E-ISSN:2456-3110

Review Article

Ethics

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 6 June
Publisherwww.maharshicharaka.in

Ethics in Ayurveda

Gupta R.1*, Tiwari S.2, Acharya P.3, Shukla O.4
DOI: http://dx.doi.org/10.21760/jaims.8.6.30

1* Rishabh Gupta, Post Graduate Scholar, Department of Samhita Siddhanta, Govt. Auto. Ayurved College, Rewa, Madhya Pradesh, India.

2 S.N. Tiwari, Associate Professor, Department of Samhita Siddhanta, Govt. Auto. Ayurved College, Rewa, Madhya Pradesh, India.

3 Pravanjan Acharya, HOD and Professor, Department of Samhita Siddhanta, Govt. Auto. Ayurved College, Rewa, Madhya Pradesh, India.

4 O.P. Shukla, Assistant Professor, Department of Samhita Siddhanta, Govt. Auto. Ayurved College, Rewa, Madhya Pradesh, India.

Ayurveda means science of life and advises practice of those ways which are good for life and abstinence of those which are harmful.[1] Patients are always looking for quality treatment from their doctors. The basic tools of good medical practice involve professional competence, healthy relationships with patients, and good ethical practice. The regulatory agencies composed “Code of Ethics and Professional Conduct” which is updated time to time. Ayurvedic Practice Guidelines protect the rights of doctors as well as patients. The Ayurvedic Practice Guide includes information on how to practice with the restrictive regimen of standard protocol, which is essential for the physician to follow ethical behaviour because medical practice is directly related to body health. There are many ethical issues associated with medicine that are relevant to everyone. Ayurveda, the traditional science of the Indian medical system, has also prescribed a code of ethics for the practice of medicine, but has not yet been recognized therefore, it is necessary to examine the ethical behaviour of Ayurvedic practice in order to maintain the quality of the Ayurvedic profession. Ethics is the essence of all religions and philosophies as it studies or preaches the practice of those that makes conduct good, leading to happiness in life. The excessive, less or mis-indulgence of Prajna (intellect) or Indiriyartha sanyoga (contact of objects with organs of perception) is mostly due to unethical mode of life. Ayurveda sufficiently throws light on the ethical way of life so that one does not become unhappy or sick and should attain happiness.

Keywords: Ayurveda, Ethics, Medical Practice, Patients, Code of conduct, Vaidyavritti

Corresponding Author How to Cite this Article To Browse
Rishabh Gupta, Post Graduate Scholar, Department of Samhita Siddhanta, Govt. Auto. Ayurved College, Rewa, Madhya Pradesh, India.
Email: 		Rishabh Gupta, S.N. Tiwari, Pravanjan Acharya, O.P. Shukla, Ethics in Ayurveda. J Ayu Int Med Sci. 2023;8(6):192-198.
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https://jaims.in/jaims/article/view/2452

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-24 2023-04-26 2023-05-03 2023-05-10 2023-05-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Rishabh Gupta, S.N. Tiwari, Pravanjan Acharya, O.P. Shuklaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Ayurveda, which has served mankind for many years, and ancient medical science was entirely based on the principles of Ayurveda. Ayurveda included information from all sources including plants, animals and more. Ethical behaviour in medical practice has been opposed since the beginning of Ayurveda practice (Kala of Kautilya’s Arthasastra).

The Central Council of Indian Medicine (CCIM) has issued Guidelines on Medical Education and Practice and a Code of Ethics for Indian Medical Professionals i.e. Ayurveda, Unani und Siddha.[2-6]

Ayurvedic ethics take an interesting position within what little discussion there is on the history of medical ethics in India.

The term 'Ayurvedic ethics' is here used in contrast to the codified ethics of the formalised and institutionalised Ayurvedic medical profession, i.e., 'Ayurvedic professional ethics'. This distinction parallels that between traditional Ayurveda, i.e., the unregulated Ayurvedic medical system as it is represented in the classical Ayurvedic texts, and modern Ayurveda, starting with the processes of professionalisation and institutionalisation in the late nineteenth and early twentieth centuries. In relation to traditional and modern Ayurveda, Ayurvedic ethics represent the ethical standards of traditional Ayurveda.

