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A History of Sanskrit Literature c34: XXVI. Medicine

A History of Sanskrit Literature c34

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English

Contents

XXVI. Medicine

1. The Development of Indian Medicine

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WE have in the Vedic literature abundant evidence of the magic which precedes or accompanies in simple peoples the practice of medical art. The belief in demons of disease which dominates the *Atharvaveda* and the ritual text-books is preserved through Indian medicine, for one of its topics is the treatment of diseases derived from this source. Anatomy had begun to be studied,¹ possibly as a result of the constant slaughter of victims by the priests for the animal offering; we have also knowledge of Vedic ideas of embryology and hygiene. Late tradition recognizes the Āyurveda, also called Vaidyaçāstra, science of the doctor *par excellence*, as a Upāṅga of the *Atharvaveda* and ascribes to it eight topics, major surgery, minor surgery, healing of disease, demonology, children's diseases, toxicology, elixirs, and aphrodisiacs. Patañjali proves the early cultivation of the science in Sanskrit by mentioning Vaidyaka along with the Aṅgas and Itihāsa, Purāṇa, and Vākovākya. Moreover, we have many names of ancient sages who gave instruction, Ātreya, Kāçyapa, Hārīta, Agniveça, and Bheḍa, but, though Saṁhitās occur attributed to these worthies, we can be reasonably certain that they are generally not original works. It is, indeed, probable, though not exactly proved, that in the earliest period of literary compositions on medicine works were styled Tantras or Kalpas and took the form of monographs on special topics and not of Saṁhitās, which are comprehensive treatises covering a wide range of topics. Ātreya is of these sages the one usually declared to have been the founder of the science, but Cāṇakya also is credited with writing on medicine.²

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¹ *Çatapatha Brāhmaṇa*, x. 5. 4. 12; xii. 3. 2. 3 f.; *Atharvaveda*, x. 2. See J. Jolly, *Medicin* (1901); Girindranath Mukhopadhyay, *History of Indian Medicine and Surgical Instruments of the Hindus*, whose views are, however, often unacceptable.

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² C. Zachariae, WZKM. xxviii. 206 f.; he is known to Arabic writers as Šānaq.

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Buddhist tradition talks of Jīvaka, who studied under Ātreya and was an expert on children’s diseases; the *Vinaya Piṭaka*¹ and other texts show a wide knowledge of elementary medicine, surgical instruments, the use of hot baths, and so forth. It was, of course, inevitable that living as they did in communities the Buddhists had early to consider the tendance of their sick members.²

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¹ *Mahāvagga*, vi. 1–14; *Majjhimanikāya*, 101 and 105.

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² Cf. Takakusu, *I-tsing*, pp. 130 ff., 222 ff.; Jolly, ZDMG. lvi. 565 ff.

2. The Older Saṃhitās

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The oldest of the extant Saṃhitās is generally held to be that ascribed to Caraka, who according to tradition was the physician of Kaniṣka, whose wife he helped in a critical case. Unhappily we cannot tell the value of such stories when they come to us at a late date. Further, we know from the text itself³ that it is not, as we have it, Caraka’s work, for it was revised by one Dṛḍhabala, who admits to having added the last two chapters and to having written 17 out of 28 or 30 chapters of book vi. Dṛḍhabala, who was a Kashmirian, son of Kapilabala, is ascribed to the eighth or ninth century, and in addition to his more substantial work he revised and altered the text, which, moreover, has come down to us in a very unsatisfactory form. The work does not claim to be original; it appears to have been a revision of a number of Tantras on special topics written by Agniveça, pupil of Punarvasu Ātreya and fellow student of Bheḍa or Bhela, whose Saṃhitā is on that ground asserted by some to be older than that of Caraka. As we have it, part i, Sūtrasthāna, deals with remedies, diet, the duties of a doctor; ii, Nidānasthāna, is concerned with the eight chief diseases; iii, Vimānasthāna, with general pathology and medical studies; it contains a statement of the regulations laid down for the conduct of the newly fledged student: he is to give his whole energies to his work, even if his own life is at stake, never to do harm to a patient, never to entertain evil thoughts as to his wife or goods, to be grave and restrained in demeanour, to devote himself in word, thought, and deed to the healing of his charge, not to report outside affairs of the house, and to be careful to say nothing to a patient likely to retard recovery. The Çārīrasthāna (iv) deals with anatomy and embryology; Indriyasthāna (v) with diagnosis and prognosis; Cikitsāsthāna (vi) with special therapy; and the Kalpa- and Siddhi-sthānas (vii and viii) with general therapy. Caraka, however, as we have him is more than an author on medicine; he gives us information of a considerable number of points of philosophy and develops a form of Sāṁkhya which has erroneously been regarded as old, whereas there is nothing to show that it is not a comparatively late addition to the text. He is familiar also with Nyāya and Vaiçeṣika views, which suggests no early date.¹ The form of the work is prose interspersed with verses, and it has no very ancient appearance, perhaps owing to the work of Dṛḍhabala. We know that it was rendered at a fairly early date into Persian, and that an Arabic translation was made *c.* 800.

