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Encyclopedia of India–China Cultural Contacts v1.c6.s2.t2: Indian Medical Science and its Transmission to China

Encyclopedia of India–China Cultural Contacts v1.c6.s2.t2

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Indian Medical Science and its Transmission to China

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Science and technology display a phenomenon of universality in their development. They tend to quickly expand and facilitate connections in the world. Diffusion of ideas and techniques from one culture to another through intentional or unintentional transmission had been observed since ancient times. It spreads over a long period of time, even a few centuries. One such significant transmission occurred between India and China during the early medieval period when Sino-Indian Buddhist contacts were followed by scientific/ medical contacts.

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Ancient Indian Medicine – Roots and Development

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The Indian medicine followed a developmental pattern that was no different from other ancient cultures. It started off with demonology and magical medicine. This is observed in Atharvaveda, which is considered to be the first recognised scientific text composed during the 7th-8th centuries BCE. Cures suggested were both magic spells and plant remedies. Yet *Atharvaveda* and other Vedic literature also reveal roots of various medical disciplines like

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*Fragments containing records of Indian medicine unearthed on the Silk Route*

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anatomy, embryology and ophthalmology. The first rational approach to medicine is seen in the composition of *Carakasaṃhitā* and *Suśṛtasaṃhitā* when the indigenous medical philosophy that provided a theoretical foundation for etiology and treatment of diseases viz, the *Tridoṣa* theory evolved.¹ Along with the *Pañcamahābhūta*² theory, it reflected contemporary ideas of cosmology, elemental theory and its relation to the human

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*Cover of Liao Yu Chun's book, Ayurveda: India's traditional medicine*

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body and health. Among the post-Sushruta works, *Aṣṭāṅgahṛdayasaṃhitā*, by Vāgabhata, is of foremost importance, for its scope and popularity. Several prominent medical works and their commentaries came about the following centuries eg *Mādhavanidānan* (6/ 7ᵗʰ century CE), *Kalyāṇakāraka* (9ᵗʰ century CE), *Śāraṅgdharasaṃhitā* (13ᵗʰ century CE), *Bhāvaprakāśa* (16ᵗʰ century CE) etc.

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By the time Buddhism established itself in India and began its outward transmission to Central and East Asia particularly to China, Korea and Japan, the Indian medical system, its prominent theories and disciplines were already defined. It has remained a controversial point whether the Buddhists borrowed medical concepts from Indian medicine and gave them the philosophical overtures or vice versa. Some scholars are of the opinion that significant growth of Indian medicine took place in early Buddhist monastic establishments followed by its later Hinduisation.³ Buddhist canonical literature is full of cursory references to medicine and surgery, but they do not reflect deeper medical insights. It ought to have been the case if the Buddhists were to be credited with significant development in medicine. Therefore, for all we know, it was the Buddhists who borrowed the concepts of Ayurveda that reached China with Buddhism in the 2nd/ 3rd centuries CE.

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Buddhism and Medicine

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Buddhists were deeply concerned with human suffering and illness. *Nirvāna* being considered as the state of the deliverance from all sufferings, the one who leads men to it ie Buddha was equated to a physician. Therefore, the name Bhaiṣajyaguru or藥師Yao shi, ‘The medicine-teacher’ or Bhaiṣajyarāja 藥王Yao wang, ‘The king of medicine’ was given to him. A healthy body was considered as a pre-requisite for the peaceful pursuit of knowledge and enlightenment. To assist the layman and monks alike in its achievement was the prime duty of Buddha and Bodhisattvas. After recognising “suffering” as a “noble truth” ie inevitable part of life, the subsequent truths were recognised as “cause of the suffering, the path to overcome it, and its final stopping”. These four truths correspond to diagnosis, etiology, therapeutics and recovery in medical terminology.⁴

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Buddhists’ commitment to medicine paved the way for entry of ancient Indian medicine or Ayurveda into China and its eventual absorption in Chinese body scientific.

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Travels of the Buddhist Monks

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Buddhism reached China in the 2nd century CE via Silk Route. Soon there was a regular flow of Buddhist monks between India and China. Chinese monks visited India for pilgrimage and also to collect canonical works. Buddhism thrived in China during the Tang Dynasty and the number of Buddhist monasteries and temples increased rapidly. The early Tang emperor Taizong (627-650 CE) developed contacts with several Indian kingdoms including Magadha that was ruled by the powerful king, Harṣavardhana. Nalanda University, therein, was a famous seat of learning at that time and Chinese Buddhist monks visited it in large numbers. Since interests in Indian medicine and other sciences were growing, these monk-travellers wrote about the distinctive nature of Indian medicine in their travelogues.⁵ By and large, under the directive of Tang emperors, Chinese monks and visitors searched for famous Indian doctors and drugs. Practice of medicine in Chinese monasteries also grew rapidly and it is reflected in literature, cave inscriptions and carvings of the time.

