Exploring Death and Dying in Ancient Sanskrit Texts: A Historical Perspective | Study notes Medicine

DEATH AND DYING IN THE UPANISADS,

BHAGAVAD-GITA AND CARAKA SAMHITA

Claire Hilton

Introduction

Death, dying and immortality appear at the

interface of medical, cultural and religious

teaching in many cultures and over thousands of

years. Chinese medicine advocated yangsheng

(life nurturing), and the desire for immortality was

documented during the Han dynasty (206 BCE –

220 CE).1 Galen (129-c216CE) wrote on both

medical aspects of long life and philosophical

ideas of creation and soul,2 whilst medical ethics

today in western cultures not infrequently links to

religious beliefs of Christianity and Judaism

originating over two millennia ago. This essay

explores death and dying in ancient Sanskrit

religious and medical texts.

The texts

The Upaniṣads are part of the divinely inspired

Vedic Sanskrit scriptures. The earliest have been

dated to around the eighth century BCE. The

spiritual content largely focuses on Brahma – the

divine source of the universe, ātman – the soul

which never dies, karma – action influencing life

and reincarnation (rebirth), and mokṣa – the path

to ultimate salvation and liberation from the

reincarnation cycle. There are various canons of

Upaniṣads. The oldest ten are often referred to as

the principal Upaniṣads, whilst the Muktika

Upaniṣad Canon lists 108. The

http://www.astrojyoti.com/Upaniṣadspage.htm

translation of the Muktika Canon3 has been used

in this essay, along with Juan Mascaró’s4

translations, checking both whenever possible.

1Paul Unschuld Medicine in China: A history of ideas

(Berkeley: University of California Press, 1985) p 109-

112

2PN Singer Galen: selected works (Oxford: Oxford

University Press, 1997)

3http://www.astrojyoti.com/Upaniṣadspage.htm

Muktika Upaniṣad Canon accessed 16 Jan.07

4Juan Mascaró (tr.) The Upaniṣads: translations from

the Sanskrit with an introduction (London: Penguin

Classics, 1965) p 7

The Bhagavad-Gita5 (Song of the Lord), a

conversation between the god Krishna and the

warrior Arjuna on the eve of the Kurukṣetra war,

is the sixth book of the epic Sanskrit poem the

Mahābhārata. It is a philosophical and ethical

work expressing many new ideas discussed in the

context of Arjuna’s reservations about the

forthcoming battle. The date of composition has

not been clearly ascertained, although it is likely

to have been between 200BCE and 200CE, with

some revisions later.6

The Caraka Saṃhitā7 (Caraka’s Compendium) is

the earliest specific ayurvedic medical text. Some

evidence points to Caraka having been a physician

to King Kaniṣka (second century CE). Caraka

states that he is recording the teaching of Ātreya

to his pupil Agniveśa, physicians now lost in

legend. The text was further edited and added to

by Dṛḍhabala probably around the fifth century

CE.8 Like classical Greek medical authors, Caraka

included theological and philosophical discussion

alongside medical advice.

There were strong traditions of oral transmission

for both medicine and religious teachings in

India.9 Medicine was said to have originated with

Brahma, the creator, indicating both its divine

nature and ancient roots.10 Although the Upaniṣad

and Bhagavad-Gita texts appear chronologically

before the Caraka Saṃhitā, because of oral

transmission it should not be deduced that medical

practices are based on these earlier philosophical

texts.

The Caraka Saṃhitā mentions various concepts

relating to life and death, whilst referring to the

collections of prayers and hymns in the four

Vedas as the ‘authoritative scriptures’ for

information on spiritual well-being.11 It would not

5Juan Mascaró (tr.) The Bhagavad Gita; translated

from the Sanskrit with an introduction (London:

Penguin Classics, 1962)

6Anna L Dallapiccola, Dictionary of Hindu Lore and

Legend (London: Thames and Hudson, 2002) p 37

7The text of the Caraka Saṃhitā used in this essay is

Caraka-Saṃhitā tr. Priya Vrat Sharma (Varanasi:

Chaukhambha Orientalia, 2000-2001), unless stated

otherwise.

