Ayurvedic Philosophy, Theory...
Ugra Karma: End of Life Ethical Considerations
Suddha Ayurveda:The Lineage of the Bhagavata Kavirajas
Vikriti Vijnana: Ayurvedic Pathology
by Kj. Nimai Nitai Das
Sooner or later, every Ayurvedic preceptor and practitioner must answer inevitable queries from a student or patient regarding extreme medical interventions. Although I have responded often to such questions over two decades of instruction and practice, a recent inquiry from an allopathic medical student has triggered a deeper examination of the ontological and moral underpinnings that inform Ayurvedic ethics.
An Indian student currently in the midst of a rotation as part of her residency in organ transplantation at a leading medical school in Boston recently participated in “harvesting” a working heart from a 12-year-old boy in a persistent and irreversible vegetative state. Her questions were both sober and sobering:
“Does the removal of the live heart constitute hatya (killing, slaying)? What is the Ayurvedic perspective on donating organs after death? What are the implications for
the jiva (soul) upon leaving the body, if one or more organs are transplanted and the rest of the body is cremated?
“What are the implications for organ recipients? If the body is so ill that vital organs are beyond repair, should we accept that as an indication to forego the transplant and simply prepare for death?”
The traditional Vedic understanding is that the jiva (soul) resides in the heart (Prasna Upanishad 3.6, Brhad Aranyaka Upanishad 4.3.7). When the jiva departs the heart, that is the actual moment of physical death. There is no mention in the sastra of any other measure or standard for ascertaining physical death (Chandogya Upanishad 6.11.3). So, if the heart is beating, one must conclude that the jiva is animating the body, and harvesting the organ is considered hatya, killing.
Donating organs after death does not involve killing the patient, but does present other problems. The jiva (except in the case of divine personalities, such as paramahamsa sannyasis) is attached to its physical frame, and will hover and linger over it while in a recognizable form, even after physical death. Therefore, cremation is meant to accelerate the process of disintegration of the material form. As a rule, the skull is crushed during cremation, so that the incineration is complete, and the life force together with the senses (traditionally known as the pranas), are properly released. Thus, those who are attached to embodied life should not donate their organs, as their sukshma and karana shariras (subtle and causal bodies) may transfer such attachment to the physical body of the recipient. Conversely, for these same reasons, anyone receiving organ donations is subject to the influence of the donor’s sukshma and karana shariras.
Important as these specific considerations are, the central issue raised by these questions is how much do we resist the natural processes of aging, decay, and death? When do we accept the inevitable? The sastra say clearly, “One who has taken his birth is sure to die.” (Bhagavad-Gita) And that is certainly the uncontroverted experience of all embodied beings throughout history. We do not and cannot “save lives;” we only postpone death –but at what personal and social cost?
Organ transplantation is but one of the medical procedures that unquestionably fall in the category that Srila Bhakti Vinoda Thakura has labeled “extraordinary endeavors to keep body and soul together.” Not only do they constitute bhukti (attachment to and gratification of the physical and subtle bodies), but also should be avoided as ugra karma, a term defined as “difficult action with limited rewards.”
End of Life
The death process follows the following general pattern, although some stages can be abbreviated to the point of imperceptibility, while others can be extended considerably. In the terminally ill, prana (life force) becomes debilitated and begins to withdraw from the sthula sharira (physical body). In most patients, this gradual retreat of prana is accomplished in an orderly fashion, with the life force withdrawing in set ways: from the periphery to the center; from less vital to more vital organs; and from the lower torso towards the head. Once prana has retreated from the physical body, the karmendriyas (faculties of action) are inoperative. The second stage consists of the withdrawal of prana into the sukshma sharira, consisting of mind, intelligence, and ego. When prana retreats from the jnanendriyas (faculties of perception), the patient loses awareness of the external environment and sinks into unconsciousness.
