This article is based on a primer written for the Dr. Weil Integrative Medicine fellowship at the University of Arizona several years ago by Arvind Chandrakantan MD and Suhag A. Shukla.
Hinduism is the world’s oldest living religion.
It is a natural religion, meaning its philosophies and practices are considered universally accessible through sincere study, reason, and experience apart from special revelation. Hinduism is also an indigenous religion made up of a diverse family of philosophies and traditions that have been practiced primarily throughout Asia for thousands of years. Today, Hinduism is a global religion with adherents representing virtually every racial, ethnic, and national background and living on every continent, and comprising majorities in three countries: India, Nepal, and Mauritius.
Most traditions, sects, or schools within Hinduism share certain distinctive, foundational concepts despite the absence of an identifiable beginning in history, single founder, central religious establishment, or sole authoritative scripture. Two of these foundational concepts are that of the oneness of existence and pluralism.
All beings, from the smallest organism to man, are considered manifestations of the Divine (existence, pure being, light of consciousness) or reflections of the Divine’s qualities, depending upon the school of thought. Because of this shared divinity, Hinduism views the universe as a family or, in Sanskrit, Vasudhaiva Kutumbakam.
Mankind, because it is believed to be the most spiritually evolved, thus carries a special responsibility to honor the equal worth of all people and the underlying unity of existence through one’s relationship with oneself and others. Ensuring that one’s thoughts, words, and actions uphold and promote values such as truth, kindness, equanimity, empathy, generosity, and equal regard is how this responsibility is met.
Hinduism, at its core, is a holistic tradition. Its teachings and practices not only inform a Hindu’s beliefs and worldview, but touch every aspect of daily life — from how a Hindu may eat, pray, and act, to how she may take care of herself and others, treat illnesses, and deal with death and dying. Teachings also describe quite elaborately, the constant interplay between the natural world, the Universe, and the individual.
Hindus have long enjoyed a dynamic tradition of scientific inquiry and application, many of the results of which form the basis of well-known spiritual-scientific disciplines, including ayurveda, siddha and other systems of traditional medicine, yoga, vāstu shāstra (spatial and architectural science), and jyotish shāstra (astrology), to name a few. The earliest surgical techniques too originated in ancient India, many of which continue to be the foundation for modern surgery. They were developed by Sushrata (~800 B.C.E.), who is considered the Father of Surgery. In the Sanskrit text, Sushrata Samhita, he meticulously described eight categories of surgery, over 300 surgical techniques, and 120 surgical instruments as extensions of the wellness and therapeutic regimens of ayurveda.
Despite the ostensibly secular and physical nature of these disciplines, each is premised on specific spiritual or metaphysical principles (discussed below) and ultimately aimed towards spiritual growth and evolution. Hinduism is thus considered more a way of life or way of being rather than a religion. Spirituality, science, medicine, and in turn, health, not only comfortably coexist in the Hindu world, but are intricately interwoven.
Why does one get sick?
The Hindu answer to why one may get sick lies in its philosophical framework of karma, dharma, and reincarnation.
Spiritual evolution is guided by karma. Karma is the universal law of cause and effect. The critical and subtler understanding of karma is that each action has a reaction and that this cycle is endless. Thus if one sows goodness, one reaps goodness and conversely, if one sows evil, one will reap evil, either in this lifetime or in future lifetimes. To avoid incurring “karmic debt,” so to speak, Hindus must strive to remain unattached to the fruits of their virtuous action in thought, word, and deed. When one can work selflessly, in other words, without expecting rewards or attachment to the fruits of one’s actions, Hindus believe that society as a whole benefits and the individual is freed from the cycle of karma and reincarnation. Also, karma should be viewed more as either positively or negatively affecting one’s spiritual progress as opposed to absolutes of “good” or “bad.”
In the context of health, be it illness, disease, and bodily suffering, or healing, both may be understood to be the result of karma. While a simplistic first glance at the concept of karma might lead one to 1) callously minimize suffering as simply “karma;” 2) erroneously conclude that illness is the result of bad karma and health that of good; or 3) throw one’s hands up in either accepting one’s own suffering or one’s inability to alleviate another’s suffering due to a sense of futility in light of fate. The Hindu view is far more complex and judgments such as these are ill-informed.
