The Student of Āyurveda (1): The pre-admission stage

For the aspiring medical student it is long journey through education and training before he becomes a qualified physician. We may discern three stages of this process: (i) the pre-admission stage; (ii) admission to studentship (initiation); (iii) the period of studenthood and (iv) system of assessment.

The prospective student has to undertake some groundwork before he is admitted to the medical course. Not only is it incumbent on the student to find a preceptor, he is also required to select an appropriate medical treatise. According to the Caraka, a wise man desirous of becoming a physician should first of all carefully select a suitable medical text after its careful examination. The selection would depend on his ability to undertake such exacting study and understand its short or long term results, keeping in mind the appropriateness of his place and his age.^[1] Hence, the student is expected to undertake a self-assessment to decide on the nature and duration of his medical studies based on his aptitude, the purpose of his study, the place of residence and his age. All these factors would help him to determine whether he is equal to the task he intends to take up. According to Cakrapāṇidatta, it is desirable that the student’s aptitude, age and area of residence should be conducive to medical study, and he should also possess the ability to do hard work.

He clarifies that the certain categories of persons do not deserve to be physicians:

(i) Those who consider medical practice as something difficult;

(ii) Those who do not have any liking for the results of medical practice;

(iii) Those whose habitation is not conducive to the knowledge of medicine;

(iv) Those who are old and as such incapable of completing the study of medical science.^[2]

As for areas unsuitable for the practice is concerned, the text does not explicate further; but probably they may have been areas where drugs were not easily procurable or habitation was sparse. As for the purpose of study, Caraka prescribes that brāhmaṇas should study the science to provide benefit to all creatures, kṣatriyas for protection and vaiśyas for earning livelihood.^[3] Nonetheless, this was not definitive in nature for the same authority also says that Āyurveda may be studied by all for attaining virtue, wealth and pleasure (sāmānyato vā dharmārtha-kāma-parigrahārthasarvaivaḥ).^[4]

Thus, the student needs to first assess himself keeping in view the factors stated and the tasks and requirements of the profession.

The next step is the selection of the medical text to which is a good deal of importance is attached for Caraka gives no less than twelve characteristics to be looked at. This would lead us to presume that the prospective student must have necessarily obtained an advanced degree of education before entering medical studies if he had to examine the several texts available for the physician.

A good medical text, like the sun removes darkness and illuminates the mind, and manifests the following the characteristics:^[5]

(i) It is followed by great, illustrious and wise physicians (for those texts which are great and popular are followed by wise persons);

(ii) It is loaded with ideas and respected by reputed experts;

(iii) It is conducive to the intellectual growth of disciples of all three categories (highly intelligent, moderately intelligent and less intelligent);

(iv) It is free from defects of repetition, transmitted by seers and has well-knit aphorisms together with commentaries thereon in proper order;

(v) It conveys elegant ideas;

(vi) It is free from vulgar and difficult expressions and has clear and unambiguous expressions;

(vii) It conveys ideas an orderly manner;

(viii) It is primarily deals with the determination of real objects;

(ix) It is free from contradictions;

(x) It has no confusion relating to contexts;

(xi) It conveys ideas quickly;

(xii) It is equipped with the definitions (of aetiology, symptomtology and therapeutics) and illustrations.

Therefore, the student should select a renowned authoritative text, well structured, written lucidly and free from ambiguities and repetitions. Besides, it should be comprehensible to all three categories of students (trividhaśiṣya-buddhi-hitam). This expression has been understood has referring to three categories of students of differing intelligence levels: very bright, moderate and less bright. It is not clear why a very bright student should select a text that would be suitable for those less intelligent than him. Besides, in that case he would also have to evaluate himself as brighter than or less so than the others.

Therefore, in Caraka’s scheme of training, an aspirant is expected to be sufficiently educated, well informed and capable of choosing a particular text and a branch of medical knowledge when he presented himself before a teacher.^[6] According to Wujastyk, the student must be aware of what literature is available in the field and must have the means to get hold of whatever literature there is. The above discussion points to a scholar with previous learning who is conversant in the methods of critical study.^[7]

The above particulars are not mentioned in the Suśruta Saṃhitā, though before commencing his study, the student is required to decide upon the branch of Āyurveda he would pursue. Thus, we are told that when Suśruta and his companions approached Dhanvantari, they first stated their purpose of study, that is, to relieve the people of their suffering and to help preserve their good health.^[8] They were then asked which branch should be taught to them whereupon they opted to learn the entire śāstra (Āyurveda) with surgery as the main subject.^[9] Here it appears that they had pre-decided on the branch they desired to specialise in.

