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A Concise History of Science in India c8: 4 Medicine

A Concise History of Science in India c8

Language
English

Contents

4 Medicine

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R. C. MAJUMDAR

Āyurveda: Origin and Antiquity

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MEDICINE is a natural art born out of the instinct of self-preservation. As in every other land, medical knowledge in India must have grown out of the sheer necessity of overcoming injury, sickness and pain. This overpowering compulsion also made man give up the indiscriminate use of raw vegetation and meat from all sources in favour of selective cultivation, husbandry, processing, mixing and cooking. The prehistoric art of selecting substances which could be assimilated by the human system with benefit and their cooking and compounding to give the most of nourishment and health forms integral parts of the indigenous medical science of India, known as the *Āyurveda*. The term *āyus* means duration or span of life; *veda* means unimpeachable knowledge. Hence the *Āyurveda* is concerned mainly with prolongation of healthy life and prevention of disease and senility and only secondarily with curing of disease. The common translation of the *Āyurveda* is ‘science of life’. Surgery is another survival skill which is as old as hunting and warfare.

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The growth of the healing art is a part of the natural process of man's adjustment to his environment, and the origin of the *Āyurveda* cannot be credited to any particular age, place or person, despite many legends to the contrary. Such legends describing a divine origin and corresponding antiquity of the *Āyurveda* are found in the introductory passages of many Āyurvedic texts, e.g. the *Caraka*, the *Suśruta* and other *Saṃhitās*. It is recorded that Brahmā (the creator) was the divine source of this science, which was brought into existence before the creation of mankind. The knowledge passed from him to the god Dakṣapati, then to the two celestial physicians (the twin Aśvinakumāras), later to Indra, the god-king, and finally to Bharadvāja, the semi-divine sage. Bharadvāja taught this science to a conference of sages meeting somewhere in the Himalayas with the common objects of alleviating human suffering and assuring a long, healthy and satisfactory life to all human beings. The same or similar legends are found in many works, sometimes in greater details. But these legends hardly possess any historical value.

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As far as recorded knowledge goes, the earliest instances of rational medical knowledge are to be found in the *Ṛgveda* and the *Atharvaveda*, both of the second millennium B.C. But there is much evidence to show that the *Āyurveda* was preceded by an earlier medical knowledge developed by the builders of the Indus civilization. The Aryans developed it by taking up the beliefs and practices of the 'black-skinned indigenous people', speculating and experimenting freely in their own way, learning much and unlearning only that which was patently wrong.

Remnants of Previous Traditions

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The medical knowledge of the pre-Aryan Indians has been so thoroughly mixed, diluted and absorbed into the Āyurvedic system that it would be an almost hopeless task to attempt to separate the earlier knowledge which survives only in some *tantras* and in the non-Āyurvedic medicine still practised by otherwise ignorant medicine men throughout India, employing inorganic remedies, secret herbs, animal products and venoms. In the beliefs and practices of the primitive aboriginal tribes of India also, a storehouse of this ancient knowledge can be discerned. The reputation of medical skill possessed by nomadic gypsy tribes, which spread from India into Europe and the Mediterranean lands in early times, can also be attributed to this primitive knowledge. Some examples of ancient Drāviḍa medical lore are believed to have survived intact without debasement in the non-Āyurvedic systems of medicine still surviving in parts of south India, and are found codified in existing treatises in Tamil and other south Indian languages. The fragmentary remnants of *Agadatantra* (use of poisons and venoms in curing diseases, and treatment of bites of poisonous animals and poisonings) found in various ancient works and of *Bhūtavidyā* (black magic and treatment of mental diseases and possessions) found in Vedic lore and in Āyurvedic treatises, as will be discussed later, testify to the existence of lost branches of non-Āyurvedic medical knowledge incorporated in the *Āyurveda*. In the *Rāmāyaṇa*, Rāvaṇa, the demon (non-Aryan) king, is said to be a master of many sciences including medical science; and the prince Lakṣmaṇa is resuscitated from a mortal injury by the medical skill of the apes, that is dark-skinned aborigines (6th canto; Lakṣmaṇa, already dead by the *śaktiśela*, is revived by a rare plant prescribed by a learned doctor from among the apes).

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Archaeological Evidence

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We know a great deal of pre-Aryan civilization, going back to the third millennium B.C., from the archaeological excavations at Mohenjo-daro, Harappa and many other sites in the Indus valley and in many other regions outside it. The discovery, in these sites, of manufactured implements and other objects of metals and alloys, glazed and decorated pottery and figurines, bricks made in kilns and engravings in precious stones, indicates a high level of knowledge of the physical and chemical sciences, likely to be matched by a similar knowledge of medicinal drugs and compounding. This is no doubt a mere conjecture, but the existence of a high level of social sanitation and of public hygiene in these communities is fully borne out by archaeological findings. Of the broad facts of town-planning, use of kiln-bricks, paved streets, municipal water-supply and drainage systems, public baths and hydropathic establishments and sanitary installations in private houses, there is abundant evidence. Water-proofed walls of baths lined with impervious bitumen, arrangements for draining and refilling public bathing tanks through conduits, enclosed bathrooms and water-closets made of brickwork connected with central water-supply and drainage, rubbish chutes emptying into external masonry receptacles (presumably cleared on a municipal basis), an efficient and elaborate drainage system running beneath the paved streets, spaced brickwork manholes of drains with removable lids, and soak-pits suggestive of sanitary privies of modern invention, all show a remarkably high level of public health activity and universal consciousness of sanitation without parallel in contemporary civilizations and, in fact, most other civilizations of historic times.

