Chapter 9b - Pathological Conditions or Processes in Ayurveda

We shall now review briefly the concepts the ancients held regarding the following pathological conditions or processes.

1. The concept of epidemic and pandemic diseases (janapadoddhvaṃsa),
2. The concept of sources and spread of infection or contagion.
3. The concept of growth and multiplication of morbific elements in the body and their mode of spread and action.
4. Certain abnormal conditions of the body-appearance

1. The Concept of Epidemic and Pandemic Diseases (janapadoddhvaṃsa)

In epidenic diseases they observed that the constitution of the body is not able to play any part in counter-acting the incursion of infesting elements. The etiological factor has all the voice in the disease-phenomena Hence the uniformity of symptoms and clinical courses observed as the etiological factor, is uniform. Constitution which is an individual concern is out of game, hence very little individual variation can occur in the clinical picture and course of the disease. In chrome diseases, individual constitution is able to create resistance and in such condition pronounced individual differences in the clinical course can occur.

Caraka Samhita devotes one chapter to explain the concept of Epidemiology (Vimāna 3). It is a thought-provoking concept and probably progress in radiation physics may be able one day to find the equivalence in value between the physical and spiritual universe and rediscover the truth laid down by Atreya.

We shall cite now the passages that explain the reasons why a large number of people are affected by a common ailment at one and the same time and why there is uniformity of clinical course of disease in spite of the individual variations of constitution in men and what are the main sources of such ailments. Caraka in Vimana 3 treats the subject thus.

[Carakasaṃhitā Vimānasthāna 3.5-14]

“5. But, how does the simultaneous destruction of communities, consisting as they do of individuals who differ from one another in constitution, diet, physique, vitality, habits, psychic make-up and age, take place by the incidence of one single disease?

6-(i). Unto him replied the worshipful Atreya, O, Agnivesa! though a community may be heterogeneous in respect of the constitution etc., of its individual members, there are other common factors which being adversely affected will cause simultaneous outbreak of diseases having similar symptoms. It is these that devastate whole populations.

6. The factors that affect a people in common are: the winds, the waters, the country and the seasons

7-(i) of these, the wind, if of the following description, is to be known as disease-inducing viz., unseasonal, totally becalmed, violently blowing, exceedingly rough, intensely cold, intensely hot, excessively dry, excessively humid, fearfully clamorous, blowing from contrary directions and clashing with itself, extremely rotatory (whirlwind), and charged with unwholesome odors, moisture, sand, dust and smoke

7-(ii). The water of the following description is to be known as bereft of virtue, having an extemely aberrant smell, color, taste and touch, abounding with putrescent matter, deserted by aquatic birds, in which the aquatic creatures are atrophied and which is unpleasant.

7-(iii). The country of the following description is to be known as unwholesome, having color, taste and touch that are unnatural, excessively damp, abounding in serpents beasts of prey, mosquitoes, locusts, flies mice, owls, birds and animals such as the jackal and abounding in woods of weeds and Ulupa grass, abounding in creepers where crops have either fallen, withered or been destroyed in an unprecedented manner, where the winds are smoky, where the sound of birds is unceasing; where the baying of dogs always assails the ears where herds of animals and flocks of birds of various kinds ere always in a state of alarm and pain; where amidst the people, morality, truth, modesty, custom, character and virtue have either declined or been given up, where tae waters are always agitated and upheaving, which is frequently subjected to the incidence of meteorites thunderbolts and earthquakes, where nature is full of menacing sounds and sights, where the sun, the moon and the stars are frequently covered by dry, coppery, ruddy and grey clouds and which lastly, is as if full of constant alarm and lamentation, crying, fright and darkness as if visited by gnomes, and as if abounding in sounds of lamentation

7-(iv). A season which is of the following description is to be known as unwholesome; evincing characteristics that are opposite to normal, or evincing its characteristics in an excessive or deficient degree.

7.The learned declare these very four factors when possessed of the morbidity described above, to be destructive of populations, when not so blemished they are said to be wholesome.

8. But even when these depopulating factors have turned inauspicious, there is no fear of diseases to those persons who are served with medicines that have been culled beforehand

12. Even if all the four factors including Time, become vitiated, as long as men are sustained by medicines, so long will they remain free of disease

14. For them moreover, the rightful use of vitalizing medications is recommended, the maintenance of the body by means of the medicinal herbs culled beforehand is also commended.