The need of ethical behavior is not strongly advocated in modern medical science (allopathy) but also in traditional medicine (Ayurveda). This article describes various aspects of ethical practice and their importance, particularly in the field of Ayurveda. The educational system of the Medical Practice prepared students to practice their profession with discipline, only after a thorough evaluation of their competence and versatility. The Ayurveda practitioner should maintain their professional standards, should attend to his/her own development in knowledge and skills, and to the development of Ayurveda and health science.

Aim of the study

1. To study the Ayurvedic ethics in view of basic “principlism” of bioethics.

2. To fulfill the needs of pluralism of bioethics.

Materials and Methods

Classical texts of Ayurveda viz. Charaka Samhita, Sushruta Samhita, Rasratna samuchhaya were consulted as research references of ancient ethical morals. Literature available regarding modern ethical science was also collected.

Right conduct: One should worship cow, brahmin, old man, saint, teacher and fire (perform worship twice daily) keep always clean feet and the openings of the discharges; cut hair, beard and nails on every fifth day; wear clean untorn clothes; apply scents; dress nicely; remain happy, comb hair, apply oil on head, on feet, in nose, in ears; smoke according to season, talk first with the guest; remain smiling; be kind on those who are in trouble; perform yajnans and havans (oblation); distribute alms; salute cross-roads; give bali to crows and dogs; give pinda to forefathers; speak few beneficial and sweet words at proper time only, control organs of pereception and be religious, envy the cause of others progress and not the result; be free from worries; be fearless, wise, zealous, clever, forgiveful, theist and humble; serve those who are elders, superior in learing, intellect and humbleness, family-members and preceptors or sidhas; walk having stick and umbrella in hand, putting head dress on the head, shoes in feet and looking six feet in front. In festivals or religious functions one should avoid places having dirty clothes, bones, thorns, hair, dirt, ashoes and also avoid places of bathing and altar. One should behave like a brother with every body, please an angry man with humbleness and assure a man who is afraid. One should oblige and be kind and sympathetic to poor sufferers. One should be truthful and peaceful; tolerate harsh words of others; appreciate qualities of peace and get rid of anger and kill causes of attachment and jealousy.[7]

One should not speak lies; upsurp others property or power; try to take his money; take interest in enimity; commit sin; behave sinfully even with a sinner; talk others faults and try to know others secrets, have contact with king's enemy, and man, sinner, abortionist, scoundral or mean; sit on mad horse or bullock or such vehicle having these, sleep on a naked or high or hard or cool bed without pillow or misfit pillow; walk on high and low peaks of mountains and climb tree; bathe in water with forceful current, sit under the


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shadow of a tree on the bank of river and move around a place burning with fire. One should not laugh loudly; pass flatus with sound; laugh or sneeze without covering face; make sound wih teeth or nails; rub bones and scratch ears or nose with teeth or nails; cut grass with teeth; crush earth balls; copy abnormal postures; see bright things like sun or fire, impure and disgusting scenes; cross shadows of a flag, teacher, temple or respectful person; live in the night in the temple, under tree, yajyna land or cross roads, garden, burrial or cremation ground, altar or go alone in a forest or empty house; keep sinner wife, friend or servant; oppose a good man or keep com- pany with rogues; be interested in scandals or live under the protection of a rascal; threaten others; sleep too long: he too much courageous, remain too long awakened or take too much bath, drink excessive water or wine or cat enormous amount of food; sit on knees for long time: go near the violent animals or animals who attack with teeth or horns; sit in front of sun, air, dew or sit in cyclone or eastward wind; or worship fire without concentration.

One should not eat with unclean mouth and keeping fire below. One should not take bath until one has refreshed, after fatigue and washed his face. Avoid taking bath as nude.

Touching One's head with clothes which were worn in bathing or wearing them again are forbidden. One should not go out without touching ghee, respected ones or good things like flower etc. One should not walk on the right side of god, teacher, good or bad articles.