In the third stage, prana withdraws into the karana sharira (causal body, consisting of ahankara). Because the sukshma sharira is incapable of exerting its organizing influence over the physical body through the medium of prana, the four elemental states of matter begin to disintegrate. (The fifth state, ether or space, is the field in which the other four states manifest, and thus cannot disintegrate, having no parts.)
Dhatus (bodily tissues) in the solid state lose cohesion, and the patient experiences a corresponding loss of body consciousness. Then the dhatus in the liquid state disperse, causing the mucous membranes to desiccate. As the dhatus in the radiant state disintegrate, the body loses warmth, and rigor starts to set in. Finally, the dhatus in the gaseous state dissolve, and the patient expires. It is at this point that the jiva leaves the heart, and is carried away with the sukshma sharira.
Ayurvedic practitioners aware of this orderly process can be immensely helpful to patients and their families, assuaging their fears and reassuring them of the immortality of the jiva, even in the midst of this experience. Chanting the Lord’s Names, recitation of prayers, scriptural readings, and the performance of other religious rites (according to the faith of the patient), are highly recommended, and constitute an integral part of Ayurvedic care of terminal patients.
Of course, palliative measures can and should be employed whenever possible to mitigate pain and suffering, but the clouding of consciousness through the use of excessive anodyne therapy should be avoided, as a conscious exit from this plane is beneficial for spiritual evolution. Death should be approached as sadhana (spiritual practice) by patients, relatives, and the Ayurvedic practitioner.
Prolongation of Life
Ayurveda classifies disease as either sadhya (remediable) or asadhya (irremediable). Among irremediable diseases, some are yapya (chronic but manageable, such as diabetes), and others are pratyakheya (terminal, such as metastasized cancer). In terminal conditions, Ayurveda considers that only palliative measures are indicated.
DNR Orders
Ayurvedic practitioners accept the natural rhythm of life and death, and do not engage in ugra karma to prolong life (suffering) at great effort and expense. An informed patient with a terminal condition should discuss his or her preferences, and make legal provisions to insure that they will be respected. If the patient has given an explicit Do-Not-Resuscitate order, it is the duty of the Ayurvedic practitioner to assist in its observance.
Removal of Life Support
According to Vedic principles, removal of life support systems is justified when the assistive device is the major impediment to the death process. Ayurveda also allows for suspension of hydration and nourishment at the request of a terminally ill patient who chooses to fast, even if such fasting will accelerate death. Prayopavesha, voluntary fasting unto death for those who are terminally ill, is to be undertaken only under the authority and with the blessings of senior members of the patient’s faith.
Assisted Suicide
Ayurvedic ethics do not condone so-called assisted suicide, deliberately causing the death of a patient at his/her request by any lethal means. If requested by the patient, Ayurvedic practitioners may describe —but not actively recommend— prayopavesha (voluntary fasting unto death) as a viable means to abbreviate prolonged suffering.
Suicide
According to sastra, suicide postpones and intensifies karma. However, as stated above, Ayurvedic ethics allow prayopavesha, voluntary death by fasting. The patient making such a decision must declare it publicly, to distinguish the act from suicide committed privately in traumatic emotional states of anguish and despair, and to allow for family and religious community intervention. Prayopavesha is allowed when the patient is unable to perform normal bodily purification, death appears imminent, and pain and suffering are extreme (such that mitigating them would entail loss of consciousness). Prayopavesha is gradual, and allows the patient to reflect and reconsider his/her decision. After due deliberation, voluntary fasting unto death should be undertaken as sadhana, with the support of a community of faith.
Autopsy, Dissection, Embalming
Invasive procedures performed on the physical body after death distress the departed jiva, unnecessarily postpone final disposition, and may affect family members negatively. For these reasons, Ayurveda understands that autopsies should be avoided unless required by law, and dissection of cadavers for the advancement of science is also discouraged. Embalming, or replacing the blood with a preservative fluid, is also contraindicated. In addition to the reasons mentioned above, embalming retards the decomposition of the physical body, promoting lingering attachment of the jiva for its deceased instrument.