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Xuanzang, 玄奘 during CE 629-645 and Yijing , 義淨 between CE 671-695 visited India. During their stay, they made Indians aware of the Chinese techniques of accupunture and pulse examination. On their return journey, they carried with them Buddhist works with their innumerable medical references. Also, valuable information on medicinal plants, methods of treatment, organisation of free hospitals and dispensaries.

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Indian monks visited China often to participate in the translation of Indian-Buddhist texts into Chinese. Because of Buddhists’ interest in medicine, their scriptures often referred to it. Among the medicine-related essays some mentioned medicine in general⁶ and others to some specific discipline of medicine like pediatrics, ophthalmology, women’s diseases etc.⁷ Standard Ayurvedic treatments of internal medicine and surgery are also mentioned. Furthermore, they often cite “Tridoṣa” theory that forms the basis of diagnosis and treatment in Ayurveda.

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With Buddhism, concepts of hot and cold food came into Chinese medicine. Also, healing of mental suffering was advocated and thus arose the art of meditation, *Dhyāna* from which evolved the Zen sect of Buddhism in Japan. A Buddhist monk Ta Mo or Bodhidharma, in CE 527 taught martial arts to the Chinese Buddhist monks at Shao Lin monastery and his method finally evolved into what is known as Shao Lin School of martial arts.

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Chinese Absorption of Indian Medicine

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Medical knowledge which permeated in this early period through the translated Buddhist texts was effective in introducing new ideas of composition of human body and evolution of diseases into China. Chinese medical theories were so far based on the theories of Yin and Yang symbolism – the male and female. This classified all the objects in the universe into these two categories depending on their nature, based on the five elements – wood, fire, earth, metal and water, the vital energy *qi* and the blood. Writings of Tao Hongjing (5th century CE) depicted influence of Buddhist four element theory for the first time.

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Gradually, Ayurvedic concepts, methods and medicines took root in China. It was manifest in diverse ways like Buddhist Canonical works, medical treatment provided by monks, Legends of Buddha and Bodhisattva as Bhaiṣajyaguru, medical manuscripts like Qiposhu or *Jīvakapustaka* found in Dunhuang caves and pictures of medical treatment and engravings of medicinal formulae as in ‘Cave of prescriptions’ in Longmen (Dragon gate) caves at Loyang in north China. Finally, Chinese historical, popular as well as medical literature, also depicted Ayurvedic influence.

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Before long, standard medical works began referring to Indian medicine and surgery as seen in Sun Simiao’s 孫思邈writings.⁸ He was a famous medical personality who lived in 7th century CE. He had studied Buddhism and Taoism too. His work also lists several medicinal formulae attributed to Jīvaka,⁹ a great medical personality of ancient India.

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Transliterated Sanskrit terms pointing at Ayurvedic connections are numerous in Sun Simiao’s works eg “Agatuo” 阿迦陀 for “Agada” meaning disease-free, “Ka mo lo” 迦摩羅for “Kāmalā” or jaundice and translated term “Zuo dao yao” 座導藥 for “Bastinetra” both meaning sitting-directing medicine ie a suppository. Although suppositories were used in China earlier as seen in “Sengshenfang” (profound medicinal formulae of the Buddhists), a 5th century work but they were not under this name.¹⁰ Sun Simiao also introduced concepts of healing of mental sufferings by means of “Chan” 禪 for *Dhyāna*, and a method of Indian massage “An mo fa” 按 摩 法 and called it a Brahmin’s method.

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Sun Simiao was interested in Taoism as well as Buddhism so he was called “a new Vimalakirti”. Demieville¹¹ comments on Sun’s Buddhist connections as follows:

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“Sun Simiao, was an eclectic author, conversant with the philosophies of the diverse Chinese schools – chiefly with Taoism but he was interested in Buddhism as well; a contemporary even nicknamed him "a new Vimalakirti",” (Jiu Tang Shu 舊唐書, 卷: 4a-b). To be a good physician, he says in the introduction (Taoist Canon 道藏1: 1b-2b), “It will not suffice to be versed in Confucian and Taoist literature: no one who has not read Buddhist books will experience love, compassion and the joy of renunciation. One will not know when approaching patients vow to convey succour to all animate beings in all their sufferings, without distinction of rank, fortune, age, beauty, friendship or intimacy, nationality (Chinese or Barbarian) or intelligence. One will not succeed in considering all patients, with even mindedness, as one’s most dear friends.” This quote reflects Buddhist medical ethics beautifully.

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Cover of Chen Ming's book, *Medieval Medicine and foreign culture*

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Ophthalmology

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When Buddhists wrote their philosophical literature they compared “removing ignorance by means of wisdom” to “taking away cataract, using a golden needle”. Even a symbolic operation of cataract with a probe was part of initiation ritual for monks, is described in a work which was translated into Chinese sometime in 4/ 5th centuries CE.

