A statue of Charaka, the sage who wrote one of the principal early Ayurveda texts. Photo: Alokprasad/Wikimedia Commons, CC BY SA 3.0
- A proposal by the National Medical Commission to replace the current physician’s oath with the “Charak Shapath” has elicited sharp and widespread dismay.
- The voices that seek to dismiss traditional medicine find fertile ground here, because prima facie it appears like another attempt to hijack a secular tradition to suit a Hindutva narrative.
- But while the context in which the lines appear in the original text may no longer resonate with us today, their intent and purpose can have universal appeal.
- We can imbibe the principles the Charaka Samhita understood to be applicable to those tasked with healing others – by codifying them in words suited to our present time.
The Hippocratic oath is a well-known part of medical training, symbolising the physician’s commitment to ethical practice that is also in the best interests of the patient. The original Greek text has been modified several times, and many medical institutions today follow a version called the ‘physician’s pledge’, published by the World Medical Association in 1948 and last amended in 2017.
The primary motive of all forms of oaths is to convey solemnity and the oath-taker’s depth of undertaking. Thus, the choice of words matters.
It was not surprising therefore that a proposal by the National Medical Commission, the government body tasked with regulating medical training in India, to completely replace the current oath with the “Charak Shapath” elicited sharp and widespread dismay.
This is because, as published, parts of the “shapath”, or oath, are quite discordant not only with current medical practice but also our idea of equality. It explicitly calls for the worship of cows and ‘brahmanas’, for example, and generically denies treatment to women if their marital partners or guardians are not in attendance.
The voices that seek to dismiss traditional medicine find easy and fertile ground here, because prima facie it appears like yet another attempt to hijack a secular tradition to suit a nationalistic, Hindutva narrative.
To a person unfamiliar with traditional medicine, the linear extrapolation may very well be that anything coming from Ayurveda is irrelevant. But this is unfortunate. While the context in which the lines appear in the original text may no longer resonate with us today, their intent and purpose can have universal appeal.
Initiating students
The “Charak Shapath” is present in one of Ayurveda’s three major texts, or Samhitas. The Charaka Samhita weaves philosophy, medical instruction, drug preparation and dietetics together in its contents. In this it is unlike medical textbooks today, where nutrition, ethics and pharmacology are treated as separate subjects.
The proposal by the National Medical Commission takes passages from chapter 8 of a section of the Charaka Samhita called “Vimanasthana”. This chapter begins with the attributes of excellence required of a student as well as a teacher. It also details how a student should be initiated into the study of Ayurveda, called “Shishyopaneeya”, and what commitments the student must make. This appears to be standard practice and is reiterated in chapter 2, “Sutrasthana”, of the Sushrutha Samhita, another of the three Samhitas.
When Ayurveda was codified, the gurukul system of education was the norm, and here, students began with a ritual of Vedic origin, with ghee-laced oblations and the recital of mantras. Fire in this context is understood to be a symbol of purity and the emphasis on cows denotes truth, among other things. Similarly, the ‘brahmana’ is respected as someone who pursues knowledge.
In its original historical context, the initiation ceremony was designed to prepare students mentally: to let go of their ego, greed, passion and anger, and to embrace a path of learning that is free of any biases. The ceremony also goes on to exhort students to be inquisitive and open to knowledge from any source, even an ‘enemy’.
The Samhitas reflect the social and cultural practices of their times, so clearly not everything they say will be applicable today. This is not peculiar to Ayurveda alone. The original Hippocratic oath instructed physicians to not help women have an abortion, for example. Only subsequent adaptations dropped it.
Why is knowledge of the Samhitas important in this context?
First, it might be worthwhile to adapt the intention behind the passages in classical texts, rather than pushing for them to be accepted verbatim. The current version of the “Charak Shapath” is not only a disservice to the wisdom in the Samhitas but also makes it too easy to dismiss traditional medicine as pseudoscientific.
For example, the term ‘brahmana’ was originally not a label of caste but of learnedness, and marked a person who doggedly pursued the ultimate truth. But today it has been reduced to denote the caste of Brahmins, and is justifiably associated with ideas of caste superiority, discrimination and oppression. For this reason, placing it in the oath can be interpreted as an endorsement for caste, which is far from the intention of the Samhitas.
In the same breadth, however, there are parts of “Charak Shapath” that are sensible. One is the injunction to a physician to work without pride and distraction, with complete dedication, and with full awareness of a patient’s condition as well as treatment.
Chapter 9 of the Charaka Samhita also lists the four qualities of a good physician: excellence in theory, extensive practical experience, dexterity and cleanliness (both physical and mental). Further along, it confers the term “vaidya” upon anyone who showers happiness on all living beings.
Imbibe the principles
For our world today, these characteristics are certainly more pertinent than the worship of ‘brahmana’ and cows.
Second, it’s important to not attribute Samhita passages to a single author because there is as yet no consensus if the Samhitas were compiled by an individual – Charaka, Sushrutha and Vagabhat – or by a school bearing their name. No doubt these were the names of individual scholars, but reserving credit for the passages to a single person is not justified.
Also of note, the classics don’t call any set of passages the “Charak Shapath”; such a partitioning is a modern construct.
Third, apart from the social and the textual contexts, the use of a quote from the classics could overlook issues of language. The classics are in Sanskrit, which is no longer a spoken language in India. If narrated in the original, most people will not understand the meaning. If they are translated, we will have to rely on the scholarship of an interpreter. They may or may not be biased, but even scholars trained to study a common language may produce different translations, as we have seen with the Ramayana and the Mahabharata.
This is an important concern because the same word in Sanskrit can have different meanings based on the context of its use. Consider the Sanskrit word ‘vata’, which many Sanskrit-English dictionaries interpret to mean ‘air’. But this is one possible meaning of vata. In Ayurveda, however, vata is to be understood as a physiological entity, responsible for any movement or stimulus and covering a wide spectrum of phenotypes.
The purpose of an oath is for the oath-taker to reflect, internalise and apply a set of generalised tenets to their practice. That won’t be possible if the words belong to a different time, and by themselves make little sense, or if they are the products of an incomplete translation.
Instead, we can imbibe the principles that the Samhita understood to be applicable to those tasked with healing others – especially by codifying them in words that are suited to our present time. It is also not fair to expect less from a country with a history as rich with philosophical teachings and diverse probes of the human condition as that of India.
Megha is with the Centre for Ayurveda Biology and Holistic Nutrition, TDU, Bengaluru. Prasan Shankar is from the Healthcare Centre, Institute of Ayurveda and Integrative Medicine, Bengaluru.