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It is invariably true that social medicine develops in any country only after a fairly high level of medical knowledge has already developed, which must have been the case with this ancient civilization of India. It is also true that the extensively studied archaeological remains of contemporary and comparable river-valley cultures in Egypt, the Middle East, China and Central America show no public sanitation comparable to the findings described above. Though this constitutes no real unassailable proof, the natural inference is that the medical knowledge of this early phase of Indian civilization was superior to, or at least comparable with, what obtained elsewhere in the contemporary world. The preserved specimens and written records in the form of hieroglyphics (which have been deciphered) of ancient Egypt show a knowledge of medicine which can compare with later Greek, Roman, Arabic and medieval European civilizations. Unfortunately, the large mass of pictographic characters on the seals and potteries of the Indus civilizations still awaits deciphering and we must wait for future success in this work—or another lucky Rosetta stone—to give us more data on the state of medical knowledge of the Indus valley and allied cultures.

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As mentioned earlier, the beginnings of the *Āyurveda* may be traced first in the *Ṛgveda* and then in the *Atharvaveda*; its nature and progress will be discussed in the next sections of this chapter. Both in its development, as also in the production of the famous medical compendiums of the later period, the methods and practices of the earlier period typified by the Indus civilization, it is reasonable to believe, exerted no mean influence.

Indian Medicine in the Vedic Period

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The Conception of Medical Science

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The oldest ideas of the Aryans on cosmic forces, origin of life, birth, death, sickness, pain, happiness and salvation are revealed in the Vedic hymns where rational ideas and insight are found to be continuously crystallizing out of a matrix of ignorance and superstition, even in the earliest *Saṃhitās*. Interwoven with archaic concepts of diseases, both of the mind and the body, as manifestations of the wrath of gods for sins committed or as possessions by demons,a to be cured by propitiation, ritual practices, sacrifices or exorcism, sorcery or charms,b we find logical speculations on the origins of diseases, use of healing drugs, beneficial treatment and surgery. There is also the clear emergence of the conception of the healing art as not a mere skill but as a social system tolerating many other ingredients such as the powers of magic and suggestions, ideas gained by experience and experiments, the social value of health, compassion to human suffering, scientific tenets and philosophical speculations. It is from these nebulous beginnings that the Āyurvedic conception of medical knowledge as a comprehensive science and philosophy of life developed later.

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During this period, the healing art was recognized as a part of the sacramental duties of the priests. The priest-sorcerers were the physicians, *par excellence*, though wandering medicine men, mentioned in the *Atharvaveda*, also practised medicine and surgery. The tradition of medicine as a part of the religious lore continued unbroken up to the later period of the Āyurvedic treatises, in which medical science is declared to be a *upāṅga* (part) of the *Atharvaveda*,c the physician a special votary of the same *Veda*d and also *Āyurveda* as an *upaveda* (secondary *veda*), forming part of the *Ṛgveda*.

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The Aryans personified the natural and cosmic forces as gods, and their influence was considered supreme in causing and curing illness. Water was the primordial element of the Aryans. 'In the waters is the nectar of immortality, and in the water is the potent curative powers.'e Divinity was also conferred upon plants with healing powers. The hymn, *oṣadhistuti* (ode to the healing plants), is addressed to *soma*, the moon god and the divine ruler of plants, and also a terrestrial plant from which sacrificial liquor was prepared.f

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An almost parallel conception of medicine is found in the sacred books of another branch of the Indo-Aryan community, the *Avesta* of the Iranians. The medical data of the *Avesta* are mostly found in the *Videvdat* dating from Vedic times. This book of the *Avesta*, also known as *Vendidād*, escaped destruction by Alexander the Great and was preserved in a Greek translation. The Spirit of Evil (*Ahira Mainya*) and other demons bring all diseases which can be cured by exorcism, *mantras* (holy chantings), sacrifices of cattle, and also by *baesajas* (drugs).

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a *AV.*, IV. 37. 10; VI. 20. 2; VI. 90; VII. 83; VIII. 2. 12.

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b *AV.*, VI. 113. 1–10; *RV.*, VIII. 47. 13.

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c *SS.* *Sū.*, 1. 3.

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d *CS.* *Sū.*, 30. 20.

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e *RV.*, I. 23. 19.

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f *RV.*, X. 97.

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Cures are effected by charms, imprecations against demons and sorcerers, sacrifices and propitiation of divine favour by the chanting of hymns and ritual practices. But a large number of plant remedies are recommended for curing diseases in many passages, mainly in the *Vājasaneyī*, *Taittirīya* and *Maitrāyaṇī Saṃhitās*. The metals gold and lead and some animal products are also used as healing agents. Sunlight, milk and milk products, honey, etc., are recommended in some passages for their therapeutic and nutritive values. Surgery and surgical methods are described for a number of conditions.

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These contradictions of the primitive and the progressive, sometimes in the same hymns, no doubt indicate a transitional stage of medical knowledge, but some of the apparently irrational methods are possibly not as worthless as they appear at first sight. Vedic treatment often follows a set formula of propitiation of the angered gods, appeasement of malignant forces, magic formulas with the auxiliary use of material remedies like amulets, external applications and internal medicines. Along with this complex and concerted attack at many levels is a psychiatric approach in the shape of frequent appeals (by suggestions and mesmeric repetitions) to the patient who is constantly assured of progressive healing and ultimate cure. This psychosomatic view of physical as well as mental diseases and the deliberate employment of the combined mental resources of the healer and the patient were retained, though in a much modified form, in the later and more scientific system of Āyurvedic medicine.