The third step for an aspiring student is the selection of a preceptor followed by the determination of his eligibility by the teacher. The eligibility of the student is an important issue for the teacher is believed to obtain all the auspicious fruits of teaching whether described in scriptures or not, as well as the virtuous qualities for himself and the disciple only when the disciple is worthy of teaching.^[10] The teacher, is therefore, is advised to examine the pupil for the desirable qualities.^[11]

Both our authorities have enumerated several qualities which we have grouped as those pertaining to personality and disposition, social background, physical characteristics and those of the intellect. We have tabulated these attributes for our convenience.

Characteristics of the student	Caraka Saṃhitā[12]	Suśruta Saṃhitā[13]
Personality and disposition	Calm; noble, averse to mean acts; persevering; humble; liberal mind; modest; even-tempered; free of anger and addictions; good character and conduct; pure habits; enthusiastic and sympathetic disposition; absence of greed and laziness; obedience to the instructions of the preceptor; devotion to the preceptor.	Good character; brave; good mannered; clean habits; humble; energetic; robust; cheerful nature, pleasant speech, and capability to withstand distress.
Social Background	Birth in the family of a physician or in a family having the disposition of a physician.	Birth in a noble family; brāhmaṇa, kṣatriya or vaiśya; meritorious śūdra of a good family[14]
Physical characteristics	Normal eyes, face and nasal ridge; thin and red clear tongue; absence of deformity of the lips, the teeth and the voice (he should not speak through the nose) and the sense organs.	Young; thin tongue and lips, slender crowns of teeth; normal eyes, mouth and nose
Intellectual attributes	Intelligent; good faculties of reasoning and memory; ability to understand the real meaning of things; fervour for study with devotion to the theory and practice of science.	Sharp intellect, steadfastness, good memory, judgement, and the ability to act according to circumstances.

If the description of the ideal teacher is written from the perspective of the student, then that of the ideal student is written from the perspective of the teacher. It is interesting to note that personality and physical traits are mentioned ahead of those qualities which are generally given precedence in modern day tests, such as intelligence, reasoning and memory. In fact the first eight attributes mentioned by Caraka are calmness; noble disposition (āryaprakṛti); aversion to despicable acts; normal condition of the eyes, the face, the nasal ridge, the tongue, the teeth, the lips and the voice; steadfastness and absence of vanity. Presence of intellect, power of reasoning and memory are mentioned later. It thus appears that the ancient teachers placed equal emphasis on a good temperament, virtuous conduct and physical perfection than mental ability. Possession of perfect sense organs is particularly crucial for the physician for diagnosis is dependant essentially on the symptoms he can perceive through them.^[15] Hence, presence of flawless senses is mentioned separately again. Cakrapāṇidatta comments that abnormal sense organs rendered one unsuitable for the study of Āyurveda.^[16]

Though there are no details as to how the teacher satisfied himself on the above qualities, one may assume that student had to undergo some manner of three fold examination of the physique, character and intellect. Moral attributes like nobility, humbleness, liberal mindedness, love for study, enthusiastic and sympathetic disposition, absence of greed and laziness, obedience to the preceptor’s instructions and devotion to him, etc., could be gauged after giving certain tasks to the student and observing him over some days. Obedience and devotion to the preceptor are not specifically mentioned by Suśruta in the qualities of the medical student but are included in the ethical code for the student which is pronounced by the teacher during the process of initiation.^[17] Suśruta categorically states that those who do not possess the requisite attributes should not be selected for initiation as a medical student.^[18] It, therefore, stands to reason, that there must have been method of testing his eligibility, as such. Perhaps the student finds out about the teacher first, and is then subject to the teacher’s scrutiny once he has approached him.^[19] Dhanvantari readily accepts Aupadhenava, Vaitarana, Aurabhra, Pauṣkalāvata, Karvīrya, Gopurarakṣita, Suśruta and others as his pupils as none of them needed any credentials (amimāṃsyāḥ) and all deserved to be taught (adhyāpyāśca).^[20] They may have been scholars of repute or scions of good families.