8 Dominik Wujastyk The Roots of Ayurveda (London:

Penguin Classics, 2003) p 3-4

9Wujastyk Roots of Ayurveda p 8-9

10Caraka Saṃhitā, Sūtrasthāna Ch I v 4-5

11Caraka Saṃhitā, Sūtrasthāna Ch XI v 27

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DEATH AND DYING IN THE UPANISADS,

BHAGAVAD-GITA AND CARAKA SAMHITA

Claire Hilton Introduction Death, dying and immortality appear at the interface of medical, cultural and religious teaching in many cultures and over thousands of years. Chinese medicine advocated yangsheng (life nurturing), and the desire for immortality was documented during the Han dynasty (206 BCE – 220 CE). Galen (129-c216CE) wrote on both medical aspects of long life and philosophical ideas of creation and soul,^2 whilst medical ethics today in western cultures not infrequently links to religious beliefs of Christianity and Judaism originating over two millennia ago. This essay explores death and dying in ancient Sanskrit religious and medical texts. The texts The Upaniṣads are part of the divinely inspired Vedic Sanskrit scriptures. The earliest have been dated to around the eighth century BCE. The spiritual content largely focuses on Brahma – the divine source of the universe, ātman – the soul which never dies, karma – action influencing life and reincarnation (rebirth), and mokṣa – the path to ultimate salvation and liberation from the reincarnation cycle. There are various canons of Upaniṣads. The oldest ten are often referred to as the principal Upaniṣads, whilst the Muktika Upaniṣad Canon lists 108. The http://www.astrojyoti.com/Upaniṣadspage.htm translation of the Muktika Canon^3 has been used in this essay, along with Juan Mascaró’s^4 translations, checking both whenever possible. Paul Unschuld Medicine in China: A history of ideas (Berkeley: University of California Press, 1985) p 109- 112 PN Singer Galen: selected works (Oxford: Oxford University Press, 1997) http://www.astrojyoti.com/Upaniṣadspage.htm Muktika Upaniṣad Canon accessed 16 Jan. Juan Mascaró (tr.) The Upaniṣads: translations from the Sanskrit with an introduction (London: Penguin Classics, 1965) p 7 The Bhagavad-Gita^5 ( Song of the Lord ), a conversation between the god Krishna and the warrior Arjuna on the eve of the Kurukṣetra war, is the sixth book of the epic Sanskrit poem the Mahābhārata. It is a philosophical and ethical work expressing many new ideas discussed in the context of Arjuna’s reservations about the forthcoming battle. The date of composition has not been clearly ascertained, although it is likely to have been between 200BCE and 200CE, with some revisions later.^6 The Caraka Saṃhitā^7 ( Caraka’s Compendium ) is the earliest specific ayurvedic medical text. Some evidence points to Caraka having been a physician to King Kaniṣka (second century CE). Caraka states that he is recording the teaching of Ātreya to his pupil Agniveśa, physicians now lost in legend. The text was further edited and added to by Dṛḍhabala probably around the fifth century CE.^8 Like classical Greek medical authors, Caraka included theological and philosophical discussion alongside medical advice. There were strong traditions of oral transmission for both medicine and religious teachings in India.^9 Medicine was said to have originated with Brahma, the creator, indicating both its divine nature and ancient roots.^10 Although the Upaniṣad and Bhagavad-Gita texts appear chronologically before the Caraka Saṃhitā , because of oral transmission it should not be deduced that medical practices are based on these earlier philosophical texts. The Caraka Saṃhitā mentions various concepts relating to life and death, whilst referring to the collections of prayers and hymns in the four Vedas as the ‘authoritative scriptures’ for information on spiritual well-being.^11 It would not Juan Mascaró (tr.) The Bhagavad Gita; translated from the Sanskrit with an introduction (London: Penguin Classics, 1962) Anna L Dallapiccola, Dictionary of Hindu Lore and Legend (London: Thames and Hudson, 2002) p 37 The text of the Caraka Saṃhitā used in this essay is Caraka-Saṃhitā tr. Priya Vrat Sharma (Varanasi: Chaukhambha Orientalia, 2000-2001), unless stated otherwise. Dominik Wujastyk The Roots of Ayurveda (London: Penguin Classics, 2003) p 3- 4 Wujastyk Roots of Ayurveda p 8- 9 Caraka Saṃhitā, Sūtrasthāna Ch I v 4- 5 Caraka Saṃhitā , Sūtrasthāna Ch XI v 27

