Chapter 10 - The Method of Theoretical and Practical Study

The Extent and Scope of the Study of Ayurveda

The entire science of Ayurveda which comprehends in its scope both medicine and surgery is divided into eight main branches of study. It is therefore known as the eightfold science of life “Ashtanga Ayurveda” (Aṣṭāṅga Āyurveda). The eight branches are:

1. Medicine i.e. Kaya Cikitsa (Kāyacikitsā).
2. Surgery known as Shalya Cikitsa (Śalyacikitsā),
3. Diseases of the part above the supraclavicular region known as the Shalakya Cikitsa (Śālākyacikitsā),
4. Obstetrics and Pediatrics known as Kaumarabhritya (Kaumārabhṛtya),
5. Psychotherapy known as Bhuta Vidya (Bhūtavidyā),
6. Toxicology known as Agadatantra, Vitalization known as Rasayana (Rasāyana), and
7. Virilification known as Vajikarana (Vājīkaraṇa).

Many treatises were written on each of these eight branches of the science and the field of study was so broad that it necessitated that students should specialize in one or more branches of the science after first acquiring a general and comprehensive acquaintance with the entire range of the science. The two great treatises that have come down to us through the ages amply illustrate this tendency to specialization. The Caraka Samhita, though it refers generally to the whole of Ayurveda is really a treatise on medicine Its speciality is the theory and philosophy of medicine and general therapeutics and where operative and other forms of surgical measures are indicated it frankly admits these to be outside the scope of its domain, and refers the students to other treatises that must have existed then Similarly though the Susruta Samhita is all comprehensive in its range of discussion, it is a treatise on surgery Similarly there exist other treatises devoted exclusively to toxicology, psycho therapy, obstetrics and pediatrics etc., though they may all keep in view the general background of the science of life as a whole in outline.

From this it would not be hazardous to infer that the tendency for specialization in one or more branches had existed though a general all-round knowledge as a back-ground for such special studies was never lost sight of.

Apart from the branches of theoretical science there were ten medical arts which a medical student was expected to know. The definition given by Shukracarya to differentiate art from science is very interesting and significant

[Śukranīti A. 4. Pra. 3]

“Whatever is the subject of study as well as of practice is termed a science, while that which even a dumb man can learn to perform is known by the name of art”

These ten branches as described by the same author are as follows: [... —Medical Arts]

1. The art of preparing flowerjuices and other intoxicating liquors.
2. The art of extracting buried arrows spears etc, and of incision of open wounds and blood vessels.
3. The art of cooking various dishes with the various exudations like asafoetida combined in different proportions.
4. The art of grafting and planting and culture of plants.
5. The art of melting and reducing to ashes stones, minerals and the like.
6. Knowledge of the preparation of all things that can be prepared from the juice of sugar-cane.
7. Knowledge of the combination of minerals and herbs.
8. The art of combining and isolating minerals.
9. The science of producing new compounds of minerals
10. The art of extracting the alkalis out of minerals.

The medical man was expected to know these ten arts viz,

1. Distillation,
2. Operative skill,
3. Cooking,
4. Horticulture,
5. Metallurgy,
6. Sugar manufacture,
7. Pharmacy,
8. Analaysis and reparation of metabolic compounds,
9. Compounding of metals, and
10. Preparation of Alkalis, as they were indispensable in the preparation and the application of his curative measures, as well as in his experimental and clinical undertakings.

Moreover an analysis and experiment with the animal, vegetable and mineral poisons, for instance, required certain amount of knowledge and skill in these allied arts and crafts. These arts gradually developed and specialized to such an extent that each became a regular independent science viz, botany, zoology, chemistry, pharmacy etc These sciences have developed as hand-maids of medicine and therefore every medical man will have them to some extent.

The importance of all-round or comprehensive knowledge and the inadequacy and even danger of partial knowledge was expressed by Atreya in very significant words.

[Carakasaṃhitā Vimānasthāna A. 7, 4]

“A full conception of the science will never be attained by the knowledge of only a part of it”.

Vagbhata also says:—

[Aṣṭāṅgahṛdayasaṃhitā Uttarasthāna 4?, 84]

“If a man be well read in Caraka but ignorant of even the names of diseases described in Sushruta and other works or if he be not wanting in practical methods but wholly ignorant of Caraka, what can such a poorly equipped man do to relieve the ailments of patients?”

Thus the dangers attending upon a narrow specialization, unilluminated oy a general back-ground of comprehensive knowledge were avoided

The student was advised to pay special attention to have full and clear understanding of the technical terms without which he would not be able to grasp the correct interpretation of the medical science.

[Carakasaṃhitā Siddhisthāna 12.47-48]

“A physician who is not conversant with the canons of exposition though he may be a student of many treatises will fail to grasp the meaning of these treatises, just as a man fails to acquire wealth when fortune has deserted him”.

Knowledge of medical sciences and arts only was not sufficient to qualify a medical man but he was expected to be acquainted with a number of other sciences which were likely to bear some relation to life.

[Suśrutasaṃhitā Sūtrasthāna 4.7]

“It is not possible to include all the knowledge of science in a single treatise”

[Suśrutasaṃhitā Sūtrasthāna 4.7]

“One who studies exclusively one science cannot arrive at a correct determination of things, therefore a physician should be versed in the various sciences to have a full grasp of things”.

