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Ancient Asian Medicine: The Indian Paradigm

Somnath Ghosh The history of development of human civilization, through the organization of social production, tells us that astronomy was the first natural science to emerge as a separate discipline from the absolute necessity of pastoral and agricultural peoples, to keep track of the changing seasons. However, astronomy could develop only with the aid of mathematics hence that discipline too had to be tackled. Then, at a still later stage of agriculture and, in certain regions of the planet Earth, and especially, when there arose towns, with big building structures and a certain development of the handicrafts, mechanics also arose, which soon made itself extremely useful in navigation and war. Throughout the antiquity scientific investigation proper, remained restricted to these first three branches, and indeed in the form of exact, systematic research it occurs for the first time in the post-classical period in Greece, Alexandria and some other places. Up till that period, physics and chemistry were not yet separated, the disciplines of botany, zoology and, human and animal anatomy had only managed to collect some facts and arrange the same as systematically as possible; and physiology, in the absence of the vital knowledge of circulation of blood, groped in the dark to explain anything beyond the most tangible bodily functions like digestion and excretion (Engels 1976: 184-185). Incidentally, like all these basic disciplines, the technology of medicine also has a very long history of development, because mankind got acquainted with the feelings of bodily distress, pangs of illness, ageing and, finally, with the irreversible phenomenon of death, right from its own emergence as a distinct species on Earth; and, the basic animal instinct within, created the natural urge among the human beings to get rid of the various forms of illness. Medicine or medical technology is dependent on the other branches of science, like physics, chemistry, botany, zoology, and physiology. Even the rudimentary development of this art of healing the sick was not possible until the development of all these sciences up to a certain level. Yet the suffering of the diseased was in no way less intense in the ancient times than it is in this modern age. The helpless disease-stricken peoples of antiquity were forced to take refuge in the illusory world of gods and demons, of incantations and spells of magic. Thus, we find the dominance, of spirits and omens, of hymns and incantations, of sacrificial rituals and offerings, and of magical activities and talismans in the ancient methods of treatment of the diseased, all over the world (Sen 1962: 106). This dominance continues even today among those who are yet to receive the fruits of advancement of modern science, in a significant way. However, even among these less advanced sections of the humanity, there are always some intelligent and watchful persons who observe the annual or seasonal repetitions of the common diseases, learn to discern and realize their typical symptoms, and also try to master, more or less, the technique of applying several plants, extracts thereof and, other natural objects for the treatment of ailments. Accumulation of such experience over a period of many years gradually culminated in the spontaneous, and gradual, building up of an art of healing the sick, for the emergence of which the generation of economic surplus through a more or less established system of Neolithic agriculture and animal husbandry acted as a simple pre1

condition. Thus, we observe the sprouting of the rudimentary science, or proto-science, of medicine or, medical technology in some seats of ancient human civilization, namely, in Egypt, Mesopotamia, India and China. This development was later on carried forward by the people of Greece, Hellenic Africa, Arabia, Persia and, Central Asia. The history of post-Neolithic, agricultural surplus based, first urbanization (Childe, 1970: 140-217, 1976: 77-79, Chattopadhyay 1986: 334-371, 1988: 1-12) in India began with the Indus Valley Civilization of Mohenjo-Daro and Harappa from around the middle of 3rd millennium B.C.E. However, till date, we have been able to discover only a very little amount of information about the knowledge of drugs and methods of treatment possessed by the Indus Valley people. Archaeological investigations have retrieved some substances preserved in earthen pots having coal like black colour. This substance, on dissolution in water, produces a solution of deep brown colour and its resemblance with silajit, an important drug effective in the treatment of digestive and liver-related diseases, as well as in those of diabetes and rheumatism, has been established (Sen 1962: 54). Apart from this, some pots have been found to contain bones of Cuttle fish, and these bones on chewing stimulates appetite and can also act as an useful medicine for the diseases of eye, ear and throat. Probably, the Indus Valley people also employed coral, leaves of the Neem tree, and the horns of deer and rhino, as medicinal substances (Majumdar and Pusalker 1953: 178). It is a fact that archaeological research has not been able to provide us with any more information about the level of medicinal knowledge of the Indus Valley people, but the town planning observed in the urban ruins of Mohenjo-Daro and Harappa definitely indicate high level of alertness about public health among the architects of these cities, and, naturally, the assumption that these health-conscious Indus Valley people may have invented a well organized method of treatment, is not at all unreasonable (Sen 1962: 110-111). We know that, with the decline of the Harappan/Indus Valley Civilization the period of first urban revolution came to an end in the Indian subcontinent (Chattopadhyay 1986:352-352, Childe 1954, Wheeler 1979). In this geographical territory, the second urban revolution appeared with the establishment of the Mauryan Empire (Woolley 1963: 458, Chattopadhyay 1986: 373). This intervening period, having a span of roughly 1000 years (c. 1500 B.C. c. 500 B.C.), witnessed a general decline in material culture and technology (Singh 1986: 406-409, Sachau 1983: 171-172), and the disappearance of the Indus Script. However, this period also saw the maturing of human expression in the composition of poetic hymns, as well as in the formulation of cosmogonic ideas, as recorded in the Vedas. Only towards the end of this thousand-year period, that the regeneration of urban culture began and, the Bramhi and Kharosthi scripts came into being (Singh 1986: 407, foot note 2). The most striking feature of this intervening period is the absence of writing and urbanity. Much of the corpus of Vedic literature was composed in this period. The composition and preservation of the large corpus of Vedic literature in the non-literate, oral phase of history of civilization in the Indian subcontinent is really a paradox. It is resolved only when we pay attention to the development of linguistics in ancient India. This development led to the creation of abstract interest in the phenomena of language, triggering later on sophisticated theoretical advances, culminating in Paninis (600 B.C.E. 400 B.C.E.) Astadhyayi (Singh 1986: 441). 2