Final Disposition
Cremation is the preferred system of disposing of cadavers, and should be performed within 24 hours of death. Due to the accelerated decomposition of the physical body accomplished by fire, cremation thoroughly releases the jiva from any lingering attachment to the physical instrument. Burial is not recommended, except for infant children and divine personalities.
I trust that the discussion of these principles and guidelines will assist all practitioners of Ayurveda to face these unavoidable ethical dilemmas with greater aplomb and certainty. Even those who do not share these Vedic perspectives may gain from the experience, as they will have had an opportunity to consider these issues before confronting them in clinical practice.
I pray that our patients will be better served. For, in the words of Acharya Charaka: “Those who practice Ayurveda while holding compassion for all creatures as the highest duty have fulfilled their mission. They obtain supreme happiness.”
Kj. Nimai Nitai Das (formerly writing for this journal as Murari Chaitanya dasa) is a Preceptor in the Suddha Ayurveda Vidyalaya, and an Asst. Clinical Professor of Family Medicine & Community Health at Tufts University School of Medicine. He can be reached at PositiveAyurveda@comcast.net
Suddha Ayurveda: The Lineage of the Bhagavata Kavirajas
by Kj. Murari Caitanya-dasa, ND, MPH
sreyas ca preyas ca manusyameta-
stau samparitya vivinakti dhirah
sreya hi dhiro'bhipreyaso vrnite
preyo mando yogaksemad vrnite
Translation: "We can accept either that which is immediately appealing (preyas) or that which is permanently beneficial (sreyas). The wise, after careful consideration, accept that which is enduringly salutary, whereas those whose judgement is poor prefer fleeting gain and pleasure. (Katha Upanisad 1.2.2) "
Preyas is that which is pleasant to the senses and instantly agreeable to the mind, but the enjoyable satisfies only our lower nature and does not lead ultimately to our eternal welfare. Sreyas is that which leads to our ultimate good, even if it is momentarily unpleasant and difficult for the mind to accept. In the following pages we will discuss some essential principles of Ayurveda, holding firmly to sreyas.
We humbly beg the forgiveness of any reader who feels disturbed or offended by our words, as it is our intention to do neither. We are interested solely in promoting a more appropriate understanding of Ayurveda, and not in securing profit or cultivating a following. We might note here that both would be achieved with greater ease by catering to the deceptive distortions that abound in today's Ayurvedic marketplace. Our practice of Ayurveda has been provided without charge for the past fourteen years, and we neither sell nor endorse products for profit. We are simply attempting to obey the order of our Preceptor, Jagad Guru Svami Bhakti Gaurava Narasingha Maharaja, who has instructed:
"ayurvedena bhakta-sevanam kuru
ayurvedena abhaktebhyo pracaranam kuru"
Translation: "Serve the bhakti yogis and edify the non-devotees through Ayurveda."
In observing this concise injunction on the internal purpose of Ayurveda, we are striving to present in clear terms the confidential teachings of the Bhagavata lineage, which is known as Suddha (Pure) Ayurveda. According to the Bhagavata kavirajas (Suddha practitioners), the ultimate goal of Ayurveda is not to preserve or restore health, but rather to facilitate bhakti yoga sadhana, the discipline of spiritual cultivation.
om namoh bhagavate dhanvantaraye
To order complete article, "Suddha Ayurveda" Volume one, Issue One, Fall 2002)
Kj.Nimai Nitai Das a is Sevaite-Preceptor in the Suddha Ayurveda Vidyalaya, which follows the traditional Tola system of Vedic education. He resides in the Guardian Sevaite Ashram in Boston, MA, where he is an ordained priest in the Bhagavata lineage. He is Assistant Clinical Professor of Family Medicine and Community Health at Tufts University School of Medicine. Email
Vikrti Vijnana
(A Traditional Exposition of Pathology in Suddha Ayurveda)
by Kj. Nimai Nitai Das
After submitting a number of discursive articles for Light on Ayurveda Journal, the author desires to introduce the esteemed readers to the traditional pedagogical methodology of the Bhagavata lineage of Suddha Ayurveda.
