In surveys of the history of medicine, the invention of science and rational medicine was generally credited to the Greek natural philoso- phers who lived during the sixth century B.C.E. Accustomed to tracing the roots of Western culture back to Greece, with some slight conces- sions to those civilizations mentioned in the Bible, European scholars generally ignored the evolution of medicine, science, and philosophy in India and China. This peculiarly narrow focus is especially unfortu- nate in the history of medicine because, unlike the ancient medical tra- ditions of Mesopotamia and Egypt, those of India and China are still very much alive. Recent scholarship, however, has made it clear that the very different paths taken in pursuit of health, healing, and system- atic inquiry in China and India are well worth exploring. Historians have come to realize that the scientiﬁc and medical traditions that developed in China and India were complex, productive, and different from European traditions in fundamental respects. Many questions remain, but there is little doubt that the most interesting questions about the evolution of science and medicine in different civilizations are related to what thinkers, investigators, and healers in ancient cultures thought they were doing, rather than the trivial question of who did what ﬁrst.
Densely populated, with a mixture of races, languages, cultures, and religions, the Indian subcontinent is a world of bewildering complexity. In the 1920s, the study of Indian history was revolutionized by the dis- covery of the wonders of Mohenjo-daro and Harappa, two major cities that were part of the forgotten Indus River Civilization that had ﬂour- ished from about 2700 to 1500 B.C.E. Recent excavations are now yield- ing evidence of the extensive trade relations that existed between Egypt and India some two thousand years ago. Scholars previously assumed that the ancient maritime trade between India and Rome was the prod- uct of Roman enterprise, but studies of once thriving Egyptian port cities suggest that the ships involved in these long and dangerous voyages might have been built in India and operated by Indian crews. The Silk Road, an Asian network of camel caravan routes, served as the primary cultural and commercial link between China and Europe between about 100 B.C.E. and the ﬁfteenth century. However, the mari- time trade route between Egypt and India might have served as another link with the Far East.
Memories of the growth, turmoil, and decay that characterized early Indian civilization have survived in the form of four texts known as the Vedas, which are revered by the Hindus as sacred books of divinely inspired wisdom. The Vedas are accompanied by later com- mentaries known as the Brahmanas and the Upanishads, which explain the older texts and speculate about the nature of the universe and the human condition. The traditional Indian healing art is known as Ayurvedic medicine.
Many aspects of Indian history are vague until the fourth and third centuries B.C.E., when the Indus Valley region was conquered, ﬁrst by the Persians and then by the forces of Alexander the Great (356–323 B.C.E.). Although Alexander spent less than two years in India, the invasion led to cultural exchanges between the Greek-speaking world and the peoples of India. During the turmoil that followed the death of Alexander, Chandragupta Maurya was able to drive out the remaining Macedonian ofﬁcials and establish his own empire. His grandson, Asoka, who reigned from about 272 to 232 B.C.E., was able to bring most of India under the domination of the Maurya Dynasty. The Artha Sastra, on the science of politics and administration, is said to have been written for Chandragupta. It contains many laws that are of interest to the his- tory of medicine, such as those regulating medical practitioners, mid- wives, nurses, drugs and poisons, prostitution, sanitation, and public health. The judicial mutilations prescribed for improper behaviors would have provided employment for legions of surgeons. For example, the penalty for a person who had insulted his parents or teachers was amputation of the tongue.
Initially regarded as a cruel despot, King Asoka became so over-whelmed with remorse over the bloodshed and misery he had caused that he renounced warfare and became a Buddhist. Buddhism origi- nated in India in the sixth century B.C.E. in the teachings of Buddha, ‘‘The Enlightened One,’’ and developed as a protest against the strict stratiﬁcation of Hindu society and the religious rituals controlled by the Brahmanic priests.
Buddha’s teachings emphasized universal love, service, and the peace of mind brought about by the abandonment of desire. According to the great stone edicts posted throughout his empire, Asoka devoted himself to peace and righteousness through good deeds, compassion, religious tolerance, and purity. Giving up the sport of hunting and the eating of ﬂesh, Asoka offered animals as well as humans his protection and established rest houses, facilities for the care of the sick, and other charitable institutions.
Although the edicts of Asoka suggest that free hospitals and dispensaries were widely distributed throughout ancient India, other lines of evidence are ambiguous. One ﬁfth-century Chinese traveler described Indian hospitals that cared for the poor and the sick, but noted that these institutions were privately endowed rather than state supported. Other observers commented on rest houses sponsored by the king where travelers and the poor could ﬁnd physicians and medi- cines, as well as food and drink. Medical aid was apparently available at some temples and schools. Charitable hospitals seem to have been more characteristic of neighboring countries that imported Buddhism and Indian medical philosophy. Later visitors to India were amazed to ﬁnd hospitals for animals and asserted that charity and mercy were more likely to be given to cows and dogs than to human beings.