And to acquire this kind of knowledge he was advised to learn it from the expert in that particular branch

[Suśrutasaṃhitā Sūtrasthāna 4.6]

“The truths expounded in other sciences but which have been referred to here (in medicine) for our purpose, are to be understood in their full context from the experts in those sciences”

For knowledge, the ancients never hesitated to approach even an unfriendly person.

[Carakasaṃhitā Vimānasthāna 8.14]

“Thou shouldst listen and act according to the words of instruction of even an unfriendly person.”

Equal importance was given to theoretical and practical training. The person devoid of or deficient in one is ill-entitled to the practice of medicine.

[Suśrutasaṃhitā Sūtrasthāna 6.48-50]

“He who is learned only in the theory of the science but not skilled in practice gets confounded at the approach of a patient even as a coward feels at entering the battle-field. He who is skilled in practice but is audacious and ignorant of the theory of the science, does not receive approval of good men and receives capital punishment from the king.”

Both these are lacking in dexterity and are inept in the discharge of their duties, for they know only half the science and are like birds with one wing only.

And in the medical arts, specially in surgery, dominant importance was attached to the practical work and training. Any amount of theoretical knowledge is of no avail and is a mere burden, if one does not possess practical knowledge.

[Suśrutasaṃhitā Sūtrasthāna 4.4]

“Even as a donkey that bears a load of sandabwood is aware only of the weight of the load but not of its fragrance, similarly are the men who have read many treatises of the science but are ignorant of their true significance. They verily carry their load like a donkey”.

Thus it is clear that the knowledge of the medical aspirant of those days was comprehensive and in no way mean or easy of attainment and in many respects beyond the actual conditions obtaining even today among the generality of the profession.

Means and Methods of Study (Theoretical)

We shall next proceed to understand the methods the ancients adopted for disseminating this standard of knowledge and enabling such a comprehensive and thorough proficiency in the science. The three means of imparting and acquiring knowledge were—

[Carakasaṃhitā Vimānasthāna 8.6]

“To this end, we shall indicate the means viz. study, teaching and discussion with those versed in the same subject. These are the three means.”

We shall now discuss in some detail the nature of these three means or methods of education. The first is Adhyayana or learning from the teacher, the text and other things pertaining to the science. This word though in its limited sense meant only the learning word by word the sacred texts, yet in a larger sense comprised the whole course of instruction, theoretical as well as practical

Caraka says:

[Carakasaṃhitā Vimānasthāna 4.3, 5]

“Three indeed are the modes of ascertaining the nature of disease, They are—authoritative instruction, direct observation and inference. Out of this group of the three sources of knowledge, the knowledge derived from authoritative instruction comes first. Thereafter investigation proceeds by means of observation and inference.”

There are the three channels of acquiring knowledge, the first and most important is the theoretical knowledge and next is the practical experience and application of the theoretical knowledge and of the last but not of the least importance is the inferential method (anumāna). It comprises of logical elaboration as well as the further supplementations by the intelligent teacher or student based on speculative or imaginative corollaries drawn from the main data of the theoretical text as well as the practical experience acquired in the past.

Theoretical

The first step in theoretical study was the mastering of the texts thoroughly. The texts of the science which were the treatises on medicine and surgery current then, such as Caraka and Sushruta Samhitas, were written mostly in a very concise style known as Sutra style. The books were in combined form of both prose and verse. The prose was in a concise style while the verse was mostly in its simplest form that is Anustup (anuṣṭup). They were meant to be easy for cramming by the pupils and comprehended in their scope of exposition an encyclopedic range of subjects Their main characteristics were the logical exposition of the theories and methodical classification into various categories

The exposition of the subject begins with a general outline of the subject in brief followed often by a detailed description of its various aspects. Again at the end there is a recapitulation of the whole matter, mentioning in brief all the subjects covered in the chapter One of the chapters is devoted entirely to the enumeration of the subjects in the form of index. This system of exposition of a treatise was intended to preserve the text intact and to prevent interpolations

The chapters represent various methods of exposition, namely simple description, catechism, debates and discussions. The teachers of Ayurveda like the philosophers that they also were, attempted to arrive at full and precise definitions of the terms and concepts, on which they used to build the frame-work of the science. They attempted to show the original derivations of words in order to enable the student to understand the original as well as the current connotation of the terms used in the treatises; they made a lavish use of similes culled from nature and daily life, in order to illustrate and clarify the meaning of their words to all the three grades of intelligence of the students that comprised the class.

There is a remarkable catholicity of outlook in their teaching and they stimulated further achievements in the field of knowledge by giving constant impetus to the pupils for progress.

This theoretical knowledge was imparted by an oral system of education. This was the practice adopted for the acquisition of Vedic knowledge as well as the knowledge of any other branch of science in ancient India.

The method adopted in actual training as described in Caraka and Sushruta is as follows:-

[Suśrutasaṃhitā Sūtrasthāna 3.58]

“Beloved one! As regards the method of study, listen as I describe it. The preceptor should impart instruction to the best of his ability, to the disciple who has approached him in a state of cleanliness wearing his upper garment and with an attentive mind at the appointed hour of instruction One should learn to recite word by word or verse by verse. Again they should be linked together properly as words, phrases and verses. Having thus formulated them, they should be repeatedly recited. One should recite neither too fast nor in a hesitant manner nor in a nasal twang but should recite bringing out each syllable distinctly without over-stressing the accents and without making any distortions of the eye-brows, lips and hands.

