AYURVEDA

Maurice Winternitz

The beginning of medicinal sciences go back to the age of the Vedas. In the magical strophes of the Atharvaveda and in the magical rites of ritualistic literature described in particular in the Kausikasutra, belonging to the Atharvaveda, we find the early beginnings of an art of healing and of a knowledge of healing herbs. As in other countries, so in India too, the magic-doctors were the first physicians. And this association with magical craft is still not wholly forgotten in India. Even till recent days we find in scientific medicinal treatises demons being mentioned as promoters of diseases and charms being prescribed as remedies. Further even in the Vedic texts we find the beginning of a science of anatomy, of an embryology and of a hygiene. In the Satapatha-Brahmana (X and XII) and in the Atharvaveda (X, 2) we find an accurate enumeration of bones of the human-skeleton. The ancient names of the science of medicine is Ayurveda, "the Veda for (lengthening of) the span of life", that is considered an upanga (subsidiary) to the Atharvaveda. The science of medicine is also called Vaidyasastra "the Science of Physicians". The physician is called vaidya, "possessing knowledge (vidya), in the same way as in the West a physician is called "doctor". In respect of the high antiquity of the science of medicine it is noteworthy that Patanjali in the Mahabhasya mentions among the science in which Sanskrit is used, in addition to the Veda, the Vedangas, and the literature that pass by the names itihasa, purana and vakovakya, that are related to the Veda, the only secular science, the vaidyakam. Even long before Patanjali, Panini had used a number of names of diseases and remedies that prove existence of a system of medicine - nay even in the Vedas we find references to medicines and physicians. According to tradition Ayurveda originally consisted of eight parts (astanga), in which major surgery (salya), minor surgery (salakyn), treatment of disease of the body (kayacikitsa), demonology (teachings on the diseases caused by demons), (bhutavidya), healing of diseases of children (kaumarabhartya), toxicolgy (agadatantra), elixir (rasayana), and aphrodisiacs (vajikarana). Like other sciences, medicine too has a divine origin. It was created by Brahman, and one after the other it went to Prajapati, Asvins and Indra, and it was transmitted by these gods to the sages (rsis). Among the ancient scholars, who are named by tradition in this connection, are those like Atreya, Harita, Kasyapa, Agnivesa, Bheda. They might have been individual authors of treatises on medicine whose writings are lost to us. In particular Atreya or Krsna Atreya is mentioned as the first teacher of the science of healing. Atreya, Harita and Kasyapa are already cited in ancient medical texts. But the works that now go under the titles Atreya-Samhita, Harita-Samhita and Kasyapa-Samhita are at least cases of recent adaptations of earlier texts, and as a rule they are simply modern works that are decorated with ancient names. [The Kasyapasamhita also called Vrddhajivakiyam Tantram is said have been taught by Marica Kasyapa to his disciple Vrddhajivaka, who is said to be its author.]

Frequent references to the Indian system of medicine in old Buddhist literature also proves its high antiquity. In Buddhist legends we meet with the boy-physician Jivaka. It is said that he had studied medicine under Atreya at Taxila. It is probable that the famous "four noble truths" of the science of medicine may be going back to him. In the Vinayapitaka medicaments in a good number are enumerated and things like vapour-bath, bloodletting, surgical instruments, emetics, purgatives etc. are also mentioned. The comparisons of the surgeon in the Mahjhimanikaya (discourse Nos. 101 and 105) point to an intensive development of surgery. Some works on medicine are attributed to famous Nagarjuna. In later ages too the Buddhists had devoted themselves to the study of medicine with predilection. The detailed report of I-tsing about his tour in India on the medical system of India as well as the fact that so many treatises on medicine were translated into Tibetan prove the same thing.

[We might be tempted to begin our description of the available treatises on Ayurveda with the Ayurvedasutra that is attributed to an unknown author. But unfortunately it is a work that was written not before the 16th century A.D. It is divided into 16 chapters, called prasnas and is in form of sutras. It has none of the merits of the sutras of other well known branches of learning.]