During the reign of Asoka, Buddhist monks held the great ‘‘Council of Patna’’ (250 B.C.E.) to determine which texts should be regarded as authentic tenets of their religion and how its members should be organized. Buddhist missionaries traveled to Syria, Egypt, Greece, Tibet, and China. Although Buddhism became well established in other parts of the world, in India the ancient Vedic traditions eventu- ally reasserted themselves. After the reign of Asoka, the history of India became a series of assassinations, betrayals, and invasions by Greeks, Scythians, Muslims, Mongols, and Europeans. Independence from Great Britain in 1947 led to riots, mass migrations, massacres, and ultimately partition into Hindu and Muslim regions. In 1950, India became a sovereign democratic republic; Pakistan became a separate Islamic republic in 1956.
Thus, although Buddhism exerted a profound impact in many of the countries that imported both Buddhism and Indian medicine, Ayurvedic medicine remained intimately linked to Hindu religious traditions. The universe portrayed by Indian religions was of immense size and antiquity, undergoing endless cycles of development and decay. Human beings were enmeshed in this universal cycle by reincarnation into positions higher or lower in the complex caste system. As inter- preted by Brahmanic priests, India’s caste system was a reﬂection of the order of nature found in the hymn of creation in the Rigveda. From the sacriﬁce that created the world, the brahmans (priests) arose from the head, the kshatriyas (warriors and nobles) from the arms, the vaisyas (farmers, merchants, and craftsmen) from the thighs, and the sudras (laborers, servants, and slaves) from the feet. The four major castes gave rise to more than three thousand subcastes and the ‘‘untouchables.’’
Growing within and beyond the boundaries of the mythic lore and epic battles of gods, conquerors, and castes, Indian medicine developed in a series of distinct phases: prehistoric, Vedic, and Ayurvedic. According to Hindu mythology, Brahma, the First Teacher of the Universe, was the author of Ayurveda, or The Science of Life, an epic consisting of a hundred thousand hymns and the source of all knowledge pertaining to drugs and medicine. The divine sage Dhanvantari, who arose from the cosmic ocean bearing the miraculous potion that conferred immor- tality on the gods, taught Ayurvedic lore to a long line of sages before it was ﬁnally committed to writing. The texts that have survived are said to be only shadows of the lost Ayurveda composed by Brahma.
While the authorship and time of composition of the Vedas cannot be determined with any precision, the Rigveda is said to represent materials from the period 4500 to 2000 B.C.E. and the Atharvaveda is prob- ably a compilation of materials created during the period from 1500 to 1000 B.C.E. In Vedic hymns and legends, gods and healers wrestled with demonic forces and performed rites that consecrated mysterious remedies against disease and pestilence. All medicines, including more than a thousand healing herbs, were said to be derived from heaven, earth, and water. Although the origin of Ayurvedic theory is uncertain, its materia medica may have evolved from Vedic or even prehistoric drug lore.
The Vedas contain many references to medical lore, anatomy, wounds, diseases, healers, demons, drugs, charms, and spells. Along with a complex pantheon of gods, the ancient Hindus believed in a vast array of disease-causing demons. Because disease was the result of sin or the work of demons, cure required confession, spells, incantations, and exorcism. Vedic healers prepared herbal remedies and charms against the demons that caused fevers, fractures, wounds, and venomous bites. Speciﬁc remedies and surgical techniques could only be therapeutic when combined with the appropriate ritual, but the roles of magicians, physicians, and surgeons were differentiated to some extent. Surgeons treated wounds and snakebites, removed injured eyes, extracted arrows, amputated limbs, and ﬁtted patients with artiﬁcial legs. If the skulls discovered at two Harappan sites are representative of a lost tradition, Indian surgeons also practiced trepanation.
Additional insights into the practice of Indian medicine and surgery can be gleaned from ancient laws, monuments, inscriptions, sur- gical instruments, artwork, and the stories told by travelers, pilgrims, and foreign invaders. A study of contemporary folklore and the work of traditional healers may also throw light on ancient practices. How- ever, the most direct guide to ancient Indian medicine is found in the classics of Ayurvedic medicine. These texts are fundamental sources
Gathering cinnamon bark in India as depicted in a sixteenth century woodcut.
for a civilization in which the oral tradition remained a dominant force, but given the complexity of Indian history and the diversity of its cultures, they must be regarded as portraits of the ideal physician rather than the typical practitioner.