One must recite systematically and in a voice not too high-pitched nor too low. No one should intrude when they are studying”

Caraka describes how the teacher imparts the knowledge to students.

[Carakasaṃhitā Vimānasthāna 8.7]

“The student, seating himself at ease on even and clean ground, should, concentrating his mind, go over the aphorisms in order repeating them over and over again all the while understanding their import fully, in order to correct his own faults of reading and to recognise the measure of those in the reading of others. In this manner, at noon, in the afternoon and in the night, ever vigilant the student should apply himself to study. This is the method of study”.

Oral Training

This is the one aspect which fundamentally differs from the modern system of education. The ancients depended much on their power of memory while the moderns are dependent upon their books One reason is the achievement and progress of the printing art that has made possible the availability of the required number of books Luckily the Indians were the people considered specially gifted with the power of memory. This is the reason why there is comprehensive encyclopedic books written in Sutra or most concise style to minimise the burden on the brain. And the ancients paid special attention for cultivating the power of memory. The power of verbal memory was developed to a degree almost incredible in present time.

It is no wonder that they memorised the whole of Caraka and Sushruta in those days and later on when memory power began to wane, Vagbhata epitomized the texts of these two books in one volume and in 1/3 size and in verse only in order to facilitate memorising

This may look like a stupendous task to us unaccustomed to such memory feats, but there are some scholars even in modern days who can remember the references from a great number of books. Both of them are memory giants but the method of application is different.

To illustrate to what extent the cultivation of memory power was carried out, Max Muller says—

“Thus this view of the subject matter of learning necessarily moulded the methods and system under which it was to be imparted. Hence we find that the preliminary stage of learning was the learning by heart the sacred texts through indefinite repetition and rehearsal by both the teacher and the taught. This means that the cultivation of memory was accorded a most important place in the ancient system of education. The powers of verbal memory were accordingly developed to a degree almost incredible in modern times”.

Again as Max Muller well puts it

“We can form no opinion of the power of memory in a state of society so different from ours as the Indian Parisads are from our Universities Feats of memory such as we hear of now and then, show that our notions of the limits of that faculty are quite arbitrary. Our own memory has been systematically undermined for many generations. To speak of nothing else, one sheet of the Times newspaper every morning is quite sufficient to distract and unsettle the healthiest memory”.

As the same author has further stated in some of his writings, this dependence on verbal memory for the transmission of sacred literature has continued to this day in a sense.

“Even at the present day when manuscripts are neither scarce nor expensive, the young Brahmans, who learn the songs of the Veda, the Brahmanas and the Sutras, invariably learn them from oral tradition and know them by heart They spend year after year under the guidance of their teacher, learning a little, day after day, repeating what they have learnt as part of their daily devotion until at last they have mastered their subject and are able to become teachers in turn.”

Max Muller himself arranged to collect various readings for his edition of the Rigveda not from manuscripts, but from the oral tradition of Vaidik Srotriyas (śrotriyā—śrotriyas) who are fittingly described by the Indian Scholar, Mr Shanker Pandurang, who was entrusted with the work, in the following passage.

“I am collecting a few of our walking Rigveda MSS. taking your text as basis”.

We may also have in this connection some idea of the quantity of literary burden and matter carried m the small heads of these young learners. The Rigveda alone, as we have already stated, consists of 1017 (1028) poems, 10580 verses and about 153826 words. But besides the Rigveda the Sutra works mention a number of other subjects to be learnt by the student

An Indian scholar informed Max Muller that even so late as the early “Seventies” the Vedic curriculum comprised of the following—

(1) The Samhita or hymns,
(2) The Brahmana;
(3) The Aranyaka,
(4) The Grihya Sutras,
(5-10) The six Vedangas

Max Muller calculates that these ten books contain nearlv 30,000 lines with each line reckoned as thirty-two syllables.

According to his informant, this course was to be finished in eight years. Now:

“A pupil studies everyday during the eight years except on the holidavs, the so-called Anadhyayas, non-reading days. There being 360 days in a lunar year, these eight years would give him 2S80 days From this 384 holidays have to be deducted, leaving him 2496 workdays during the eight years”.

On this compulation, a student of the Rigveda has to learn about twelve slokas a day, a shloka of thirty-two syllables.

Personal Touch

The instructions, being personal, consisted of a great deal of elaboration of the succinctly worded texts and even supplementation from a line of traditional instruction carried down through a successive line of teacher and pupil. In his teaching, the teacher always took into view the three grades of the intelligence of the pupils. They may be highly intelligent moderately intelligent and of the lower type of intelligence Without this supplementary part, the texts perhaps would yield very meagre fruit of Knowledge. One has therefore to remember while assessing the value of this difficult and concise texts that they were only the skeleton requiring the filling up of much vital stuff from parallel tradition of supplementary lore, they were mere precis, bare outlines of the subject prescribing only the germs of principles and theories to be explained and expounded by the learned teacher. That was prevalent in ancient times, and was maintained by the personal and direct conveyance from the teacher to the pupil. This method of direct imparting of knowledge was known generally as Adhyapana (adhyāpana). It included the imparting of the text of the treatise as well as exposition in elaborate terms of the implications of the texts which method was known as Vyakhyana (vyākhyāna) or Vivarana (vivaraṇa). This elaboration of the implications in the texts of a treatise was known as Tantra-yukti.

