Chapter 1 - The history of Medicine in India (Introduction)

The History of Medicine is both history and medicine as expressed significantly by Dr. Henry Sigcrist. As history, it must show a chronological order and the dates and definite periods of the great leaders and teachers of medical thought and practice. As medicine, it must represent the gradual unfoldment of ideas from the most primeval beliefs and fancies. It must be a gradual or a radical transition from stage to stage of medical concepts, of the discovery and utilization of the treasures of plant, mineral and animal products, and the systematic and ever-widening study and observation of the processes in the human organism in health and disease. Are we in a position to compile and present to the world such a regular and comprehensive picture of the history of medicine in India?

The answer, to our great regret, is in the negative. The causes for such a condition are many and varied. The foremost of them is that medical history is a part and parcel of national and regional history. Thus unless the facts of chronology and of the political and cultural history of India are fully established, it would not be feasible to attempt similar portrayal of the medical part of Indian history. However important medicine, science and philosophy may be, each one of them is but an aspect of the total life of a people and is the off-shoot and a tributary of the whole national or racial life.

The difficulties met with in any attempt at writing a regular history of the evolution of medicine in India have been fully considered by Castiglioni in his great volume of History of Medicine, in the chapter dealing with Persian and Indian medicine. To most authoritative historians of India, nothing is certain before 326 B.C., the invasion of Alexander, or at any rate before the seventh century B.C., i.e., the time of the Buddha. It is admitted by historians that much of the material such as inscriptions, stone-tablets and the relics in excavations still await unravelling by expert investigators, while the sole source left to them at present is the evidence of literary and religious texts of the Vedas, the Brahmanas, the Puranas and of lay literature.

There are peculiar obstacles in the way of ascertaining the chronology, names and biographical details of persons that have played important roles in the evolution of the history of India in general and of her medicine in particular. Max Muller writes with reference to History of philosophy in India thus and this applies to the history of medicine with equal force.

“From the actual works themselves written by the poets, philosophers and scientists of India, very little material is to be had pertaining to the life and work of the author. Most often even the name has to be learnt from the colophons or such other appendages to the original, contributed by the editors, commentators and such others. The difficulties in computing the dates are augmented by the prevalence of different eras in vogue in the various parts of India”.

Again the country has been subjected to waves of foreign invasions and depredations from time to time and much valuabe material in the form of literature edicts, inscriptions., paintings and other art-forms have been lost or destroyed. This state of affairs is ever more accentuated where Ayurveda is concerned. Much of the old literature or the various branches of medicine has been lost, and successive waves of invasion and foreign domination of India have cast the achievements of her medicine into the limbo of oblivion. Thus for over fifteen-hundred years now, Indian medicine has suffered stagnation and decay. Very few, if any, efforts have been made by either Indian or foreign scholars to connect the loose ends of medical history and progress and evolve a continuous record of the evolution of Indian medical thought and practice. While on the other hand, a blind sentimental exaltation of the past led to an unquestioned acceptance and adoration of whatever was called ancient medicine and prevented a thorough and enlightened inquiry and scientific scrutiny into its claims for acceptance. Some others, taking a wholly superficial view and being repelled by its seemingly queer methods and concepts, rejected it as holding no validity for modern times.

We shall have to steer clear of all these prejudices and predilections and attempt to construct a faithful history of its evolution first and then launch upon an inquiry into its validity for then, for now or for ever

What are then the sources that are helpful to such an end? Apart from the conventional list of the sources of history we have today in India a vast field opened up by the excavations of Mohenjo-daro and Harappa and our vision is carried back to thousands of years before the period from which we formerly hoped to begin our history.

This may not be Vedic or Aryan in its nature, but what is that to us who are concerned with history and history of medicine as such, in its wide all-embracing human aspect. Whether Dravidian or Aryan or whatever else, the large roads, aqueducts, drains, baths and other sanitary features of the civic and domestic life revealed in these excavations presuppose a highly developed sense of health and sanitation. It is but natural to suppose that such a civic and domestic sanitary sense must be based on and supported by a knowledge of disease and medicine of no mean order. The innumerable inscriptions, tablets and material waiting study and deciphering will surely yield rich results pertaining to the medical wisdom attained by that civilization. Mineral pitch and other drugs and chemicals that were in use in those days reveal a high degree of medical knowledge. Next the study of the Vedas, the oldest record of Aryan wisdom and perhaps of human wisdom itself, is still a fertile source and if studied minutely from the medical researcher’s point of view, much material of an unprecedented kind is bound to come to light. The Atharva Veda is of special significance in this context.