Interestingly, all three oversimplifications are interrelated. First, Hinduism warns that it is impossible to understand the complexities of past karma and how it may be playing out in the present. A present situation could have already been mitigated or aggravated by actions in the recent past (current lifetime). In suffering, one may actually experience life lessons that lead to spiritual progress. Or in the alternative, healing may enable an individual to continue, after being temporary stalled, on a path of destructive behavior. The possibilities are endless and as such, lead to the second clarification, and that is that because one cannot fully understand the nature of suffering or healing and their effect on one’s spiritual progress, one also cannot know or understand their karmic cause or effect; one can only understand that the suffering or healing, and one’s actions related to such are either burning off karmic debt or incurring karma. Lastly, karma is not fate, but a proactive means by which individuals, both those suffering and those providing healing, shape their own destinies, with kind, compassionate, and selfless action leading towards spiritual advancement. Those providing comfort and healing, in recognition of all beings’ shared divine Source, should see the recipient as an extension of their Self (soul).
Dharma is a multi-layered term and its meaning dependent on context. It is also the mode of conduct for an individual that is most conducive to spiritual growth. There are several categories of dharma, including Sanatana Dharma or Eternal Law, which encompasses the inherent laws of nature and the Divine, and samanya dharma and vishesha dharma.
Sāmānyā dharma includes general laws that govern all forms and functions, including one’s duty to strive towards and achieve ideals such as contentment; forgiveness; self-restraint; non-stealing; purity; control of senses; discrimination between right and wrong; spiritual knowledge; truthfulness; and absence of anger. These ethical ideals or precepts are commonly known as yamas and niyamas.
Vishesha dharma, or special duties, expound upon social law or the laws defining an individual’s responsibilities within the nation, society, community and family; law according to life stage or the laws governing age-appropriate duties related to the natural process of maturing from childhood to old age; and personal law or the individualized application of dharma according to an individual’s sum of past karma, intelligence, aptitudes, tendencies, physical characteristics and community.
Hindu philosophies hold that every being, human and non-human (ie. plants and animals), has an ātmān (Consciousness, soul, Existence | Consciousness | Bliss). This ātmān is related to the one, all-pervasive Divine. The degree of the relationship between the individual ātmān and Divine differs amongst Hindu schools of thought and ranges from absolute duality to absolute non-duality (one in the same), with several perspectives in between.
Regardless of which relational belief a Hindu holds, most Hindus believe that the ātmān is immortal and evolves by experiencing varied lives through the process wherein the ātmān reincarnates into different physical bodies through cycles of birth and death. Guided by the Laws of Karma (see above), the ātmān continues on its path of spiritual growth and evolution. The ultimate aim of Hindus is for the ātmān to attain freedom from this continuous cycle of birth and rebirth and discover its divine origin (moksha). Because life and death are not viewed as mutually exclusive, but rather a continuum, the concept reincarnation provides many Hindus solace in the knowledge that physical suffering affects only the impermanent body and not the eternal, immortal ātmān.
What is the role of spirituality in health, wellness, and life?
Four Goals of Life
The four traditional goals of life (purushārthas) lend a good understanding to how Hindus view the relationship between spirituality and health and wellness. There are four life goals or objectives that are meant to enable the individual to grow and evolve spiritually. These goals are:
- Dharma: A sense of goodness, balance, and universal well-being
- Artha: A sense of security and material prosperity
- Kāma: A sense of mental and physical happiness
- Moksha: A sense of wholeness, which comes through spiritual freedom and our endeavors
Kāma and artha are legitimate aims in Hinduism, but must always be guided by dharma. Thus, any of these goals must be pursued in balance of the others, according to one’s stage in life, in moderation, and always with the greater good and ultimate individual life goal in mind. The human body, including the mind, is thus the vehicle which enables an individual to pursue and achieve the four goals throughout life.
Four Life Stages
According to Hindu teachings, most individuals live through four stages (āshramas) in life. These stages are student (brahmacharya), householder (grhasta), retiree (vānaprastha), and renunciant (sanyāsa).
The student stage is marked with both physical and intellectual discipline, including celibacy and spiritual and secular study. The ultimate purpose of student life is acquiring knowledge and building character. This stage traditionally begins at age of seven and ends once one’s studies are complete.
Upon completion of one’s studies, the householder stage follows. As the term implies, householder is a phase which begins with marriage and includes raising a family. This phase also is the period in which three of the four goals of life, namely dharma, kāma, and artha, are actively pursued alongside religious duties.
