Bhesajjakkhandhaka (Chapter on Medicine)

by Hin-tak Sik | 2016 | 121,742 words

This study deals with the ancient Indian Medicine (Ayurveda) in Early Buddhist Literature and studies the Bhesajjakkhandhaka and the Parallels in other Vinaya Canons. The word Bhesajja means “medicine” and is the sixth chapter of the Khandhaka, which represents the second book of the Pali Vinaya Pitaka. Other works consulted include the Bhaisajya-s...

(a) Brief History of Āyurveda

As mentioned, the empirical and systematic Āyurveda is likely to have originated from the śramaṇ-ic medicine, which had been preserved by wandering ascetics, especially Buddhist monks (and nuns). Its arising as a distinctive medical system was accompanied by the appearance of the classical Āyurvedic treatises in the period around the turn of the Common Era. However, the Āyurvedic tradition has given different accounts of its origin in these treatises. What are the accounts of its origin?

The early significant classical Āyurvedic literature such as the Caraka Saṃhitā and the Suśruta Saṃhitā contain their narrations of the history of ancient Indian medicine. In these texts, it is claimed that Āyurveda is linked to the Vedic medicine, and this tradition is regarded as upāṅga (secondary part) of the Atharva Veda and upaveda (secondary Veda) of the Ṛg Veda (Filliozat 1964, 1; Mazars 2006, 6). However, such a claim is doubtful because it includes a lot of mythology. Stories involving gods and sages in the transmission of the teachings of Āyurveda, like other sciences in Indian history, are found both in the Caraka Saṃhitā and the Suśruta Saṃhitā. According to the Caraka Saṃhitā (Sūtrasthāna 1. 4-14, 27-31), medicine was created by the god Brahmā, who transmitted the knowledge to other gods successively: Dakṣa (one of the ten Prajāpatis), the twins Aśvins, and Indra. Indra then revealed the medical knowledge to the sage (ṛṣi) Bharadvāja, who shared it with other sages including Ātreya Punarvasu. Ātreya Punarvasu had six disciples: Agniveśa, Bhela, Jatūkarṇa, Parāśara, Hārīta and Kṣārapāṇi. These six disciples composed their own works. According to Roy (1986, 157), only two of these works–those of Agniveśa and Bhela–have come to us. Agniveśa’s work (the Agniveśa Tantra) was later redacted by Caraka, whose work is known as the Caraka Saṃhitā (and more details of this text will be provided later). Bhela’s exposition, the Bhela Saṃhitā, has survived as a manuscript (Benner, 2005, 3853). According to the Suśruta Saṃhitā (Sūtrasthāna 1. 3, 20), the same story of transmission of medical lore as in the Caraka Saṃhitā is found up to the god Indra (except that the name Prajāpati is used instead of Dakṣa). Then Indra passed the knowledge to the god Dhanvantari who manifested as Divodāsa, the king of Kāśī (i.e. Vārānasī or Benares). Divodāsa, at the request of a group including Suśruta, Aupadhenava, Vaitaraṇa, Aurabhra, Pauṣkalāvata, Karavīrya, and Gopurarakṣita, transmitted the knowledge to them. Suśruta, the author of the Suśruta Saṃhitā, is believed to have received the teachings directly from Divodāsa.

