The Medical Student and the Teacher (Introduction)

[Full title: The Medical Student and the Teacher: Understanding the Issues in the Transmission of Medical Education]

A distinguishing characteristic of a true physician of the āyurvedic tradition of the Saṃhitās is a well-grounded understanding of all the precepts of medical science. He is required to be acquainted with the principles of treatment (cikitsāprabhṛta) and to be well versed in the texts (śāstravān).^[1] An in-depth understanding of the subject and the ability to recite, interpret and summarise the contents of medical treatises are considered by Caraka and Suśruta as the hallmarks of the good physician.^[2] For developing a comprehensive understanding of the subject it is essential to have the guidance of a qualified preceptor. Caraka and Suśruta describe Āyurveda as a vast subject dealing with myriad issues which are complex enough to confound even the intelligent and the well-learned.^[3] Hence, it is imperative to study the subject from authoritative texts under the guidance of a qualified preceptor.

The concept of an ideal physician is explained by Suśruta in the following words:

sāstraṃgurumukhodgīr ṇamādāyopāsya cāsakṛta.
yaḥkarma kurute vaidyaḥ sa vaidyoanye tu taskaraḥ.^[4]

One who practices medicine after having learnt the science directly from the preceptors and having regularly meditated upon the same, is a physician in the real sense of the term; others are imposters (quacks).

Consequently, the processes of teaching and learning have been dealt with in some detail in our Saṃhitās. Medical education drew upon the Vedic system of education: the system called Gurupāramparya or Sampradāya which Udyotkara in his Nyāya-Vārttika defines as “uninterrupted ideal succession of pupils and teachers, by which knowledge is conserved and transmitted.”^[5]

Caraka explains why the instruction received from a credible person is so important. The sources of knowledge (pramāṇa) are four-fold: āptopadeśa (scriptural authority), pratyakṣa (direct observation), anumāna (inference) and yukti (reasoning).^[6] The term āptopadeśa signifies the importance of the communication or instruction given by a trustworthy person.^[7] Āptas are credible and competent authorities who are absolutely free of the predominance of rajas (emotional factors) and tamas (ignorance, indolence, resistance) by virtue of their power of penance and knowledge, and who are always in the possession of uninterrupted knowledge pertaining to the past, the present and the future.^[8] The term “āpta” literally means “reached” or

“overtaken”, and in an extended sense, “abundant” or “full”. It is generally used in the sense of “true” or “trustworthy”.^[9] Āptas are, therefore, reliable authorities free prejudices, emotional influences and defects of the cognitive instruments.^[10] Caraka further points out that the words of āptas are true beyond doubt as they are free of rajas and tamas; hence, it is impossible that they would lie.^[11]

The association of rajas and tamas with truth/ untruth is explained by commentator Cakrapāṇi. One tends to lie when he does not have sound knowledge; even when he has adequate knowledge, he may be hindered from speaking the truth under the influence of emotional factors like attachment or dislike. None these hindering factors exist in a person when rajas and tamas are eliminated and there is predominance of sattva. Such characterization of a reliable authority would be a natural trait of those who have attained spiritual perfection like the Creator. It is also applicable to those worldly persons who have acquired perfect knowledge of their subject and in whom likes and dislikes have ceased to exist. As the scriptures represent the words of such enlightened sages, the words themselves are regarded as the source of knowledge.^[12]

Perception (pratyakṣa), the second source of knowledge, is the comprehension of objects attained through the sense organs or the mind.^[13] According to Ḍalhaṇa, the direct knowledge of objects by the mind and the sense organs constitutes perception. It implies an undistorted knowledge of the object which is possible only in the absence of delusion.^[14] It provides the basis of empirical knowledge for aspiring physicians. Thus, dependence (āśraya) on an experienced preceptor (which is one of the defining attributes of the vaidya)^[15] equips one with the two wings of medical science-the theoretical and the practical.