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Despite its deceptive primitive garb, its obsession with magic and religion and its heavy leaning on irrational methods, Vedic medicine contains so much of rational observations and inferences and so much accurate medical knowledge that it almost merits the name of a science. Different ailments affecting the head, eyes, ears, heart, lungs and stomach, skin diseases, urinary complaints, progressive emaciation (consumption), external and internal abscesses, jaundice, rheumatism and neuralgia are listed in the early Vedic texts. Some of the diseases named are: *ailava* (eye diseases), *alaji* (inflammation of the eyes), *akṣata* (rupture or ulceration of the lungs), *apaci* (scrofula), *arśa* (piles), *āsrāva* (formation of pus), *balāsa* (chronic asthma or bronchitis), *harimā* (jaundice), *hṛdroga* (heart diseases), *hṛdyota* (malfunctioning of the heart), *jāyānya* (a type of consumption), *karṇaśūla* (earache), *kāśika* (chronic cough), *kilāsa* (leprosy), *kuṣṭha* (persistent skin diseases), *rājayakṣmā* (severe and progressive wasting disease), *sikatā* (calculi), *śīrśakti* (headache), *śīrṣāmaya* (diseases of the head), *takman* (fevers), *udara* (dropsy), *visarpa* (extensive skin eruptions), *visalyaka* (neuralgia), *viṣkandha* (rheumatism), *yakṣmā* (consumptive conditions), etc. Due to semantic reasons the English equivalents are subject to mistakes, and are at best approximate. In some cases their symptoms are described.

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The *saṃhitās* also name nearly 300 limbs and inner organs of the body of which a complete list is given by Filliozat.a The birth of a baby is described in the *Atharvaveda* and the physician is recommended, in case of complications in delivery, to operate upon the *mehana* (birth channel), *yoni* (womb) and *gavīnaka* (connecting canal).a Other surgical processes described or mentioned are incisions for boils, surgical relief of angry swellings caused by imbedded arrows, etc.,b treatment of fractures,c use of a reed as catheter to relieve painful or blocked urination,d surgical removal of an injured eyeballe and the replacement of a leg amputated in battle by an iron limb.f The last reference may be metaphorical rather than actual.

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a Filliozat (2), pp. 144 ff.

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The idea of rejuvenation (of the ageing body and its faculties) is first found in the *Ṛgveda*. *Āyuṣyāṇi* (measures and treatment aimed at maintaining perfect health of mind and body and also promoting *longevity*) is one of the twin aims of medical science according to the *Atharvaveda*, the other being *bhaiṣajyāni* (curative treatment by medication). Hygiene and dietetics are considered integral parts of medical knowledge and many passages are devoted to the preventive aspect of medical science. Milk is said to confer strength, nutrition, intelligence, brightness of complexion and also to help proper growth of the foetus, and hence recommended for the pregnant woman.g The benefits of *surā* (alcoholic beverages) and of *madhu* (honey) are also described in many hymns. Rice of good quality taken as a cereal is said to improve vital capacity and help infants to grow their milk teeth.h

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There is no attempt to classify the anatomical and physiological information nor are the diseases classified according to any scheme. There is, however, a rudimentary attempt at symptomatic treatment, the drug administered being chosen with an eye to its supposed ability of making good the visible deficiency.

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Medical Knowledge in Later Vedic Texts

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The medical references in the earlier *saṃhitās* are casual and fragmentary, but the later Vedic works are distinguished by a search for order and by speculations about origins and underlying causes. A number of passages contain plausible theories about the composition of living and non-living matter, the biological functions, the relationship of the *śarīra* (human body and organism) to its environment, the nature of the vital and motive forces in a living body, and other matters. The theory that the same five elements, *pṛthivī* (earth or solid), *apas* (water or liquid), *vāyu* (air or gas), *jyoti* (fire or radiant energy) and *ākāśa* (ether or empty space), constitute the human body (microcosm) as well as the macrocosm is accepted as axiomatic truth in many passages.i Life in its various manifestations is said to have three possible types of origin, *aṇḍaja* (oviparous), *jarāyuja* (viviparous) and *svedaja* (born by combined effect of warmth and moisture).a The *vāyu* (wind) in the human organism is classified into five types according to physiological locations and functions, and the idea of identifying *vāyu* with the nervous system (with motor and sensory functions and control of the seat of consciousness as well as the involuntary muscles) is clearly discernible.b Physiological data, presumably obtained by dissection, are found in many passages. The human body is supposed to contain, dispersed in all its parts, 100 *dhamanīs* (major blood-carrying tubes), 1,000 *hirās* (minor veins, etc.),c 72,000 *hitas* (extremely minute capillaries)d and 10,800 *pesas* (muscle-fibres).e The therapeutic values of milk and milk products are described in the later Vedic texts also; milk compounded with turmeric is recommended for jaundice;f freshly churned butter is said to be of great dietic value to children and pregnant women, but clarified butter is recommended for healthy adults;g clarified butter mixed with various drugs is given for preventing miscarriage.h

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a *AV.*, I. 11.

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b *AV.*, VII. 78. 1.

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c *AV.*, IV. 12. 1, 2 and 7.

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d *AV.*, I. 3.

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e *ṚV.*, I. 116. 16.

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f *ṚV.*, I. 116. 15.

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g *ṚV.*, I. 187. 9; *Taitt. S.*, VI. 2. 5. 3.

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h *AV.*, IV. 35. 5; VII. 140. 2.

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i *Ait. Br.*, ii. 3. 2. 2; *Ait. Up.*, iii. 5. 3; *Kauś. Ār.*, vii. 2. 2; *Tait. Up.*, iii. 2. 1.

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Some surprisingly advanced theories and valid observations are found in a work styled *Garbha Upaniṣad*, the antiquity of which has been doubted by many scholars. The suspect passages may also have been interpolated at a later date. It contains, among other things, a detailed description of the periodic changes which occur in the foetus during the period of gestation, a theory of metabolic changes occurring in the body and a list of the six different tastes, seven body elements (blood, flesh, fat, connective tissues, bones, marrow and semen) and three waste products (stool, urine and sweat). Even if this last evidence is ignored, Vedic literature furnishes us with an array of medical facts and theories which are impressive, considering their antiquity. This knowledge must have served as a valuable source material for the later science of *Āyurveda*. In fact, many of the physiological ideas are retained with modifications and elaborations in the latter.