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³ Trans. Calcutta, 1890–1911; often ed.

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¹ Dasgupta (*Ind. Phil.*, i. 280 ff.) seeks to prove Caraka early (*c.* A. D. 80), but, even if the contemporaneity with Kaniṣka asserted in China (Lévi, IA. xxxii. 282; *WZKM.* xi. 164) is real, the date of our text is dubious. On Dṛḍhabala see Hoernle, *Osteology*, p. 11; JRAS. 1908, pp. 997 ff.; 1909, pp. 857 ff.

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Suçruta is equally famous with Caraka, and he is named with Atreya and Hārīta in the Bower Manuscript, while the *Mahābhārata*² represents him to be a son of Viçvāmitra, and Nāgārjuna³ is credited with having worked over his text. Moreover, like Caraka, he won fame beyond India, for in the ninth and tenth centuries he was renowned both in Cambodia in the east and Arabia in the west. But his text also is not definitely assured until we have, as in the case of Caraka, the commentary of Cakrapāṇidatta in the eleventh century. We know of the older comments of Jaiyyaṭa and Gayadāsa, and Cakrapāṇidatta is supplemented by the comment of Ḍallana⁴ of the thirteenth century. We have also a revised text of Suçruta prepared by Candraṭa on the basis of the commentary of Jaiyyaṭa.⁵

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² xiii. 4. 55.

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³ Cordier, *Récentes Découvertes*, p. 12.

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⁴ Ed. Calcutta, 1891. See Hoernle, JRAS. 1906, pp. 283 ff.; Jolly, ZDMG. lviii. 114 ff.; lx. 403 ff.

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⁵ Eggeling, IOC. i. 928. Trans. Calcutta, 1907–16.

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The Saṁhitā begins with a Sūtrasthāna, which deals with general questions and makes out that Suçruta's teacher was king Divodāsa of Benares, an incorporation of Dhanvantari, physician of the gods. In Nidānasthāna (ii) pathology is developed;

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Çārīrasthāna (iii) covers anatomy and embryology; Cikitsāsthāna (iv) therapeutics; Kalpasthāna (v), toxicology; and the Uttaratantra, which is clearly a later addition, supplements the work. The view of Hoernle¹ that even this later book is as old as Caraka and the *Bhela Saṃhitā* appears to be quite untenable, for it rests on his erroneous view that the anatomical views of Suçruta were known to the author of the *Çatapatha Brāhmaṇa*, a view which has been disproved.² It is of interest to note the high standard demanded from a doctor by Suçruta; the introduction of the student is based on the formal initiation of a youth as a member of the twice-born; he is made to circumambulate a fire, and a number of instructions are given to him, including purity of body and life; he is to wear a red garment—an idea with many parallels; his nails and hair are to be cut short; he is to treat as if they were his kith and kin, holy men, friends, neighbours, the widow and the orphan, the poor and travellers, but to deny his skill to hunters, bird-catchers, outcastes, and sinners.

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¹ Hoernle, *Osteology*, pp. 8 ff.

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² Keith, ZDMG. lxii. 136 ff.