The following sutras constitute an exploration of the doctrine of pathology (vikrti vijnana) in Suddha Ayurveda. Sutras (aphorisms) are concise statements that elucidate complex subject matters. Because they often require extensive commentary to facilitate understanding, aphoristic texts have fallen into disuse in the West, particularly in scientific exposition.
However, traditional Vedic pedagogy continues to utilize this time-tested approach, as it serves as a mnemonic device for both instructors and students engaged in the act of learning. Aphorisms also facilitate the transmission of knowledge in disciplic succession, and promote uniformity in practice among adherents of a particular school.
In one hundred eighty (180) sutras is condensed the essential knowledge of pathology. Although voluminous commentary might be required to “spell out” the concepts set forth in these aphorisms, the experienced Ayurvedic practitioner should readily recognize that all essential aspects of pathology have been addressed with clarity and precision. These sutras will be presented over the next three issues.
Sanskrit Ayurvedic terminology is utilized throughout, always defined in parenthesis after the initial use of each term (with the exception of commonly used terms, such as dosa, vata, pitta, kapha, etc.). Sanskrit terms are used for the sake of precision, as western equivalents are still in flux, and may be misinterpreted. The transliteration scheme is based on ITRANS, but without diacritics, to facilitate printing.
Vikrti Vijnana (from the Suddha Ayurveda Sutra)
1. All glories to Bhagavan Sri Krsna Caitanya, the Supreme Absolute, Who guides us through suffering to the understanding of our constitutional position as eternal servitors in the spiritual world, and Who gives us the knowledge by which we understand the origin and nature of our suffering.
2. Dosa, dhatu, and mala have normal standards in respect of pramana (quantity), guna (qualities), and karma (functions).
3. Normalcy, known as prakrti or samya, is unstable.
4. When pramana, guna, and karma undergo changes, prakrti becomes vikrti, or vaisamya (anomalous).
5. Samya confers svasthya (health), while vaisamya gives rise to asvasthya (illness) and roga (disease).
6. Prakrti vijnana (physiology) is the study of samya (normalcy), while vikrti vijnana (pathology) is the study of vaisamya (anomaly).
7. Without knowledge of the normal, knowledge of the abnormal is both irrelevant and misleading.
8. Vikrti vijnana is based on the understanding of the texts and the practical observation of the patient, and is broadly divided into sarvaroga and pratiroga samprapti vijnana.
9. Sarvaroga samprapti vijnana (general pathology) consists of knowledge of nidana (causes), samprapti (evolution), purvarupa (premonitory symptoms), rupa (symptoms), and upasaya (diagnostic tests) as applicable commonly to all disease states. These are known as nidana pancaka, the five means of diagnosis.
10. Pratiroga samprapti vijnana (specific pathology) consists of knowledge of anomalous changes in the dosa, dhatu, and mala, which are characteristic of specific disease states.
11. Shuddha Ayurveda relies principally on general pathology, as it ordinarily provides sufficient information to institute an effective line of treatment.
12. Nidana pancaka are useful in the diagnosis of all diseases, whether individually or collectively.
13. Certain definite causes (nidana) are known to produce certain specific effects. Therefore, if the patient reveals the existence of such causes, the vaidya may diagnose the disease.
14. Premonitory symptoms (purvarupa) are recognized by the experienced vaidya as indicative of a disease yet to develop.
15. Clinical symptoms (rupa) are the characteristic signs and features of disease and can be detected by inspection.
16. When the rupa are unclear, exploratory diagnostic tests (upasaya) assist the vaidya in identifying the disorder.
17. Finally, observation of the various anomalous changes that take place in the dosa, dhatu, and mala during the course of disease (samprapti) allow the vaidya to arrive at a definite diagnosis.
18. Nidana is used in Ayurveda in the sense of karana (cause) of disease, and is based on karana karya siddhanta (doctrine of cause and effect).