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Medicine in Buddhist Literature

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The fundamental conceptions and observations on different subjects, scattered pell-mell in Vedic literature, were collected together under appropriate titles from the sixth century B.C. onwards in separate texts known as *sūtras*.

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Erudite and comprehensive treatises were also written on most of the subjects, and a part of this vast literature survives up to the present time. Followers of all religious faiths—Brāhmaṇas, Buddhists, Jains and others—contributed to this specialized literature. In medicine, the contributions of Buddhist scholars are of great significance and outstanding value. Nāgārjuna the medical author, the later Nāgārjuna (who composed many treatises on *rasacikitsā*, metallurgy and alchemy), Vāgbhaṭa, many of the Siddha authors of the iatrochemical school, and nearly all the medical missionaries who carried Indian medical science into Tibet, Central Asia, China and Ceylon were followers of the Buddhist faith. The contributions of the Buddhist scholars contain no new features differing basically from other works. In medicine, as in other branches of knowledge, there was no division on the basis of religion, for the Buddhists of these centuries were not an isolated community but characteristically and completely Indian in outlook.

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a *Ait. Up.*, iii. 5. 3.

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b *Brh. Up.* iii. 2. 2–8; *Chānd. Up.*, iii. 13. 1–5; v. 19. 23; *SS. Sū.*, 15. 1; *SS. Ni.*, 1.

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c *AV.*, I. 17. 1; VI. 90. 2.

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d *Brh. Up.*, ii. 1. 19.

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e *Gop. Br.*, i. 5. 5.

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f *Kauś. Sū.*, xxvi. 17.

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g *Ait. Br.*, I. 1.

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h *Kauś Sū.*, xxv. 12. 23.

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Some of the Buddhist canonical literature contain medical information interwoven with religious matter. The *Bhaiṣajyavastu*, forming part of volume 3 of the *Gilgit Manuscripts*, gives instructions regarding the use and dosage of medicinal drugs, classification of plant drugs, the useful parts of various plants, etc. But these follow Āyurvedic tenets and are of no special value. The *Cīvaravastu* (Part 2, volume 3 of the *Gilgit Manuscripts*) contains a long passage on the medical training of Prince Jīvaka (physician of King Bimbisāra, a contemporary of Gautama Buddha) and some marvellous cures effected by him. If the information in this work is accepted at its face value, difficult surgical operations called *kapāla mocana* involving removal of a portion of the skull and reaching the brain inside, eye surgery, curetting of the cervical region, removal of vaginal tumours, as also medical treatment of dropsy, internal tumours, varicose veins, eye diseases, etc., must have developed at this early age. The medical stories found in the *Cīvaravastu* and other Buddhist canonical works may not be true in all details, but they certainly give us an idea of the degree of knowledge—actual and probable, real or hypothetically possible—current at the time when these texts were composed, i.e. two or three centuries before the Christian era.

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Very interesting information is given about Jīvaka besides the above details of medical cure. He studied medicine at Taxila under a world-renowned physician for the prescribed period of seven years. But, before he was given the licence to practise medicine, he had to undergo a sort of practical examination prescribed by his teacher, who directed: ‘Take this spade and seek round about Takṣaśilā a *yojana* on every side, and whatever plant you see which is not medicinal, bring it to me.’ After a good deal of botanical investigations, Jīvaka could not discover any plant that was devoid of medicinal properties. The teacher was satisfied and gave him a little money with leave to go home and practise as a physician.a This story implies a current belief that all plants as well as reeds, water, stone and metals possess medical value, i.e. potentiality of healing. The same idea is found in the *Caraka Saṃhitā* which states that ‘each and every substance, due to its inherent and specific properties, can be utilized in some disease or other’.b Jīvaka also learnt the great value of meticulous observation and of valid deductions based on such observations. By observing the area over which an elephant had passed earlier, he was able to give many details about the animal and its rider and to correlate his deductions with details considered unimportant by others. This anecdote points out the value of accurate observation and deductions in the medical profession. Jīvaka also learnt that erudition and skill in the science of medicine should not merely lead to a lucrative practice but should be taught to others in order to benefit humanity.

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a Majumdar (R. C.), II, pp. 276-77.

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b *CS. Sū.*, 26. 12, 29.

Āyurveda: The Special Treatises

Āyurvedic Saṃhitās

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*Āyurveda* had its origin in the healing art of the Vedic period. Its development as a comprehensive and rational medical system came in the succeeding centuries side by side with the flowering of the philosophies, arts and sciences in the golden age of Hindu civilization. Our knowledge of this ancient science comes mainly from the surviving written treatises, the oldest of which are the *saṃhitās* named after Bhela (or Bheḍa), Caraka and Suśruta. The first has reached us in a single and very incomplete manuscript but many independent references in other ancient works as well as the internal evidence put its authenticity and antiquity beyond reasonable doubt. It is very possibly the oldest medical treatise in existence. Nagnajit, an authority on toxicology, mentioned in the *Aitareya* and *Śatapatha Brāhmaṇas*, is also mentioned in this work as a contemporary living person.a This makes the original *Bhela Saṃhitā* a work of the period of the *Brāhmaṇas*. The work, as recent studies indicate, contains some valuable materials to fill up gaps in both the *Caraka* and *Suśruta Saṃhitās*; but on account of its fragmentary and mutilated character, it does not provide a full exposition of Āyurvedic medical knowledge.

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The other two works now available as later redactions, respectively by Dṛḍhabala (eighth or ninth century A.D.) and Nāgārjuna (*c.* third century A.D.), of earlier works belong entirely to a different category. Both are erudite and exhaustive compendiums, incorporating and codifying the theoretical and practical knowledge of medicine and its contributory arts and sciences available at the times. The *Caraka* and *Suśruta Saṃhitās* were followed in later centuries by more sophisticated treatises, commentaries and medical encyclopaedias (which were largely based on materials obtained from the two earlier works), but they have retained their place during two millennia as the two most complete and representative works on *Āyurveda*. Most of our present knowledge of the extent and depth of Indian medical science is obtained from these two standard works.