The above-mentioned accounts of the origin of the Āyurvedic tradition, however, do not seem to have a historical base (Filliozat 1964, 11). Such myths, as Wujastyk (1993, 758) has pointed out, are not compatible with the empirical and rational approach of the medical teachings and practices of Āyurveda. It is also suggested by Zysk (1991, 6, 26; 1996, xv) that, during the early centuries of the Common Era, the empirico-rational medical knowledge acquired by the heterodox ascetics was assimilated into Brāhmaṇism and rendered it as a brāhmaṇic science. By applying a mythical origin to it, the “heterodox” medicine can be linked to the “orthodox” Vedic tradition. It has also been demonstrated by Chattopadhyaya (1977, 18) that there are incompatible ideas in the classical Āyurvedic texts, which are due to superimpositions of religious ideology onto the scientific medical knowledge so as to make the medical science acceptable to orthodoxy (or to save the science by conceding to religion). In addition, another argument for such assimilation is indirectly provided by a passage in the Caraka Saṃhitā (Sūtrasthāna 30. 20-21): a physician should claim allegiance to the Atharva Veda tradition if being questioned as to which Veda his science affiliates. If it is true that Āyurveda is a sub-branch of Veda or a secondary Veda, such a claim of loyalty is redundant; since Āyurveda is “foreign” and is absorbed into Brāhamaṇism, such a claim is deemed essential. All these, therefore, suggest Āyurveda is unlikely to have arisen from the Vedic medicine, and it could have been incorporated into the Brāhmaṇic tradition. It is now generally accepted, as mentioned earlier, that the Āyurvedic tradition developed from the śramaṇ-ic healing tradition, especially the Buddhist tradition, rather than from the Vedic tradition. Claims made by some scholars that the Āyurvedic tradition dates from several millennia Before Common Era are not accepted by many Indologists. Such claims are reckoned as ideas of “nationalism, religious fundamentalism, a partisan attachment to romantic ideas of India’s spiritual heritage, and other such causes,” according to Wujastyk (1993, 759). Scholarly research does not agree with these claims.

Continual production of numerous medical texts over its long history is a characteristic of Āyurveda (Benner 2005, 3852). The history of Āyurveda may well be illuminated by means of these texts. The earliest of these are the Bhela Saṃhitā, the Caraka Saṃhitā, and the Suśruta Saṃhitā. The Bhela Saṃhitā has only one damaged manuscript extant. The Caraka Saṃhitā and the Suśruta Saṃhitā have survived, and they are regarded as the foundation of Āyurveda. These two texts often are cited or quoted in later Āyurvedic works (Wujastyk 1993, 760). The date of composition of the Caraka Saṃhitā and the Suśruta Saṃhitā is not certain, but it is believed that they were formed in the early centuries of the Common Era (Mazars 2006, 8; Wujastyk 1993, 759). Brief descriptions and dating of the major medical texts are as follows.

The tradition of the Caraka Saṃhitā is, according to Wujastyk (1993, 759), associated with Takṣaśilā (present-day Taxila) of north-western India. The Caraka Saṃhitā is a redaction of the Agniveśa Tantra by Caraka and thus the name of the treatise. Caraka is believed by scholars (such as Basham (1976, 20-21), Filliozat (1964, 16-17), Mazars (2006, 8), and Zysk (1991, 33)), based on the Chinese sources, to be a court physician of the Indo-Scythian king Kaniṣka whose reign was at the end of the first century or in the first half of the second century Common Era. This text thus could have been edited at that time, though the original teachings may be much earlier and may even be as early as the time of the Buddha in the fifth century Before Common Era.[1] The Caraka Saṃhitā which comes to us, according to the text itself (Siddhisthāna (Siddhisthāna) 12. 37-40), has parts restored and reconstructed by a Kashmiri savant named Dṛḍhabala (circa the fifth to sixth, or ninth century).[2] Apart from the vast detailed medical information, the Caraka Saṃhitā is notable for its lengthy philosophical discussions (Wujastyk 1993, 760). A manuscript found by Lieutenant Hamilton Bower in 1890 at Kucha (Chinese Turkestan) seems to be related to the tradition of the Caraka Saṃhitā. This document, known as the Bower Manuscript, which is dated palaeographically to be the second half of the fourth century Common Era, contains some medicinal formulae which are almost identical with those in the Caraka Saṃhitā but has no reference to Caraka. Thus this text may represent another lineage of Ātreya Punarvasu apart from those of Bhela and Agniveśa (Subbarayappa 2001, 24; Winter 2011, 149-150).