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“Tathagata” surpasses mundane physicians in ophthalmology because he understood how to cut off the cataract (timira) of ignorance with the iron of wisdom.¹²

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“Also, the Buddha, the king of physicians or Vaidya-Rāja clears away the membrane or Paṭala, of ignorance with a golden needle.”¹³

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These and the other similar ideas expressed in Buddhist canonical literature, which became abundant in China by 4/ 5ᵗʰ centuries CE, turned out to be an eye-opener to the Chinese, both figuratively and literally. Influence of Indian medicine is most apparent in the case of ophthalmology. The very first mention of ophthalmic surgery in Chinese medical works is found in Sun Simiao’s work. He refers to cutting a white growth in the eye in the case of disease “pterygium” in his work “Prescriptions Worth a Thousand Pieces of Gold”.¹⁴

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There are several references in Chinese historical documents which refer to Indians performing successful eye surgeries. Even popular literature was no exception. Famous Chinese poet Bo Juyi (772-846 CE) in one of his poems, refers to a classic of Nagarjuna – the Doctor and a medicine called “Drug of Bright Eyesight”¹⁵. Yet another poet Liu Yuxi (772-842 CE) wrote in his poem, entitled “The Brahmin Priest Physician Who Bestowed Eyes”, how an Indian monk, who also happened to be a physician, removed cataract opacity from his eyes and enabled him to see clearly once again. These poems suggest that Nagarjuna was considered as an authority on eye diseases at that time. His book was well-known and specially the method of golden needle for the removal of cataract was famous as an effective surgical treatment introduced by the Indians.

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Since ophthalmology and surgery were not developed in China at that time, these ideas aroused the curiosity of Chinese Buddhists who were the elites of that society interested in various scholarly pursuits including medicine.

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Surgery in Chinese Medicine

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Ancient Indian medicine freely prescribed both medical and surgical treatments. The situation was different in the case of ancient Chinese medicine where surgery, together with anatomy, was still the most primitive branch of medicine. The reason is two-fold. One being the Confucian doctrine which regarded human body as a sacred gift from one’s parents, not to be mutilated in any way, came in the way of any development in the field of anatomical knowledge and surgery. The second was the prevalent medical philosophy which was based on the idea that imbalance of Yin and Yang gives rise to an illness. As a result, to counter this imbalance, pharmaceutical drugs were prescribed and usual treatment for any malady was administration of drugs. Before the introduction of Indian surgical ideas Chinese medicine had not developed surgery to any noticeable extent. This is perhaps the reason why Indian ophthalmic surgery sent waves in the then Chinese medical circle and it was willingly absorbed in their traditional system.

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Indian Ophthalmology and its Special Features

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Sushruta in his work, *Suśṛtasamhitā*, introduced various topics related to the eye, its morphology, and relation of its parts ie the muscles, blood, white and black parts and empty channels, to five principal elements viz *bhu, agni, jala, vayu* and *akasa* meaning earth, fire, water, wind and aether, respectively.¹⁶ Then came the eye diseases and their etiologies. Susruta classified the eye diseases in a number of different ways eg they were based on 1. morphology of the eye, 2. curability of eye diseases, 3. etiology of eye diseases and lastly 4. the treatment. This was a novel approach for that period. Classification of diseases in other ancient cultures used to be chiefly based on the symptoms only. Susruta discussed altogether 76 eye diseases which included diseases of junctional areas, eye-lids, conjunctiva, then those of cornea and also those of the inner parts of the eye like various kinds of cataracts, glaucoma and night blindness.

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Treatment suggested by Susruta is of three types: 1. general 2. local and 3. surgical. General treatment includes purification of the body. The local treatment includes spray, fomentation, application of fine powders in the eye and chemotherapy. Surgical methods include scraping, cutting, needling, puncturing or trephining.

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Ancient Indian medical men tried to diagnose the eye diseases on the basis of the lesion location, symptoms and pathogenesis. Functioning of the inner parts of the eye eg the optic nerve or the relation of the flow of aqueous humour to intra ocular pressure, all this was unknown at that time. Yet they recognised diseases like optic atrophy and glaucoma to be different from cataract. They could recognise this from their experience. Incurability of optic atrophy and also that of the final stages of glaucoma was known to them. Temporary relief of elevated ocular pressure was achieved by bloodletting, sometimes using leeches.

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Ideas like classification based on anatomy of the eye involving basic principles of surgical interventions, eg removal of cataract opacities, polypus-like growths, cautery to stop the unwanted growth, epilation and tearing of the eyelid in the case of entropion and bloodletting to relieve the intra-ocular pressure in the case of glaucoma, as well as pharmaceutical prescriptions which are miotic/ mydriatic or germicidal in their application, agree basically with the modern understanding of the diseases and their treatment.