1. In India, there are living traditions of practical therapeutics handed down from teacher to disciple obtaining in various obscure parts, which tradition and lore are not embodied in any written record of medicine. These have to be tracked down and investigated. There is a variegated field of priestly, magical and empirical medicine and special ophthalmic, surgical and medical manipulations that are quaint but often effective and they must be properly studied and understood and embodied in the record of medical history. The literature of the post-Vedic period, the Brahmanas, the Tantras, the Ramayana, the Mahabharata and the Puranas as well as the literature of the classical times contain inuumerable references to medical topics and are yet to be thoroughly ransacked and codified. The literatures of Buddhism and Jainism are a fertile source of information for the history of medicine.

2 Ancient monuments in the form of inscriptions on monoliths, stone-tablets and metal plates are a fruitful source. The edicts of Ashoka resembling as they do the edicts of Darius the great, on the rock of Behistun in Persia contain references to his medical benevolence and injunctions to his subjects in the observances of sanitary regulations and attention to men and animals in disease and distress and to the usefulness of hospitals. Much valuable material may yet be gathered from these and such other sources.

3. Paintings and other art-forms such as icons friezes and frescos, such as are still preserved in caves and temples like Ajanta, Ellora and the Buddhist Stupas of Amaravati and Nagarjuna Konda contain much material for the keen eye of medical research

4. Instruments and appliances prevalent in various parts and preserved in various museums.

5, Medical literaure both in Sanskrit and in the vernaculars, and oral as well as written traditions of folk-lore, proverbs etc,

6. The medical literature of neighbouring countries and the general literature such as travellers’ memoirs ‘and pilgrims’ travels of the surrounding countries with whom India has had contact since the most ancient times.

7. As an example of how ancient works of art reveal, to the searching eye of the medical investigator, features of value to the medical historian, the following lines from:

“The Surgical Instruments of the Hindus by Girindranath Mukhopadhyaya are valuable.

“Personages and scenes in connection with medical practice, and pictures of herbs may have been represented in works of art which must be thoroughly examined. But unfortunately we do not possess any such work of art and so we can learn nothing to our purpose from this source.” In the interpretation of the subject of the friezes of the Rani Naur and Ganesha’s cave, Dr, R. L. Mitra says, “The shampooing in the Ganesha cave may be for a parent, but the close seat with the right hand round the neck of the male personage in the other, would be highly unbecoming in an unmarried female. But if the stooping figure be taken to be that of a wounded man, a wounded priest for instance, the lady may be a maiden nursing him without any offence to propriety. It is true that the appearance of the figure on the mattress does not indicate suffering from a wound, but in the Rani Naur Frieze, the stooping head affords some indication of it.”

8. The pictures, descriptions, sculptures, temples and shrines wherein the god or gods and goddesses pertaining to medicine or those impersonating diseases are found, form fruitful subjects of research. We have thus the various representations of Dhanvantari, various manifestations of the goddess of small pox etc., Putana (Pūtanā) and other evil spirits that afflict children and Hariti (Hārītī), goddess or protecting angel of children. A statue of this goddess is excavated from Sabri Bahlol and is kept in Peshawar museum (No. 241). Hariti is reputed to be the consort of Kubera, the god of wealth and was at one time worshipped for the protection of children.

Dr. Reddy of Madras cites a scene in Amaravati sculpture showing a surgeon in action cutting the flesh from king Shibi and filling the scales of the balance, and also a scene in Nagarjuna Konda sculpture showing an illustration of fainting and collapse.

Besides these, a keen study of the works on other sciences such as astronomy, political science, metallurgy, botany, and study of precious stones, throw rich light on allied aspects of medicine. Works like Brhatjataka, Kautilya, Rasashastra or alchemy are still available and contain medical references whose full significance still awaits investigation.

It is not, however, our purpose to overburden these pages with a recital of the many sources from which; material for a history of medicine in India could be gathered; nor do we suggest that so far scholars have not attempted such a task in some measure or other. We feel that if these sources are more fully explored with an eye to finding material or medical history, they will yield adequate enlightenment on the state and evolution of medicine in India from the earliest times, going back to pre-Aryan civilization of the Indus valley and afford opportunity for joining scattered data into a whole.