The Suśruta Saṃhitā is another significant classical Āyurvedic text which is supposed to have been composed by Suśruta in Benares (Wujastyk 1993, 759). The date of composition of this text is also not certain. It is believed by many scholars (such as Basham 2004, 500; Benner 2005, 3853;Filliozat 1964, 11-15; Roy 1986, 160; Subbarayappa 2001, 15) to have been composed in the third to fourth century Common Era (but like the Caraka Saṃhitā its teachings can be traced to a few centuries earlier). It is known from Ḍalhaṇa (circa the eleventh to twelfth century), a commentator of the Suśruta Saṃhitā, that this text was reconstructed by a certain Nāgārjuna. But scholars cannot come to any consensus which Nāgārjuna was the redactor for the Suśruta Saṃhitā, since there appears to be a number of Nāgārjunas in Indian history, other than the famous Buddhist philosopher (Filliozat 1964, 12-14; Srikanta Murthy 1992a, 200-201).[3] The Suśruta Saṃhitā is famous for its detailed descriptions of highly developed surgical techniques in ancient India, which are lacking in the Caraka Saṃhitā and other medical texts (Benner 2005, 3853; Wujastyk 1993, 761, 763). The school of Suśruta was referred to as “Dhanvantarīya” in the Caraka Saṃhitā (Cikitsāsthāna (Cikitsāsthāna) 5. 44, 63-64) when mentioning certain surgical skills. Filliozat (1964, 14-15) expresses that “the school of Suśruta … was already constituted along with its original teaching at the time of the Caraka-saṃhitā.”

In both the Caraka Saṃhitā and the Suśruta Saṃhitā (as well as in the Bhela Saṃhitā), systematic medical knowledge can be noted, indicating the presence of already highly evolved medical traditions (i.e. the Caraka and the Suśruta traditions). Moreover, close similarities between the Caraka Saṃhitā and the Suśruta Saṃhitā with regards to the doctrinal contents, the divisions, as well as the theoretical and practical instructions point to a common heritage of these two traditions (Filliozat 1964, 1, 26; Wujastyk 1993, 760).

The Aṣṭāṅgahṛdaya Saṃhitā (Aṣṭāṅga Hṛdaya Saṃhitā) by Vāgbhaṭa (circa 600 Common Era), who was a known Buddhist, is respected as one of the “great triad” (bṛhat trayī) in Āyurvedic literature, the other two being the Caraka Saṃhitā and the Suśruta Saṃhitā. These three texts represent the principal sources of Āyurvedic knowledge. The Aṣṭāṅga Hṛdaya Saṃhitā is held to be composed in the early seventh century. Its popularity can be noted by the abundant copies of the manuscript found in India and by the presence of foreign translations. It is notable as a summary of essential medical knowledge from previous works especially the Caraka Saṃhitā and the Suśruta Saṃhitā (Benner 2005, 3853). Another text of similar nature–a comprehensive summary of pre-existing medical works–the Aṣṭāṅga-saṃgraha (Collection of Eight Branches), is also ascribed to Vāgbhaṭa. This work is thought to be a different recension of the same text, since identical passages are found in both texts (Wujastyk 2003b, 196). However, scholars cannot come to a consensus whether these two works were composed by the same Vāgbhaṭa, or by two Vāgbhaṭas–one being the grandson of the other (Mazars 2006, 9).[4]

Many other Āyurvedic texts have been produced in the history of Indian medicine. Three of great authority, collectively known as the “small triad” (laghu trayī), are the Rogaviniścaya (Diagnosis of Diseases)–also known as the Mādhavanidāna (Aetiology by Mādhava)–by Mādhava (Mādhavakara) (circa 700 Common Era), the Śārṅgadhara Saṃhitā (Śārṅgadhara’s Compendium) by Śārṅgadhara (circa early fourteenth century), and the Bhāvaprakāśa (Bhāva’s Elucidation) by Bhāvamiśra (the sixteenth century). Mādhava’s book deals with causes and symptoms of different diseases, and it is crucial in setting an example for pathological categorisation and description of diseases in later texts (Benner 2005, 3853; Wujastyk 1993, 760). Śārṅgadhara’s work mainly deals with medicinal recipes (Benner 2005, 3853). It also introduces new foreign elements: medicinal substances such as metallic compounds and opium, and medical ideas such as examination of the pulse (nāḍīparīkṣā) (Mazars 2006, 11; Wujastyk 1993, 760). Bhāvamiśra’s book covers various aspects of Āyurveda (such as basic principles, aetiology, diagnosis, treatment, etc.), especially the description of many groups of drugs. It is distinguished by the introduction of a new foreign disease–syphilis (phiraṅgaroga)–to Indian medicine (Srikantha Murthy 2011, 9-10 (of Introduction section)). Apart from the well-known classical texts, later Āyurvedic works encompass diverse types of medical literature, such as commentaries of major treatises, encyclopaedic syntheses, summaries of large texts, specialised manuals, pharmaceutical dictionaries, and even allegorical medical drama.[5]