  • Even an acute poison can become an excellent drug if it is properly administered. (On the other hand) even a drug, if not properly administered, becomes an acute poison. So a wise patient desirous of longevity and health should not accept any medicine prescribed by a physician ignorant of the principles governing its application.[8]
  • If the one pretending to be a wise physician, without knowing the prin- ciples governing its applicability, prescribes a medicine for a patient, distressed, lying (on bed ) having faith (in the former's prescription), he, the mischievous one is a sinner, devoid of virtuous acts, the messenger of death (as it were), even a talk with him will lead a man to hell.[9]

  • One can take the poison of a serpent, melted copper; one can take iron-pills heated with fire, but the one (physician) wearing the garment of wise ones should not accept food, drink or wealth from a patient seeking his shelter. Thus, the wise one who aspires to be a physician should make special efforts to maintain his (good) qualities so that he can be the life - giver to human beings.[10]
  • The curable diseases are cured by medicines possessing opposite qualities, (when) administered with due regard to the place, dose and time. No medicine is to be prescribed for incurable diseases. The purpose of the Ayurvedic prescriptions in general, the cases, where symptoms indicative of approaching death occur, are incurable in nature and as such need not be treated at all.[11]
  • A wise physician should examine the distinctive features of the diseases beforehand and then he should start his treatment (only) of the curable diseases. So a physician who can distinguish between curable and incurable diseases, he, with his right applications will not subscribe to the wrong notions prevailing among the pseudo-physicians.[12]
  • A physician who can distinguish between curable and incurable diseases and initiates treatment in time with the full knowledge (about the various aspects of therapeutics) can certainly accomplish his object (of curing the disease). On the other hand, a physician who undertakes the treatment of an incurable disease would undoubtedly subject himself to the loss of wealth, knowledge and fame and will also earn bad reputation and other royal sanctions or punishments.[13]

Ethics related to Ahara: One should not eat food, without taking bath and keeping jewels in hand; wearing torn clothes, without doing havan, japa or mantras like Gayatri etc. offerings to God, feeding parents, teacher or guest if present, one's dependents or servants, without applying scent, sandal; without wearing mala and washing mouth, hands, feet, with unclean mouth; without facing north; with sad mind or without mind (disinterested). One should not eat food brought by enemy, unfavourable men, rogue, unclean men, hungry servant, in unclean utensils, at improper place, at improper time, at a narrow place, without


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feeding fire, without prokshan (making pure by sprinkling proper water), without having charmed by mantras and while talking ill of others. One should not eat stale food with exception of meat, ginger, dry vegetables and fruits. One should leave something out of the given food to him with exception of curd, honey, salt, ghee and sattu. One should not eat curd in the night. Eat only sattu in the night or cat sattu, after taking food. Eat sattu in large quantity, or twice in between food or while drinking water or by cutting it with teeth.[14]

Ethics related to Vihara: One should not sneeze, eat, sleep in an abnormal posture. One should stop all works when natural urges are there. One should not discharge in front of air, fire, water, moon, sun, brahmin, teacher, respectable person or a crowd. Wherever japa or homa, sacrifice, studies or some festival or function is going to take place, one should not discharge cough from nose or mouth.

One should not insult women or believe them much or tell them secrets or hand over them full control of the house. One should not perform intercourse with other man's wife or woman liking other man or having dislike for intercourse or who is not versed in sexology, who is in menstruation or who has bad conduct or who is not clean or who is ugly. One should not perform intercourse in organs than vagina. One should not perform intercourse at crossing, in temple, garden, a place of cremation, altar, inside water, at the place of brahmin, teacher, god or good herbs. One should not perform intercourse, in the morning or evening and on forbidden dates like 1st, 11th, 15th, 22nd and 30th of the month. One should not do intercourse without taking rejuvinating aphrodisiac drugs or food; without preplanning; without full erection; without taking food; or after taking more food; while having an urge for defecation or micturation; in abnormal posture or uncomforable bed; after labour or exercise, fast, fatigue and only after loneliness is procured.[15]

Sushruta here adds that one should not perform intercourse with teacher's wife, old woman, pregnant woman, sterile woman, ill woman or woman suffering from venereal diseases.[16]

Other Ethical Principles: One should not insult his elders, gentlemen or speak ill of them. No worship of Gods or anybody should be done in impure condition.[17]

One should not study during lunar or solar eclipse or in the evening or during lightening or during earthquakes. One should not study without concentration, with wrong pronunciation or in low or high pitch.[18]

One should not, waste time, walk in prohibited area; study, eat, sleep or do intercourse in the evening; make friends with old or foolish or unhappy or impatient men; drink wine or do prostitution, open secrets of others; insult others; feel proud; speak ill of others; beat cows, raise objection on kind old-man, teacher or inst:tution; speak much; turn out his brother or affectionate one or who knows our secrets.[19]