The oldest dated medical texts that have come down to us in the Bower-manuscripts were written by Buddhist authors. These are old Indian manuscripts (written in incorrect Sanskrit mixed with Prakrit that were found by British Lt. H. Bower in the year 1890 in a Buddhist stupa in Kutcha in Kashgar - (Chinese Turkistan) and had been deciphered by R. Hoernle. On palaeographical grounds these manuscripts are considered to be of the second half of the fourth century A.D. Of the seven texts contained in them there are three that deal with topics concerning medicine. One of these texts is on the origin of garlic [lasuna] that cures several diseases and may let life last up to one hundred years, on digestion, on an elixir for span of life of one thousand years, on proper way of mixing of ingredients, on remedies that make one strong, on eye-lotions, ophthalmic ointments, etc. The second fragment contains formulas for 14 remedies for internal and external maladies. The most voluminous fragment is the Navanitaka ("The Butter", i.e. an extract from the best of all earlier manuals), that in 16 sectors deals with powder, decoction, oil, enema, elixir, aphrodisiacs, children's tendencies, preparation of compounds etc. Since the concluding portion of the work is missing, the name of the author is not known to us. All these works are written in verses, and partly they are composed in meters of ornate poetry, as is usual in later-day compilations of prescriptions. But the prescriptions have throughout an antiquarian appearance. Their language is Prakrit mixed up with Sanskrit. In the Navanitaka many medicinal authorities have been quoted, in particular Agnivesa, Bheda, Harita, Jatukarana, Ksarapani and Parasara, all of whom may have been disciples of Punarvasu Atreya; but from among the authors known to us only the name of Susruta occurs here.

[In Central Asia, in the region of Kutcha, have been found three leaves of a MS of a work entitled Yogasataka by the mission conducted by Pelliot. Here the Sanskrit text is accompanied with a translation in the dialect of Kutch. The age of the MS concerned appears to be about the 7th century A.D. This Yogasataka is extant in its Tibetan translation and its manuscripts are available in Nepal and India. It is a work written in different meters, viz. Vasantatilaka, Upajati, Dandaka, Sardulavikridita etc. and is meant to be learnt by heart. Its authorship is attributed to Nagarjuna in Ceylon and Tibet and in most of the MSS. Possibly this Nagarjuna is the same scholar who completed the Susrutasamhita and to whom are attributed several other medical treatises.

The Chinese pilgrim Yi-tsing, at the end of the 7th century, says that recently a writer has put the 8 chapters into one volume, and this is a thing that may have reference to the Yogasataka.]

Susruta is one of the 'three ancients' (as the Indians say) of medicinal literature: Caraka, Susruta and Vagbhata. Under these three names we possess Samhitas, great compendia of medicine, that in all probability go back to some Tantra and Kalpa literature that is now lost to us and in which certain topics of medical sciences were treated.

The Carakasamhita, according to its own testimony, is not an original work, but merely an adaptation of a Tantra by Agnivesa, a disciple of Punarvasu Atreya and a fellow student of Bheda (or Bhela). The Carakasamhita is closely connected with the little known Bhedasamhita. According to the Chinese Tripitaka (translated in 472 A.D.) Caraka was the personal physician of Kaniska whose wife was once assisted by him in case of an abortion. Apparently there is nothing that may stand in the way of assuming this report to go to make Caraka a contemporary of Kaniska (therefore, to fix his age probably in the 2nd century A.D.). But there is no definite proof in support of this. As against this it is certain that we do not possess that text of the Carakasamhita in its original form. The text is preserved wholly in a delapidated condition and the manuscripts and the editions differ strongly. About one-third of the work was completed in the 8th or 9th century A.D. by Drdhabala, son of Kapilabala. Drdhabala, however, was not satisfied with this alone, and he revised the text of the whole Samhita and prepared an appendix. Drdhabala is a Kashmirian and the commentators speak about a "Kashmirian recension" of the Caraka-Samhita. However, the basic part of the work, that like the KautiliyaArthasastra, is written in prose mixed with verses at the end of each chapter, is certainly old and probably the oldest of the extant medical manuals.

The Carakasamhita consists of 8 chapters (sthanas); 1. Sutrasthana, that in general describes means of healing, diet, duties of a physician etc.; 2. Nidanasthana, on the 8 principal ailments; 3. Vimanasthana, on tastes, food, general pathology, medical studium; 4. Sarirasthana, on anatomy and embryology; 5. Indriyasthana, on diagnosis and prognosis; 6. Cikitsasthana, on special therapy; 7.8. Kalpa- and Siddhanta-sthana, on general therapy.