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The *Bhela Saṃhitā*³ is preserved in a single, very defective manuscript. It contains the same divisions as the *Caraka Saṃhitā*, and what is preserved is mainly in Çlokas, with a limited amount of prose. Where comparison with the *Caraka Saṃhitā* is possible, there seems no doubt that the *Bhela*, which knows Suçruta, presents an inferior tradition. As regards osteology Hoernle⁴ holds that a third version of the system of Ātreya, in addition to those of Caraka and Bhela, is to be found in the *Yājñavalkya* and *Viṣṇu Smṛtis* and the *Viṣṇudharmottara* and *Agni Purāṇas*, but the provenance of this list in *Yājñavalkya* must be regarded as uncertain in the extreme. Moreover, the conclusion drawn by Hoernle as to the original account of Ātreya and its relations to these later versions must be held to be vitiated by an excessive number of suggested corrections resting on modern knowledge of the true number and kinds of bones in the human body.⁵

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³ Ed. Calcutta, 1921; Hoernle, *op. cit.*, pp. 37 ff.; *Bower MS.*, pp. 54 ff.

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⁴ *Op. cit.*, pp. 40 ff.

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⁵ A *Kāçyapa Saṃhitā* is also known, of uncertain date; Haraprasād, *Report I*, p. 9. So there are *Hārīta* or *Ātreya*, and *Āçvina* texts.

3. The Medical Tracts in the Bower Manuscript

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We attain a certain measure of certainty as regards date in regard to the tracts on medicine which form part of the contents of the manuscript from Kashgar known by the name of its discoverer in 1890.¹ Palaeographically it can be referred with fair certainty to the fourth century A. D., and in the first of its seven² treatises one tract³ deals with garlic (*laçuna*) and its valuable qualities for prolonging life; a second gives also a recipe for an elixir to secure a thousand years of life, and discusses eye-washes and eye-salves with many other topics. Another text (iii) gives fourteen recipes for external and internal application, while great importance attaches to the *Nāvanītaka* (ii), which by its title proclaims itself the cream of former treatises. Divided into sixteen sections it gives information regarding powders, decoctions, oils, elixirs, aphrodisiacs, and other recipes, including a treatise on children's diseases which often is cited and preserved in manuscript in varied forms. The treatises are written in verse, not seldom the more elaborate metres being used, and this peculiarity is preserved not rarely in later recipes. The advantage, it may be surmised, of this proceeding was that, as the syllables were fixed in number and length, it was possible to ensure in some measure the correctness of important recipes.

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¹ Hoernle, *The Bower Manuscript* (1914).

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² Parts I–III are medical, IV and V on *Pāçakakevalī*, cubomancy, VI and VII *Mahāmāyurī Vidyārājñī*, a charm against snake-bite.

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³ Forty-three verses with eighteen or nineteen metres, including Aupacchandasika, Çārdūlavikrīḍita, Suvadanā, Pṛthvī, Vaṅçasthavila, Mandākrāntā, Pramāṇikā, Pramitākṣarā, Toṭaka, Sragdharā, Sudhā, Mālinī, Çālinī, Mattamayūra, Kusumitalatāvellitā. The other parts use few metres save the Çloka, Āryā, and Triṣṭubh forms.

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Among the authors cited are Ātreya, Kṣārapāṇi, Jātūkarṇa, Parāçara, Bheḍa, and Hārīta, all sons of Punarvasu Ātreya, but Caraka is not mentioned, though Suçruta's name occurs. This, however, is no evidence against use of the *Caraka Saṃhitā*, which may be regarded as certain, for Ātreya ranked as the teacher of Caraka, and the pupil, therefore, was covered by the teacher's name. The *Bhela Saṃhitā* is also used.

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The language of the Bower Manuscript⁴ is of a peculiar character, being popular Sanskrit heavily affected by Prākritisms, suggesting comparison with the mixed dialect of Buddhist Sanskrit, which it may resemble in being an effort to write Sanskrit by persons used to writing in Prākrit. A barbarous Sanskrit is found also in medical formulae discovered in Eastern Turkestan, accompanied by a version in an Iranian dialect.¹ It must, of course, be remembered that doctors were often men of a restricted culture who could not be expected to be familiar with the niceties of Sanskrit, a phenomenon seen far more strongly in the works on architecture.

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⁴ Prākritisms are rare in Parts I and III, very common in IV–VII.