In this chapter, we have looked at the nature of medical training, the attributes of the teacher and the eligible student, teaching methodology and the teacher-student relationship which help us to gather some idea about the transmission of medical knowledge. We have also looked at the initiation of the medical student and how medical studentship differed from that of religious studentship.

According to our medical treatises, Āyurveda has an unbroken lineage of illustrious teachers that is traced back to the creator, Brahmā.^[16] After it was originally propounded by Brahmā, this knowledge was transmitted through the other deities to the sages. The continuity of dissemination of the science is emphasised when Caraka says it is not known if ever Āyurveda was non-existent at any time after it was propagated.^[17] This trajectory of transmission is similar in our two medical compendia with minor differences. According to the Caraka Saṃhitā, Brahmā taught Āyurveda to Dakṣa, who then taught the Aśvins, and they in turn passed on the knowledge in its entirety to Indra. Indra was approached by ṛṣi Bharadvāja for learning this science when he was advised by other sages to do so.^[18] Bharadvāja, in turn, taught the newly acquired knowledge to an august assembly of sages, following which Punarvasu Ātreya expounded it to his six disciples: Agniveśa, Bhela, Jatūkarṇa, Parāśara, Hārita and Kṣārapāṇi.^[19] In the Suśruta Saṃhitā, we are told, that the knowledge of medicine was transmitted through almost the same succession of teachers: from the Creator it was passed to Prajāpati, to the Aśvins, and then to Indra. It was from Indra that Dhanvantari acquired the knowledge of Āyurveda.^[20] This narrative conveys in mythical style the notion of knowledge of medicine being transmitted in its entirety from Brahmā to Bharadvāja or to Dhanvantari without any alteration. It is important to note that each of the personalities who received the knowledge of medicine also imparted it to the next suitable candidate. It appears, therefore, that dissemination of the science was considered a duty of the physician.

Footnotes and references:

[1]:

Caraka Saṃhitā Sūtrasthāna 16.3.

[2]:

Caraka Saṃhitā Sūtrasthāna 30.16.

[3]:

Suśruta Saṃhitā Sūtrasthāna 4.5.

[4]:

Suśruta Saṃhitā Sūtrasthāna 4.8.

[5]:

R.K.Mookerji, Ancient Indian Education: Brahmanical and Buddhist, Delhi: Motilal Banarasidass Publishers Private Limited, 2011 (first edition 1947), p.xxxi.

[6]:

Caraka Saṃhitā Sūtrasthāna 11.17.

[7]:

S.K.R.Rao, Encyclopaedia of Indian Medicine: Clinical and Diagnostic Methods, Vol. III, Mumbai, 2005, p. 11.

[8]:

Caraka Saṃhitā Sūtrasthāna 11.18.

[9]:

S.K.R.Rao, Encyclopaedia of Indian Medicine, Vol. III, p. 9.

[10]:

S.K.R.Rao, Encyclopaedia of Indian Medicine, Vol. III, pp.9-10.

[11]:

Caraka Saṃhitā Sūtrasthāna 11.19.

[12]:

Cakrapāṇidatta’s commentary on Caraka Saṃhitā Sūtrasthāna 11.18-19.

[13]:

Caraka Saṃhitā Sūtrasthāna 11.20; Suśruta Saṃhitā Sūtrasthāna 1.16.

[14]:

Ḍalhaṇa’s commentary on Suśruta Saṃhitā Sūtrasthāna 1.16.

[15]:

Caraka Saṃhitā Sūtrasthāna 9.22.

[16]:

Caraka Saṃhitā Sūtrasthāna 1.24.

[17]:

Caraka Saṃhitā Sūtrasthāna 30.27.

[18]:

Caraka Saṃhitā Sūtrasthāna 1.4-5.

[19]:

Caraka Saṃhitā Sūtrasthāna 1.25-26, 30-31.

[20]:

Suśruta Saṃhitā Sūtrasthāna 1.20.