11 May

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.

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