The retiree stage begins when one’s obligations to raising children ends — generally when the child enters his or her own householder stage. This phase involves gradual withdrawal from social and material obligations and attachments and ushers in a time of increased religious and spiritual focus. In the past, this withdrawal would often be literal, with the individual relocating to live in forests or outskirts of villages and minimizing interactions with others. In modern times, while many retirees decrease their focus on the mundane and increase their spiritual and religious practices, few leave or completely detach from family and society.
The final stage is that of renunciation. The individual renounces all familial and social ties to dedicate his or her life to pursuing moksha through prayer, meditation, and contemplation. The final stage of the renunciant has always been optional. Only those with sufficient spiritual maturity take to sanyasa, often under the guidance of a spiritual guru.
While most Hindus go through the stages of life in the order in which they are prescribed, some may choose to forego the middle stages and proceed from student to renunciant. This individual makes a lifetime commitment to monkhood which may include a renunciation of all duties and obligations of family life. Lifetime vows may also include vows of celibacy, renunciation of wealth and personal property, contemplative study of scripture, daily meditation and prayer, certain dietary restrictions, and simple living among others.
With regard to health and healing, where a Hindu is in terms of life stage may significantly impact health-related decisions such as life-prolonging treatments versus palliative treatment.
What are the forms of wellness and healing that Hindus have traditionally relied upon?
Ayurveda is the most recognized and practiced Vedic medicinal tradition around the world. The aim of Ayurveda is to cultivate a healthy mind and body in order to pursue the four Purushārthas (goals of life). Ayurveda is categorized as having eight limbs or angas which are based on on the different systems of the body and their treatments. The eight anga or limbs are:
- Kāya chikitsa – general medicine
- Bāla – children and their diseases and treatment (Pediatrics)
- Graha – mental disorders, seizure by spirits and their treatment (Psychiatry)
- Urdvānga – diseases of face, eyes, nose, throat, and ears and their treatment
- Salya – surgery
- Damshtra – different kinds of poisons and their treatment (Toxicology)
- Jarā – anti-aging rejuvenatory therapies
- Vrsha – male and female infertility and their treatment
Ayurveda is based on Panchabhautika Siddhānta, or the Doctrine of the Five Elements. The five elements include Prthvi (earth), Ap (water), Tejas (fire), Vāyu (air), and Ākāsa (ether). These elements are said to pervade the universe both in their gross and subtle forms in all living and non-living things. Thus, everything in nature is understood as interrelated and constituted, in varying proportions, of these elements.
Ayurvedic treatments are based on Tridosha Siddhānta, or the Doctrine of The Three Humors. Dosha is a Sanskrit word which means “that which vitiates or aggravates.” The three doshas are vatta (air and ether dominant), pitta (fire and water dominant), and kapha (water and earth dominant). They are the building blocks of the body, both physiologically and psychologically. When the three doshas are in equilibrium, they bring about health and when out of balance, cause disease.
Ayurveda teaches that daily routine, including diet, physical activity, and environment, collectively affect the balance and imbalance of doshas. Ayurveda thus prescribes daily and seasonal routines, including diet and physical regimen, to help maintain harmony of the three doshas.
Like Ayurveda, Siddha medicine is considered by many to be a science of Vedic origins. It is, however, a different form of medicine and more commonly practiced in the southern regions of India. Ayurveda and Siddha medicine share many commonalities including a focus on preventative medicine, the use of herb-derived medicines, and a basis in the tridosha theory.
In the Siddha medicinal system, the three doshas are referred to as vatta, pitta, and kapham. They are believed to be generally present in all individuals in a proportion of 4:2:1, but this ratio may change with age. Disease reflects an imbalance in the ratio, thus, Siddha treatments too are aimed towards correcting imbalances.
Unlike Ayurveda, Siddha emphasizes adherence to yamas and niyamas (ethical ideals or precepts) as a part of a wellness lifestyle. The use of animal products is also more common in Siddha medicine than in Ayurveda. Siddha medicine also has more external applications of medicines (32 different methods) as opposed to many of the surgical techniques found in Ayurveda. Siddha practitioners are often referred to as Naturopaths, Herbologists, or Traditional Medicine Practitioners.