be expected that scriptural and medical texts would have identical objectives. Caraka states that the objectives of medicine are to encourage long life, reasonable wealth and a good rebirth,^12 whereas the goals of religious teaching are to ensure mokṣa. However, various themes relating to death and dying emerge from the texts, in particular, longevity, spiritual preparation for death, and the role of the physician ( vaidya) in the care of the dying. Longevity Attitudes to death can not be entirely divorced from expectations of longevity, although clearly many people did not live until old age. Early Sanskrit texts such as the Atharvaveda contain hymns or prayers to achieve longevity.^13 The term ayurveda itself means ‘knowledge of life’, not in the metaphysical sense but medically as enhancing length of life.^14 Caraka explores longevity medically, whilst acknowledging psychological and spiritual aspects, and the potential impediments caused by disease to the performance of religious observances.^15 In Śārīasthāna (relating to the body), Caraka describes the examination of the newborn for appearances and behaviours which are associated with longevity. Thus longevity rituals begin in infancy.^16 Although for Caraka, moderation is the key to longevity,^17 specific age-sustaining drugs are also listed in his pharmacopoeia.^18 This contrasts with religious texts. For example, the Athavaśiras Upaniṣad refers to a magical somapāna drink to achieve a state of deathlessness^19 20 and the Mahānārāyaṇa Upaniṣad requests divine protection, asking Death Caraka Saṃhitā, Sūtrasthāna Ch X1 v 3 A L Basham ‘The practice of medicine in ancient and mediaeval India’ p 18-43 In Asian medical Systems: a comparative study ed. Charles Leslie (Berkeley: University of California Press, 1977) p 19 Wujastyk Roots of Ayurveda p xvii Caraka Saṃhitā, Sūtrasthāna Ch I v 6- 7 Caraka Saṃhitā, Śārīrasthāna Ch VIII v 51 Caraka Saṃhitā, Sūtrasthāna Ch XI v 37 Caraka Saṃhitā, Cikitsāsthāna Ch 1 v 13- 26 Athavaśiras Upaniṣad tr. PR Ramachander www.astrojyoti.com Caraka appears to mention soma only briefly ( Cikitsāsthāna Ch I v 5, Ch IV v 15-21), although Suśruta includes it ‘to prevent senility and death’ Suśruta Saṃhitā tr. Priya Vrat Sharma (Varanasi: Do not cut off my life. Do not injure my interest. Do not cripple my strength….Do not hurt my progeny and life.^21 It also asks the divine Ashvin physicians to ‘chase away death from us by virtue of the power of religious work’,^22 introducing at least in medico- religious terms, the concept of physicians intervening to prolong life. The Bhagavad-Gita says little on longevity except for encouraging nutritious foods.^23 Longevity is also related to deeds done in the present life ( purusakāra ) and in previous lives, Caraka using the terms karma and daiva (fate) interchangeably.^24 Sufficient positive aspects of both are associated with a long and happy lifespan.^25 However, if lifespan was completely predetermined, there would be no need for ritual practices such as mantras, expiation and fasting to enhance it, nor would one need to take precautions such as avoiding poisonous reptiles, enemies or fierce animals.^26 Caraka makes an analogy with the axle of a vehicle: if properly used the vehicle gradually wears out, but if driven inappropriately, as one may misuse the body ( prajñā-aparādha , culpable insight or violations of good sense),^27 the axle may break in an untimely manner.^28 Medicine may be of benefit, although the effects of very bad karma may not be averted. Caraka states that old age starts at sixty years and goes on to a possible 100 years.^29 One hundred is also referred to as an ideal in the Īśā Upaniṣad^30 in Chaukhambha Visvabharati, 2000) Vol 2 Cikitsāsthāna XXIX p 539 Mahānārāyaṇa Upaniṣad tr. Swami Vimalananda www.astrojyoti.com 51 v 1 Mahānārāyaṇa Upaniṣad tr. Swami Vimalananda www.astrojyoti.com 48 v 1 Bhagavad-Gita tr. Mascaró 17. 8 Caraka Saṃhitā Śārīrasthāna Ch I v 116. Mitchell Weiss ‘ Caraka Saṃhitā on the doctrine of karma’ p 90-115 In Karma and rebirth in classical Indian traditions ed. Wendy Doniger Flaherty (Berkeley: University of California Press, 1980) p 90 Caraka Saṃhitā, Vimānasthāna Ch III v 36 Caraka Saṃhitā, Śārīrasthāna Ch VI v 28 Weiss ‘Doctrine of karma’ p 90- 115 Caraka Saṃhitā, Vimānasthāna Ch III v 38 Caraka Saṃhitā, Vimānasthāna Ch VIII v 122 Īśā Upaniṣad tr. Mascaró p 49

