Charaka's 120-Chapter Medical Textbook Set Out How Ancient India Trained Physicians, Examined Patients and Discussed Epidemics

The Charaka Samhita is a Sanskrit medical textbook of 120 chapters in eight sections. The edition now being published online by a Charak Samhita research centre counts 8,419 verses and 1,111 prose passages in the surviving text, and its introduction says about 43 commentaries in Sanskrit were written on the work across the centuries. The man whose name it carries, Charaka, was its reviser rather than its first author, and a third physician, Dridhabala, finished it.

Eight sections, 120 chapters

The editors of that edition set out the layout. Each section is a sthana. Sutra Sthana, the first, has 30 chapters of general principles. Nidana, Vimana and Sharira have eight chapters each: the first covers how eight major diseases arise and are recognised, the second diet, epidemics, teaching and examination, and the third the body and its development before birth. Indriya has 12 chapters on prognosis, Chikitsa has 30 on treatment, Kalpa has 12 on preparing medicines, and Siddhi has 12 on the five cleansing procedures called Panchakarma. The counts add up to 120.

The last chapter of Siddhi Sthana says the text holds 12,000 verses, against the 8,419 in the edition now in print. The edition’s introduction describes the work as one of the Brihatrayi, the three major treatises of Ayurveda, and calls it the most important of them.

Three layers, three names

The text traces its own lineage. In the translation of the first chapter, the sage Bharadwaja goes to Indra seeking long life, knowledge passes through the sages, and Punarvasu Atreya teaches six disciples, with Agnivesha named first. Agnivesha’s treatise, the Agnivesha Tantra, is the base layer.

Charaka revised that treatise, and the revision is the Samhita. In 1908 the scholar A. F. Rudolf Hoernle described the surviving book in the Journal of the Royal Asiatic Society as the joint production of two physicians, Charaka and Dridhabala, both from Kashmir. Charaka’s portion, he noted, presents itself as a revision of Agnivesha’s work.

Dridhabala finished it. According to the edition’s page on Siddhi Sthana, he added 17 chapters of Chikitsa Sthana, the whole of Kalpa Sthana and the whole of Siddhi Sthana, and it names Panchanadapura, which it identifies with modern Panjore in Kashmir, as his city. By that count he wrote 41 of the 120 chapters.

A name in a Chinese Buddhist text

Encyclopaedia Iranica notes that Caraka is the name of King Kanishka’s physician in the Chinese version of the Buddhist text Sutralankara, and that it has been suggested he was the same man who revised the Samhita. The entry points readers to G. J. Meulenbeld’s 1974 study for the full discussion of the evidence. Jean Varenne, writing in Encyclopaedia Universalis, likewise describes Caraka as a physician at the court of Kanishka of the Kushan dynasty. The sources below do not agree on the date of the book itself.

How a physician was chosen and taught

Chapter 8 of the Vimana section is the text’s account of medical education. It names three ways to deepen knowledge: study, teaching and discussion with authorities. It also has the teacher examine the ideal disciple before agreeing to teach.

At the start of study, the teacher addresses the student before a sacred fire, in the presence of brahmanas and physicians. In the edition’s translation the student is told to speak only the truth, to eat no meat, and to follow the teacher except where that would bring the king’s anger, loss of life or great unrighteousness. The student is told to try to restore health to patients and all creatures by all means, and not to hate a patient even at a cost to his own daily expenses. He is not to treat women in the absence of their husbands or guardians, never to reveal the matters of a patient’s house, and not to boast too much of his knowledge.

The authors of a 2010 Journal of Anatomy review say the text includes an Oath of Initiation akin to the Hippocratic Oath. Teaching physicians appears in other tuput stories too: the Buddhist Vinaya tells of the physician Jivaka studying seven years at Takshashila, and the pilgrim Huili listed medicine among the subjects studied at Nalanda.