Caraka describes these Tantrayuktis as being similar in their relation with the texts to the sun in his relation with the forest of lotuses or to a lamp to the house. It awakens the mind and illuminates it so as to make the sense of the treatise exhaustively clear.

[Carakasaṃhitā Siddhisthāna 12.46-47]

“What the sun is to the lotuses in a pond and what the lamp is to the house, the canons of exposition are to the treatise in subserving the double purpose of awakenment and illumination

One who has acquired a good grasp of even one branch of this science will be able to acquire an understanding of the other branches as well on account of his being well grounded in general principles.”

That the mastering of a branch of science enables a pupil to acquire, with ease, proficiency in other branches is a statement in Caraka which bears out the fact that not only mastery in any one or more branches of Ayurveda but a good acquaintance though not mastery in all branches was the ideal aimed at. That a sound and thorough mastery and not any haphazard learning was the ideal enforced is clear and that thoroughness was relentlessly aimed at, both by the master and the pupil, is fully borne out.

This signifies the importance of the teacher, and Sushruta emphasises the necessity of study under a Guru in very vehement terms:

[Suśrutasaṃhitā Sūtrasthāna 4.8]

“He who learns his science directly from the preceptor and repeatedly studies and practises it, is indeed the real physician while all others are mere pilferers.”

Medical Conferences

The idea of holding national and international conferences of scholars and scientists in any branch of knowledge is not confined to modern times alone as some may be disposed to think. This was a custom obtaining in ancient times too and we have ample evidence in the Caraka Samhita to think that either periodically or whenever there arose doubt and differences of opinion on important questions affecting the theory and practice or science, there took place large or small conferences and discussions to resolve the doubts and establish an authoritative doctrine on the subject. These were different in their character from clinical meetings and debates that we have already surveyed These were national gatherings where scholars and thinkers from various parts of the country and even scholars from neighbouring countries, assembled in e interests of the advancement of science as a whole and for the promotion of exchange of doctrines and their international dissemination

The Caraka Samhita opens with the description of one of the greatest such conferences of sages, when the people as a whole were confronted with the phenomenon of acute disease and premature death and selected and deputed one of them—Bharadvaja, to learn the science of life from Indra. (Carakasaṃhitā Sūtrasthāna 1.6-12 [?]). There is a conference on a smaller scale of sages depicted, wherein the nature of Vata and other body-forces is discussed (Carakasaṃhitā Sūtrasthāna 12 [?]).

There is another conference devoted to the discussion of the theory of Taste and of the elemental composition of its varieties, (Carakasaṃhitā Sūtrasthāna 26)

There is a conference of sages for discussing the origin of disease and the formation of body-elements (Carakasaṃhitā Sūtrasthāna 25).

On the question of eugenics, of marriage, inheritance and constitutional traits and pecularities, there are discussions among sages and the leader of them, Atreya, gives out two authoritative conclusions on each subject after the debate (Carakasaṃhitā Śārīrasthāna 2.3)

Other such discussions are on subjects like timely and premature death (s) and relative merits of various purgative drugs (Carakasaṃhitā Siddhisthāna 11) and other such topics. Thus as a sincere and serious method of advancing the cause of the science and the well-being of mankind, the conferences and debates and discussions were held in Caraka’s times even as they are done today. This bespeaks the high degree of enlightenment and the love of progressive knowledge among the learned and their sincere desire for human welfare in those early times of history

Practical

The common charge made against the ancient Indian genius in general and her medicine in particular is that its nature is more speculative and theoretical than practical and useful India suffered in the estimation of the world more through world’s ignorance of her achievements than through the absence or insignificance of such achievements.

The two fields in which India excelled in the past were philosophy and medicine Hers was not a philosophy to be studied in the arm chair and left at that Her philosophers were realists and practical men They tested the validity of their conclusion by resorting to the practice of yoga and religious devotion Yoga and practical religion were closely allied to philosophy and never was philosophy a mere intellectual or imaginative pastime and adventure

The Hindus have been a practical people and have never allowed their theories to run away without yielding actual results affecting daily life is the opinion of the great western scholars who have studied original books with a scientific spirit.

This is even more true of the realm of medicine. Medical theories have to be justified and tested in everyday life, and medicine and surgery in India could not have survived if they had not stood this test of day to day verification and fulfilment. That they did is due to the fact that the system of medical education laid great emphasis on the study of anatomy and physiology, on dissection of dead bodies and on practical demonstrations, on models as well as on the clinical study of patients in order to enable the students to have a thorough grasp of the secrets of the structure and functions and behaviour of each and every part of the human mechanism in health and disease.

Both the treatises, Caraka and Sushruta repeatedly emphasize the necessity and importance of practical work. Sushruta, the treatise on surgery tries to give even greater importance to practical study:

[Suśrutasaṃhitā Sūtrasthāna 1.16]

“Now listen as I describe its foremost branch which is not in conflict with direct experience, authoritative text, inference and example.”

He gives priority to practicals in the enumeration of methods of study. In ancient works the order of words or phrases is kept meticulously according to their importance.

