Medical Genetics in Classical Ayurvedic Texts: A Critical Review

P Ram Manohar

(Received 18 May 2016)

Abstract

In the early classical texts of Ayurveda, there are descriptions regarding the genetic basis ofdiseases. The Caraka Sahitā explains that the human body in its entirety is represented in a seed formin the male and female reproductive elements. The complete blue print is called a bīja, which is composedof many components called the bījabhāgas. The bījabhāgas are further made up of smaller parts called asthe bījabhāga avayavas. Each organ of the body is formed from specific bījabhāgas or bījabhāga avayavas.Such bījabhāgas or bījabhāga avayavas are called as janakas (progenitors) of specific structures of thebody and when defective can cause partial or total defects or absence of specific organs or parts of thebody. Birth defects have been listed and described in the early Ayurvedic texts attributing defects ofbījabhāgas and bījabhāga avayavas as the underlying cause. Blindness by birth and sexual anomalies areexamples. Additionally, specific diseases have also been said to originate from defects in the componentsand component parts of the reproductive elements. Examples are skin diseases and haemorrhoids. Thetexts also differentiate between diseases originating from familial inheritance and other causes that affectthe bījabhāgas. Congenital diseases are also listed and described separately. This paper is an attempt tocritically review the descriptions related to medical genetics in the early classical texts of Ayurveda andto contextualise these speculations in the backdrop of the historical evolution of medical knowledge inthe world.

Key words: Ayurveda, Medical Genetics.

* Research Director, Amrita Centre for Advanced Research in Ayurveda, Amrita Vishwavidyapeetham University, Kollam,Kerala, Email: rammanoharp@gmail.com

1. INTRODUCTION

Medical genetics refers to the applicationof genetics in medical care. The diagnosis,management and counselling of patients withgenetic disorders comes within the purview ofmedical genetics. The origin of medical geneticsin modern times is traced to the period markingthe culmination of the second world war around1945.

Scholars are of the opinion that Aristotlecould be considered to have discovered theprinciple implied in DNA, referring to theprinciple of the “unmoved mover” that “acts,creates form and development and is notunchanged in the process” (Vinci, Tom; Robert2005). It was Aristotle who emphasized the

importance of blood in heredity. He believed thatthe blood supplied the genetic material fordevelopment of all parts of the human body. Eventoday, we use the phrase “it is in the blood” tomean that certain traits are inherited from theparents. Speculations on heredity seems to havebeen recorded by the ancient Greeks as early aseighth to fourth century BC. Ancient Greekthinkers observed the inheritance of physical traitsin humans. The concept of “Pangenesis” proposedby Hippocrates (460-377 BC) believes that peopleinherit acquired characteristics. He proposed thatthe entire organs of the parents contributedinvisible seeds that were transmitted duringconception to create the characters and featuresof the child (Manoli & Fryssira, 2015).

Indian Journal of History of Science, 51.2.2 (2016) 417-422 DOI: 10.16943/ijhs/2016/v51i2.2/48455

Historical Notes

418 INDIAN JOURNAL OF HISTORY OF SCIENCE

The classical Ayurvedic texts datingseveral centuries before the Common Era havealso proposed interesting observations andconcepts about genetic disorders, which have notbeen adequately examined or acknowledged ascontributions to the history of medical ideas. Thereare vivid accounts in ancient text books ofAyurveda like the Carka Sahitā aboutinheritance of diseases and the genetic basis forthe transmission of such diseases from parents tothe progeny. In this paper, we will examine someof these descriptions.