2. The Concept of Sources and Spread of infection or Contagion

A. Sources of Infection or Contagion

Regarding the sources of infection in epidemic diseases Caraka lays down that the wholesale vitiation of the air, water, country and season are the sources of vitiation.

[Carakasaṃhitā Vimānasthāna 3.6]

“The factors that affect a people in common are the winds, the waters, the country and the season”.

[Carakasaṃhitā Vimānasthāna 3.7]

“The learned declare these very four factors when possessed of the morbidity described above, to be destructive of populations, when not so blemished, they are said to be wholesome”

Susruta states that epidemic diseases spread from man to man.

[Suśrutasaṃhitā Nidānasthāna 5.34]

“Dermatosis, fever, consumption and eye-sore are infectious diseases and spread from man to man.”

It will be interesting to note that Dalhana, the commentator who flourished in about 10th century A.D. while commenting on this verse, quotes (śītalikādaya—small pox etc.) as examples of (aupasargika) i.e., communicable diseases.

The term (upasargaja) is defined as follows by Dalhana:

[...]

“Infectious diseases are those fever etc that result from contact with those ailing from them”.

The words (saṃsargaja-upasargaja-sañcāriṇa[?]) used in connection with such communicable disease-condition, are quite suggestive and significant.

B. The Method of Communication of Infection

Caraka states:

[Carakasaṃhitā Vimānasthāna 3.20]

“In consequence, the people perish as the result of infectious contact or ingestion”.

Cakrapani, the learned commentator, explains this further as under—

[...]

“As regards contact and ingestion, by contact, that of infected water etc, is meant, and by ingestion, that of all infected articles of diet is meant. This is the primary sense. Generally even infected smell of the air is to be included, for unwholesome odor is said to be due to infection of the atmosphere”.

Sushruta gives a more detailed account of mode of communication of disease.

[Suśrutasaṃhitā Nidānasthāna 5.23-33]

“It is by close conversation, body-contact, breath-contact, eating together, using the same bed, seat, clothes, flower-garlands and toilet, that infectious diseases such as dermatosis, fever consumption and eye-sore spread from man to man”.

3. Concept of Growth and Multiplication

[Concept of Growth and Multiplication of Morbific elements in the Body and their Mode of Spread and Action]

Sushruta compares the growth of vitiating elements to yeast fermentation which has already been explained in the chapter of vitiating pathogenesis (Suśrutasaṃhitā Sūtrasthāna 21.28). Here the simile of yeast fermentation used to explain the increase of growth of morbific elements is quite suggestive

Caraka seems to have a clearer awareness of the biological factor involved in the vitiating elements. He refers the phenomenon of the periodicity of fever to the recurring cycles of growth, spread, spending itself out and withdrawal of the vitiating element. This description agrees fully with the cycle of evolution of malarial parasite in the human body. Caraka illustrates this by using the simile of the seed and the soil.

[Carakasaṃhitā Cikitsāsthāna 3.68-70]

“Just as the seed lies dormant in the soil aud germinates in season, in the same manner the toxic matter lies quiescent in the body-element and flares up when the time is ripe.

Thus the morbific factor gathering strength and biding the propitious time, manifests itself as the tertian or the quartan fever as soon as the disease-resisting power in the body is lowered.

In this manner, the disease-generating factors, having worked themselves out, lapse into quiescence and retire to their respective stations in the body, then mustering up their strength, once again, these toxic elements afflict the patient with fever at their own ripe times”.

As the seed begins to grow at its proper time 'so does the morbid factor Morbid factor having increased in amount and gaining strength and getting the favourable time for action and not being counter-acted by anti-bodies, causes the disease symptoms Having expended all the power and getting powerless it reconciles or returns to its original soil and growth, and repeats the cycle of growth, spread, action and return.

(4) Certain Abnormal Conditions of Body-appearance

They had observed certain abnormalities in appearance of the persons who where otherwise living in good health. So these conditions are not grouped under the disease list but they are described in a separate chapter just after the enumeration of all the disease conditions.

The eight censurable body conditions described therein are as follows.—Obesity or Tenuity, Dwarfism or Gigantism, Albinism or Pigmentation and Hirsuites or Baldness. (Carakasaṃhitā Sūtrasthāna 21.3) These are probably connected with some abnormality of the function of Glandular system of the body. The body has however adjusted to live in health.