death appear harder to comprehend, such as a discussion on the spiritual merits of Varanasi The most corrupt man or woman will attain moksha, if he or she dies at Banares [Varanasi]. Other sinners will be fried in burning pits of live coals after death.^53 In summary, the scriptural texts imply that a successful death requires knowledge of the impending event, with preparation to allow a peaceful and tranquil death, and the appropriate rituals to ensure best passage of the transmigrating soul.^54 55 We need to see if the medical approach is compatible with this. The physican’s role The vaidya is advised on an extensive physical examination for signs suggesting death in the foreseeable future. This examination would include complexion, voice, palpation, sense organs, shadow, lustre, together with psychological symptoms such as the patient talking feebly about his own death, suffering hallucinations^56 or other signs of delirium,^57 or changes in the environment such as in the patient’s residence.^58 The list of bodily signs to be examined to determine prognosis amounts to many pages which can not all be listed here. However, they are often very precise and specific such as lips being ‘blue like jamun fruits’,^59 or changes in the tone of voice appearing for the first time to resemble that of a sheep or goat, ‘feeble, subdued, indistinct, choked, faint, poor and stammering’.^60 The specific duration between observing the sign until the occurrence of death varies between signs, some predicting death within a year,^61 others predicting imminent death.^62 The ability of the vaidya to observe and Bhasma-Jābāla Upaniṣad (translator not stated) www.astrojyoti.com Kaṭha Upaniṣad Part 3 tr. Mascaró p 61 Bṛhadrāṇyaka Upaniṣad tr. Swami Madhavananda www.astajyoti.com Ch 1 v. 17 Caraka Saṃhitā, Indriyasthāna Ch X v 14- 17 Caraka Saṃhitā, Indriyasthāna Ch X1 v 20- 21 Caraka Saṃhitā, Indriyasthāna Ch 1 v 3 Caraka Saṃhitā, Indriyasthāna Ch 1 v 18- 26 Caraka Saṃhitā, Indriyasthāna Ch 1 v 15 Caraka Saṃhitā, Indriyasthāna Ch II v 8- 16 Caraka Saṃhitā, Indriyasthāna Ch X v 1 analyse the meaning of such signs implies considerable knowledge and skill. The image of imminent death of the emaciated, wasted, cyanotic (blue), feeble dependent person, possibly delirious, with changes in pattern of respiration is also clearly conveyed in various parts of Indriyasthāna. In a moribund patient, Caraka talks of the physical changes in the body at the time of the departure of the ātman ,^63 overlapping with the understanding of the atma in scriptural texts. Similarly, spiritual texts such as the Upaniṣads do not shy away from a physical description of dying, although this is far less detailed than in the medical text.^64 The medical-spiritual interface is again reflected here. In the Caraka Saṃhitā the dying person is referred to as flowered, explained in the relationship and inevitable cycle of flower to fruit and seed, but also flowered in the context of a change in bodily smell.^65 A similar metaphor is found in the Upaniṣads: as a fruit ‘is loosened from its stem, so the spirit of man is loosened from the human body and returns by the same way to life, wherefrom he came’.^66 Caraka looks for auspicious signs, especially when the messenger is sent to him – the time of day, the date, the constellation, earthquakes, solar or lunar eclipses. Auspicious signs are also sought by the physician on his way to assess the patient and in the patient’s home: talk with pleased gods, a clean tank, unclean objects, subduing enemies and many more.^67 Perhaps this reflects the earlier origins of medical practices in the Atharvaveda where supernatural causes and magical treatments for disease were evident.^68 In addition it appears that many of the inauspicious features especially related to the messenger sent to the physician may reflect on the Caraka Saṃhitā, Indriyasthāna Ch XII v 43- 61 ‘The supreme teaching’ in Upaniṣads tr. Mascaró p 139 Caraka Saṃhitā, Indriyasthāna Ch II v 8- 16 ‘The supreme teaching’ in Upaniṣads tr. Mascaró p 138 and Rambachan ‘Hindu way of death’ p 640 Caraka Saṃhitā, Indriyasthāna Ch X11 v 67- 88 Basham ‘Practice of medicine’ p 19 Dominik Wujastyk ‘Medicine in India’ p 19-37 In Oriental Medicine: an illustrated guide to the Asian arts of healing ed. Jan Van Alpen and Anthony Aris (London: Serindia Publications, 1995) p 20

