Ayurveda, the learned system that forms the basis of the traditional medicine widely practiced in India today, is called ‘‘the science of life.’’ The practitioner who has come to understand the science of life is known as the vaidya. The physician, the medicine, the attendant, and the patient constitute the four pillars of Ayurvedic medicine. The task of the physician was to exercise good judgment about his duties, the attendant was expected to prepare medicines and perform nursing duties, and the patient’s role was to provide an accurate history of the disease and follow the physician’s instructions. It was important for the physician to assess his patient and his assistant carefully, because when therapy was unsuccessful only the physician’s competence would be questioned.
Properly speaking, Ayurveda is composed of eight branches:
internal medicine, diseases of the head, surgery, toxicology, demonic diseases, pediatrics, rejuvenation, and aphrodisiacs. The primary objec- tive of the science of life was the maintenance of health, rather than the treatment of disease. Health was not simply the absence of disease, but a state attained and enjoyed only by vigorous pursuit of an elaborate, individualized program of prophylactic measures prescribed by the Ayurvedic doctor.
Caraka, Susruta, and Vagbhata, the semilegendary authors of the classic texts that illuminate the eight branches of Ayurvedic medicine, are honored as the ‘‘Triad of Ancients.’’ Although many colorful stories have become associated with these sages, there is little deﬁnitive bio- graphical information about any of them. Traditionally, Caraka is said to have lived sometime between 1000 and 800 B.C.E., but Western scholars have placed him as late as the ﬁrst century. In any case, the Caraka Samhita (the collected writings attributed to Caraka) probably reached its present form in the ﬁrst century. Honored as the ﬁrst great treatise of Indian medicine, the text describes hundreds of drugs and classiﬁes them in terms of the diseases for which they are useful.
Susruta is said to have practiced medicine and surgery about 600 B.C.E. While the Susruta Samhita (the collected writings attributed to Susruta) might be considered more systematic than the Caraka Samhita in its treatment of pharmacology, its emphasis on the art of surgery is of particular interest. Because Vagbhata’s text mentions both Caraka and Susruta, he is obviously the most recent author, but his biography is similarly obscure. Other classics of Ayurveda dealt with obstetrics, gynecology, and pediatrics. A fourteenth century text still popular with practicing vaidyas includes a description of pulse diagnosis, which reﬂects the absorption and adaptation of foreign techniques into Ayur- vedic theory and practice.
According to Caraka, the attainment and maintenance of health and happiness was a necessary and noble pursuit. Diseases obstructed the attainment of humanity’s highest goals, but Ayurveda, the most sacred of the sciences, beneﬁted human beings in their present and future lives. The Caraka Samhita provides a guide to the three forms of medicine: mantras and religious acts; diet and drugs; and psychic therapy, or subjection of the mind.
Both Caraka and Susruta devoted considerable attention to the characteristics that distinguished the true physician from pretenders to the art. Understanding the anatomy, physiology, and development of the human body, as well as the origin and evolution of the universe, a wise physician was never in doubt about the etiology of disease, recognized the earliest and most subtle signs and symptoms, and knew which diseases were easily cured and which were incurable.
Because physicians were members of a professional group rather than a speciﬁc caste, a practitioner could accept students from all of the three upper castes. Students were expected to live with and serve their teacher until the master was satisﬁed that their training was com- plete. Access to the classics could only be obtained by listening to a master physician read and explain the texts. It was the student’s duty to memorize the sacred texts and demonstrate competence in medicine and surgery. Using fruits, vegetables, meats, and manikins, the appren- tice developed his surgical skills before operating on patients. For example, he learned to make incisions by operating on cucumbers and practiced venesection on the veins of dead animals or lotus stems.
The good physician exhibited four primary qualiﬁcations: theoreti- cal knowledge, clarity of reasoning, wide practical experience, and personal skill. Sympathetic and kind to all patients, the physician devoted himself to those who could be cured while maintaining a sense of detachment toward those who would die. The surgeon must have courage, steady hands, sharp instruments, a calm demeanor, unshakable self-conﬁdence, and the services of strong-nerved assistants. Although the physician must never desert or injure a patient, he was not obligated to accept patients who were known criminals, or those suffering from incurable diseases. Yet, the ideal doctor would strive with all his might to cure his patient even if he placed his own life at risk.
Ayurvedic physiology explained bodily functions in terms of the three dosas, the primary ﬂuids, humors, or principles—vata, pitta, and kapha—which are usually translated as wind, bile, and phlegm. Although the basic principles of Indian humoral pathology are similar to those of Greek medicine, the Ayurvedic system provides additional complications. The three Ayurvedic humors, in combination with blood, determined all vital functions. The body was composed of a combination of the ﬁve elements—earth, water, ﬁre, wind, and empty space—and the seven basic tissues. Bodily functions were also dependent on ﬁve separate winds, the vital soul, and the inmost soul. Some Ayurvedic healers were interested in the art of pulse diagnosis, life breath (prana), and channels (nadis), concepts that are reminiscent of classical Chinese medical theory.
Health was the result of a delicate and harmonious balance among the primary humors that was easily disturbed by accidents, wounds, stress, and demonic possession. Thus, illness could be thought of as the result of an imbalance among wind, bile, and phlegm, or, in a more philosophical exposition, as the physiological result of abuse of the body, errors in judgment, and the passage of time. The degree of derangement determined whether the disease would be minor, major, or incurable. Except for a few perfectly balanced individuals, all human beings were born with some degree of discord among the three humors that created a predisposition to particular diseases. Discord among the three humors produced a disturbance in the blood. Therefore, the physi- cian had to remove ‘‘bad blood’’ by venesection or leeching, and restore humoral balance by prescribing an appropriate diet.