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By their own testimonies, the extant texts of the two great *saṃhitās* are revisions of the original with additions and alterations. There is evidence of many medical treatises which were composed before these two but are now quite untraceable, and each of these two names a particular earlier treatise on which it is based. Caraka's original was the *saṁhitā* of Agniveśa,a a disciple of the medical sage Ātreya. Long passages in the *Caraka Saṁhitā* are in the form of questions and answers between Ātreya and Agniveśa. This original *Agniveśa Saṁhitā* was referred to even so late as the eleventh century A.D. by Cakrapāṇi Datta in his *Āyurvedadīpikā*. In a similar way the *Suśruta Saṁhitā* contains a series of discourses between the holy sage Dhanvantari and his disciple Suśruta,b but much of the original material seems to have been revised by the redactor, Nāgārjuna, who has also made considerable additions to the text, according to the commentator Ḍalhaṇācārya.

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a Sharma, (S. V.), pp. 228–30; *see Journal of Dept. of Letters*, Calcutta, 6, p. 30.

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Chronology of the Saṃhitās

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There is no reason why the given sequences of authorship and editorships should not be accepted as correct, but acute difficulty is encountered in providing the above-named persons with actual historical dates. There is a sage Ātreya in the *Ṛgveda*; another one of the same name was a famous medical teacher at Taxila at the time of Gautama Buddha; and two more are found in the *Caraka Saṁhitā*c itself; an Agniveśa is found in the *Mahābhārata* who is unlikely to be the disciple of Ātreya. Caraka is a class title of a school of physicians, existing from Vedic times,d and also the personal title of a physician in the court of King Kaniṣka,e and very possibly the title of many other physicians belonging to the same school of medicine. According to many commentaries by reputed Indian authors of the first millennium A.D. and later, Patañjali, the great philosopher and alchemist of early Buddhist times, was identical with Caraka of the *Saṁhitā*.f Again Dhanvantari is a legendary, divine personage in many Vedic texts of widely different ages; Suśruta is said to be the son of the Vedic sage, Viśvāmitra, but another Suśruta is referred to by Kātyāyana (a contemporary of Candragupta Maurya), the author of a *vārtika* to Pāṇini's *Vyākaraṇa*; Nāgārjuna is the name or title of at least two, possibly three, philosophers, alchemists and scholars between the third century B.C. and al-Bīrūnī's time, tenth century A.D. The difficult task of identifying the medical authors has to be undertaken only on the basis of available evidence and chance references in other sources of established chronology. The most commonly accepted dates for the composition of the *Caraka Saṁhitā* (which formed the basis of Dṛḍhabala's version) and Nāgārjuna's redaction of the older *Suśruta Saṁhitā* are A.D. 100, and third to fourth century A.D. respectively. These conclusions were arrived at by the Chronology Committee of the National Institute of Sciences of India after considering the entire available data on the subject. The original *Agniveśa* and *Suśruta Saṃhitās* must have preceded these works by many centuries, as they had to be extensively revised and restored.

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a *CS. Sū.*, 2.

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b *SS. Sū.*, 1. 1.

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c *CS. Sū.*, 1. 9.

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d *Taitt. S.*, vi. 4. 9.

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e Levi, pp. 444–84.

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f Sen, Gananath (1), p. 11.

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The Contents of the Āyurvedic Saṃhitās

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The *Caraka* and *Suśruta Saṃhitās* mention the eight different branches of medical knowledge,a but the treatises are not written accordingly. The former is an exhaustive work on the first branch (therapeutic medicine) only, though it contains many sections dealing with surgery and the other six branches. It deals mainly with anatomy, physiology, aetiology and prognosis, pathology, treatment, objectives, influence of environmental factors, medicines and appliances, and procedure and sequence of medication. For discussion of these topics the work is divided into eight *sthānas* (sections) containing 150 chapters in all. The *Suśruta Saṃhitā* follows more or less the same pattern, but it gives surgery the place of honour. In fact, the Dhanvantari school of medicine, to which it belongs, believes surgery to be the most ancient and most efficacious of the eight branches of medical knowledge.b The *Suśruta Saṃhitā* contains six *sthānas* dealing with fundamental postulates, pathology, embryology and anatomy, therapeutic and surgical treatment, toxicology, and a final section on subsequently gained and specialized knowledge of topics dealt with in earlier sections, and contains a total of 184 chapters. In both the works the topics are not distributed in the text in the way that would appear logical to modern minds, and often the same topic recurs in different isolated chapters. Still, the over-all picture is of codified, scientific treatises, the *Suśruta* being more concise in language and a repository of more factual information; it describes the necessity and *modus operandi* of dissections on human cadavers for gaining accurate anatomical knowledge.

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The special physiological and pathological ideas of *Āyurveda* as also its special methods of a diagnosis and treatment will be discussed later. Some of its achievements merit special mention. The *materia medica* is extensive and represents a full utilization of environmental resources. More than 600 drugs of animal, plant and mineral origin are used in the *Caraka* and about 650 in the *Suśruta Saṃhitā*. The large variety of medicinal prescriptions, methods of compounding, therapeutic methods including psychiatric processes and surgical processes employing specific instruments for each type of operation are scientific, sound and exhaustive. Suśruta describes more than 300 different operations employing 42 different surgical processes and 121 different types of instruments. Some irrational methods are, however, prescribed for some mental aberrations and diseases of new-born infants.