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Nagarjuna in Chinese Ophthalmological Works

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From the 6^th century CE onwards there appeared several Chinese texts which mentioned Indian medicine, and especially Nagarjuna's ophthalmology. Also three prominent works on ophthalmology which appeared in China over a period of some four-five centuries were related to Indian medicine. Firstly, during Tang Dynasty there appeared *Indian Classic of Ophthalmology* compiled in 752 CE. A little later, there was another text by Bodhisattva Nagarjuna entitled 'Treatise on Ophthalmology' which must have been written around the mid-8th century CE.¹⁷ This is the one which was mentioned in the poems mentioned earlier. Then yet another work appeared early in 12th century CE by the name 'Nagarjuna's complete treatise'¹⁸.

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There were many new trends in Chinese ophthalmology as a result of the Indian influence. The classification of eye diseases was now based on anatomy, and treatments suggested were combination of Indian surgical methods and traditional Chinese methods of internal medicine. Ophthalmic surgery in all its aspects was introduced into Chinese medicine at this time. Inclusion of certain drugs in the prescriptions eg “Amalika” which was called A mo qin 阿黎勒 “Haritaki” or 訶黎勒He li qin in “Triphalā” translated as 三果, “Chakshus” or Jue ming zi决 明子and “Jaṭāmańsi” or Ma xi and黄連 Huang lian in Chinese, further suggest a useful integration of the two medical systems.¹⁹

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Entry of Indian knowledge provided foundation for the establishment of ophthalmology as a separate discipline in Chinese medicine and remained a dominant element in its development for over a millennium, in its various aspects such as medical philosophy, etiology, nosology, diagnosis, treatment, medical writings and education. As to ophthalmic surgery the Indian imports remained the sole dominant factor till perhaps the entry of western surgery.

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Other Medical Disciplines - Gynecology

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With ideas and techniques, technical terms traversed too eg Nao sha for *Navasāra* ie Ammonium chloride and Totamu for *Tutthanāga* ie zinc (frequently used in alchemy and metallurgy) and Zuo dao yao for *Bastinetra* which was employed in gynecology. Medical personalities like Jīvaka or Qi po 耆婆, Kaśyapa or Ka ye fo 迦葉佛 and ‘Rāvaṇa’ or Lu fu na 囉哺拏 are mentioned in the context of gynecology, obstetrics and pediatrics respectively.²⁰ Both Jīvaka's and Kaśyapa's names are closely related to ancient Indian female pathology and pediatrics.²¹ Likewise Rāvaṇa’s name is associated with pediatrics in ancient Indian medicine.

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As monastic medicine flourished, gradually some monasteries became famous for their medical treatment. The Monastery of Benevolent Aid or惠濟寺 Huijisi is located at the Xiaoshan county in Zhejiang province of China. It is locally called 竹林寺 Zhulinsi or the Bamboo Grove Monastery. It has been famous for its practice of medicine till the 19th century. Monks of the Bamboo Grove Monastery were regarded as experts in the treatment of women’s diseases. ²² Yixinfang also quotes a Sanskrit *Dhāraṇī* or Mantra from a canonical work大集陀羅尼經 Da ji tuo lo ni jing (*Mahādhāraṇī* classic). It is to be uttered to ease difficult childbirth.²³

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Pharmaceutics

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The Bibliography of Sui Dynasty (581-618 CE) enlists Indian books on scientific topics like mathematics, pharmaceutics and astronomy. They were attributed to Bodhisattva Nagarjuna and Brahmin sages. As the use of Indian drugs increased, they found entry in Chinese pharmacopoeia eg 本草拾遺 Bencao shiyi (a supplement for the pharmaceutical natural histories) of 725 CE by Chen Zangchi. He added 368 new entries including阿勒勃 A-le-bo or *Āragvadha* (Cassia Fistula L). He also wrote about波羅門皂莢 Bolomen zaojia (Brahmin Soap Bean Tree, Glenditsia Sinensis). 段成式 Duan Chengshi has also described it in his work 酉陽雜俎 Yu yang za zu (Miscellany of Yuyang Mountains) of 860 CE. Again, Buddhist cave engravings viz Longmen caves and others included pharmaceutical formulae.

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The Silk Road not only carried Chinese porcelain, gun powder and paper but also the art of accupuncture and pulse examination to the West. Similar was the case when Indian spices, precious stones traversed to foreign lands, Buddhist philosophy and the pragmatic knowledge went along. Just as medicine came in handy to the Christian missionaries, it became bait for the sympathetic reception of Buddhist faith in China. Silk Route, which linked China to India, Arabia and further west, was thus a bridge between the eastern and Western civilisations where along with exchange of goods it promoted scientific exchanges and mutual cooperation in their development.

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Vijaya J. Deshpande & Kamal Sheel

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