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¹ Hoernle, *Bhandarkar Comm. Vol.*, pp. 416 ff.; cf. JRAS. 1925, pp. 110 f., 623 ff.

4. Later Medical Works

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Indian tradition traces Vāgbhaṭa as the third of the great names of medical science, not without recognition that he is later than Suçruta. Two writers of this name must be distinguished, though both claim the same parentage in their works, the *Aṣṭāṅgasaṁgraha*² and the *Aṣṭāṅgahṛdayasaṁhitā*,³ as we have them. The elder Vāgbhaṭa, Vṛddha Vāgbhaṭa, is son of Siṁhagupta, and grandson of Vāgbhaṭa, and his teacher was the Buddhist Avalokita. His work was clearly used by the younger writer, whose metrical form as contrasted with the prose mixed with verses of his predecessor confirms his later date. For the date of the elder writer we have a valuable hint in I-tsing's reference⁴ to a man who shortly before had made a compendium of the eight topics of medicine; to identify him with Vāgbhaṭa, who was clearly a Buddhist, seems eminently reasonable. For Vāgbhaṭa we have also the Prākrit form Bāhaṭa, and for Siṁhagupta Saṅghagupta. The younger writer was very possibly a descendant of the older, though we have no proof for such a conjecture beyond the fact that it might explain their confusion. His work was probably also that of a Buddhist; it was translated into Tibetan, and there seems no reason to put him more than a century after his elder namesake. Both agree in citing Caraka and Suçruta, including in his case the Uttaratantra.⁵

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² Ed. Bombay, 1880.

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³ Ed. Bombay, 1891.

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⁴ Hoernle, JRAS. 1907, pp. 413 ff.; Keith, IOC. ii. 740.

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⁵ Cordier (JA. 1901, ii. 147 ff.) treats the two works as recensions of one original.

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Of the eighth or ninth century is the *Rugviniçcaya*¹ of Mādhavakara, son of Indukara, which is an important treatise on pathology, of decisive importance on later Indian medicine. It is probable, if not proved, that Mādhava is older than Dṛḍhabala. The *Siddhiyoga*² or *Vṛndamādhava* of Vṛnda follows in its order of diseases that of the *Rugviniçcaya*, and provides prescriptions for curing a large number of ailments from fever to poisoning. The suggestion that Vṛnda is the true name of the author of the *Rugviniçcaya* is plausible, but unproved. Vṛnda is used largely in Cakrapāṇidatta's treatise on therapeutics, the *Cikitsāsārasaṃgraha* (*c.* 1060), and Mādhava and Suçruta in the work of the same name by Vaṅgasena, son of Gadādhara, of the eleventh or twelfth century. In 1224 Milhaṇa wrote at Delhi the *Cikitsāmṛta* in 2,500 verses. To a Nāgārjuna are ascribed a *Yogasāra* and *Yogaçataka*.³ The *Saṃhitā* of Çārṅgadhara was commented on by Vopadeva, son of the physician Keçava, and protégé of Hemādri (*c.* 1300), who also wrote a *Çataçlokī* on powders, pills, &c. Çārṅgadhara provides for the use of opium and quicksilver and the use of the pulse in diagnosis, methods which have been referred to Persian or Arabic sources. Later works are numerous and expansive; especially favoured are Tīṣaṭa's *Cikitsākalikā* (14th cent.), Bhāva Miçra's *Bhāvaprakāça* (16th cent.), Lolimbarāja's *Vaidyajīvana* (17th cent.).⁴ Numerous monographs on different kinds of diseases, including Surapāla's *Vṛkṣāyurveda* on plant diseases, are recorded, but none are early.

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¹ Cf. Hoernle, *Osteology*, p. 14; JRAS. 1906, pp. 288 f.; 1908, p. 998; Vallauri, GSAI. xxvi. 253 ff.

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² Ed. ĀnSS. 27, 1894.

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³ Cf. Haraprasād, *Report I*, pp. 9 f.; *Nepal Catal.*, p. xxii.

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⁴ An *Āyurvedasūtra* (*Bibl. Sansk.*, 61, Mysore) is a late revival of the old style; the 'considerable antiquity' of JRAS. 1925, p. 355, is clearly a mistake.