As Indian Medical science paid as much attention to the study of practical work as it did to theoretical side, we shall review in detail some of the various references pertaining to practical work found in the classics of medicine. To get recognition by the king, the physician should study as well as do the practical work.

[Suśrutasaṃhitā Sūtrasthāna 3.47]

“The physician should definitely study this science. After studying, he should take practical training. One skilled in both science and art deserves recognition by the king”

[Carakasaṃhitā Sūtrasthāna 1.127]

“Therefore the intelligent man who desires health and long life, should not take any medicine prescribed by a physician who is a stranger to the art of application.”

While describing the qualities of a Vaidya, Caraka gives equal importance to practical work as to theoretical study.

[Carakasaṃhitā Sūtrasthāna 9.6]

“Clear grasp of theoretical knowledge, wide practical experience, skill and purity (of body and mind)—these are to be known as the tetrad of desiderata in a physician”

[Carakasaṃhitā Sūtrasthāna 1.18]

“Hence the physician who possesses the fourfold accomplishment consisting of theoretical knowledge, clear interpretation, right application and practical experience, is to be regarded as the reclaimer of life”.

[Carakasaṃhitā Sūtrasthāna 29.13]

“But salutations be constantly proffered to those others who are learned in the science, skilful, pure, expert in performance, practised of hand and self-controlled”

[Carakasaṃhitā Vimānasthāna 6.19]

“The man who is acquainted with the characteristics of all diseases, and is versed in all therapeutic measures (is a worthy physician).”

[Carakasaṃhitā Vimānasthāna 8.4]

“He should be one who is thoroughly versed both in theory and practice, who is skilful, upright, pure, deft of hand, well equipped, possessed of all his faculties, who is conversant with human nature and line of treatment, who possesses special insight into the science, who is free from self-conceit, free from envy, free from irascibility, endowed with fortitude, who is affectionate towards his pupils, proficient in reading and skilful in exposition.”

[Carakasaṃhitā Vimānasthāna 8.86]

“The physician is he who ‘physics’, who is skilled in the application of textual wisdom and who knows all aspects of life correctly. The following are the qualities of a physician—full knowledge of the texts of the science, experience of practical work, deftness of hand...”

Botany

[Carakasaṃhitā Sūtrasthāna 1.120-123]

“The goat-herds, shepherds and cow-herds and other foresters are acquainted with the names and forms of plants.

No one can claim to have a perfect knowledge of the use of medicinal herbs by the mere acquaintance with the names or even the forms of them.

If one who knows the uses and actions of herbs, though not acquainted with their forms may be called a knower of science, then what need be said of the physician who has a knowledge of herbs in all their aspects.

He is the best of physicians who knows the science of the administration of drugs with due reference to clime and season, and who applies it only after examining each and every patient individually”.

[Carakasaṃhitā Vimānasthāna 8.87]

“Of that this is the test—That it is of such and such nature, of such quality, of such efficacy, is born of such a country or region, of such a season, gathered in such a manner, preserved in such a way, medicated thus, and in such dosage, administered in such a disease, to such a person, either eliminates or allays such and such a humor and if there be any medication, in similar manner should it also be examined”.

Preparation of Drugs

[Carakasaṃhitā Vimānasthāna 1.22 (2)]

“Preparation is the process performed to modify the natural properties of substances. That process again is that which modifies radically the properties of substances”.

[Carakasaṃhitā Kalpasthāna 12.48-49]

“By skilfully carrying out synthetic and analytic procedures on drugs by time-factors and by pharamaceutical processes even a small dose of a drug may be made to produce powerful action and a big dose of medication may be made to produce a very mild result.”

Caraka describes thus the importance of practical knowledge in the preparation of drugs and in prescribing them

[Carakasaṃhitā Sūtrasthāna 4.29]

“He is the best of physicians who knows the art of combination as well as the systematic administration of these preparations both internally and externally”.

[Carakasaṃhitā Sūtrasthāna 2.16]

“The art of prescription depends on the knowledge of dosage and time, and on this art, in turn, depends success, hence the skilful physician stands ever superior to those possessing merely a theoretical knowledge of drugs”.

[Carakasaṃhitā Sūtrasthāna 1.127]

“The drug whose name, form and properties are not known or the drug which though known, is not properly administered, will cause disaster”.

[Carakasaṃhitā Sūtrasthāna 26.37]

“Many are the ways in which an author expresses his ideas. Hence it is after due appreciation of the context of the particular place and time in question, the intention, of the author and the technicalities of the science, that the meaning of the text should be determined.”

Anatomy:

[Suśrutasaṃhitā Śārīrasthāna 5.47-51]

“Therefore a surgeon desiring knowledge free of all doubt must investigate well the dead body and study the human anatomy. In short direct observation and theoretical knowledge together conduce to the enhancement of the surgeon’s store of knowledge as a whole.

It is for this reason that the body of a man who has not died of poison or of a long-standing disease and who has not lived to be too old and whose bowels and excrements have been removed should be fitted in a case and wrapped in sacred grass or bark cloth or reeds etc, and placed in a running current of water at a spot not exposed to public view. When it is soaked well for seven days, it should be taken out and scrubbed slowly with a brush made of either cuscus grass, hair, bamboo or balwaja grass and all the body-parts such as skin etc, and the details of the external and internal bodylimbs as have been described (in the text) should be observed keenly with the eyes.