19. Karana is of three kinds, namely, samavayi (inherent, inseparable, and material cause), asamavayi (non-inherent, separable cause), and nimitta (instrumental cause).
20. Samavayi karana is that material cause which is inherent in the effect, and whose destruction leads invariably to the destruction of the effect, eg, the destruction of the wood in a table will invariably lead to the destruction of the table.
21. Asamavayi karana is that cause which may be either in the effect or apart from it, and whose destruction will not lead to destruction of the effect, but rather may bring about changes in it, eg, the dismantling of component parts of a table does not destroy the table, but changes its function.
22. Nimitta karana is that cause which exists apart from the effect, and whose destruction does not lead to the destruction of the effect. For example, the destruction of the hammer used to build a table does not destroy the table, but may affect our capacity to build another table.
23. Nimitta karana is subdivided into pradhana (efficient), and sahakari (contributing) eg, the carpenter is the efficient cause, and the hammer is the contributing cause of the table.
24. In Ayurveda, the dhatu are the samavayi karana (inherent cause) of the disease.
25. The union of anomalous dosa and dhatu is the asamavayi karana (separable cause).
26. The dosa are the instrumental efficient cause, and the aggravating substances and activities that derange dosa are the instrumental contributing causes.
27. Shuddha Ayurveda attaches greater importance to sahakari karana and describes them in detail as the causes of disease.
28. Sahakari karana are described under three broad divisions, namely, karma (physical, vocal, and mental activities), artha (activities of the sense organs), and kala (the vagaries of time and season).
29. These three, in samyoga (proper proportion), maintain health, whereas in mithya yoga (improper proportion), they cause disease.
30. Improper physical, vocal, and mental activity is the result of prajnaparadha (volitional transgression).
31. Improper sensory activity is the result of asatmya indriyartha, or unsuitable contact of sense organs with their objects.
32. The changes that take place in the external environment during the various times of day and seasons of the year are known as parinama.
33. Each of these three karana has three vikalpa (subdivisions), namely, atiyoga (excessive), hinayoga (inadequate), and mithyayoga (improper) aspects.
34. Prajna means correct knowledge, while aparadha means transgression or offense. Prajnaparadha is therefore defined as improper behavior due to incorrect knowledge, or volitional transgression of right conduct.
35. Prajnaparadha is caused by loss of dhi (discrimination), dhrti (conviction), and smrti (memory).
36. When rajoguna and tamoguna influence manas (mind), prajnaparadha ensues.
37. Human activities are categorized as kayaka (physical), vacika (vocal), and manasika (mental). Prajnaparadha is thus of three kinds.
38. Kayaka prajnaparadha is described as atiyoga when engaging in excessive exercise or sexual activity.
39. It is described as hinayoga when too little or no physical activity is performed.
40. It is described as mithyayoga when engaging in suppression or premature initiation of urges, improper yoga postures, activities that endanger life, and activities that debilitate.
41. Vacika prajnaparadha is described as atiyoga when indulging in excessive speaking or speaking for extended periods of time.
42. It is described as hinayoga when speaking very little or observing silence for extended periods of time.
43. It is described as mithyayoga when speech is untrue, untimely, quarrelsome, harsh, irrelevant, impolite, or abusive.
44. Manasika prajnaparadha is described as atiyoga when indulging excessively in thinking, calculating, and other mental activities over long periods of time.
45. It is described as hinayoga when making little or no use of the mental faculties.
46. It is described as mithyayoga when indulging in emotions such as fear, grief, anger, greed, jealousy, lust, or finding fault with others.
47. Asatmya indriyartha samyoga refers to improper or unaccustomed contact between the five organs of perception and their sense objects.
48. These improper contacts may be accidental, inevitable, or intentional, and have deleterious effects on the sense organs themselves, the mind, and the body.
49. Improper contact between caksurindriya (eye) and rupa (sight) is described as atiyoga when seeing very bright light or contemplating objects for extended periods.