One should not loose patience, become unruly, stop pay of servants, disbelieve ones' own man, try to achieve personal pleasure, disbelieve everyone and become troublesome to others.[20]

One should not, waste working time, do work without proper thought and steady mind, get over powered by organs of perception, do anything due to anger, pleasure, fear, displeasure, feel very happy on good results or success and unhappy on failure. Keep nature's law in mind. One should not loose semen. One should pray God.[21]

In short one should be constantly striving for brahmacharya, knowledge, giving alms, friendship, kindness, happiness and peace.[22]

The urge for urination, defecation, seminal discharge, flatus discharge, vomiting, sternulation, erectation, pendiculation, hunger, thirst, lacrymation, sleep and deep breathing after exercise should never be suppressed.[23]

One should always suppress unhealthy mental arges (greediness, fear, sadness, anger, ego, jealousy, shamelessness and attachment); urge of unhealthy speaking (harsh words, lies, back-biting and untimely words) and unhealthy bodily urges (theft, violence, intercourse with others wife and giving physical torture to others).[24]

One also finds in Charaka Vimanasthan good description of moral conduct to be followed by the teacher and the taught. Similarly, in Charaka Sutrasthan one finds a very good detailed description of medical ethics or moral conduct to be followed by physician and the patient both.[25]



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One who speaks truth, avoids anger, avoids drinking wine and sexual intercourse, does not do violence, does not do hard labour, remains peaceful, speaks sweet, remains pure, does jaba, gives alms regularly, does tapas, worships God, teacher and elders, remains aloof from cruclities, always kind and generous, sleeps and wakes at proper time, always eats milk and ghee; does not feel proud; has good conduct and thought; is not narrow-minded; directs his indriyas in spiritual direction; serves the old people; reads religious books; and is continuously rejunvinated even if he does not take Rasayans for long and healthy living.[26]

It is also found that there had been sufficient give and take between the Ayurvedic compendia and books of religion like Smratis and Puranas as far as the ethical and hygienic living is concerned.

Practice fees

Dhanvantari Bhaga - Doctor's commission by patient in the form of medicine share.

In ancient times, Ayurvedic doctor himself was preparing medicines for patients. Usually, patients with his relatives used to come from far distances to consult the doctor. The doctor would diagnose the disease and make medicines for him. While he was preparing medicines, he was entitled to retain certain percentage of the medicine so that he can use in other poor and needy patients. The percentage of such a type of commission depended upon dosage form.

In case of Rasaushadhis herbo- mineral preparations like Bhasma etc. it was 50%.

In case of herbal oils and ghee - Taila and Ghrita and for herbal jams (Lehyams) it is one eighth part (12.5%).

In case of Loha (Iron preparations), Churna (herbal powders), Vataka (tablets) - it was one seventh part (14.28%).[27]

Rudrabhaga - Doctor's commission by Medical shop owner.

In later periods, as medical system evolved, there were medical stores. which used to give commission to the doctor based on the amount of medicine prescribed to patients. This percentage was called as Rudrabhaga and it was one eleventh part (9.1%).[28]

Responsibilities and Ethics for medical practitioner

Sushruta provides guidelines for working as a healthcare professional. A person becomes a doctor when they have completed the studies, training and other formalities required to practice medicine. A physician, who is well versed in the science of medicine and has attended to the demonstrations of surgery and medicine, and who himself practises the healing art, and is clean, courageous, light-handed, fully equipped with supplies of medicine, surgical instruments and appliances, and who is intelligent, well read, and is a man of ready resources, and one commands a decent practice, and is further endowed with all moral virtues, is alone fit to be called a physician.[29]

There are some other rules of ethics related to the medical profession:

  • Wellbeing must be the primary goal.
  • Careful and respectful of patients.
  • There should not strict time limit to examine the patient.
  • You must not publicly disclose confidential patient information.
  • Do not hesitate to refer a patient if diseases are not curable by ayurvedic physician.[30]
  • Patients must be treated regardless of nationality, religion, culture, race, gender, disability, social status, and political status.[31]
  • Be well dressed, polite and maintained professionally.

Good relationship between Doctor & Patients

The doctor-patient relationship is based on mutual trust, the patient must be sure that he is receiving the appropriate treatment and the doctor must be sure that the patient privacy has not to be disclosed about his illness.