It is not possible to see with the physical eyes the subtle principle of the spirit in the body for it is visible to the eye of wisdom or meditation alone.

The wise physician therefore should know the truth both by studying the body as well as the text of the science and resort to practice having cleared all his doubts by the help of both observation and authoritative texts”

Surgery

[Suśrutasaṃhitā Sūtrasthāna 9.3-6]

“After the disciple is fully versed in the texts of the science, he should be given practical training by means of dummies and substitutes for the human limbs. He should be taught the practical line of procedure as regards oleation therapy”

The art of making excision or amputation (chedya) should be demonstrated on a Puspaphala (a kind of gourd), Alabu (Bottle-gourd), Kalindaka (water-melon), Trapusa (cucumber), or Ervaruka (Phut cucumber). The art of cutting either in the upward (utkartana) or downward direction (apakartana) should be also taught. The art of making incisions (bhedya) should be demonstrated by making cuts in the water bag or in the bladder or in the leather pouch full of slime or water. The art of scraping (lekhya) should be instructed on a piece of stretched skin with hair on it. The art of perforation or venesection (vedhya) should be taught on the vein of a dead animal or on a lotus stem. The art of probing or sounding (eṣya) should be taught on worm-eaten wood, or on the reed of a bamboo, or on the mouth of a dried bottle gourd. The art of extracting (āhārya) should be taught by withdrawing seeds from the kernel of a Scarlet-fruited gourd, Bael or Jack-fruit, as well as by extracting teeth from the jaws of a dead animal. The act of draining or evacuating (visrāvya) should be taught on the surface of a Salmali plank covered over with a coat of bees wax, and the art of suturing (sīvya) should be demonstrated on pieces of thin and thick pieces of cloth, skin or hide Similarly the art of bandaging or ligaturing should be practically learned by tying bandages round the individual limbs and members of a full-sized dummy. The art of plastic surgery of the ear should be practically demonstrated on a soft muscle or flesh or on the stem of a lotus lily. The art of cauterizing or applying strong alkaline preparations (caustics) should be demonstrated on a piece of soft flesh; and lastly the arc of inserting tubes and catheters into the region of the bladder or into an ulcerated channel, should be taught by inserting a tube into a lateral orifice of a pitcher full of water or into the mouth of a bottle gourd.

Here are the two verses—

He who practises experiment on things above-mentioned in a systematic manner does not err in carrying out operative measures.

Therefore the wise physician desiring dexterity in operative and cauterization procedures should practise on suitable objects these operative experiments

Practice of other operative measures

[Suśrutasaṃhitā Sūtrasthāna 25.32]

“One desirous of saving his life should avoid even from a distance the physician who often makes improper and unskilful use of alkali, operative instruments, thermal cauterization and drugs, even like a virulently poisonous serpent”

Practice in Venesection

[Suśrutasaṃhitā Śārīrasthāna 8.20]

“No one can be said to be fully skilled in venesection. For these veins and arteries are naturally always vibrant with motion. Like fish they are ever moving. Therefore should the physician venesect with great care.”

Clinical Examination

The greatest importance to practical training is given in the clinical examination of the patient.

[Carakasaṃhitā Vimānasthāna 4.7]

“Seeking to know the nature of a disease by direct observation, the physician should explore by means of his sense-organs, with the exception of the tongue. The entire field of sensible data presented by the patients body.”

[Carakasaṃhitā Vimānasthāna 4.10]

“Having considered all factors and from all points of view, as far as is possible, the learned physician should, thereafter, formulate his opinion first as regards the nature of the disease and next as regards the line of treatment”

[Carakasaṃhitā Vimānasthāna 7.4]

“The physicians, knowing all that is to be known, examining everything in every respect possible and diagnosing after full investigation will never be mistaken and will be able to achieve the desired result”.

[Carakasaṃhitā Vimānasthāna 7.7]

“But the wise ascertaining, in every way, everything that is to be examined will never blunder in the proper line of treatment”

[Carakasaṃhitā Indriyasthāna 1.26]

“Thus are declared the signs and symptoms of fatal prognosis in the subject of complexion and voice. He who knows these thoroughly well, will not be confused in the art of prognosis.”

[Carakasaṃhitā Indriyasthāna 3.7]

“The physician who by palpation ascertains these various palpable signs, will never be confounded in the matter of prognostic knowledge of the life-span of a patient.”

[Carakasaṃhitā Indriyasthāna 4.37]

“The physician who perceives these foreboding symptoms of the sense-faculties in their right nature knows the death or.survival of a patient.”

[Carakasaṃhitā Indriyasthāna 12.90]

“Thus we have propounded the subject under consideration correctly. The student of the medical science should pay constant heed to it. Thus alone, will he become a successful practitioner, securing for himself success, enduring fame and riches.”

[Carakasaṃhitā Cikitsāsthāna 30.306]

“The physician who keeps on observing repeatedly the development of diseases and the condition of the patient will not err in treatment”

[Carakasaṃhitā Sūtrasthāna 10.5]

“Hence those alone that act after investigation are considered wise.”