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Historically important is the branch of Indian literature dealing with the merits of metallic preparations of which quicksilver (*raseçvara*) ranks first in importance. Quicksilver is attributed equal power over the body as over metals, and it serves as the philosopher's stone to transmute base metals while enormously increasing their bulk, an idea expressed in the *koṭivedhin rasa* of the *Rājataraṅgiṇī*. Elixirs of this sort are deemed to give perpetual youth, life for a thousand years, invisibility, invulnerability, and other good things. The date of the earliest writings is uncertain; the *Rasaratnākara*¹ of Nāgārjuna is assigned by Ray, but not on completely convincing grounds, to the seventh or eighth century. Albērūnī² (1030) derides the whole science of elixirs, Rasāyana, as worthless. The *Rasārṇava*³ is assigned by its editor to *c.* 1200, and we have in the *Sarvadarçanasaṁgraha*⁴ a fairly early proof of the love of alchemy in the account of the Raseçvaradarçana, the system of quicksilver. These adepts were Çaivas, but they were also convinced of the high importance attaching to the preservation of the body as a means to obtaining release in life, and the text cites passages from the *Rasārṇava*, *Rasahṛdaya*, and *Raseçvarasiddhānta*. The *Rasaratnasamuccaya*⁵ is ascribed to Vāgbhaṭa in some texts, in others to Açvinīkumāra or Nityanātha; it has been assigned conjecturally to 1300. Nityanātha is author of the *Rasaratnākara*, while a *Rasendracintāmaṇi* by Rāmacandra is extant, and the Jain Merutuṅga wrote a comment on a *Rasādhyāya*. The interest of these works is, however, entirely dependent on substance.

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¹ Ray, *History of Hindu Chemistry*, ii, Sanskrit Texts, p. 14. On the question of origin cf. chap. xxiii, § 3. The lateness of Arabic alchemy is proved by J. Ruska, *Arabische Alchemisten* (1924).

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² Sachau, *Alberuni's India*, i. 188 ff.

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³ Ed. BI. 1908–10.

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⁴ Chap. ix. On Govinda's *Rasahṛdaya*, in twenty-one chapters, see Haraprasād, *Nepal Catal.*, pp. xxii, 239 ff.

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⁵ Ed. ĀnSS. 19, 1910; on the date cf. Jolly, *Festschrift Windisch*, p. 192, n. 1.

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Medical dictionaries may be ancient; none of those preserved is old. The *Dhanvantari Nighaṇṭu*⁶ may in principle be older than Amara, but it refers to quicksilver and, therefore, presumably is later than his—dubious—date, which indeed has been placed after Vāgbhaṭa on the score of his use of the term *jatru*.⁷ The *Çabdapradīpa* was written for Bhīmapāla of Bengal by Sureçvara in 1075, while Narahari's *Rājanighaṇṭu*⁸ dates from 1235–50, and Madanapāla's *Madanavinodanighaṇṭu*,⁹ a comprehensive dictionary of materia medica, is as late as 1374. Works on terms of dietetics and cookery are also recorded, such as the *Pathyāpathyanighaṇṭu*.¹⁰

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⁶ Ed. ĀnSS. 33. The *Sārottaranirghaṇṭa* of a Buddhist exists in a MS. of 1080; Haraprasād, *Report I*, p. 6.

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⁷ Hoernle, JRAS. 1906, pp. 929 ff.

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⁸ Ed. ĀnSS. 33.

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⁹ Ed. Benares, 1875.

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¹⁰ For descriptions of many later works cf. *Madras Catal.*, xxiii (1918) and the *I. O. Catal.* i. 973 ff.; ii. 750 ff.