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Symptoms are described for a large number of pathological conditions and diseases, including *diabetes mellitus*, pulmonary tuberculosis, malignant growths, leprosy, gangrene, erysipelas, jaundice, diphtheria, tetanus, calculi, general paralysis, insanity, epilepsy, epidemic diseases, bites of poisonous snakes and animals, and hydrophobia. Rational and apparently efficacious surgery is described for many conditions including complicated fractures and dislocations, piles, fistulas and sinuses,a tumours, carbuncles and malignant growths, cataracts and complicated opthalmic operations,b strangulated hernia,c urinary stones causing uraemia, impacted gall-stone, intestinal perforations and protrusions of the viscera due to accidental injuries,d amputation of major limbs, tonsilitis, bone abscesses and abscesses of internal organs, serious head injuries with exudation of brain matter, major obstetric operations including removal of the foetus by craniotomic and other methods,e and congenital malformations of the nose, ears or lips.f The last-named operation required plastic surgery involving grafting of skin and muscular tissues from surrounding areas and other parts of the body and was also used to help people whose noses or ears had been removed for penal reasons, apparently a common practice of the period.

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a *CS. Sū.*, 30, 28.

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b *SS, Sū.*, 1.

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Apart from the above achievements, *Āyurveda* is remarkable for its special conceptions and theories. It must be emphasized that the curing of diseased conditions and the maintenance of health are not the only aims of *Āyurveda*. It is also concerned with harmonizing secular conduct and spiritual pursuit through a realization of the true relationship between the complex of body, mind and soul and the eternal universe. As such, it is more a comprehensive philosophy of life, with salvation as its goal, than a science in the modern sense of the term. Theories of creation of life, of biological processes, of sensory and intellectual perceptions,g genetic and eugenic rules, and the physiological and pathological effects of heredity and gestation,h theories of digestion, metabolism, circulation of body fluids and functions of bodily eliminationsi and the all-embracing theory of the three omnipresent humours responsible for the origin and prognosis of all pathological conditions and forming the very basis of Āyurvedic treatment—all are found in the medical *saṃhitās*. There is a rigorous standard for the training of physicians, and a meticulous code of personal ethics and social conduct for the medical profession.j In insight, farsightedness and depth, the Āyurvedic medical code stands a favourable comparison with the Hippocratic code. The entire texts of the *saṃhitās* are also distinguished by careful and penetrating observations, exhaustive and classified information, and an able presentation of the available knowledge in medicine and allied subjects like chemistry, botany, etc., contributing to medicine.

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a *SS. Ci.*, 3, 7, 8.

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b *SS. Ci.*, 3, 8, 17. 12; *Uttara*, 3, 7, 8.

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c *SS. Ci.*, 19. 9–12.

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d *SS. Ci.*, 2.

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e *SS. Ci.*, 15.

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f *SS. Sū.*, 16.

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g *CS. Śā.*, 5.

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h *CS. Śā.*, 3; *SS. Śā.*, 1–3.

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i *CS. Ci.*, 15; *CS. Vi.* 6; *CS. Sū.*, 28; *SS. Sū.*, 14, 35.

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j *CS. Vi.*, 8; *CS. Sū.*, 9, 10, 29, 30; *SS. Sū.*, 2, 5, 7, 10, 25, 34.

Lost Treatises of Āyurveda

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Apart from the two great *saṃhitās*, there were many other treatises on the therapeutic branch of medicine, termed the Ātreya school of medicine. Some of them are lost beyond all possible hope of recovery, but their names and subjects are available from references in existing works. Such lost treatises include the *saṃhitās* credited to Agniveśa, Kṣarapāṇi, Jatukarṇa, Parāśara, Hārīta, Kṣaranāda, Viśvāmitra, Kapila and Gautama. Of the Dhanvantari school with its stress on surgery, the lost works are the *Vṛddha Suśruta* or *Sauśruta tantra*, the treatises credited to Aupadhenava, Aurabhra, Pauṣkalāvata, Gopurarakṣita, Vaitaraṇa and Bhoja. The *Bhoja-saṃhitā*, also known as *Vṛddhabhoja*, should not be confused with a lexicon compiled by Bhojarāja of a much later age.

Extant Classical Works on Āyurveda

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Among the major existing works of the Ātreya school (apart from the Caraka) are about 50 known commentaries and editions of the Agniveśa of *Caraka Saṃhitā*,a the notable works being those of Dṛḍhabala (ninth century), Cakrapāṇidatta (eleventh century) and Śivadāsa (eleventh century). Among a smaller number of editions and commentaries of *Suśruta Saṃhitā*, the most notable are those of Nāgārjuna (third to fourth century), Ḍalhanācārya (tenth-eleventh century) and Cakradatta (eleventh century).

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Next in importance as well as in age (with the possible exception of *Kāśyapa Saṃhitā*) come two works with somewhat similar names, the *Aṣṭāṅga Saṃgraha* also known as *Vṛddha Vāgbhaṭa* and the *Aṣṭāṅgahṛdaya*, known simply as *Vāgbhaṭa*. Both are comprehensive works on therapeutics and surgery, one in prose-*cum*-verse and the other in verse alone. From the distinctive name of the first work as the ‘ancient’ Vāgbhaṭa, some assumed differences in quality, and from the very fact of the existence of two different works, it has been supposed that there were two different authors of this name, one earlier and one later. The authors (or author) in both cases, however, claim the same parentage and profess the same school of Buddhist faith. It is known that Vāgbhaṭa was the son of Siṃhagupta, an inhabitant of Sind and a disciple of Avalokita, the Buddhist sage, but no separate particulars are available about the other author. The internal evidence also shows an identity of style, medical views and mode of presentation, and there is no real evidence to show that there was more than one author of this name.b

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The first mention of a medical book on *Aṣṭāṅga* is found in the memoirs of the Chinese traveller I’Tsing of the seventh century. The author of this book has been identified with the Buddhist Vāgbhaṭa who may, therefore, be placed in the seventh century A.D. or a little earlier.

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a Rây and Gupta, p. 1.

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b Sen, Gananath (2), p. 51.