Caraka is not only a physician, but also a moralist and philosopher. He prescribes even a number of religious and moral instructions with reference to hygienic rules as well as in connection with the theory of sin being the primary cause of a malady. With all force Caraka says that man should strive for attainment of the three objectives: preservation of vitality, gaining of wealth and peace in the world to come. Then there are discussions about the soul etc. in which the standpoint of the Sankhya philosophy is admitted, just as in the Sarirasthana that begins with an analysis of the theory of Purusa and Prakrti. Further Caraka is fully conversant with the Nyaya-theories about syllogisms and the categories of Vaisesika. In connection with the passage: The three sustainers of the body are: food, sleep and patience. And he adds an interesting discourse on the importance of sleep for health.

According to the Vimanasthana, the initiation of a student into the medical study takes place after religious ceremonies of the type of Upanayana for beginning of the Vedic studies. A junior physician is expected to possess a high sense of responsibility and discipline.

"Whole-heartedly he must try for healing the maladies; even when he has to play with his own life, he must not cause any inconvenience to the patient; he must never even once think of approaching the wife of another person, nor his property.... When he is in the company of a known person, authorized for ingress and enters into the house of an ailing person, he must be properly dressed and should proceed in a pensive manner with absolutely strict control, while taking all possible cares. In case he is inside, his words, thought and mind must not to go to anything other than the treatment of the patient and what is associated with his condition. The events of the house must not be disclosed and he must not communicate the apprehension, the possible approach of early death of the patient that may cause discomfort either to the patient or to anybody else.

The oldest extant commentary on the Carakasamhita is the one by Cakrapanidatta of the 11th century A.D. But before this the work had already been translated into Persian and from it into Arabic. The name of the commentary of Cakrapanidatta is Ayurvedadipika as well as Carakatatparyatika. One Carakasambita has its authorship attributed to Agnivesa.

The most famous Indian medical treatise is the Susrutasmhita that likewise is written in verses mixed up with prose, but in respect of language and the subject-matter it must have been younger than the primary stock of the Carakasamhita. In the Mahabharata (13, 4, 55) Susruta is included among the sons of Visvamitra. Nagarjuna probably had prepared a new redaction of the work of Susruta. In the Bower manuscripts he is mentioned by the side of Atreya and Harita. In the 9th and 10th centuries the name of Susruta had been well known as a famous physician equally well in Combodia and in Indo-China as also in Arabia in the West. So it is certain that Susruta was an ancient author who might have been a little younger than Caraka and might have lived in the early centuries of the Christian era, and equally uncertain is the antiquity of the text of the Samhita, that in its, extant form is attested first in a commentary of the 11th century A.D.

Exactly as the Caraka-Samhita, the Susruta-Samhita begins with a mythological introduction on the origin of Ayurveda. King Divodasa of Varanasi is named here as the teacher of Susruta, who is said to have been an incarnation of Dhanvantari, the divine surgeon. This myth in associated with the fact that, as against Caraka, Susruta is essentially a surgeon and deals in detail with surgery, that in the Caraka-Samhita is almost wanting. Susruta too begins with the Sutrasthana, in which common problems are treated. The second main division (Nidanasthana) deals with pathology, the third the (Sarirasthana) is devoted to. anatomy and embryology, the fourth (Cikitsasthana) is on therapy, the fifth (Kalpasthana) is on toxicology. The concluding part forms the Uttaratantra "the supplementary book", that was added early. It is devoted to eye-diseases and to topics not mentioned in the old part.

Susruta too demands the strictest discipline and the highest morality in respect of qualities of the body and the mind from young physicians. At the time of initiation of a disciple (upanayana), the student is taken about the holy fire and he is solemnly instructed to give up voluptuousness and to abstain from anger, greed for money, pride, vanity, grudge, vulgarism, idleness, falsehood, deception, etc. They must always have their nails and hairs cut short; they should always remain clean; they should be dressed in reddish garment and should lead a straightforward, pure and respectable life. A physician should treat holy men, friends and neighbours, widows and orphans, poor and tourists not differently from if they were his relatives. On the other hand he must not render any medical aid to hunters, bird-catchers, excommunicated persons and sinners.

The oldest commentaries on the Susruta-Samhita written by Jaiyyata (or Jaijjata or Jajjata) and Gayadasa have not come down to us. Of the available commentaries the oldest are the Bhanumati of Cakradatta and the Nibandhasamgraha of Dallana of the 11th and 12th centuries respectively.