Throughout the centuries, Āyurveda has shown change and development in various aspects of this tradition, rather than a static tradition as thought by some historians. There have been new diseases, diagnostic skills, prognostic methods, medicinal substances, therapeutic formulae, and healing interventions introduced and practised (Wujastyk 1993, 766-768). Especially with the Muslim invasions of India since the eleventh century Common Era onwards, Āyurveda has been influenced by other medical traditions such as Siddha medicine and Ūnāni medicine (Micozzi 2011, 38). Moreover, with the arrival of Europeans in India since the sixteenth century, exchanges of medical ideas and practices between Āyurveda and Western medicine have occurred (Wujastyk 1993, 770-772). Western medical elements have been added to the Āyurvedic lore, such as the new disease syphilis, as mentioned. Nowadays, Āyurveda is still a major medical system serving the Indian (and the world) population, besides modern biomedicine. Professional training and qualifications of Āyurveda are controlled and provided by accredited colleges and universities in India (Wujastyk 1993, 772-774). This medical tradition has also interacted with modern science and technology, as well as biomedical science (Micozzi 2011, 38-39).

Footnotes and references:


Some scholars, like Filliozat (1964, 18-21), have raised the doubt that the court physician Caraka and the redactor Caraka might not be the same person. Chattopadhyaya (1977, 29-30, 260-61) and Zysk (1991, 33) have argued that the term “caraka”, derived from the root car which means ‘to move’ or ‘to wander’, could represent the group of wanderers or roving physicians and not necessarily point to a certain person.


The primary source (Caraka Saṃhitā Siddhisthāna) mentions that Dṛḍhabala was born in Pañcanadapura (present-day Panjab, in the Kashmir area). Modern scholars have different views on when Dṛḍhabala lived. Some claim that he was in the fifth to sixth century Common Era, and some say the ninth century Common Era. See Chattopadhyaya 1977, 32; Mazars 2006, 8; Meulenbeld 1999, 141; Roy 1986, 157; Weiss 2005, 714.


Srikanta Murthy (1992b, 291-297) has an essay discussing several possible Nāgārjunas in Indian history.


Meulenbeld (1999) has said that the name Vāgbhaṭa is a common one in India. Rama Rao (1992) has identified several Vāgbhaṭas in Indian history who have composed texts for various subjects. For more discussions on Vāgbhaṭa(s) and his/their works, see Meulenbeld 1999, 597 ff. and Rama Rao 1992, 205-221.


There are many types of Āyurvedic literature, as mentioned in the works of: Basham 1976, 21; Benner 2005, 3853; Mazars 2006, 9-10; Wujastyk 2005, 1410-1411. Some given examples of the later Āyurvedic literature are the Siddhayoga (ca. the tenth to eleventh century), the Mānasollāsa (the twelfth century), the Lakṣmaṇotsava (the fifteenth century), the Āyurveda saukhya of the Ṭoḍarānanda (the sixteenth century), the Vaidyajīvana (late sixteenth century) the Vīramitrodaya (the seventeenth century), the Śivatattvaratnākara (early eighteenth century), the Vaidyaka-śabdasindhu (late nineteenth century), and the Bṛhannighaṇṭuratnākara (late nineteenth to early twentieth century). The Jīvānanda (the seventeenth century) is an allegorical medical drama. Roy (1986, 157-159) provides extensive lists of Āyurvedic texts (according to the branch of Āyurvedic medicine), of which many books have been lost, in the history of Indian medicine.

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