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The *Aṣṭāṅgahṛdaya* is by far the most concise and scientific exposition of Āyurvedic knowledge, incorporating the teachings of the Ātreya, Dhanvantari and Rasāyanaa schools of medicine and distinguished by its knowledge of chemical reactions and laboratory processes. The work has been translated into many Indian and foreign languages, and enjoys a deserved reputation rivalling those of Caraka and Suśruta. The important commentaries on Vāgbhaṭa’s works are by Aruṇadatta (thirteenth century), Candrānanda, Hemādri and Indu.

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The *Kāśyapa Saṃhitā* is another ancient treatise dealing mainly with paediatrics. It is probably of an age not much later than that of the *Bhela Saṃhitā*, if we consider that it is admittedly an abridged edition or version of an earlier work, the *Vṛddha Kāśyapa*.b It is quoted in the Bower manuscript and contains many quotations, not found elsewhere, from the most ancient works of the Ātreya school including some missing treatises.

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A valuable work, specializing on the diagnostic aspect of medical knowledge, is due to Mādhavakara (eighth or ninth century) and is entitled *Rugviniścaya* or *Mādhava Nidāna*. It is a compilation from the earlier works of Agniveśa, Suśruta and Vāgbhaṭa, but its merit lies in its scientific selection of knowledge included, concise presentation, and as a valuable clinical guide. It is famous all over India as the best Āyurvedic work on diagnosis of diseases. Two commentaries on this work, *Madhukoṣa* by Vijayarakṣita and *Ātaṅkadarpaṇa* by Vācaspati, are also valuable aids to diagnosis. The *Gadanigraha*, a medical treatise by Ṣoḍhala (seventh century), *Ṣoḍhalanighaṇṭu*, a medical lexicon by the same author, *Siddhayoga* by Vṛndakuṇḍa (ninth century), and *Cakrasaṃgraha*, a valuable treatise containing quotations from earlier works by Cakrapāṇidatta (about A.D. 1050), are other important works on the Ātreya and Dhanvantari schools, containing also some information on inorganic medicines, written before A.D. 1200. Only a few of the Āyurvedic works listed above are available in printed editions, others being in the form of written manuscripts preserved in various collections in India and abroad. The descriptions and locations are to be found in Aufrecht’s Catalogue. Kavirāj Gananath Sen has made an assessment of the comparative merits of these different works.c

Āyurveda and Its Eight Classical Divisions: Other Medical Systems of Ancient India

The Eight Aṅgas of Āyurveda

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The term *aṣṭāṅga* (eight-limbed) used in the titles of Vāgbhaṭa’s works is actually a synonym of *Āyurveda* which, from ancient times, has been supposed to contain eight branches of medical knowledge. These branches are enumerated in the introductory passages of all important Āyurvedic works though most of them specialize in one or at most two branches and give only limited space to the rest. The lists given by Caraka, Suśruta and Vāgbhaṭa are identical though different in order.a Caraka uses the term *viṣagaravairodhikapraśamana* for antidotes and cures for poisons and venoms in place of *agada* (toxicology). The eight branches and the topics they include are enumerated below:
(i) *Kāyacikitsā* (therapeutics) dealing with the aetiology, diagnosis, prognosis, treatment and recommended diets in fevers, gastro-intestinal irritations, coughs, consumptive maladies, urinary complaints and other ailments, curable by the administration of drugs, externally or internally;
(ii) *Śalyatantra* (surgical knowledge) divided into two branches; the first deals with diagnosis, prognosis and treatment of conditions amenable to surgical methods, specifications and uses of different surgical instruments, methods of bleeding, cauterization by heat and alkali, use of leeches, and minor surgical implements in appropriate contexts; the second deals with surgical knowledge applied to gynaecology and obstetrics;
(iii) *Śālakyatantra* (treatment of diseases of the eyes, ears, nose, tongue, oral cavity and throat);
(iv) *Bhūtavidyā* (knowledge of mental diseases and diseases of supernatural origin) dealing with the true nature, symptoms and treatments of conditions like insanity, epilepsy, etc., in which people behave as if affected by demons;
(v) *Kaumārabhṛtya* (knowledge of infantile disorders, care of young children and treatment of diseases specific to children);
(vi) *Agadatantra* (toxicology) dealing with symptoms caused by accidental or intentional administration of mineral, vegetable and animal poisons, bites by venomous snakes and other poisonous creatures, their immediate antidotes and methods of treatment;
(vii) *Rasāyana* (knowledge of tonics and processes for arresting the process of physical and mental decay) dealing with potent drugs and prescriptions to combat ill health, natural decay and senility, their dosages and methods of administration; (viii) *Vājīkaraṇatantra* (knowledge of virilifics) dealing with lost or diminished virility, potency and procreative ability.

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a Keith (3), p. 510.

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b Subba Reddy, pp. 1–35.

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c Sen, Gananath (1), pp. 5 ff.; (2), pp. 32 ff.

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The Ātreya and Dhanvantari Systems

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The medical literature specializing in the therapeutic and surgical branches of medical knowledge has already been reviewed in the previous section. Most of the works mentioned there however claim to be a comprehensive treatise on *Āyurveda* (and hence on all its branches) and generally devote some passages or even sections to the other six branches.

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a *CS*, *Sū.*, 30; *SS*, *Sū.*, 1.

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Quite a number of treatises specializing in the other *aṅgas* were also in parallel existence with the works of the Ātreya and Dhanvantari schools. But the zeal displayed by later scholars for reproducing or editing the latter works seems to have been lacking for the other branches. Original works in the other *aṅgas* are generally met with only in the form of quotations in later works or in names only; commentaries and revised editions are conspicuous by their absence. Even the quotations that are found are few and far between. A study of the literature of *Āyurveda* in the post-Vedic period leaves a strong impression that the works of the Ātreya and Dhanvantari schools were always considered the elite among medical treatises while the others were considered second-class matter.