2. DESCRIPTIONS OF GENETIC DISORDERS INCLASSICAL AYURVEDIC TEXTS

Classical Ayurvedic texts mention aboutgenetic disorders with various terms likesahajarogas, kulajarogas or ādibalapr-avttarogas. Diseases like haemorrhoids, certainskin diseases and diabetes are some of the diseasesthat have been considered to be inherited inAyurveda. Sahajaroga means that which is presentfrom birth (Agniveśa et al. 2013), Kulajarogameans that which runs in families(Agniveśa et al.2013) and ādibalapravttaroga (Dhanvantari et al.2008) means that which arises from defects in themale and female reproductive elements. There arealso many anomalies at birth which have beentraced to have genetic origins in Ayurveda. Theancient physicians put forth theories to explainthe phenomenon of genetically inherited diseases.Eight disorders by birth are also described in theAyurvedic texts - giant and dwarf, obese and thin,hirsute and hairless, albinic and melanoid.Ayurvedic texts have also discussed various sexualanomalies at birth including impotency andmaldevelopment of sexual organs.

3. THEORIES REGARDING THE GENETICTRANSMISSION OF TRAITS

We find some explanations in the CarakaSahitā about specificity of the transmission of

genetic information within a given species. Froma human being, only a human being can be born.Just like molten metals poured into a mould takesthe shape of a mould, even so various factorscoalesce together to produce a human being fromanother human being. How does a human beingbring forth another identical human being? In hiscommentary on the Caraka Sahitā, the famouscommentator Cakrapāidatta points out that thehuman reproductive element (manuyabījam - lit.the seed from which the human being is born) ismade up of many seed parts (bījabhāga)representing the various organs and parts of thebody (pratyaga). From this seed and its parts isborn a replica human being with the same set ofparts and organs. He further clarifies in anothercontext that the bījabhāga or part of the seed hasfurther subdivisions called bījabhāgāvayava. Forexample, if the part of the seed (bījabhāga)represents the uterus, then the component of thepart of the seed (bījabhāgāvayava) represents partsof the uterus. In this manner, from a human being,another life exhibiting the general features ofhuman beings is born (Agniveœa et al. 2013). Itis very tempting to compare the divisions of thehuman genetic material into the bīja, bījabhāgaand bījabhāgāvayava with the Chromosome, DNAand Gene described in modern genetics althoughthere is no evidence to indicate that there was anunderstanding of the molecular basis of geneticsas known to science today.

The schematic representation of theprocess of transmission of genetic diseases inAyurveda is illustrated in Fig. 1.

By the term bīja both the male and femalereproductive elements viz., Śukra - semen andŚoita - menstrual blood are taken. In certaincontexts, the word bīja means either one of them(Agniveśa et al. 2013)1.

1 Cakrapāni defines these terms very clearly in his commentary. He says that bīja means śukra and śoita - bīja śukraśoite. Thismeans that both the male and female reproductive elements contribute to the genetic makeup of the individual. In anothercontext, he defines bīja as just śukra - bīje iti śukre.

HISTORICAL NOTE: MEDICAL GENETICS IN CLASSICAL AYURVEDIC TEXTS 419

Fig. 1 Schematic Representation of the Genetic Transmission of Traits in Human Beings as described in classical texts ofAyurveda

The bījabhāga is defined by Cakrapāi asthose parts of the bīja that are responsible for thedevelopment of specific parts and organs of thebody2 (Agniveśa et al. 2013).

The bījabhāgāvayava has been defined byCakrapāi as components of the bījabhāga thatare responsible for the development of specificparts of a particular organ, for example the uterus3

(Agniveśa et al. 2013).

4. THE TRANSMISSION OF GENETIC DISEASES AS

DESCRIBED IN THE AYURVEDIC TEXTS

In Ayurveda, many diseases have beendescribed to have genetic origins. In the

description of diabetes, juvenile diabetes ordiabetes at birth has been attributed to arise fromgenetic defects (bījadoa)4. In his commentary,Cakrapāi clarifies that diabetes at birth happenswhen the doa that is responsible for themanifestation of diabetes damages the bīja orgenetic material5 (Agniveśa et al. 2013). In thecontext of skin diseases the same theory is putforth to explain genetic transmission. The textexplains that even if the father is affected by thedisease, if the seed (bīja) has not been affected,then the progeny will not acquire the disease. Onthe other hand, if the seed (bīja) of the father hasbeen affected by the disease, then the child willalso inherit the disease. In Ayurveda, the rectum