While studying the Vedic literature we find that the major portion of the first three Vedas, namely, the Rk, Yaju and Sama, are concerned principally with sacrificial and other religious rituals, and contain no reference to medicine. In contrast, the last of the four Vedas, the Atharvaveda, contains specific instructions and prescriptions for treatment and remedy of human maladies, both psychic and somatic, based on magical charms, spells, etc. The magical activities implied by the word Atharva were used for welfare of the common mass, such as, treatment of diseases or toxic actions, enhancement of nutrition, providing antidote for draught condition, etc., while the incantations or rituals meant for bringing evils to enemies, were included in Angiras and as both these stuffs are the subject matter of the Atharvaveda, it was also called Atharvangirasaveda. The views of the sages of Atharvaveda were more practical than those of the Rgveda; they had observed that human life is engrossed with poverty and misery, that people were panic-stricken, they had bad dreams and imagined that they saw mysterious omens and, that they were afraid of their rivals. In order to save the lives of human beings from these tragedies and to remove all obstacles to peaceful life, either man-made, or, god-ordained, these sages of Atharvaveda relied more on magical incantations and charms (Bandyopadhyay 1993). Hence, we find the Atharvaveda to consist mostly of charms, spells, incantations, magic, sorcery, demonology and witchcraft. However, it also deals with plants and vegetable products as helpful agents in the treatment of diseases and for the prolongation of life. In the Atharvaveda the hymns for the cure of diseases and from possessions by demons of diseases are known as bhaishajyani(the herbal therapy) (Ray 1956: 37), while those, which have for their object the prolongation of life and preservation of youth and health, are known as ayushyani (the elixir therapy, consisting of metal, mineral, and animal-product based drugs, apart from herbals) a term which later on gave place to rasayana, commonly known as the Sanskrit equivalent of alchemy (Ray 1956: 37, Needham 1990: ). Thus, we observe that the origin of the so-called alchemical/iatro-chemical notions gathered around gold, lead, soma juice and other medicinal plants as early as the age of the Atharvaveda, in India. Since the Vedas enjoyed a very high canonical sanctity and were viewed more as revelations than as human compositions, there is no wonder that medicine, and the attending chemical knowledge as well, in ancient India have seldom been able to free themselves completely from the influence of magic, religion and alchemy as auxiliaries. Thus, it is but natural that apart from linguistics, the only other proto-scientific evolute from the Vedas is the science or proto-science or technology of medicine, namely, Ayurveda literally, the lore of life, or, the science of longevity whose origins go back to at least five thousand years from now, to the period of Indus Valley Civilization, as mentioned earlier, and which began as an appendix to Atharvaveda (Sen 1962: 113, Hoernle 1907, Part - I: 109-114, Svoboda and Lade 1998: 44). The incantation-based medicine of Atharvaveda evolved into a system of empirical medicine, in the Ayurveda, roughly around c. 6th century B.C.E, this implies that the extensive development of Ayurveda is contemporaneous with the time of Siddhartha Gautama the Buddha, and he supported both the study and the practice of medicine. This connection between Ayurveda and Buddha and his teachings is not at all fortuitous or accidental. Actually, the Four Noble Truths of the Buddhist darsana have a close similarity with the four successive questions, which the neophyte Ayurvedic physicians of India were taught to ask themselves, by their Gurus, before engaging 3

themselves in the actual treatment of a patient. These questions are: 1) are the complaints of the patient based on some real suffering; i.e., has the person a real disease or is the person only seemingly ill? If the answer to this is in the affirmative, then, 2) with what kind of suffering is the patient afflicted and what is its origin? Next, 3) whether the disease is curable or not; after completion of the diagnosis in the second step, this third step is crucial in the sense that if the answer to this question is in the negative then the physician is supposed to withdraw from treatment of the patient, but if the answer is positive, and the disease seems curable, then the doctor will ask himself the fourth and the last question about proper therapy, namely, 4) what kind of treatment is imperative for this particular ailment? Incidentally, the Four Noble Truths, as delineated in Theravada Buddhist Ethics, are: 1) realizing that misery exists; 2) realizing that misery has a cause; 3) realizing that the particular cause of the misery is eradicable; and, 4) realizing that misery will cease after one has pursued the Eightfold Path (the Astangika Marga), leading ultimately, to Nirvana (Dale 1964: 145, Zimmer 1948: 33-34, Sogen 1912: 69-70). The striking resemblance between the two issues, in question, is further concretized by the facts that there are, actually, eight main divisions of Ayurvedic therapy, namely, Kayacikitsa (General Medicine), Salyatantra (Surgery and Obstetrics), Salakyatantra (Treatment of the diseases of ear, nose, throat and eye), Bhutavidyatantra (Discussions on Psychic diseases and their treatment), Kaumaravrityatantra(Pediatrics), Agadatantra (Poisons, their actions and remedies), Rasayanatantra (Geriatrics), and Vajeekaranatantra (Rejuvenation therapy and Virilityenhancement). Further, two very significant and well-known Ayurvedic treatises bear the titles, Astanga Sangraha and Astanga Hridaya Samhita (Sen 1962: 113 [vol. I], 71-72 [vol. II], Svoboda and Lade 1998: 46). Thus, the doctrines of Buddha appear to have provided the functional as well as the operational foundation of Ayurveda. It is to be remembered that the period of proliferation and establishment of Ayurveda also coincides with the beginning of several great systems of Indian Darsana, namely, Bauddha, Jaina, Samkhya, Vaiseshika, and Nyaya-Vaiseshika (c. 600 300 B.C.E.), as well as certain common orthodox doctrines of the Indian Darsanas, such as, those of Transmigration of Soul, Karma, Mukti, Life is Suffering, etc., which were settling to the status of dogma around this time (Dale 1964: 33). There is no reliable historical evidence regarding the actual composers of Ayurveda. Probably, the experiences and knowledge of many expert physicians and physiologists/anatomists went into the formation of this empirical discipline. The Indian tradition speaks of three major source books of Ayurveda, called the Vriddha-trayi or the three elder ones. These are the Caraka-Samhita, Susruta-Samhita, and AstangaSamgraha / Astanga-Hridaya-Samhita. There exist a considerable number of commentaries on these and, many digests are based on them. There are certain early, fragmentary medical works as well, like the so-called Bower Manuscript and the BhelaSamhita. What come down to us as the Kasyapa-Samhita, Harita-samhita, though undoubtedly bearing the names of some ancient authorities, are not considered to be really ancient works by scholars. Hence the Vriddha-trayi remains the most basic sources on ancient Indian medicine. Of these again, the Astanga-samgraha is more in the nature of a medical manual prepared by the famous physician, Vagabhata (c. C.E. 200-300), undoubtedly depending on the Caraka-samhita and Susruta-samhita, hence Astanga is not to be considered as basic as the other two, of which the primary interest 4