Choosing a proper dietary regimen was a formidable task that had religious as well as medical and physiological aspects. Although there is no doubt among historians that the early Hindus ate meat, modern Hindu fundamentalists consider vegetarianism and the prohibition on beef-eating hallmarks of Hindu identity. In several Indian states, it is against the law to kill a cow. Yet, evidence from the Vedas, epic poems, and archaeological sites indicates that the ‘‘holiness’’ of the cow is a relatively recent myth. Early Indian traditions included the sacriﬁce of oxen and other animals to Vedic gods, and the consumption of such animals as part of the ordinary diet. Some historians believe that the taboo on meat-eating was the result of the evolution of the Hindu, Buddhist, and Jain doctrines of reincarnation and nonviolence. Themes woven throughout the Indian medical classics suggest a fun- damental relationship between foods and the cosmological order. Vegetarianism, nonviolence, and compassion for all beings were funda- mental to health, healing, and the social order. Nevertheless, Ayurvedic prescriptions sometimes contradicted the ideal Hindu concept of nonvio- lence and vegetarianism. For particular patients, the physician might even prescribe broths made from lion or tiger meat.
Diagnosis was a daunting mission; more than a thousand diseases were alluded to in the ancient texts. Fever was given pride of place as the ‘‘king of all bodily diseases.’’ When the fever was intermittent, the intervals between the peak periods provided the key to prognosis. Interest in the intervals between episodes of fever, which is also found in Greek medicine, probably reﬂects experience with the patterns of malarial fevers.
Accurate diagnosis was the key to selecting the proper treatment for curable disease. After listening closely to the patient’s narrative concerning the illness, the physician studied the patient’s general appearance, abnormalities, internal noises, blood, body ﬂuids, and excretions. The physician employed palpation (touch) and auscultation (listening), elicited latent symptoms by using drugs as therapeutic tests, and assessed the odor and taste of secretions and discharges. If a physi- cian did not want to taste the secretions himself, he could assign this task to his students, or feed them to insects and observe their reactions. The most famous diagnostic taste test provided information about the ‘‘honey urine disease,’’ which presumably was the disease now known as diabetes. Contemporary Ayurvedic practitioners assert that recog- nition of the microbial origin and infective nature of certain diseases is implicit in the classics texts. Perhaps the ancients suspected a parasitic origin for leprosy and smallpox, but the ‘‘parasitic agents’’ that transmitted epidemic diseases were more likely to be disease-causing demons than micro-organisms. Nevertheless, methods of coping with an invisible demonic agent may be quite effective against microbes. For example, rituals performed while worshiping the goddess Sitala might have included inoculation for smallpox.
The art of therapeutics incorporated the ﬁve canonical therapies. Various kinds of massage, anointment with oils, and yoga were regarded as therapeutic. For example, yoga, a complex system of postures, meditation, and breath control, was used to calm the mind and establish harmony between mind and body. Contemporary advocates of yoga claim that it promotes good health and has therapeutic value in the treatment of physical, psychosomatic, and psychiatric disorders. Origi- nally, however, yoga developed as a means of self-realization, rather than a therapeutic approach. Some forms of yoga, such as Kundalini Yoga, which is part of Tantra Yoga, are said to speciﬁcally promote mental health and the functioning of the nervous system. Tantra Yoga teaches that the body contains six nerve centers, or chakras. This form of yoga was popularized by Sir John Woodroff (Arthur Avalon), author of The Serpent Power (1919). Practitioners of this form of yoga expected to experience a remarkable sense of awakening or even the release of supernatural powers by stimulating the Kundalini power and directing it toward the brain.
A wealth of remedies, all part of Ayurvedic pharmacology, allowed Caraka to assert that with proper treatment even aged and inﬁrm patients might regain youthful powers. Almost one thousand drugs derived from plant sources are referred to in the major Ayurvedic classics, but many are unidentiﬁable materials or ‘‘divine drugs’’ such as soma. Vedic myths say that Brahma created soma to prevent old age and death, but the identity of this ‘‘king of plants’’ was a mystery to later sages. Healers also prepared remedies based on minerals, gems, metals, and animal products, such as honey, milk, snakeskin, and excrements. For diseases involving corruption of the bodily humors, the proper remedies included internal cleansing, external cleansing, and surgery. Diseases caused by improper diet called for remedies that accomplished internal cleansing, but physicians often began treatment with a seven-day fast. Some patients recovered during this period and needed no other remedies; presumably, some died and also needed no further remedies.
Mundane drugs typically came from well-known plants. Some were assigned multiple uses. For example, senna, which was prepared from cassia, was probably used by Ayurvedic healers for at least two thousand years. Recipes including senna were recommended as laxatives, and for skin diseases, eye problems, coughing, and fevers. Another traditional Indian medicine made from the resin of a tree that grows in India, Pakistan, and Afghanistan has been used to treat various illnesses for two thousand years. Scientists who have been searching for pharmacological agents in traditional remedies discovered that sap from the guggul tree (Commiphora mukul) contains a compound that helps regulate cholesterol levels.