Doctor must have some properties for good treatment and recovering patient from disease like :

  • Excellence in medical knowledge
  • An extensive practical experience
  • Dexterity
  • Purity[32]

Acharya Sushruta said that patient can also play an important role in the successful treatment by


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  • Strong will power
  • Knowledge of treatment
  • Following doctor's instructions
  • Fearlessness[33]

are some of the characteristics of a good patient and these enhance the overall recovery process.

Ethical conductance regarding patient consent

Acharya Sushruta mentioned that if there is a situation where the disease is left untreated, the patient will definitely die and if treated with a probability of success than the disease being curable, the doctor should discuss the condition of patient with the patient's family and taken written consent. must obtain written consent.

Ethical conductance about treatment and prognosis

Shadvidha Pariksha i.e., hearing test (ear), touch (skin), sight (eye), taste (tongue), smell (nose) and prashna (question) helps the doctor to make a diagnosis correctly predicted.[34] Acharya Sushruta described that curable diseases would become incurable if the orthodox people concealed their illness and those who had no control over their senses and mind. The curable disease will get worse if not treated in initial stage and can ruin the patient's life. It is quite necessary to plan the treatment only after the correct diagnosis of the disease.

Conclusion

The above assessment shows that Ayurveda attaches great importance to ethics. Similar concepts such as respect for self-control, kindness, non-malignancy, and justice are found in Ayurvedic texts. An attempt has been made here to bring to light the ethical standards that have been a part of Indian medicine for a long time. Medical ethics described in Ayurveda includes all aspects of a medical practitioner. Good behaviour in its entirety has been described. Diligent people follow these remedies to maintain positive health, devoid from all diseases, live a hundred years and not die prematurely. He, praised by good people, became famous throughout the world, attained virtue and wealth, and became a friend of all creatures. Those who perform virtuous deeds reach (after death) the wonderful abode of good spirits. As such, this code of conduct must always be followed by everyone.

Reference

1. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra Sthana 1/28,29 and 30/22.

2. Anantram Sharma, Sushrut Samhita, Vol.1, Chaukhamba Surabharati Prakation Sutrasthana, 2015.

3. Bhaishajya Ratnavali, Vidyotini Hindi Vyakhya, Kaviraj Ambikadatta Shastri, 15th Edi., Chaukhamba Publication, 2002.

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5. Kunte Moreshwar Anna, Navare Krishna Shastri, Ashtaang Hridayam, Rashtriya Sanskrit Sansthan, 2002, New Delhi.

6. Sharma R.K. and Dash Bhagwan, Charaka Samhita Vol – I, Chowkhamba Sanskrit Series, 2005, Varanasi Publication.

7. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/19.

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12. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 10/21,22.

13. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 10/7,8.

14. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/19.


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15. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/22.

16. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Chikitsa sthana 24/124-129.

17. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/23.

18. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/24.

19. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/25.

20. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/26.

21. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/27-28.

22. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 8/29.

23. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 7/3-25.

24. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 7/26-29.

25. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; vimaan sthana 8, Sutra sthana 29,9.

26. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Chikitsa sthana 1/4/30-35.

27. Rasaratna Samucchaya by Vaghata, English translation by Dr. Ashok D. Satpute, Chaukhambha Sanskrit Prakashan, Delhi 2003, 8/2.

28. Rasaratna Samucchaya by Vaghata, English translation by Dr. Ashok D. Satpute, Chaukhambha Sanskrit Prakashan, Delhi 2003, 8/3.


29. Yadavaji Trikamji, Nanda kishor Sharma eds. Sushruta Samhita Sutra sthana (Bhanumati, Chakrapani, commentary, Sanskrit) Varanasi: Krishnadas Academy; 2015, Sutra sthana 34/19.

30. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Chikitsa sthana 5/44.

31. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 11/16.

32. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 9/6.

33. Kashinath Shastri. Caraka Samhita, 2007. Varanasi; Chaukhambha Sanskrit Sansthan; Sutra sthana 9/9.

34. Yadavaji Trikamji, Nanda kishor Sharma eds. Sushruta Samhita Sutra sthana (Bhanumati, Chakrapani, commentary, Sanskrit) Varanasi: Krishnadas Academy; 2015, Sutra sthana 10/4.


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