Two features of the student’s eligibility criteria need notice. First, Suśruta’s includes the traits of courage (śaurya), strength (śakti) and vigour (bala) and the ability to bear distress (kleśasahaṃ) in the criteria which do not occur in the descriptions of any other author. The last mentioned characteristic, according to Wujastyk, can be understood in two ways: being equal to experiencing one’s own distress, or to experiencing someone else’s suffering, for example the patient’s during surgery.^[21] In keeping with the specific needs of the discipline, the surgeon is required to be able to withstand the sight of blood and gruesome injuries. Secondly, there is a clear reference to the age criterion in the same treatise unlike Caraka, and is in fact, the first specification mentioned by Suśruta. Caraka permits the study of medicine to be taken up in accordance with the age factor though it is not considered appropriate for the aged by Cakrapāṇidatta (as we have already noted). However, surgery by its very nature is considered suitable only for young persons. A good surgeon at the time of an operation should be necessarily bold, swift in action and confident; his hands should neither sweat nor tremble.^[22] On the other hand, Caraka mentions two other attributes: liberal mindedness (udārasattvaṃ) and love for the study and practice of science.

The question of the student’s varṇa affiliation is interesting. Both our authorities admit members of the upper three varṇas to medical studies.^[23] Suśruta, however, adds that according to some authorities, a meritorious śūdra from a good family may also be taught, but without the initiation ceremony and the use the Vedic mantras.

Thus:

śūdramapi kūlaguṇasampannaṃ mantravarjam anupanītam adhyāpayed ity eke.^[24]

It has been commented, “The use of “according to some,” on the other hand, points to this being an unusual practice, known to Suśruta by hearsay rather than from common occurrence.”^[25] Admission of śūdras appears to an exception; hence, it is not mentioned in the stanza on the required qualifications of the student. Nonetheless, it is evident that the medical profession, unlike that of Vedic scholarship, was not an exclusive domain of a particular caste. It is also interesting that although Caraka declares only the upper three varṇas eligible for the medical course, śūdras are not expressly prohibited either. Again it may be pointed out that the practice of admitting śūdras by some teachers is not disputed in our texts reflecting the open-mindedness of medicine–the acceptability of all in medical studies.

Altekar opines that it is quite probable that kṣatriya and śūdra surgeons may have been by tradition and environment, better adepts in the use of the knife than their brāhmaṇa and vaiśya compeers.^[26]

Footnotes and references:

[1]:

Caraka Saṃhitā Vimānasthāna 8.3.

[2]:

Cakrapaṇidatta on Caraka Saṃhitā Vimānasthāna 8.3.

[3]:

Cakrapaṇidatta on Caraka Saṃhitā Vimānasthāna 8.3.

[4]:

Caraka Saṃhitā Sūtrasthāna 30.29.

[5]:

Caraka Saṃhitā Vimānasthāna 8.3

[6]:

M.S.Valiathan, The Legacy of Caraka, Hyderabad, 2009 (Reprint), p. lxxxii.

[7]:

D. Wujastyk, Well-Mannered Medicine, p.70.

[8]:

Suśruta Saṃhitā Sūtrasthāna 1.4.

[9]:

Suśruta Saṃhitā Sūtrasthāna 1.10.

[10]:

Caraka Saṃhitā Vimānasthāna 8.14.

[11]:

Caraka Saṃhitā Vimānasthāna 8.8.

[12]:

Caraka Saṃhitā Vimānasthāna 8.8.

[13]:

Suśruta Saṃhitā Sūtrasthāna 2.3.

[14]:

Suśruta Saṃhitā Sūtrasthāna 2.5.

[15]:

The methods of examining a patient are by inspection, palpitation and interrogation; Suśruta Saṃhitā Sūtrasthāna 10.5.

[16]:

Cakrapāṇidatta on Caraka Saṃhitā Vimānasthāna 8.8.

[17]:

Suśruta Saṃhitā Sūtrasthāna 2.6.

[18]:

Suśruta Saṃhitā Sūtrasthāna 2.6.

[19]:

Dagmar Wujastyk, Well-Mannered Medicine, p.78.

[20]:

Suśruta Saṃhitā Sūtrasthāna 1.4-5.

[21]:

Dagmar Wujastyk, Well-Mannered Medicine, p.76.

[22]:

Suśruta Saṃhitā Sūtrasthāna 5.10.

[23]:

Caraka Saṃhitā Sūtrasthāna 30.29; Suśruta Saṃhitā Sūtrasthāna 2.3.

[24]:

Suśruta Saṃhitā Sūtrasthāna 2.5.

[25]:

Dagmar Wujastyk, Well-Mannered Medicine, p.76.

[26]:

A.S. Altekar, Education in Ancient India, Delhi, 2009 (Reprint), p.43.