We hope thus to reclaim much territory for history which is now covered by the mists of picturesque legend and myth. It is interesting to note that Castiglioni in his volume of History of Medicine remarks that “India offers all the attraction of a large and marvellous museum in medicine as in other fields, the magic practices of the primitive people, the cult of stones and trees, the belief in amutters and charms, the periodeuteis or travelling physicians and ambulant doctors of Greek description, the scholastic, pedantic, dogmatic and the most modern type of specialists are found in actual active practice shoulder to shoulder. All the stages of evolution of the science of medicine from instinctive, empirical, magical, priestly, religious, metaphysical and scientific practice, thus all the stages of evolution of medicine are represented in this country”. This will give an important link to connect the list of medicine of the whole world.

The question of Chronology

Despite all that we have said and hoped for the purpose of chronology, we have no landmarks to guide us in our sallies into ancient history of medicine in India, beyond the invasion of Alexander and the time of the Buddha calculated from the former date. As we shall see later in the course of these pages, the great medical teachers Bharadwaja (Bharadvāja), Atreya (Ātreya), Divodasa (Divodāsa) and Sushruta (Suśruta) are much anterior to the Buddha and even the time of the Mahabharata. Though we may not assign exact dates to these teachers and their times, we shall yet indicate the successive order of the periods they occupied, in the light of the racial and traditional history of the Indian people.

The excavations of the Indus valley reveal the possibility of a long and rich period of civilization before the entry of the Vedic Aryans into India. Thus there is a pre-Vedic period of Indian civilization and consequently of Indian medicine which must have inevitably resulted from and enriched that civilization.

From the actual record of medical wisdom in the Vedas, though in its most rudimentary forms, we have a Vedic period of medicine.

Next as the consequence of the elaborate ritual of the sacrifice and the discussions, assemblies and discourses associated with it during its long performance, there emerged a systematic and rational method of exposition of philosophy and of medicine. This is the great Brahmana period of philosophy and also the Samhita period or the period of systematic codification of medicine. This may justly be called the scientific era of medicine in India. Ayurveda then attained its age of maturity emerging from its nonage of Vedic medley of charms and simple drugs, of incantation and magic-ritual, into the maturity of a rationally expounded science of health and disease and a systematic practice of remedies, related to dose, time and constitution. This lasted from the time of Atreya upto the end of the seventh century after Christ i.e. almost till the beginning of the Mohammedan invasion of India. This millenium was the heyday of Ayurveda, the golden era in the medical history of India, comparable to that of Hippocrates and Galen in the West. This was followed suddenly by dark centuries of stagnation, neglect and decay, when the original texts fell into disuse and the noble professions of the surgeon and the physician fell into even disrepute. It was a mode of seeking a mean livelihood and the practisers of it degenerated into pretentious charlatans, ignorant and wily, avaricious and mean. The Smritis and the codes of social observances stigmatized these professions by making their members unworthy of attendance at ceremonial dinners. They were to be unworthy of silting in a line with one at meals. The later editors and commentators like Madhava, Cakrapani, Sharngadhara, Bhavamishra and others helped merely to keepalive the ancient works and their lore from being totally lost. They were evidently aware of the decadent condition of the science and under the circumstances of social life and political upheavals in their days, they could not have done better.

It is necessary to remember that at the time of Madhava, the great Vijayanagar-empire of the south was the bulwark of Sanskrit culture and sciences. The great Vedic commentary of Sayana and the Nidana of Madhava point to a revival of Vedic traditions in philosophy, science and art. The Siddha and other traditions of the south received a fillip from the rulers of the empire and the remnants of ancient medical practices and methods alongside the local traditions of Agastya, Siddha and other systems that subsist even today in the south owe their survival not a little to the spirit or renaissance born and maintained in the days of the Vijayanagar empire. But that renaissance was short-lived and was enveloped by the spreading darkness of political instability in India during the Mohammedan period and the later vissicitudes of Moghul, Maratha and East India Company’s fortunes. With the establishment of the British rule, the flood of Western culture, science and medicine, upheld and patronised by the state, put off all chances of recovery for the Indian system of medicine. It is only in the latter days of British rule, that Ayurveda attracted the notice of the enlightened among the rulers as well as the ruled, partly as a result of the scholarly interest of orientalists of the west and partly of the growing claims of the nationalist spirit of cultural renaissance in India.