degree of distress shown by the messenger,^70 and possibly therefore the gravity of the situation. The need for spiritual preparation for a good death does not appear to fit precisely with the practices recommended by Caraka. An example concerns giving information on the likelihood of death The physician, though observing the signs of death, should not disclose the approaching death without having been requested for. Even on request, he should not express it if it is liable to cause the patient’s death or affliction to somebody else.^71 This may conflict with the vaidya ’s oath of initiation in which he agrees always to tell the truth,^72 although the concept of dharma (responsibility) is such that certain apparent obligations may have varying implications in differing circumstances (Personal communication, Dominik Wujastyk, 2007) Telling less than the full truth for the patient’s benefit appears in other ayurvedic teaching, such as the instruction to therapeutically give owl meat, generally considered unpalatable, but telling the patient that it is peacock.^73 There is clearly an implication to do no harm, as in Hippocratic teaching. However, in the society in which these texts were written, not knowing of impending death may have impaired a person’s preparation for achieving moksha, therefore causing spiritual harm. Within Caraka’s Indriyasthāna (diagnosis and prognosis) text, specific groups of symptoms are mentioned indicating that the physician should withdraw from treating the patient, such as the combination of ‘vomiting after a meal, indigestion, galloping debility, excessive thirst and cardiac pain’.^74 It is made very explicit that Caraka Saṃhitā, Indriyasthāna Ch X11 v 9- 24 Caraka Saṃhitā, Indriyasthāna Ch XII v 62- 64 Caraka Saṃhitā, Vimānasthāna Ch VIII v 13 Caraka Saṃhitā, Cikitsitasthāna Ch VIII v 147 Caraka Saṃhitā tr. A Chandra Kaviratna and P Sharma 2 nd^ revised and enlarged edition (Delhi: SRI Satguru Publications, 1996) Caraka Saṃhitā, Indriyasthāna Ch VI v 3-6 one suspects this may be synonymous with a ‘heart attack’ in modern terminology. The experienced physician…..should not be inclined to treat him after observing the fatal signs.^75 How much was for the physical or spiritual well being of the patient and how much for the material well being of the physician is unclear. In practicing medicine, Caraka stated that the vaidya may achieve all three aims of the ethical doctrine of life, spiritual wellbeing, life satisfaction and material gain,^76 and Treating an incurable disease certainly he suffers from loss of wealth, learning and reputation and from censure and unpopularity.^77 There were also other groups of patients he should not treat including slanderers, violent people and the poor (who could not afford treatment),^78 who may have jeopardised his reputation. The concluding remarks of Indriyasthāna reinforce the physician’s obligation to assess the indicators of unavoidable death, for his own success and reputation,^79 suggesting no further treatment would be available. However, patients were also divided into curable ( sādhya ) and incurable ( asādhya ) which included a group where symptoms could be suppressed ( yāpya ).^80 This palliation of symptoms was permitted by means of diet and skilled nursing.^81 The physician may have continued to have been involved. Caraka states that if the relatives of the patient were ‘begging for his life’ the vaidya could prescribe ‘the diet with meat soup’.^82 This suggests that some palliative support was practiced, even for dying patients, thus making the statements about withdrawing from treatment even less clear, but possibly more compassionate. Alternatively, it may just have been widely culturally understood that withdrawing care by the vaidya implied the fatality of the medical condition. This in itself, when based on thorough Caraka Saṃhitā, Indriyasthāna Ch XII v 62- 64 Basham ‘Practice of medicine’ p 23 Caraka Saṃhitā, Sūtrasthāna Ch X v 7- 8 Caraka Saṃhitā, Vimānasthāna Ch VIII v 13 Caraka Saṃhitā, Indriyasthāna Ch XII v 89- 90 Caraka Saṃhitā, Sūtrasthāna tr. Kaviratna and Sharma. Ch X v 1- 16 Caraka Saṃhitā, Sūtrasthāna tr. Kaviratna and Sharma. Ch X v 8- 11 Caraka Saṃhitā, Indriyasthāna Ch XII v 14- 17