The third of the "three ancients" is Vagbhata. When Harita says that Atri thought for the Krta-, Susruta for the Dvapara- and Vagbhata for the Kaliage, he probably means rightly that Vagbhata was by several centuries separated from Atri, (on whose teachings are based those of Caraka) and Susruta. There are two famous works that go under the name of Vagbhata : Astanga-Samgraha, "Compilation of the Eight Parts (of medical science)" and the Astangahrdaya-Samhita "Compendium of the essentials of the Eight Parts (of medical science)." In respect of form the Astangasamgraha, that is written in mixture of prose and verses, is older than the AstangahrLiayasambita, that is written only in verses. In respect of the subject-matter as well the former work is older of the two. The quotations in later-day medical treaties appear to refer to the former as "Vrddha-Vagbhata", whilst the second one is simply called Vagbhata. Since in the composition of the Astangahrdayasamhita, the Astangasamgraha was utlized there can hardly be any doubt that we must distinguish between an older and a younger Vagbhata. Apparently the older Vagbhata lived in the beginning of the 7th and the younger in the 8th century A.D. Probably the older Vagbhata is the person about whom Itsing has said, without mentioning his name, that he had "in brief" collected together the 8 parts of medical science. Since undoubtedly he was a Buddhist, as probably was also the younger Vagabhata, whose Astangahradayasamhta had been translated into Tibetan. The older as well as the younger Vagbhata cites from Caraka, Susruta and indeed from the Uttaratantra too.

A not much later or perhaps written contemporaneously with the Astangahrdayasamhita, therefore, in the 8th or 9th century, A.D. is the Rugvaniscaya, "Research into Maladies" of Madhavakara, son of Indukara. The work is usually called Madhavanidana or briefly Nidana. It is outright the chief work on pathology, in which most important diseases have been treated in detail, and this work has served as the standard for all subsequent works. The fame of the work is proved by existence of the large number of its commentaries. The existence of this work is presupposed by the Siddhiyoga or the Vrndamadhava of Vrnda, in which prescriptions and recipes for all diseases from fever to poisoning are laid down. Vrnda himself admits that he follows the Rugviniscaya in respect of sequence of maladies. In any case the two treatises are closely connected and they were written shortly after oneanother, if not, as conjectured by Hoernle, Vrnda is only a second name of Madhavakara and if the two treatises have one and the same author.

Cakrapanidatta of Bengal, whom we already know as a commentator of Susruta, was a successful medicinal author and he wrote one Cikitsasarasangraha, a great compedium on therapy that might have been written in about 1060 A.D. As his main source the author mentions one Siddhiyoga that he has actually almost copied. [He was the author of a work Dravyaguna too.] In the 11th or 12th century A.D. Vangasena, son of Gadadhara, wrote a voluminous work under the same title the Cikitsasarasangraha, in which the descriptions of diseases given in the Madhavanidana have been copied outright, and Susruta too has been unsparingly utlized. At the latest in the 13th century A.D. was written the Sarngadharasamhita by Sarngadhara, since in about 1300 A.D. Vopadeva had already written a commentary on it. The fact that it has been a popular and much read work on therapy is proved by the large number of its extant manuscripts. Opium and quick silver preparations are mentioned in this work, in which Vrnda has in addition been abundantly utlized, and in which remedies and the method of diagnosis are accurately laid down - things that do not occur in earlier works and probably that were introduced under I'ersian or Arabic influence. Vopadeva, the famous grammarian, who is already known to us, was a son of Physician Kesava of Berar and a protegee of Minister Hemadri. He is also the author of one Satasloki, 100 verses on the exposition of powders, pills etc., with the author's commentary. To the same age belongs apparently also the Cikitsakalika or Tisatacarya, a work that is already quoted in the 14th century. Tisata's son Candrata, known also elsewhere as a medicinal authority, has written a commentary on it. Down upto the most recent times have been written often and again big and voluminous manuals of the science of medicine as a whole or on its different aspects. We may here mention the name of the Bhavaprakasa of Bhavamisra of the 16th century A.D. in which is mentioned syphilis, a disease brought to India by the Portuguese and the Sarsaparilli as the remedy against it. In the 17th century A.D. Lolimbaraja, who is known also as an epical ornate poet, wrote a popular manual on therapy the Vaidyajivana in ornate metros.

Probably there have existed from a very early period monographs on individual topics of medicine; but we possess only recently written works on several diseases, like fever, infantile sickness, ophthalmic ailments, etc. as well as monographs on aphrodisiacs, on feeling the pulse etc. To the medical literature belong also the works that encroach partly into the regions of Religion and partly into that of Astrology in which the diseases are considered to be consequences of the sins committed in former lives. One such monograph is Jnanabhaskara ("Sun of Knowledge"), in which diseases have been considered from the stand-point of the theory of Kansan and penances and sacrifices have been prescribed as therapy in the form of a dialogue between the Sun-god and his charioteer.