With the attainment of full independence, India finds herself at the cross-roads and has to make her choice now. There is the imperious call of the spirit of science in every heart desiring advancement and equality with other nations of the world and there is also the fond attachment to a hoary past, glorious but apparently not in accordance with what is now regarded as valid and reasonable. Not that it is irrational, but it derives its strength and support from intuition elaborated by a system of speculative and highly imaginative reason. We are today facing a world steeped in the spirit of experimental science, analytical in method and verifiable by laboratory methods alone and which cannot brook abstractions that cannot be put into the test tube and shaken, however valid they may sound in themselves. But the difficulty of the task is minimised when we remember that between now and the Vedic age, there was a period of experimentation and research in the realm of medicine second ton none in the history of world-medicine. This was the scientific period of medicine in India.

The Vedic Period of Ayurveda

Instinct is the inner compulsion that the animal organism feels in the choice of what is good and beneficial for its survival and protection. In the early man, this grew into the higher faculty of the mind called intuition. The propounders of Ayurveda thus knew that the protective power and device was ingrained in lie itself and acquired varied expression in the plant, animal and man according to the exigencies that each of these stages of animation gave rise to. The plant developed its thorns and a thick coat of bark to prevent its easy vulnerability. Animals and birds knew by instinct what particular action or thing helped to get over an affliction. And equally naturally did the early man see with his mental eye the measures and things that relieved him of ailments. In Caraka, we find it expounded that there never was a time when Ayurveda did not exist, even as it was the case with life. The life-stream carried in its current its own supporting and protecting wisdom that became manifest at the beginning of each cycle of time to the seers. It is only in that sense that Ayurveda can be said to have a beginning. Otherwise it is as beginningless as life itself and runs parallel to it through all time (Caraka, Sutra. 30,27). The Veda thus naturally contains reference to such instinctive and intuitive origins of medicine.

Osler, the great writer on modern medicine refers to (1) natural phlebotomy which the hippopotamus knows for it thrusts itself against a sharp-pointed reed in the river bank when it feel it needs phlebotomy, (2) the use of emetics by the dog, (3) the use of enemata by the ibis. Berdoe refers to the use of valerian by cats, antidotal herbs for snake-poison by the mongoose, of plantago major by the toad, of salt by the cow, buffalo, horse and camel. Similarly licking of the wounds by the animals, stopping the bleeding by monkeys and other instinctive performances of remedial gestures and applications by animals and birds have been noticed and described by writers on the history of medicine.

The Atharva Veda mentions the animals and birds from whom the use of healing herbs and drugs could be learnt.

[Atharva Veda, Kāṇḍa 8, Sūtra 7]

“The boar knows the plant; the mongoose knows the remedial (herb), what ones the serpents, the Gandharvas know, those I call to aid for him. 23

What (herbs) of the Angirases [Angirasas?] the eagles know, what heavenly ones the Raghatas know, what ones the birds, the swans know, and what all the winged ones, what herbs the wild beasts know—those I call to aid for him. 24

Of how many herbs the inviolable kine partake, of how many the goats and sheep, let so many herbs, being brought, extend protection to thee. 25”

The natural desires and inclinations of the ailing man are even now indications of his needs not to be disregarded by the attending physician. Sushruta is emphatic on the value of such inclination known as ‘Prakanksha’ (Prakāṅkṣā).

Vedic medicine and post-Vedic medicine too have been guided in a great measure by what is known now as the doctrine of signature. The color, texture or shapes of things that were similar to the affected parts or elements of the body were indications to them of their usefulness as remedies and as replenishing agents. Thus substances that could tinge the fluids bright red were helpful in promoting the blood or in checking hemorrhages. Milk and other substances of its color and consistency were regarded promotive of the body-elements of similar texture and color like semen, and ojas or the protoplasmic cell-fluid. Osler mentions the use of plant eye-bright for centuries in diseases of the eye because the black speck in the flower suggested the pupil of the eye Caraka mentions lap as beneficial in hemoptysis.

The Atharva-veda mentions turmeric and yellow birds into which jaundice is charmed to enter, leaving the human patient.

[Carakasaṃhitā Cikitsāsthāna 11.15]

It is from such beginnings, that man guided by the instincts of the lower animals and the intuition of the best among his own species, has evolved the present complex system of the healing science, harnessing fancy, imagination and reason in the service of health and life.

With the awakening of his mind to the super-sensual reality behind life, he felt the need to propitiate by conduct and ceremony, the mysterious powers behind life in the form of gods, spirit aud angels. Thus the Atharva-veda is a reeord of psycho-somatic technique of healing by a combined procedure of charms, prayers, incantations amulets and drugs. The Atharva-veda is a compendium of medicine in its various stages of evolution and contains the most primitive as well as highly advanced stages of therapy. A hymn recounts the four kinds of remedies or therapies that protect life.