of Susruta is surgery though on the whole it shares the doctrinal content of Caraka and accepts the drugs and diets prescribed by the later. The Caraka is an enormous medical compilation, parts of which are entirely in verse; the parts in prose alternating with those in verse, concluding with mnemonic verses. Its language is classical Sanskrit and does not correspond to a definite period. The text contains 126 chapters in all, which include the sub-chapters on rasayana and vajikarana, and these are arranged in eight books (again we meet the number eight!), namely, Sutra-sthana, Nidana-sthana, Vimana-sthana, Sarira-sthana, Indriya-sthana, Cikitsa-sthana, Kalpa-sthana, and Siddhi-sthana. A great deal of rigor has not been maintained in the arrangement of the main subjects discussed in these eight books. The text as a whole is full of repetitions and digressions; it also describes debates and disputes among various authorities on questions of basic theoretical importance (Chattopadhyay 1988: 153-154). Caraka mentions the conclusions shared by all contemporary schools of medicine, and these are; there are causes; there are diseases; there are ways of curing the curable diseases (Chattopadhyay 1988: 151,154, Caraka Samhita 1949). The therapy recommended by the Caraka is based mainly on the use of drug and diet. It recommends surgery only in a few exceptional cases and that too somewhat reluctantly. In contrast, Susruta emphatically argues in defense of the primary importance of surgery in medical science and technology, as instantaneous actions can be produced with the help of surgical operations, cauterization, etc. Compared to the Caraka, the Susruta is lesser in bulk; it is also written in classical Sanskrit, partly in verse and partly in prose. The main body of the text contains 120 chapters arranged in 5 books, namely, Sutra-sthana, Nidana-sthana, Sarira-sthana, Cikitsa-sthana, and Kalpa-sthana. To this main body of the text has been added later on, an appendix in 66 chapters on assorted topics, which is called the Uttara-tantra (postscript to the treatise) (Chattopadhyay 1988: 155, Susruta Samhita 1972), and possibly this addition was done by the Buddhist scholar Nagarjuna, of 6th 9th century C.E., the so-called final redactor of the Susruta, who removed Salya-tantra from the canon, apparently under the influence of the Buddhist doctrine of non-violence (Sharma 1982: 540, Rosu 1982: 65, Misra 1981: 9-10,18). According to the basic theoretical generalization of Ayurveda, as delineated in the Caraka Samhita or the Susruta Samhita, everything is made of matter, especially, of the five great elements (panca mahabhuta: kshiti[Earth], apa[water], tejas[Fire], marut[Air], and, vyoma[Ether/Sky]) and, everything is involved in the ceaseless process of coming into being and passing out of existence, where the role of the physicians and of their medical technology, is to maintain the health of the healthy persons and to remove the disorders in the ailing. In fact Caraka states that everything that exists in the vast external universe, in the macrocosm, also appears in the internal cosmos of the human body, in the microcosm, in altered form. The universe is thus continually influencing the living human body and the latter is likewise influencing the former. Prana (the life force), tejas (the subtle fire), and ojas (the essence) are the quintessential expressions of the five elements as applied to embodied life. Furthermore, prana, tejas, and ojas individually express the intrinsic attributes of Air, Fire, and Water elements, respectively, in their greatest degree. The life force, subtle fire and essence are considered to be too subtle to satisfy all energy requirements of a living body and so they metamorphose into doshas, a dosha being something that can go wrong (Svoboda and Lade 1998: 49, 5