[Carakasaṃhitā Nidānasthāna 8.36-37]

“The wise physician should carefully investigate even the minutest changes in the hypertrophy, normality and the atrophy of the morbid element as well as the strength of the body, gastric fire, vitality and mind.

The circumspect physician, constantly observing the variations in the stages of the disease should prescribe such treatment as is helpful in attaining the fourfold blessing of therapeusis”

Caraka is even so particular as to prescribe that the clinician must possess the normal and healthy condition of the mind and hands which are used to examine the patient.

[Carakasaṃhitā Nidānasthāna 1.13]

“Therefor the physician who is of sound mind and understanding should know accurately the diseases from the view-points of etiology and symptomatology etc”.

[Carakasaṃhitā Indriyasthāna 3.4]

“The physician desirous of ascertaining by the method of palpation the measure of life left to the patient, should palpate the latter’s entire body with his hand which must be in a normal condition. If it is not so, he should get the palpation done by someone else’

[Aṣṭāṅgahṛdayasaṃhitā Sūtrasthāna 12.38]

“One who investigates very minutely all these in the determination of the morbid condition as well as in deciding the line of treatment and then starts the actual treatment, can never fail in his task”.

To illustrate the importance of constant practice, Vagbhata compares the medical training to other practical art

[Aṣṭāṅgahṛdayasaṃhitā Sū 12.56]

“Practice bestows on a man true insight which leads to success in treatment even as the skill to distinguish between the good and the bad among precious stones is not derived from a mere acquaintance with the theoretical knowledge of gems.”

It must be noted that the Guru was accompanied by his students when going for clinical examination of the patient. The following Jivaka’s story bears ample evidence of this fact.

Jivaka’s Story

With Atreya as his teacher, Jivaka mastered everything excellently at the slightest of instruction from his Guru Now Atreya was wont, when he visited his patients, to take a young Brahman along with him One day he took Jivaka also with him, gave him directions to administer certain remedies and then went away. Jivaka thought, Tn the present case the master has made a mistake. If the patient takes this medicine, he will die this very day. As the remedy which the master has prescribed is not good, I shall contrive an expedient’ So he left the house along with Atreya, and said when he came back again, ‘The doctor has told me not to give the medicine which he had prescribed, but a certain other remedy. When the patient was treated in this way he became better. The next time Atreya visited the patient, after asking how he was getting on, he gave directions that the same medicine should be given to him on the following day Being asked whether he meant the medicine which he had prescribed first or that which he had afterwards ordered, he said, ‘what did I prescribe first and what afterwards?’ He was told, ‘You prescribed the one when you were present here, about the other you gave orders to Jivaka’ He said to himself, ‘I made a mistake. Jivaka is endowed with great insight’. Then he said that the medicine which Jivaka had prescribed was to be given.

Atreya became well pleased with Jivaka and took him along with him wherever he went.

The Brahmans’ sons, said,

‘O teacher, you are well pleased with him because he is a king’s sou, and you bestow instruction upon him, but none upon us’

He replied,

‘That is not the case. Jivaka possesses great intelligence, and he is able to comprehend intuitively whatever I indicate to him.’

They said,

‘O teacher, how do you know this?’

He said to the Brahman’s sons,

‘Go and ask the prices of various commodities, you ask of such a one and you ask of such another’

And having so spoken he sent them off to the market. He also gave orders to Jivaka to ask the price of a certain article. The Brahmans’ sons did as they were bidden. Jivaka did likewise.

But then he said to himself,

‘Suppose the master asks the prices of other wares, what shall I be able to reply? I shall make myself acquainted with the prices of other commodities as’ well’

When they had all returned to their teacher, they rendered an account of those things which they had been ordered to do.

Then Atreya began to ask the prices of articles which he had not mentioned, saying to each of them:

‘O Brahman’s son, what does this commodity cost?’

He whom he questioned, replied that he did not know. In like manner did the others make reply when he questioned them.

But Jivaka, when he was asked told him the price of every kind of goods.

‘O Brahmans’ sons, said Atreya, ‘have you heard?’

‘Yes, we have heard.’

‘Behold, this is the reason why I said that Jivaka, as he is possessed of remarkable insight, intuitively comprehends any matter, intimation being given to him’.

Impetus. For independent Thinking and Reasoning

Caraka is not satisfied that the Vaidya should limit himself to the knowledge he has aquired from his Guru, but he requires that he should enhance it by thought and practice.

[Carakasaṃhitā Siddhisthāna 2.25-26]

“But the intelligent physician should not determine this according to the letter of these directions exclusively, but must use his own discretion and reasoning in arriving at decisions in situations in view of their nature of place, time and the vitality of a particular patient.”

[Carakasaṃhitā Siddhisthāna 2.28]

“Hence despite the directions laid down, therapeutic measures should be decided upon by the physician, with the use of his own discretion. The success achieved without the exercise of reason is indeed success resulting from chance”.

[Carakasaṃhitā Kalpasthāna 12.50]

“According to one’s own intelligence, thousands and millions of preparations may be made. As the combinations of drugs are very numerous, there can be no limitation to the extent of their combinations”.

Caraka condemns vehemently those who do not possess practical art.

[Carakasaṃhitā Sūtrasthāna 29.11]

“Such persons, outcastes from the science of healing both theoretical and practical and of time and of measure, are to be shunned, for they are the messengers of death on earth.”