Four parts of treatment, and the physician first

Chapter 9 of the first section names four components of treatment: the physician, the medicine, the attendant and the patient. Each has required qualities. For the physician the translation lists theoretical learning, extensive practical experience, dexterity, and purity of body and mind. For the patient it lists a good memory, obedience to instructions, fearlessness, and the ability to describe the illness.

The same chapter ranks the physician first, because of his specific knowledge, administrative capacity and managerial skills, and verses 24 and 25 add that the other three depend on him.

Chapter 11 lists four means of valid knowledge. They are the words of authorities and scriptures, direct perception, inference and reasoning, which the text calls yukti. The introduction to the Vimana chapter adds that the physician needs complete knowledge of the patient’s condition before treating, through a tenfold examination. The factors listed there include the patient’s constitution, the essence of the body tissues, the measurements of body parts, mental state, digestion, capacity for exercise and age.

Nine answers to one question

Chapter 26 of the first section stages a debate. A group of sages goes to the forest of Chaitraratha and takes up how many rasas, or tastes, there are and how they relate to diet. The participants include Atreya, King Nimi of Videha and Kankayana, a physician from Bahlika. The positions put forward range from one taste to eight, and Kankayana says tastes are innumerable, which makes nine answers. Atreya rules that there are six, and names them.

The Vimana chapter on the physician adds rules for such arguments. A friendly discussion should be conducted with confidence, with free questions and full answers to a sincere questioner, and without gloating over a win. Before a hostile debate, the text says, compare yourself and the opponent on learning, understanding, retention, imagination and eloquence.

What affects a whole population

Chapter 3 of the Vimana section deals with epidemics. The translation of verse 6 reads: “The common factors which affect mass population are vayu (air), jala (water), desha (land) and kala (season).” Verse 4 advises gathering medicinal herbs before they lose their taste, potency and other properties. Verses 12 to 18 name elimination therapies and rejuvenation measures, along with conduct such as truthfulness, compassion and living in a wholesome country. The edition cites the commentator Chakrapani on the point that one can move to another land to escape the effects of a polluted place.

This article describes what the text says and what scholars say about it. It is not a guide to treatment, and nothing in it is medical advice. For what clinical trials report on Ayurvedic remedies today, see our review of the evidence. For the surgical side of the same medical tradition, see the story of the first nose job.

Translations and commentaries

The edition’s introduction says the Samhita was translated into Arabic in the 8th century and into Persian in the 10th, and later into Tibetan and Mongolian. A 2022 survey by Mehmet Kavak lists Caraka, under the Arabic name Sarak al-Hindi, among the Indian authors whose medical texts were translated or quoted in Arabic, in whole or in part. The survey’s abstract gives no dates or translators.

Of the roughly 43 Sanskrit commentaries, the edition names Chakrapanidutta’s Ayurveda Deepika as the most authoritative. In 1909 Hoernle published a second paper, titled for the Bower Manuscript, on the order in which the chapters of the Chikitsa section are to be read.

Where the dates differ

The edition’s introduction says no chronological records mark the stages of the text. The estimates in the sources vary widely.

• The edition itself places Agnivesha around 1000 BCE, speculates that Charaka lived in the 8th century BCE, and dates Dridhabala to about 300 CE.
• The PMC article “Medical geography in Charaka Samhita” takes Punarvasu Atreya as 1000 BC, Charaka as the second century BC and Dridhabala as 400 AD.
• The Journal of Anatomy review says the original date of the Samhita is not known, that some estimate its composition to the early 4th century BCE, and that Charaka lived in the mid 2nd century.
• Hoernle placed Charaka in the 2nd century CE and Dridhabala in the 8th.
• Jean Varenne, in Encyclopaedia Universalis, says a constituted medical corpus appears in the 1st and 2nd centuries CE, and that Dridhabala reworked the surviving versions in the 8th century.

The edition now being compiled online keeps the original sequence of sections and chapters.