50. It is described as hinayoga when remaining in dim light or darkness, or seeing objects dimly or not at all.
51. It is described as mithyayoga when seeing objects that are too near or too far, and sights that are inspiring fear, fearful, terrifying, unprecedented, annoying, emotional, or abnormal.
52. Improper contact between srotrendriya (ear) and sabda (sound) is described as atiyoga when hearing very loud or very high-pitched sounds for extended periods.
53. It is described as hinayoga when hearing little or no sound at all.
54. It is described as mithyayoga when hearing abusive language, insults, terrifying words, words describing great loss, news of accidents, murder, theft, and the like.
55. Improper contact between ghranendriya (nose) and gandha (smell) is described as atiyoga when smelling substances that are highly pungent, malodorous, or intoxicating for extended periods.
56. It is described as hinayoga when using the olfactory sense little or not at all.
57. It is described as mithyayoga when smelling substances that are putrid, intensely disliked, unpleasant to the mind, decomposed, poisonous, or cadaveric.
58. Improper contact between rasanendriya (tongue) and rasa (taste) is described as atiyoga when tasting any of the six tastes for extended periods.
59. It is described as hinayoga when using the sense of taste very little or not at all.
60. It is described as mithyayoga when indulging in overeating, undereating, eating incompatible foods, and transgressing the rules of eating.
61. Improper contact between sparsanendriya (skin) and sparsa (touch) is described as atiyoga when coming in contact with substances that are very hot or very cold, or indulging in bathing, oleation, or massage for extended periods.
62. It is described as hinayoga when refraining from bathing and touching.
63. It is described as mithyayoga when indulging in improper bathing, improper dress and posture, trauma, contact with unclean objects, and contact with pathogens.
64. Bhutasparsa (contact with pathogens) is also termed bhutabhisanga, and includes contact with both mahat (large) and ksudra (minute) living beings.
65. Contact with mahat prani is occasional and preventable, while contact with ksudra prani is constant and unpreventable.
66. Even though Ayurveda recognizes the existence of minute pathogens, these are not considered potent causes of disease, as they can not produce disease independently.
67. The dosa, dhatu, and mala possess specific bala (strength), which gives them the capacity to resist and prevent disease, even in the presence of pathogens.
68.These two capacities are termed vyadhi ksamatva (resistance) and vyadhibala virodhitva (counteraction).
69. Parinama is the third and last cause of disease, and literally means change or transformation. Kala (time) is thus called anavasthita (unsteady) and nitya (eternal).
70. Ayurveda classifies kala into bahya (external) and abhyantara (internal) time. The former refers to the time of day, week, month, and seasons, while the latter refers to the different stages of life, of disease, and of administration of remedies.
71. Improper passage of time is described as atiyoga when the normal features of a particular time or season are excessive.
72. It is described as hinayoga when the normal features of a particular time or season are diminished or not apparent.
73. It is described as mithyayoga when the features of a different period or season appear out of the expected time. Periods or seasons exhibiting abnormal features are known as vyapanna rtu (diseased season).
74. Abnormal conditions of the three karana are due to adharma (improper conduct), either vaiyuktita (individual) or samajika (collective).
75. Vaiyuktita adharma is of two kinds, drsta (concerning this life), and adrsta (concerning previous lives). Both, either alone or in combination, produce diseases that may be of three types, namely, drstapacaraja (caused by improper conduct in this life), purvaparadhaja (caused by improper conduct in previous lives), and sankaraja (caused by a combination of both).Editor’s note: These sutras were composed by the author who has drawn on the oral teachings of the Suddha Ayurveda tradition. In this tradition, every kaiviraga (poet) composes his own text to convey the teachings.
Kj. Nimai Nitai Das (formerly writing for this journal as Murari Chaitanya dasa) is a Preceptor in the Suddha Ayurveda Vidyalaya, and an Asst. Clinical Professor of Family Medicine and Community Health at Tufts University School of Medicine.
Contact at: PositiveAyurveda@comcast.net
Editor's Note: The remaining 105 sutras are available as a reprint.