There is a very voluminous literature on witchcraft and alchemy, a derived branch of medicine, that is devoted to the wonderful healing power of metallic preparation called rasa. Mercury is considered to be rasendra, rasesrara "king of rasas", that is prescribed as an elixir for life, as a rejuvinator and as a medicine that can cure all possible ailments. Since mercury is one of the things that are considered to have the potency to change ordinary metals into gold, the works that deal with rasa come also within the sphere of alchemy. In about 1330 A.D. Alberuni read in India such rasayana-works as are named by him. Approximately one hundred years before him there lived a famous especialist of this art, Nagarjuna of Daihaka, near Somanatha, who wrote a great comprehensive work on these topics. Alberuni speaks with great contempt about this pseudo scientific work and says that it would be best if this costly science of rasayana were banished into such farthest away regions of the world, where nobody could read it." In the Sarvadarshnasangraha, in its chapter IX, "the mercury system"... (rasesvaradarsana) has been described. The adherents of this system are Saivas, who belive in oneness of the soul with Siva, but admit that emancipation during lifetime depends upon stoutness of the body that must be made strong through use of mercury. And here the works Rasarnava, Rasahrdaya and Rasesvarasindhanta are cited. This work, therefore, must have been written in about at least 1300 A.D. The Rasarnava, is a comprehensive work of 18 patalas in verses and has been cited also in the Rasaratnakara of Nityanatha and in the Rasendracintamani of Ramacandra. The Jaina Merutunga wrote in 1386 a commentary on one Rasadhyaya of Sirnhagupta, ascribed in several commentaries to Nityanatha or to Asvinikumara too.

Medico-botanical glossaries, that bear the ancient name "Nighantu", were perhaps existent from a very early period; but the extant dictionaries , of this type are not very old. Indeed the Dhavantarinighantu must be older than the Amarakosa. Since in our text mercury too is mentioned, it has not come down to us in its original form. In 1075 Suresvara or Surapala, the court-physician of King Bhimapala of Bengal, wrote the Sabdapradipa, a dictionary of medical botany. In between 1235 A.D. and 1250 A.D. Kashmirian Narahari wrote his meteria medica, the Rajanighantu or the Nighanturaja or Abbidhanacudamani. In the year 1374 Madanapala wrote one Madanavinodanighantu, a comprehensive dictionary - materia medica of (enumeration of plants, animals, herbs and a remedies of all sorts). To this class of treatises belong the dietical dictionaries like the Pathyapathyanighantu of Trimalla and medicinal books on cookery. All the medical dictionaries are composed in verses. Further in the 19th century of quite a large number of works on materia medica lie in Sanskrit as well as in English have come to light. [The Hrdayapriya of Paramesvara is also an important work that may be mentioned here.]

[We may make a mention here of some of the authors of medical treatises who are considered to be Buddhists, although in their treatment of the subject they follow the lint of the Brahrmana authors. Such are Nagarjuna and Vagbhata. the Bhesajjamanjusa, "Basket of Remedies", is a work written in Pall, that is still in use in Ceylon and conforms strictly to the teaching of Ayurveda.

Although in the most ancient Buddhist schools practice in medicine was prohibited for the monks, later they were permitted to study it and they practised it at Cast in their own circles. The Mahavagga-Pali contains a chapter on medicines, remedies and hygiene. Besides there exist certain works in Chinese and Tibetan translations only.

Like the Buddhist texts, the Jaina-texts too contain allusions to medicine and treatment of diseases. A work like Kalyanakaraka, "Doer of Good", of an unknown date written by one Ugraditya, who was a Jaina, is based on Ayurveda, but it prohibits completely use of all the animal products on religious grounds.]

The similarities between Indian and Greek medicines are very numerous, and at least some of these similarities are necessarily to be explained on the basis of borrowings of Greek teachings, although there can be no doubt that the origin of the Indian medical science is to be searched for only in the indigenous region. This must particularly have been the case with Surgery. Many remedies, like opium and mercury, the Indian learnt from Persians and Arabians, to whom they also owe their knowledge of the diagnostic of pulse-feeling. On the other hand Indian treatises were translated early into Persian and Arabic. The medical system of Tibet, Ceylon and of the East Indies are dependent upon the Indian system.

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