2 bījasyāgapratyaganirvartako bhāgo bījabhāga3 garbhāśayabījabhāgāvayava ityatrāpi pūrvavadvyākhyeyam, avayavaśabdena garbhāśayasyārtavasya caikadeśa ihocyate4 jāta pramehī madhumehino vā na sādhya ukta sa hi bījadoāt5 bījadoāditi, pramehārabhakadoaducmabījajātapramehitvāt

420 INDIAN JOURNAL OF HISTORY OF SCIENCE

or guda is said to be made up of three rings calledvalīs. Haemorrhoids is considered to be also agenetically transmitted disease in Ayurveda. Inother words, people can inherit susceptibility tothe disease. Cakrapāi explains that this happenswhen the part of the seed (bījabhāga) that isresponsible for the development of the gudavalīsor rings of the rectum, then the person developshaemorrhoids (Agniveśa et al. 2013).

Thus, the reason for genetic transmissionof disease has been traced to the affliction(upatāpa) of the part of the seed (bījabhāga) thatis responsible for the development of the part ofan organ6. Further it has been stated that defectcaused by docas in the seed or part of the seedrepresenting a particular organ will result in thecomplete damage to that particular organ7

(Agniveśa et al. 2013). The schematicrepresentation of the genetic transmission ofdiseases is illustrated in Fig. 2.

In the Suśrutasahitā, the genetics ofconditions like blindness, dumbness and deafnessat birth is explained. The question is raised as tohow conception takes place and the child is bornwith defects in spite of the damage to the seed(bīja). The answer is that the damage to the seed(bīja) is partial and affects on a part of the seed(bījāvayava). When a part of the seed is affected,only the organs related to that part is afflicted8

(Dhanvantari et al. 2008).

When the part of the seed responsible forthe development of the eyes is affected, a personis born blind9 (Dhanvantari et al. 2008).

Fig. 2. Schematic Representation of causation of genetic diseases of Ayurveda

6 yasya yasya hyagāvayavasya bīje bījabhāga upatapto bhavati tasya tasya hyagāvayavasya viktirupajāyate7 yasya yasya hyavayavasya bīje bījabhāge vā doā prakopamāpadyante tam tamavayava viktirāviśati8 tasmādya evāśo bījasya duo bhavati tatkāryasyaiva garbhāvayavasya viktirabhāvo vā bhavati9 yathā - dyārambhake bījabhāge due jātyandho garbho bhavati na tu garbha eva na bhavati

HISTORICAL NOTE: MEDICAL GENETICS IN CLASSICAL AYURVEDIC TEXTS 421

In a similar way, the genetic basis for theformation of the docic constitution of an individualhas also been explained by Dalhaa in hiscommentary on Suśruta Sahitā. When the partof the seed that determines the expression of doasget afflicted, the dominance of that particulardoa is seen in the individual and the otherexpressions are not affected10 (Dhanvantari et al.2008).

A person with mixed sexual characteristicsis born according to Caraka when the part of theseed responsible for the development of the maleand female reproductive elements are equallyafflicted11 (Agniveśa et al. 2013).

When the part of the seed (bījabhāga)representing the uterus is afflicted in the femalereproductive element (śoita), then a barrenwoman is born. When the component of the partof the seed (bījabhāgāvayava) representing theuterus is affected, then the woman gives birth tostill borns. When the parts of the seed (bījabhāga)responsible for the expression of feminine featuresare affected then a transgender woman is born whoexhibits external characteristics of a womandevoid of the female genitalia (Agniveśa et al.2013).

In a similar way, a sterile male is bornwhen the part of the seed (bījabhāga) representingthe male reproductive element is afflicted. Whenthe component of the part of the seed(bījabhāgāvayava) representing the malereproductive element is afflicted a male whoseprogeny does not live is born. When the parts ofthe seed (bījabhāga) responsible for the expressionof masculine characters are affected then atransgender man is born who exhibits externalcharacteristics of a man devoid of male genitalia(Agniveśa et al. 2013).