Mascaró, Juan (tr.) The Bhagavad Gita; translated from the Sanskrit with an introduction. London: Penguin Classics, 1962 Mascaró, Juan (tr.) The Upanishads: translations from the Sanskrit with an introduction. London: Penguin Classics, 1965 Rambachan, Anantanand, ‘The Hindu way of death’ p 640 - 648 In Handbook of Death and Dying ed. Clifton D Bryant. London: Sage Publications, 2003 Vol. 2 Sharma, Priya Vrat (tr.) Caraka-Saṃhitā. Varanasi: Chaukhambha Orientalia, 2000- 2001 Sharma, Priya Vrat (tr.) Suśruta Saṃhitā. Varanasi: Chaukhambha Visvabharati, 2000 Singer, PN Galen: selected works. Oxford: Oxford University Press, 1997 Thakur, Upendra The History of Suicide in India: An introduction. Delhi: Munshi Ram Manohar Lal 1963 Unschuld, Paul Medicine in China: A history of ideas. Berkeley: University of California Press, 1985 Vatuk, Sylvia ‘The art of Dying in Hindu India’ Chapter 13 p 121- 128 In Facing death: where culture, religion and medicine meet ed. Howard M Spiro, Mary G McCrea Curnen, Lee Palmer Wandel. Newhaven: Yale University Press, 1996 Weiss, Mitchell ‘ Caraka Saṃhitā on the doctrine of karma’ p 90-115 In Karma and rebirth in classical Indian traditions ed. Wendy Doniger Flaherty. Berkeley: University of California Press, 1980 Wujastyk, Dominik The Roots of Ayurveda. London: Penguin Classics, 2003 Wujastyk, Dominik ‘Medicine in India’ p 19- 37 In Oriental Medicine: an illustrated guide to the Asian arts of healing ed. Jan Van Alpen and Anthony Aris. London: Serindia Publications, 1995 http://www.astrojyoti.com/Upaniṣadspage.htm Muktika Upaniṣad Canon accessed 16 Jan. 07 Zysk, Kenneth ‘The evolution of anatomical knowledge in ancient India, with special reference to cross cultural influences Journal of the American Oriental Society (1986) 106 687- 705

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DEATH AND DYING IN THE UPANISADS,

BHAGAVAD-GITA AND CARAKA SAMHITA