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The Śālakyatantra System

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A class of physicians known as *Śālākis* specialized in this branch of medicine, the chief treatise of which was *Videhatantra* supposed to be the work of King Janaka of Videha. This work is mentioned as important in the sections on *Śālakyatantra* found in the *Suśruta Saṃhitā*,a and has been extensively quoted by Ḍalhaṇācārya, Vijayarakṣita Śrīkaṇṭhadatta and others. Other works on this branch of medicine, quoted by the last three authors, are *Nimitantra* and *Sātyakitantra*. Caraka mentions the *Kāṅkayanatantra* and the *Śaunakatantra*. Ḍalhaṇa and Śrīkaṇṭha also mention other works in this branch, attributed to Gārgya, Gālavya, Karālabhaṭṭa, Kṛṣṇātreya, as also another work *Cakṣuṣyatantra* dealing with eye diseases alone. None of these works are available now but all must have been extant in Ḍalhaṇa's time (tenth-eleventh century). The sparse quotations available do not permit of a proper assessment of these works.

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Bhūtavidyā

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No special treatise on this subject has been quoted or even named in the surviving works. This branch of *Āyurveda* survives now only as chapters in the works of Caraka,b Suśrutac and Vāgbhaṭa.d The *Caraka Saṃhitā* treats all psychic maladies, including grave diseases of the nervous system, insanity and demoniac possessions, in a single chapter. The *Aṣṭāṅga* and *Suśruta Saṃhitā* consider demoniac possessions as separate from mental diseases. The *Agnipurāṇa* and the *Vāyupurāṇa* also deal with demoniac possessions and the remedial measures recommended for them. From the fact of Caraka's classification of demoniac possessions in the same chapter with mental disorders and Suśruta’s declaration that malignant spirits cause diseases but do not physically ‘possess’ human beings (*na te manuṣyaiḥ saha saṃviśanti*), it seems likely that in these times *bhūtavidyā* simply meant psychic disorders caused by unknown forces. The later treatises after Vāgbhaṭa ignore this branch of medicine altogether, possibly to avoid being branded with the stigma of superstition.

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a *SS. Sū.*, 24; *SS. Ci.*, 22.

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b *CS. Ci.*, 9.

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c *SS. Uttara*, 39-62.

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d *Aṣṭ. Hṛ Uttara*, 4 and 5.

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The Kaumārabhṛtya System

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The *Kāśyapa Saṃhitā*, as is to be expected, contains considerable information on infantile disorders and care of new-born babies and older children. The *Uttaratantra* of Nāgārjuna’s version of the *Suśruta Saṃhitā* devotes no less than 12 chapters to this branch of medicine. Invocation of divine blessings, chanting of holy words and propitiation of supernatural forces formed a major part of such treatment, along with treatment by therapeutic drugs. The chapters in the *Suśruta Saṃhitā* convey the clear impression that an extremely high value was put on the health, welfare and mental happiness of children at this time. This started even from the period of conception, and an equally high value was placed on the physical and psychological well-being of expectant mothers. Midwifery and gynaecological knowledge was not, however, included in the branch of *Kaumārabhṛtya*.

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The treatises known to have dealt specially with this subject were the *Jīvaka tantra* quoted in Cakradatta’s commentary *Bhānumatī* on the *Suśruta Saṃhitā*, *Pārvataka tantra*, *Vandhaka tantra* and *Hiraṇyākṣa tantra* (quoted by Śrīkaṇṭha Datta). These works survive only in names, except for occasional quotations.

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The Agadatantra System

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The *Caraka Saṃhitā* devotes only one chapter to this branch of medicine but the *Suśruta* has one of its six *sthānas*, e.g. *Kalpasthāna*, entirely on toxicology. Apart from symptoms, first-aid measures and long-term treatments, there is a very good classification of different poisons and on different methods by which unwary persons may be slowly or quickly poisoned. The detection of some inorganic poisons by flame tests is a remarkable feature. There is also an exhaustive classification and description of different types of poisonous snakes and the symptoms of their bites. Similar information (including a faithful account of the symptoms of hydrophobia) is found for poisonous insects, aquatic and amphibious creatures and land animals. In fact, the *Kalpasthāna* of the *Suśruta Saṃhitā* is a valuable treatise on toxicology by its own right.

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A treatise on toxicology, also named *Kāśyapa Saṃhitā*, written in Sanskrit but printed in local script, is found in South India. Some passages in this work are identical with certain quotations in the works of Ḍalhaṇa, Cakrapāṇi and Śrīkaṇṭha.a But the authenticity of the text cannot be verified. Śrīkaṇṭha also gives quotations from another work in this field, the *Avalamvayanasaṃhitā*, which must have survived up to the seventeenth century but is now untraceable. Another treatise on *agadatantra*, the *Sanaka Saṃhitā* (or *Śaunaka Saṃhitā*), survives in an Arabic translation discovered by Max Müller.b Ḍalhaṇa quotes from another treatise on this subject, apparently his own work, in his commentary on Nāgārjuna’s *Suśruta Saṃhitā*.

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In Cochin and Travancore, many other Sanskrit works on *agadatantra* are available in the local script. Their authenticity and antiquity have not been established beyond doubt.

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The Rasāyana System

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The conception of *rasāyana* (restorative treatment) is a notable feature of *Āyurveda*. With age there is a degeneration of bodily tissues, sensory perceptions, as also of physical and intellectual vigour. *Āyurveda* considers this process not only preventible but even reversible and does not consider senility an inseparable condition of old age. This branch of medicine employs some remarkable processes, as well as herbal, mineral and metallic substances as tonics. Here also most of the specialized works are unavailable, but a fair knowledge of the methods and drugs are obtained from the sections devoted to *rasāyana* in the works of Caraka, Suśruta and Vāgbhaṭa. Mercurial and other inorganic preparations of the *Rasacikitsā* school of medicine (*vide later*) found in Tantric works were also credited with similar rejuvenating powers.

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