50). The three doshas inside a living body are: Vata, Pitta, and Kapha, which are the grosser forms of prana, tejas, and ojas, respectively. Vata arises from Air and Ether, Pitta from Fire and Water, and Kapha from Water and Earth, of each of these two elements attached to a particular dosha, one functions as its active component and the other acts as the passive medium through which the active element is expressed. All movements of any kind in the physical body of every living being is governed by Vata; all transformations of every kind and particularly those involving the digestion of food and information are governed by Pitta; stability, including such functions as lubrication of joints and organs, is governed by Kapha. Bile, phlegm and other bodily secretions are vehicles for the three doshas, substances through which they display their qualities and perform their actions. As mentioned above, all five elements are essential to life, and their harmony, or disharmony, which arises when Vata, Pitta, and Kapha are balanced, or imbalanced, determines an individuals condition of health or disease. A healthy organism produces just enough of the three doshas to meet physical needs, while an unhealthy body overproduces or under-produces the doshas at the expense of the bodys vitality, adaptability and immunity (Svoboda and Lade 1998: 50-51). The three doshas pervade the entire body but concentrate only on those tissues in which they are particularly required. Actually, by arranging and nourishing the tissues and by sequestering and excreting the wastes, the doshas make the body function. The products of digestion, or the dhatvagni, are the seven tissues, or the body-elements, the so-called dhatus, which anchor mind and spirit firmly to the physical body. These seven dhatus are: Sap (rasa), Blood (rakta), Flesh (mamsa), Fat (medas), Bone (asthi), Marrow (majja), and the Reproductive Tissue (sukra). Sap (rasa), the foundation of the body, is the first juice absorbed by the body from the digested food, and it has been variously translated by modern scholars as, chyle, lymph chyle, fluid of life and organic sap. Susruta emphasizes the importance of the Sap as: Knowing that humans are the product of rasa, one must be especially careful about the preservation of rasa (Svoboda and Lade 1998: 54-55). According to Susruta, the origin of this Sap is through the complete transformation of the food, made of matter in five forms by the agency of digestive fire into its subtlest essence, and it is termed rasa (presumably derived from the root, ras, to move) as it ceaselessly circulates throughout the organism. More importantly the branch of Ayurveda devoted to the path (ayana) of this all-important rasa within the body and the control of it through drugs or otherwise has been named as rasayana (Chattopadhyay 1977: 53, Chatterjee 2002: 193, 505). Each of these seven dhatus acts as the raw material for the next; that is Blood is formed from Sap, Flesh from Blood, Fat from Flesh, and so on. At each stage of transformation the next tissue in the sequence is produced along with a waste and a secondary tissue. The Reproductive Tissue includes all the reproductive fluids of the male and female bodies; it produces no waste, and its secondary tissue is the fetus it creates (Svoboda and Lade 1998: 55). Thus, we find that based on the Samkhya doctrine of cosmogonic creation of matter in the macrocosm, Ayurveda formulated a theoretical schemata regarding the hierarchical generation of the primary body-elements, or dhatus inside the microcosm through the transformation of the entering environmental matter, inclusive of food, within the body. According to this scheme therefore, health means nothing but the balance or equilibrium of these body-elements, while disease is the loss of this balance resulting from the wrong way of absorbing environmental matter, i.e., either the over6

absorption or the under-absorption of a specific form of it. In the manifestation of a human disease, Ayurveda, unmistakably, identifies the loss of the prevalent equilibrium within the human body of the three doshas, through the intervention of external environment -- clearly a direct influence of the Samkhya doctrine of evolution of the unmanifested prakriti, where the three gunas sattva, rajas, and, tamas -- were in total harmony, by receiving the stimulus, or disturbance from the purusha. In fact, according to Ayurveda, diseases are basically of three types: endogenous (breakdowns from within), exogenous (attacks from without), and mental any of which can subsequently lead to others; the tissues and the wastes being the things in the human body that are vitiated by the doshas and the vitiation spreads from one tissue or waste to the others. Hence, to an Ayurvedic physician the therapeutic principle really means that if there is an excess or inadequacy of bodymatter in a particular form within the body, he has to prescribe as drug or diet (the restoring external agents) certain specific substances which, when transformed within the afflicted body, lowers or raises the affected body-matter to its required level, to the level at which it retains balance with body-matter in other forms. How does the physician select the efficacious substances from the plethora of natural objects that can be administered either as drug or as diet? This problem, pertaining to the operational aspect of Ayurvedic therapy, has been tackled using the principle of six categories: dravya, guna, karma, samavaya, samanya, and visesa, as enumerated in the Vaisesika or Nyay-Vaisesika Darsan (Faddegon 1918: 177-180, Dasgupta: Vol. I: 285-294, 313-319, Riepe 1964: 231-238), and formulated cryptically by the acclaimed theoretician of Ayurveda, Bharadvaja, as: samanyam ca visesam ca gunan, dravyani karma ca / samavayam ca; here the categories, samanya and visesa do not maintain their original connotation (in which they are applied in the Vaisesika theory) in Ayurveda. To handle this specific problem the theoreticians of medical science in ancient India had, not only to formulate the problem, namely, how the actions and properties of substances used as drugs and diet can be linked or connected to their material (bhauta) composition, but they were also required to develop some conceptual tools for solving it. Of the conceptual apparatus developed for the purpose, three of the above mentioned six categories are most important, and they are: dravya or substance, guna or qualities, and karma or action, thoughspecially for explaining the relation between the substance and its qualitiesthe need is also felt for the fourth category, the samavaya, the inseparable or inherent relation. The therapeutic agents are viewed as belonging to the general category of natural substance or dravya. Medically speaking, the most important aspect of these substances is their actions or karma on human beings. Though the necessity of these two categories for the problem at hand is more than obvious, but, here, we must acknowledge the view of the ancient physicians that the clue to the matter-composition of these substances as well as to their actions, can only be provided by their qualities, and hence the need for the third category, namely, the qualities or guna. How far is this procedure of judging a substance from the qualities really dependable? It cannot at all be dependable, if the relation between the two, the substance and the quality, is accidental, transitory or detachable. However, the traditional experience of the physicians instruct them that it is not always the case, and that there are cases where the relation between the qualities and the substances is peculiarly inseparable, as for example, the relation 7