5. Greece and Indian Medicine

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The striking similarity in many points between the Greek and the Indian medical systems¹ has long been well known. We find in both such things as the doctrine of humours, whose derangement explains disease, the three stages of fever and other disorders which correspond to the Greek triad of ἀπεψία, πέψις, and κρίσις; the division of means of healing into hot and cold, or dry and oily; the healing of diseases by remedies of opposing character; the insistence in the manner of Hippokrates on prognosis; the oath exacted from doctors and the rules of etiquette and professional conduct declared to be incumbent on healers. There are also many detailed correspondences; both systems emphasize the influence of the seasons on health, and contrary to Indian feeling we have in some cases insistence on the use of strong drink as a remedy. Quotidian, tertian, and quartan fevers are noted, consumption is prominently dealt with, while little account comparatively is taken of affections of the heart. There are also similarities in regard to embryology; the doctrine of the simultaneous development of the members is held, the connexion of the male sex with the right side is noted, and a like cause is given for the production of twins; the viability of an eighth-month foetus is asserted, that of a seventh-month is denied; there is similarity in regard to the removal of a dead foetus. In surgery there is similarity in the operation for stone, in modes of dealing with haemorrhoids, in blood-letting, in the use of leeches, including according to Suçruta² those from Greece, cauteries, many surgical instruments, and the use of the left hand to deal with the right eye in ophthalmology. It must, however, be confessed that it is very difficult to determine how much is due to Greek influence and how much is merely parallel development. The doctrine of the three humours, which at first sight might be held to be definitely Greek, is in close connexion with the Sāṁkhya system of the three Guṇas or constituents; moreover, one of the humours, wind, is already known in the *Atharvaveda*, and the *Kauçika Sūtra*¹ is alleged by the comment, perhaps with justification, to have recognized the doctrine of three, wind, bile, and phlegm.

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¹ See Jolly, *Medicin*, pp. 17 f. with references. He deals also with Indian relations to Persia, China, &c. Cf. G. N. Banerjee, *Hellenism in Ancient India*, pp. 220 ff. For parallels in beliefs as to birth see Printz, ZDMG. lxxix. 119 ff.

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² i. 13. The oath of the doctor in Caraka (ZDMG. xxvi. 448 f.) has often been compared with that in Hippokrates (iv. 629 ff.); Jones, *The Doctor's Oath* (1924).

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¹ Bloomfield, SBE. xlii. 246, 483, 516 f.

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On the other hand,² we must recognize that we have certain information that both Ktesias (*c.* 400 B. C.) and Megasthenes (*c.* 300 B. C.) visited or lived in northern India, and other facts can be adduced to suggest derivation, especially of surgical doctrine, from Greece. Whatever was the case with Hippokrates, there is no doubt of the prevalence of dissection of the human body in the Alexandrian schools of Herophilos and Erasistratos in the third century B. C., while in India we have no original passage in Caraka which admits of this, though Suçruta has two chapters on surgical instruments and one on the mode of operation. But there is difficulty in postulating Indian borrowing, because the Alexandrians developed such accurate knowledge, comparatively speaking, of the muscular and vascular systems that it is difficult to suppose that India, if it had borrowed its anatomy from Greece, would have been content to remain indifferent to the other advances made in Greece. The definite evidence of relation is rendered almost impracticable of attainment by the absence of any early Greek lists of the bones of the human body as reckoned in Greek surgery. Celsus, it has been noted, giving the Greek osteology of the first century B. C. speaks of the carpus and tarsus as consisting of many minute bones, the number of which is uncertain, but says that they present the appearance of a single, interiorly concave, bone, and in Suçruta and Caraka respectively we have the opposed views of a number of small bones and a single bone. Again, the Greek and the Indian views correspond in regarding the fingers and the toes as consisting each of three joints springing from the metacarpals. Against these facts Hoernle points out that, if a Talmudic summary can be regarded as representing Greek views, which is possible, there must have been a profound difference between the Greek and the Indian enumeration of bones in the body. Greece, of course, borrowed from India the use of several medicinal plants, but there is clearly no ground for the assumption of Indian influence in early days on Greek medicine. The disrepute of anatomy¹ acted as a fatal barrier to the progress of India in the field of surgery and hampered its success in the field of medicine.²

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² Cf. Hoernle, *Osteology*, pp. iii ff.

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¹ In Vāgbhaṭa this is already clearly evident.

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² On Greek medicine cf. R. O. Moon, *Hippocrates and his Successors* (1923); T. C. Albutt, *Greek Medicine in Rome* (1921); C. Singer, *Greek Biology and Greek Medicine* (1924). See also H. Fichner, *Die Medizin im Avesta* (1925); D. Campbell, *Arabian Medicine* (1926); E. G. Browne, *Arabian Medicine* (1921); Neuburger, *History of Medicine*, i. (1910).

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