At its broadest, yoga, from the root word “yuj” in Sanskrit, means to unite. Most Hindu texts discuss yoga as a practice to control the senses and ultimately, the mind. The most famous is the Bhagavad Gita (dating back to 6th-3rd Century BCE), which speaks of four types of yoga – bhakti, or devotion; jnāna, or knowledge; karma, or action; and dhyāna, or concentration (often referred to as raja yoga, though not all sources agree on the term) – as paths to achieve moksha, the ultimate goal according to Hindu understanding.
Of the four, the description of dhyana yoga has the most in common with yoga as it is largely understood today. Yet, while the yogas are described as four distinct paths, they are all ultimately interdependent, and with the full practice of one, comes the inclusion of the remaining three.
That which is practiced as “Hatha Yoga” – a form of dhyāna or rāja Yoga – in much of the Western world is more focused on only a single limb of Yoga: āsana (posture). While āsana is only one and a comparatively minor aspect of the broader holistic discipline of Yoga, it does offer many health benefits.
Beyond increasing muscle tone and flexibility, regular practice of asana has been associated with lower blood pressure, relief of back pain and arthritis, and boosting of the immune system . Increasingly, many believe āsana practice to reduce Attention Deficit Disorder (AD/HD)  in children, and recent studies have shown it improves general behavior and grades . However, the full potential of the physiological, intellectual, and spiritual benefits of āsana are likely increased manifold if practiced as a component of the holistic practice of Yoga which includes:
- Yama : ethical ideals or precepts guiding interactions with others and the world
- Niyama : ethical ideals or precepts guiding one’s inner world
- Āsanās : physical postures
- Prānāyama : breathing exercises (control of prana)
- Pratyahāra : control of the senses
- Dhārana : concentration and cultivating inner perceptual awareness
- Dhyāna : devotion and/or meditation on the Divine
- Samādhi : union with the Divine
What does it mean to “heal” or “be healed”? How does “healing” occur?
“Healing” and “being healed’ have different contextual meanings depending on which traditional system of medicine is being utilized. All traditional systems share a holistic viewpoint about illness. All modalities of healing in Hinduism seek to restore the balance between the body, mind, and soul (spirit). Sickness is viewed as a combination of past events (prarabdha karma), present events, including deviations from a healthy lifestyle. It is also believed to be an imbalance in the tridosha (three doshas) and all traditional therapies are directed towards balancing the doshas, as well as working on the physical, psychological, and spiritual nature of illness.
Healing in the traditional context thus refers to correction of imbalance. Ayurveda and Siddha providers will routinely prescribe prayer, varying degrees of austerity in food, rest, and contact with others, as well as medicinal therapies which are geared towards the tridosha equilibrium.
The Ayurveda or Siddha provider has a variety of methods at his or her disposal. Traditionally, the provider may come and see the patient at his or her home. The provider may also analyze the horoscope of the patient (jyotish shāstra) to see the effect of the planets (grahas) on the individual. Many traditional providers may follow up with examination including pulse analysis (nādijyoshiyam), compassionate listening, and encouraging words. They will also analyze the patient’s diet to determine the predominance of doshas. Based on their analysis, they will prescribe an appropriate diet and medicines to balance the doshas, as well as prayer, asanas, and meditation to assist with the physio-spiritual aspect of illness.
What would you say to a clinician about the faith of his or her Hindu patients as it relates to their partnered efforts towards healing and health promotion?
Hindus may make use of many means of wellness, healing, and health promotion, be they medical or therapeutic (both allopathic and traditional); astrological (jyotish shāstra); spatial (vāstu shāstra); spiritual (prayer, mantra, rituals); etc. Some forms of destiny may also inform a Hindu patient’s understanding of his or her health (hence the role of Jyotish shāstra, gemology, etc.). To this end, a health-care provider’s familiarity and openness to traditional therapies, such as Ayurveda, Siddha medicine, and yoga, may assist in gaining the patient’s confidence and trust.
Karma may play very strongly into the belief of how, when, and why life-altering disease or illness has occurred as may other Hindu concepts, including dharma and lifestage. Many Hindus will recognize and welcome their own active role in the management of their disease or symptoms, thus a health-care provider may serve as a catalyst in the patient’s harnessing of the healing potential of concepts such as karma and dharma. Accordingly, a basic understanding of Hindu philosophy, especially karma, dharma, and reincarnation will also prove useful in any discussions on spirituality, healing, and health promotion.