between matter in its earthy-form and its specific quality of smellsuch relations are expressed through the fourth category of samavyaya or inherence. This relation of inseparableness or inherence is, therefore, exceedingly important from a medical viewpoint, because only when the existence of qualities are thus impossible without the substance, are they infallible indices for the nature of the substance concerned. This identification of the nature of a substance by its inseparable qualities enables the physicians to know, and thereby to regulate the action (karma) of the substances on human bodies. This action is determined by the inherent nature of the substance, i.e., by its matter-composition. From the medical point of view, therefore, the substance is the substratum not only of its inseparable qualities but also of its inseparable action. The nature of a substance, once identified by its inseparable qualities, can thus be effectively recommended by the physician for regulating the change required for the afflicted body. This means that though both the inseparable quality and the inseparable action have for their substratum the same substance, the inseparable quality of a substance is only a passive pointer to the nature of the substance, while the medical effect of it is entirely due to the function it has because of its matter-composition. Karma or action is thus the function of a substance inherent in it, and the said function has two forms, called conjunction or samyoga and disjunction or vibhaga, which means the addition and diminution of some particular form of body-matter. These increasing or additive action of substances used as drug or diet have been termed by the Ayurvedic physicians, samanya, whereas their diminutive action is called visesa. Thus, in the Vaisesika system the word samanya means a class concept, but in the Ayurvedic parlance it means the concrete things which have similar/common constituents or characteristics; while visesa, in the Vaisesika system means the ultimate specific properties differentiating one atom from another, in the Caraka Samhita it means concrete things which have dissimilar or opposite constituents and characteristics. Samanya and Visesa thus have significances in Ayurveda that are quite different from what they have in the Vaisesika-sutras. A substance causing conjunction to a body element (i.e., adding to it) is termed samanya in relation to this particular body-element, while a substance causing disjunction to a specific form of body-element (i.e., diminishing it) is called visesa in relation to this body-element. Thus, the six categories, with which the ancient medical theoreticians in India attempted to systematize a vast stock of empirical data concerning the natural substances entering as input within the human system and of their ways of affecting this body, are: dravya (substance), guna (quality), karma (action), samavaya (inseparable relation), samanya (alternatively also called vrddhi-karana or the cause of increase) and visesa (or hrasa-hetu the cause of diminution). These categories are then immediately put to use, as in the Caraka Samhita, to classify the substances according to their qualities in two separate lists: the first one consist of five qualitiessound, smell, touch, color and taste that are perceivable by the sense-organs; and the second one consists of ten pairs of mutually opposing qualities heavy and light, cold and hot, wet and dry, dull and acute, stable and mobile, soft and hard, clear and sticky, smooth and rough, and solid and liquid which are qualities of substances manifested after their digestion within the body, not just through sense perceptions. Thus, in the classification of effective substances according to their qualities, it is recognized by the theoreticians of Ayurveda, that anything that goes into the system influences it with its characteristics and the most 8

important of them is food, which affects the system thrice: before digestion when it is tasted by tongue, during digestion while it moves through the gut, and after digestion when it passes into the tissues. These effects are then further categorized as: taste (rasa), potency (virya), and post-digestive effects (vipaka); wherein we find two significant peculiarities: i) out of the five sense-perceivable qualities only one, namely, the taste-quality has been picked out for classification, and ii) the term rasa appears in yet another connotation within the gamut of Ayurveda. The Caraka and the Susruta Samhitas mention that the rasas, or the taste-qualities are six in number: sweet (madhur), sour (amla), saline (labanakta), pungent (katu), bitter (titkta), and astringent (kashaya); and this notion, possibly, arose out of the principle of identification of the element of water, rasa, with the sense of taste, in Samkhya, as each of the tastes, are thought, to arise out of the mixture of water together with the other four gross elements in varying proportions, in the Ayurveda. These taste-qualities are not only derived from the five gross elements but they also tend to increase or decrease the three dosas in the body. However, the ancient theoreticians of Ayurveda understood from their experience, that the medical effects of the large variety of substances are not fully explained in terms of taste alone, so they formulated the category of vipaka, which tends to explain the change of the taste-quality (rasa) of a substance altogether after digestion, and that in such cases the changed taste following the process of digestion (paka) could be operative, which can be taken care of through the category of vipaka. Even this was not sufficient, for there were many other effects of medicine which could not be explained in terms of the taste feeling of the substance by the tongue (rasa), or in terms of the final effect produced by the substance after digestion (vipaka) hence the term virya, or potency-in-chief was introduced; it is an effect of the substance, that is felt throughout its presence in the body, and as such it is medically much more important than either taste or post-digestive effect. However, to cope with the multivarious qualities and produced effects of substances administered as drugs or diets, the ancient physicians had to put forward another quality-classification of substances to account for the observed specialized attributes or powers of certain foods, medicines, and poisonsand that is called, prabhava (special power). Thus, substances with special powers may produce unusual effects in the body or mind, effects which cannot be predicted by the classificatory knowledge of taste, potency, or post-digestive effect (Chattopadhyay 1979). It is clear from what have discussed above, that the main methodological tool of Ayurveda was categorization, or, classification of diseases, causes of diseases, as well as of the therapeutic substances or drugs for alleviating these diseases and this tool or methodological apparatus is definitely a contribution of the Grammarian school of thought, or, Vyakarana Darsana to Ayurveda. It is to be noted further, that this categorization or typological classificatory attempt of traditional Indian medicine is not restricted to diseases, their etiology and the applied drugs and dietary substances only it is extended even to the patients or clinical subjects also. Ayurveda believes that every human being has a typical rhythm, an innate gait, (determined by what may be referred to as genes and chromosomes in the present day terminology), and that it reflects the bodys internal energy equation. All of us tend to favor particular energy pathways, organs, glands, nerves, limbs, thoughts, and images. The sum total of this preference produces our own individual gaits. Ayurveda calls a persons characteristic 9