Sushruta who valued so highly the diagnosis of the formation of pus in the body pours out his hatred for the ill-trained man who blunders in diagnosis.

[Suśrutasaṃhitā Sūtrasthāna 17.6]

“The medical man that can distinguish the non-suppurated, the suppurating and the fully suppurated conditions is alone the true physician while the rest are charlatans living on deceit.”

[Suśrutasaṃhitā Sūtrasthāna 17.10]

“He who out of ignorance undertakes to cut open a nonsuppurated swelling and one who fails to open up one that is ripe, both being devoid of discrimination in the science are to be regarded as out-castes.”

Adhyapana or Instruction

The next method, more correctly a next step in the method of education was Adhyapana or exposition before others. This method was regarded important in making the subject clear to the person himself and enabling him to acquire a knack for imparting it to others:

[Carakasaṃhitā Vimānasthāna 8.14]

“The teacher who teaches the worthy disciples will obtain all the auspicious fruits of teaching, those described and even others not described here and obtains all auspicious qualities for himself as well as for his disciple. Thus has been described the method of instruction.”

The method of teaching (adhyāpana) was exposition which consisted of expounding the subject before students; senior students and post-graduates acted as junior teachers and it formed a part of their own training. This method helped to produce efficient teachers of the science. That a sound and thorough mastery and not any haphazard learning was the ideal enforced, is clear and that thoroughness was relentlessly aimed at both by the master and the pupil, is fully borne out

Clinical Discussions and Conferences

The third method of the acquisition of knowledge was the discussion with the men of his own line of learning after he has fully acquired his scholarship and skill in exposition, that gives the final finishing of his proficiency and enlarges his field of vision by throwing light on many an obscure point and sharpens his wits and methods of cogent argument. He becomes then an adept in the full sense of the term. This would correspond to the clinical meetings of the colleges and conferences of the present day

Logic was one of the subjects in secondary school education. Logic was the foundation for the scientific medicine. And if the medicine is to be maintained on scientific level, every medical man should be taught the basic principles of logic. Otherwise the doctor, devoid of logic, will convert the scientific medicine into dogmatic practice.

[Carakasaṃhitā Vimānasthāna 8.15]

“We shall hereafter expound the method of discussion A physician should discuss with another physician Discussion with a person of the same branch of science is indeed what makes for the increase of knowledge and happiness. It contributes towards the clarity of understanding, increases dialectical skill, broadcasts reputation, dispels doubts regarding things heard by repeated healing and confirms the ideas of those that have no doubts. It enables one to hear a few new things in the course of discussion. Sometimes, secret meanings, which the teacher imparts to the ministering disciple in a propitious moment gradually, the excited disputant, desirous of victory reveals in the process of discussions Hence it is that discussion with men of the same branch of science, is applauded by the wise”.

That the medical conferences were held for the advancement of the science and for the acquisition and spread of knowledge, has already been described in the course of this chapter.

Scientific Concept

All these methods, rules and regulations and the meticulous study of logical postulates aimed at one thing and that was to make medicine a scientific structure of practical utility.

These facts clearly bear out and are certainly convincing enough that the ancients had developed and maintained a high standard of theoretical science and practical art of the medical profession; and when one reads:—

[Carakasaṃhitā Sūtrasthāna 30.84-85]

“The whole of suffering which cleaves to mind and body has ignorance for its basis and (conversely) all happiness is founded in clear scientific knowledge. However, this very knowledge of mighty import is no illumination to those who are devoid of understanding, as is the orb of the sun to those who have lost their eye-sight”

One comes to the conclusion that a vital essence of success or failure of the medical profession depends upon one factor and that is whether the medical knowledge is purely scientific or otherwise. If it is scientific, it would lead to happiness and success; if it is unscientific it will bring misery and unhappiness.

Added to this when we read the following aphorism showing the importance attached to the study of the whole as against the part, our heads bow down with veneration to these Maharsis.

[Carakasaṃhitā Vimānasthāna 7.4]

“A full conception of the science will never be attained by the knowledge of only a part of it.”

The physician therefore was required to be fully equipped for such clinical tests, to be sound of judgement and to be keen in his sense-perceptions. It is no wonder that with such meticulous elaboration of the methods of examination, the physicians of India were far-famed in the past for their skill in diagnosis and healing. This medical glory of India was at its zenith during the time beginning with the period just preceding Buddha until the 8th century A.D., when the physicians of India were invited to Jundishapur and Baghdad for consultation and were put in charge of the hospitals. Its highest achievement was during the period of Ashoka when the culture of India was carried across her oceans to the south, and the mighty mountains and the table-lands to the north. The greater India of that day including Tibet, parts of Java, Sumatra in the east and extending up to Bactria and Persia, almost upto the shores of Greece, in the west, was built not by military conquest, not by invasions and commercial exploitation but by the devout and humanitarian priests and missionaries who carried the sacred words of knowledge and the means of healing along with them. In a word, they possessed the means of healing, both spiritual and physical. That is an ideal that India of ancient times pursued without laying herself open to the charge of imperialism and exploitation in the wrong sense. Hers was the imperialism of the spirit and of knowledge whose empire knew no bounds, not even of time and space, and transcended the distinctions of race, color, and religion. In a word her domain was the heart and soul of man i.e. of all mankind and she built it up with all the strength at her command.