The Medical Traditions of India and China

11 May

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

Medical Traditions of India  and China

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.

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