physical and mental constitution, prakriti (which means the manifested universe as a whole, and a persons constitution is a representation of that persons innate, intimate, universe, or microcosm), which is to be distinguished from vikriti -- the condition or current state of a persons health that varies from moment to moment (Svoboda and Lade 1998: 65). This personal constitution, which is fixed at the moment of conception, is determined by conditions prevailing in the bodies and minds of the childs parents at that time. Severe disease may make the underlying constitution irrelevant to diagnosis, but that pattern is etched permanently into the, so-called, genetic material of the person concerned. The diet and activity of the mother during pregnancy, conditions in the womb during pregnancy, and the events during delivery may also influence the childs subsequent health and happiness, but these are all secondary to the constitution type and, consequently, in Bengali traditional usage, this is called dhat (probably derived from dhatu) of the particular human being, in question. Ayurveda recognizes eight principal constitution types (again, that magical number, eight!!): (a) balanced (where all three doshas are in equilibrium), (b) vata (where vata is stronger than the other two doshas), (c) pitta (where pitta is predominant), (d) kapha (where kapha predominates), (e) vata-pitta or pitta-vata (where the two indicated doshas are stronger than kapha), similarly, (f) pitta-kapha or kapha-pitta, (g) vata-kapha or kapha-vata, and, finally, (h) imbalanced (where the three doshas tend to go out of equilibrium). Empirical study reveals that most people have double predominance. Ayurveda, actually, makes a list of characteristics, like: body frame (narrow, broad, etc.), weight (loses and gains easily or not), skin texture, sweating, fertility, speech, emotion, memory, etc., typical to persons belonging to each of the three mono-constitutions, vata, pitta, and kapha, while dual-constitution persons are said to posses suitable mixtures of these mono-constitutional characteristics. It must also be mentioned in this context, that time, like personal constitution, is one of the more significant factors implicated in the causation of disease. Diseases are said to arise at the junctions of the seasons literally, at the junction of winter with spring (kapha aggravation), spring with summer (pitta aggravation), and summer with winter (vata disturbance) as also at the other seasons of ones life, namely, those pertaining to day, age and digestion. This is because the body must adapt to changing external conditions, but it becomes imbalanced if the adaptation is less than perfect. Actually, it was realized by the ancient Ayurvedic physicians that no single factor is wholly responsible for either health or disease; they are the results of concerted actions of many causes (Svoboda and Lade 1998: 65-67, Dash 1978 and 1991, Filliozat 1964). Caraka in summarizing the ideal attributes of a medicinal substance says: A medicine is one which enters the body, balances the doshas, does not disturb the healthy tissues, does not adhere to them and gets eliminated through urine, sweat and feces. It cures the disease, gives longevity to the bodily cells and has no side effects (Svoboda and Lade 1998: 53). Another unique Indian medical belief revolved the concept of marma. Ayurveda portrays the human body to be composed of a number of intricately interwoven, onion like, layers: (i) the changeable body of fluids, tissues and wastes, (ii) relatively less changeable body of muscles, bones and nerves, (iii) the subtle body, and, (iv) the causal body. In the physical body energy and fluids move through visible channels, like nerves and blood vessels, while in the vital body prana moves through the subtle conduits and plexuses called nadis and charkas. The nadis direct the activity of the 10

physical channels through which energy flows, including the nerves, bones, joints, muscles, ligaments and glands, which then move the body juices around. A Marma, actually, is a joint in the human body beneath which vital channels intersect and in this intricate system of connected channels of our body the most vulnerable points are those where things join together, i.e., the marmas. Some of these intersections are physically identifiable while others are subtle structures. Since Vedic times warriors in India targeted marmas on the bodies of their enemies to inflict maximal damage and surgeons used their knowledge of marmas to treat such injuries. The Susruta Samhita classifies 107 marmas on the basis of the structure (muscles, blood vessels, ligaments, nerves, etc.), on the regional location, the dimension, and the consequences of injury (disability, simply intense pain, delayed death, swift death, etc.). The practitioners of the martial art kalarippayattu, of Kerala, recognize 160 to 220 marmas in martial practice, and use 107 marmas of Susruta in therapy. According to the teachings of kalarippayattu, injury to a marma blocks or cuts the associated nadi at that point, interrupting the flow of both the prana, the life force, and its waste product and servant, the vata, in that area. Marmas exist only insofar as there is prana in the body that is, a dead body has no marma within it; the death or damage predicted for injury to a marma occurs only when such a marma is active. More interestingly, pranas movement through and concentration in the marmas is supposedly controlled by the lunar day (Svoboda and Lade 1998: 59, 61-64). From what has been said above, about the attempts of the theoreticians of Ayurveda to rigorously systematize the effects produced by substances used as drugs and or diets to rectify the imbalance of the doshas in an afflicted human body, it is quite clear that the process of classification and categorization of substances according to their qualities and actions was pushed too far to enable the Ayurvedic physicians to chart out in the forms of tables of ready-reckoners, exhaustive listings of drugs, diets, their effects, and of the constitution types of human beings in terms of these doshas, on the basis of the empirical data about available natural substances and results of observation made on numerous diseased persons. However, such an attempt of schematic understanding, relying principally on the pancha-bhuta theory and the principle of three humors or doshas, indicated also in the Rgveda-samhita, and in the Atharvaveda, in the form of the tridhatussushka (dry), sikta (wet), and sanchari (spreading)according to Sayanacharya (Sen 1962: 112), is bound to degenerate into dogmatic formulas, applied by physicians, generation after generation, without bothering to reexamine the issue of disease causation in a healthy being, with a more incisive attitude, open mental framework, and a greater stress on knowledge about human anatomy. Possibly, the decadent intellectual tenor of that age and the rigors of the logic of the grammarians, which provided the basic methodological structure of medical science in ancient India, forbade such critical, exploratory attempts. Still, this theoretical exercise on the part of the ancient medical theoreticians of India is remarkable, at least, on three counts: a) it treats diseases as something having natural rather than divine origin; b) it provides us with a huge body of categorized, empirical data that can function as the data-base for generating a more advanced scientific approach of medical treatment, in future; and, c) it has provided the factual support towards the important epistemological idea of perpetual flux of the Nyaya-Vaisesika system (Chattopadhyay 1979: 134-135); and possibly, in a mediated way, the method of Panini reinforced its 11