The therapies of holy chants, of the juices of plant and animal parts, of devotion to gods or naturo-therapy and of human contrivance by means of drugs—they are the therapies that protect life.

[Atharva Veda 11-4-16]

“O, life! when you are propitious, the drugs of the Atharvans (charms), the drugs of the Angirases (juices of plant and animal parts), the divine drugs (prayers to sun, water añd other natural elements), and the drugs of human artifice all bear fruition.”

Thus even so long back as the Vedic times, they knew medicine in its various aspects of psycho-therapy, organotherapy, naturo-therapy and drug therapy.

Snake-poison and other kinds of poisonous bites by the fangs of cruel animals were common in those times as the charms and drugs against their conditions are most common in the Atharva Veda. Toxicology as a special branch had already come into being with the Atharvans as a class of persons learned in charms and incantations against poison, sorcery and toxic conditions.

The combined therapy of drug and incantation was applied to somatic ailments as well, the fever, the king of them all, was known as Takman which yielded to both drug and charm each singly or both combined.

As regards the surgical and therapeutic skill, the physicians of the gods, the Ashvin [Ashvin] twins, were wonder workers. They could replace the head of a man with that of a horse.

They healed the withered hand of Indra after he wielded thunder against his foes.

[Carakasaṃhitā Cikitsāsthāna a-1, pā-4]

“The Ashvins [Ashvins] who are the physicians of the gods are celebrated as the resuscitators of sacrifice, for it is they that reunited the severed head of sacrifice. It is these two, again, that successfully treated Pusan when his teeth had become loosened, Bhaga when he had lost his eye-sight and Indra when his arm had become stiffened These two, moreover, cured Soma, the moon-god, of consumption and restored him to his happiness when he had fallen from his state of good health. When Cyavana, the son of Bhrigu, had become decrepit with loss of voice and body-lustre, as the result of old age, but hankered still for sense-pleasures? it is the Ashvin [Ashvin] pair that made him young once again. On account of these and many other miracles of healing, these two, the greatest of physicians, came to be regarded with honor by such great personages as Indra and others”.

With adherence to the mode of sacrificial worship, the anatomy of the higher animals like the cow, sheep and horse were well known to the ancient Aryans Though not often, even human sacrifice was practised which must have yielded a reasonably vivid picture of human anatomy. Wars with the rival tribes and clansmen on the north-west of India and with the dark chieftains of the natives “Dasyus” must have necessitated to the acquisition of a degree of surgical skill.

A thorough investigation of the material in the Atharva-veda from the medical historian’s point of view remains yet to be accomplished. There are 114 hymns in it devoted to medical topics. Fever, consumption, various wounds such as Apaci, Vidradhi, etc., leprosy, dropsy, heart-disease, headache, worms, eye and ear diseases, poison, rheumatism, madness and epilepsy are some of the outstanding subjects mentioned in the Atharvaveda.

Even a cursory perusal of it is enough to conclude that a considerable knowledge of psychosomatic medicine and a practical knowledge of human anatomy and surgical skill, obtained already among the Vedic-Aryans. It is from such beginnings and on such foundations that the later sages, researchers in the vital science of Ayurveda, eight branched and three propped, evolved a medical system complete, with its framework of general principles of the science of the human organism and of the five-elemental composition of drag and the human cell controlled by the triad of forces called “Tridhatu” (tridhātu).

Of this we shall have to speak later in this volume, Suffice it to know now that from this period of Vedic medicine, we enter upon the variegated scene of the Samhita period or the period of systematic and scientific compilation. The story of Ayurveda as scientific medicine begins after this quaint age of the Vedas, when the mortals and the immortals mingled and interchanged their gifts, when gods, spirits and demons were everyday realities and when the Yaksas (Yakṣa) dwelt in running brooks and waving tree-tops and the Gandharvas haunted the valleys and dells of the mountains. In such circumstances of living, naturally enough, the priest and physician were one, and religion and sacred ritual were not far distinguishable from the healing art. At the end of this Vedic age must we place the great congress of sages described in the opening lines of the Caraka Samhita, who gathered together to discover the way of healing and long life, faced with the undeniable reality of deadly disease and pestilence that snatched away the flower of humanity and made impossible the higher progress and evolution of life through meditation and thought. With that conference in the northern Himalayas, dawns the age of scientific medicine in India. The history of that medicine, the story of its beginning and unfoldment, we shall trace in broad outline in the following pages, with the limited resources at our disposal.