5. DISCUSSION AND CONCLUSION

Genetic transmission of diseases wasunderstood and described in the early stages ofthe evolutionary history of Ayurveda. The CarakaSahitā and the Suśruta Sahitā, the earliest textsof Ayurveda, discuss about the genetic basis ofdiseases and also illustrate the concept citingexamples of a few diseases.

Ayurveda also upholds the Indian traditionof marrying outside the gotra (Agniveœa et al.2013). Gotra means a clan and refers to peoplewho are descendants of a common male ancestor.People within the gotra are considered to besiblings. Scholars speculate that there may be agenetic basis for this practice, though the classicaltexts are silent on the medical or genetic reasonsbehind this tradition. There is an opinion that thegotra system prevents inbreeding and completelyeliminates all recessive defective genes from theDNA.

Formal accounts of the history of geneticsand especially medical genetics acknowledge thecontributions of Greek thinkers like Aristotle andphysicians like Hippocrates in ancient times. Thecontributions of Ayurveda to the history of medicalideas in the area of medical genetics is not wellrecognized.

The ancient physicians of Ayurveda putforth the theory that the entire genetic informationrepresenting each and every part of the humanbody was transmitted from the parents to theprogeny. While the seed or bīja (the male andfemale reproductive elements) mapped thecomplete blue print of the human body, the partof the seed or bījabhāga represented specific bodyparts or organs. The part of the seed or bījabhāgaswere further made up of smaller componentscalled the bījabhāgāvayavas which represented

10 tathā doākhye bījabhāge due tatkāryasyaiva garbhaśarīrabhāvasya samadhātorapekcayā vikti sphumitakaracaraādilakcaābhavati na tu garbhavyāghāta

11 bījāt samāśādupataptabījāt strīpusaligī bhavati

422 INDIAN JOURNAL OF HISTORY OF SCIENCE

parts of the organs. However, there is no evidencesuggesting that they were able to decipher orisolate the actual physical structures that preservedand transmitted the genetic information.

The complete damage of the bīja makes itimpossible for the conception to happen or thefetus to be viable. Partial affliction of the part ofthe seed or its components cause partial defectsto be present in the individual. Even theconstitution of the person was considered to bedetermined by the parts of the seed and itscomponents.

Ayurveda considered genetically inheriteddisorders to be incurable. The goal was to preventgenetic diseases by application of the methods ofrejuvenation and reproductive medicine. Ayurvedaalso considered bad lifestyle and immoral life tobe triggers for genetic diseases. For example,Cakrapāi explains that the reason for peoplebeing born blind is the damage to the part of theseed caused by the effect of past actions (karma)12

(Agniveśa et al. 2013).

The Ayurvedic understanding that physicalconstitution based on the preponderance of the

docas has a genetic basis has recently foundsupport from modern scientific research. P.Govindraj et al. discovered that PGM1 correlateswith phenotype of Pitta as described in the ancienttext of Caraka Sahitā, suggesting that thephenotypic classification of India’s traditionalmedicine has a genetic basis (Govindaraj et al.2015).

BIBLIOGRAPHY

Agniveśa et al., 2013. Caraka Sahitā Y. Trikamji, ed.,Varanasi: Chaukhambha Prakashan.

Dhanvantari, Susruta & Nagarjuna, 2008. Suśruta SahitaY. Trikamji & N. Ram, eds., Varanasi: ChaukhambaSurabharati Prakashan.

Govindaraj, P. et al., 2015. Genome-wide analysis correlatesAyurveda Prakriti. Scientific Reports, 5, p.15786.Available at: http://dx.doi.org/10.1038/srep15786.

Manoli, I. & Fryssira, H., 2015. Medical genetics andgenomic medicine in Greece: achievements andchallenges. Molecular Genetics & Genomic Medicine,3(5), pp.383–390. Available at: http://doi.wiley.com/10.1002/mgg3.179.

Vinci, Tom; Robert, J.S., 2005. Aristotle and ModernGenetics. Journal of the History of Ideas, 66(2),pp.201–221.

12 andhatvādīndriyopaghātarūpe durdaivameva kāraa