grip on this system. That the Paninian method was very significant for the exercises in medicine in ancient India, is also borne out by the fact that the renowned Ayurvedic physician Narahari, who lived in Kashmir in the 13th century and composed a dictionary of herbal medicine titled Avidhanachuramani, was also a famous grammarian. However, there are indications, that in the post-Bhartrihari period of development of Indian philosophy and logic, the stress on the grammar-based, logical approach was considerably lessened. Other significant works on medicine, medicinal chemistry and general chemical methods of utility, apart from these two (Caraka-samhita and Susrutasamhita), belonging to this period, were: Navaneetak, or the Bower Manuscript, discovered by the British army officer A. Bower, from the excavations at a Buddhist stupa in Chinese Turkistan, around the beginning of the twentieth century, the Astanga Samgraha of the elder Vagbhata, and the Astanga Hridaya Samhita, of the junior Vagabhata. Of these the Bower Manuscript is possibly the eldest existing medical manuscript, whose origin probably goes to the 4th century A. D., according to paleographic evidence. Many of the chapters of this work may be regarded practically to be revisions of the corresponding ones of the Caraka Samhita. The work contains mention of the Susruta Samhita, but not of the Caraka Samhita. Recipes of several important preparations, described in the Bower Manuscript, agree in all essentials, and sometimes word for word, with those of the existing recensions of the Caraka and the Susruta Samhitas. The treatise on medicine next to the Caraka and the Susruta, in which one can find some chemical information worthy of note, is Astanga Samgraha, of the elder Vagbhata. This treatise may be regarded as an epitome of the Caraka and the Susruta line of thought with some gleanings from the works of Bhela and Harita. Mineral and natural salts figure chiefly in the prescriptions along with vegetable drugs; mercury is incidentally mentioned, in a recipe for the preparation of a collyrium along with, lead, stibium, and camphor. However, the mention occurs in such a perfunctory manner as to exclude any assumption about the knowledge of its compounds. Some metallic preparations are recommended in it, which would presuppose an advanced knowledge of chemical processes. Astanga Hridaya Samhita is composed in the form of verses, based on the Astanga Samgraha of the elder Vagabhata. In terms of popularity, it superceded the earlier work, and was translated in both Tibetan and Arabic. The physician, named Sindaksar, or Sindicar, mentioned in the works of ar-Razi (Sen 1962, Stapleton et al 1926), the famous Islamic alchemist and iatrochemist of the 9 th 10th century C.E., along with the description of the merits and demerits of herbal substances, is possibly the junior Vagabhata of Sind. A careful study of these two works of the two Vagabhatas, reveal that the advancement in Anatomy and Surgery that was achieved during the period of Caraka and Susruta suffered deterioration during this period, and the meager discussions about them that exist in these two treatises are very incoherent and are at times not even correlated. This indicates that, the study of Anatomy and Surgery practically declined during the period of these two Vagabhatas. In the Vedic period surgery used to enjoy a coveted position and surgeons used to receive honor and reverence in society. In the succeeding Brahamanic age, with the rise of various superstitions, treatment with surgical instruments gradually became a very downcast and despicable profession. Being despised and discarded by the educated Brahmins, surgery took refuge among the illiterate, low-lying communities of the society. The doctrine of non-violence (ahimsa) of the Buddhists and the Jainas also impeded the 12

advancement of surgery (Sen 1962). Hence, in spite of developments of the other branches of medical technology, the rapid decline of surgery could not be checked, in the Buddhist age. The void thus created by the gradual phasing out of surgery on the one hand, and the decadence of Ayurvedic medicine on the other, due to its excessive dependence on the theory of three humors, provided the necessary operational space and impetus for the discoveries and innovations in the field of mercurial and mineralbased medicines, and thereby the age of alchemy proper made its appearance in India, in and around the 7th century A.D., as a hand-maiden to the Tantrik or Siddha system of medicine, also known as the Rasa Cikitsa Paddhati (Rosu 1982: 65-66, Mazumdar 1982: 233). Actually, the so-called religious alchemy evolved and devolved in India in three phases: a) the magical alchemy that dominated the field from the 2 nd to the 10th century A. D., b) the tantrika alchemy, which enjoyed its golden age between 13th and 14th century, and, c) the siddha/sittar alchemy which thrived from the 13th to the 17th century, mainly in south India --- and throughout these three phases, it interacted with, and was at times even indistinguishable from, other theoretical and applied sciences in which mercurial and mineral-based preparations played a central role (Ghosh 2006, White 1996: 52). The most important of these was, definitely, Ayurveda, whose two foundational works, the Caraka Samhita and the Susruta Samhita, contain references to external, therapeutic uses of mercury (Caraka Samhita: 6. 7. 70 71 and Susruta Samhita: 4. 25. 39; 5.3. 14; 6. 35. 7). The goal of Tantrika alchemy was bodily (Gold like) immortality, (Diamond like) invincibility and transcendence of human condition i.e., Nirvana or Jeevan Mukti. This focus of the Tantrika alchemical method has been aptly summarized in the text of Rasarnava with the pithy formula (Rasarnava, 17, 165a, 166a): Yatha lohe tatha dehe / purvam lohe parikseta tato dehe prajojayet which means: as in metal so in the body . first test (mercury) on a metal, then use it on the body. Moreover, the two elements placed here in mutual relation, metals (loha) and bodies deha), define the two distinctly different but interconnected branches of the Tantrika alchemical syntheses: they are the lohavada or transmutational alchemy and dehavada or elixir alchemy. The most significant point that this verse highlights is that even within this body of alchemical activity, transmutation of metals into gold was not an end in itself, but rather the necessary means to the ultimate end of bodily immortality (White 1996: 54). Sometime in the 14th century, the general disappearance of the Tantrika alchemy occurs, and along with it, the appropriation of its techniques of transmutation and transformation by the other Indian systems of thought and practice, both old and new. Many of the techniques of Tantrika alchemy were churned back into the Ayurvedic tradition and this legacy of Tantrika alchemy in this later Ayurveda is, rasasastra, the Aurvedic Pharmacy, an indispensable part of the Ayurvedic practice. It is a discipline that continues to be taught in the Ayurvedic parlance even today. This reapplication of transmutational and elixir alchemy to therapeutic ends is known as rogavada, or the Medicinal alchemy, specific to the north Indian Ayurveda. Another development of the same order is rasacikitsa, or the Mercurial medicine. This school continued for centuries to thrive and even to rival classical Ayurveda, with its shifted emphasis on therapeutic techniques rather than on transmutation and bodily immortality, in south India and in the eastern states (like Greater Bengal), and the Sind, 13

