancient Ayurvedic approach. Unless one has a thorough grounding in Vedic astrology or Jyotish (apart from Medical and Metaphysical knowledge) one cannot appreciate this part easily. This is a difficult area for even a well trained astrologer. Intelligence, good samskara , adherence to dharma , hard work and experience enable an astrologer to reach this level of understanding. Obviously the mercenary and purely business-minded astrologer lacks such a holistic, dharmic and spiritual understanding. The reader is cautioned not to fall prey to the unscrupulous mercenary half-baked astrologer advising costly remedies.
Mantra (chanting), Mani (gemstones), Aushadha (medicines), Homa/Yajna ( Vedic fire rituals), Niyama (spiritual discipline), Prayaschitta (expiatory acts, Upavasa (spiritual fasting), Yatragamana (pilgrimages) and jyotisha (astrology) form the mainstay of Daiva Cikitsa . Remedial measures of this type seek to address the root of karma by neutralizing the negative karmas of the past through adopting positive karmas such as atonement, charity, selfless service and penance, in the present.
Daiva Cikitsa is neither outdated nor quackery. It is a valid and effective mode of therapy where rational approaches fail. Unfortunately due to the current leanings towards modernist assumptions in modern medicine this unique form of therapy has been neglected by most modern day Ayurvedic practitioners who themselves are not exempt from the bias of modernist assumptions. A large number of Ayurvedic practitioners trained in the universities only (with no traditional source of learning) try to appeal to the standards of Modern medicine and its logic. Nevertheless Daiva cikitsa is not entirely non-existent today. It is still practiced in India as part of Hinduism through popular religion and astrology. However both the theoretical as well as practical aspects of this mode of treatment can be fully appreciated only through a multi-disciplinary approach that blends Ayurveda, Jyotisha and the Darsanas . Unfortunately there are very few people who have such a multidisciplinary background. While there is a need to revive this ancient mode of treatment and restore its rightful place in Ayurveda , the negative side of such a revival has to be borne in mind. There is an inherent danger that a revival of Daiva cikitsa can lead to - gross abuse and commercial gimmicks which commercial astrology has already seen. Moreover if it is not handled carefully it can breed negativity and superstition.
Finally as Carl Jung wrote, “unexpected cures may arise from questionable therapies and unexpected failures may arise from allegedly reliable methods”. Let me reproduce more of Jung's words here. “…I am now in my eighth decade, and the changing opinions of men scarcely impress me any more; the thoughts of the old masters are of greater value to me than the philosophical prejudices of the Western mind. Unexpected cures may arise from questionable therapies and unexpected failures may arise from allegedly reliable methods…” Ayurveda is a complete art of healing, one that integrates both allegedly “reliable” and “questionable” therapies or the rational and non-rational approaches in its attempt to heal illness from its very source.