and was exported to Tibet, China, South East Asia and Sri Lanka, along with classical Ayurveda (Rosu 1982: 65-66, Bose 1982: 233). After the 10th century, the Central Asian conquerors imported their own system of medicine into India. However, Ayurveda too continued to be in practice. In the 13th-14th century, a treatise on Ayurvedic pharmacology (rasasastra), the Sharngadhara Samhita, appeared, and during the 16th century all Indian medical knowledge was collected and compiled by the order of Mughal Emperor Akbar (Svoboda and Lade 1998: 46). The conquests by the Europeans, however, were nearly fatal for Ayurveda, especially after 1835, when the British decided neither to recognize nor to support Indian sciences in their Indian dominions (Kumar 1997: 179). Ayurveda began its renaissance in the wake of the Indian upsurge against British Rule (along with the renewal of the arts and sciences in India) at the beginning of the 20 th century, and today, in independent India, it exists as one of the six medical systems officially recognized by Indian government the other five being: Allopathy, Homeopathy, Unani, Siddha and Naturopathy.

References 1. 2. 3. 4.
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5. Chattopadhyay, D.P. 1979. Science and Society in Ancient India, 1st published in 1977.
Calcutta. --.1986. History of Science and Technology in Ancient India, Firma KLM Pvt. Ltd., Calcutta --. 1990. Theoretical Fundamentals of Natural Science, NISTADS/CSIR Publication, Delhi.

6. Dasgupta, S. N. 1975. A History of Indian Philosophy, Vols. I and II, 1st Indian edition, Motilal
Banarasidass, Delhi.

7. Dash, B. 1978. Fundamentals of Ayurvedic Medicine, Bansal & Co. Delhi. 8. Engels, F. 1976. Dialectics of Nature. Translated from the German by Clemens Dutt. Progress,
Moscow.

9. Faddegon, B. 1918. The Vaisesika system Described with the Help of the Oldest Texts,
Verhandelingen der Koninklije Akademie van Wetenschapen te Amsterdam: Johannes Mueller.

10. Filliozat, J. 1964. The Classical Doctrine of Indian Medicine. Munsiram Manoharlal, Delhi. 11. Ghosh, S. 2006. Role of Mercury in Alchemy or Proto-chemistry: Western and Eastern
Perspectives, Proceedings of the Second Biennial Conference of Indian Association for Asian & Pacific Studies, 2004, University of Sambalpur, Orissa. Progressive Publishers, Kolkata.

12. Hoernle, A. R. R. 1907. Studies in the Medicine of Ancient India, Part I. Oxford. 13. Kumar, D. 1997. Science and Raj, 1857-1905. Oxford University Press, Delhi. 14

14. Majumdar, G. 1982, Medicine, in: Bose, D.M., Ed. A Concise History of Science in India. 15. Majumdar, R. C. and Pusalker, A. D. 1953. (Edited) The History and Culture of the Indian
People, Vol. I, Vedic Age. George Allen & Unwin.

16. Misra, S. 1981. Ayurvediya Rasasastra. Jaikrishnadas Ayurveda Series, 35, Benares:
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17. Riepe, D. 1964. The Naturalistic Tradition in Indian Thought. Motilal Banarasidass, Delhi. 18. Rosu, A. 1982. Le renouveau contemporain de lAyurveda, in: Wiener Zeitschrift fuer die
kunde Sudasiens, Vol. 26. --.1982. Yoga et Alchimie, Zeitschrift der Deutschen Morgenlandsichen Gesellschaft, Vol. 132, pp. 363 379.

19. Sen, S. 1962. Vijnaner Itihaas. Indian Association for the Cultivation of Science, Jadavpur.
Calcutta, 2nd ed., Vols. I and II.

20. Sharma, P. 1982. Ayurved ka Vaijnanik Itihas. Banaras: Chowkhamba Orientalia. 21. Stapleton, H. E. et al. 1923. Memoirs of the Asiatic Society of Bengal, Vol. VIII, No. 6. 22. Svoboda, Robert and Lade, Arnie. 1998. Chinese Medicine and Ayurveda. Motilal Banarasidass,
1st Indian Edition, Delhi.

23. White, D. G. 1996. The Alchemical Body. The University of Chicago Press, U.S.A. &London.

CATEGORY: HISTORY OF MEDICINE KEY WORDS: INDIA / AYURVEDA / CARAKA / SUSRUTA / RASASASTRA / TANTRA

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