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Ayurveda
Text and History of Ayurveda
A Hindu Heritage of Healing
by Neria Harish Hebbar, MD
The Origins - The Myths and Legends
 Indian
art of healing is almost as old as the religion of Hinduism itself.
Āyurveda attained a state of reverence and is classified as one of the Upa-Vedas
- a subsection - attached to the Atharva Veda. The Atharva Veda contains
not only the magic spells and the occult sciences but also the Āyurveda
that deals with the diseases, injuries, fertility, sanity and health.
However, the secrets of life were revealed even in the first Veda, the Rg
Veda. The five elements of creation, the Pancha-maha-bhuta, namely the
earth, water, fire, air and ether form the basis and essence of all life
forms. Out of these arise the three doshas, namely Vata, Pitta and Kahpa.
These three doshas unfortunately have been crudely translated as air, bile
and phlegm. But the Āyurveda texts, which treat all diseases based on the
disequilibrium of these three doshas, are lot more complex. The knowledge
consists of three aspects of Āyurveda known as the Tri-Sutras - cause of
illness (etiology), symptomatology of disease process and treatment of
disease.
Āyurveda incorporates all forms of
lifestyle in therapy. Thus yoga, aroma, meditation, gems, amulets, herbs,
diet, astrology, color and surgery etc. are used in a comprehensive manner
in treating patients. Treating important and sensitive spots on the body
called Marmas is described both in Āyurveda and in Dhanur Veda (another
Upa-Veda dealing with martial arts and military science). Massages,
exercises and yoga are recommended.
The venerable state of the art of
healing was enhanced by the myths and legends of the god of healing,
Divodasa Dhanvantari, a patron deity of medicine. The science of medicine
was said to have been taught to the sages by Divodasa Dhanvantari, who
later wrote them down in the text of Āyurveda. According to another
legend, the knowledge of healing originated from the creator Brahma
himself, who taught it to Daksha (protector of all beings), who in turn
taught it to Indra. When diseases and death became rampant a gathering of
the great sages was held in the Himalayas. Sage Bharadvaja volunteered to
learn the craft from Indra. He then taught the science to his pupil Ātreya,
a legendary healer, who then transmitted this knowledge through his
disciples. Compilations of this knowledge are called the Āyurveda. Other
patron saints of medicine were the twins called Ashvins, who were patrons
of eyesight and were physicians that treated the gods themselves.
Ātreya held a competition among his six disciples namely Agnivesha, Bhela,
Jatūkarna, Parāshara, Hārīta, and Kshārapāni. Each established a school of
his own and taught the traditions of Āyurveda. Agnivesha Samhita was
the most
Texts of Āyurveda
Compilations of Ātreya and Agnivesha are lost. The knowledge we now have
is by three surviving texts of Charaka, Sushruta and Vaghbata. Charaka
(1st century A.D.) based his Samhita on Agnivesha Samhita. Sushruta (4th
century A.D.) based his Samhita on the Dhanvantari School of Āyurveda.
Vaghbata (5th century A.D.) compiled the third set of major texts called
Ashtanga Hridaya and Ashtanga Sangraha. The former is more succinct and is
based on both Ātreya and Dhanvantari schools. Ātreya's School of
Physicians and Dhanvantari's School of Surgeons became the basis of
Āyurveda and helped organize and systematically classify into braches of
medicine and surgery.
Sixteen major supplements (Nighantus) were written in the ensuing years
- Dhanvantari Bahavaprakasha, Raja and Shaligrama to name a few - that
helped refine the practice of Āyurveda. New drugs were added and
ineffective ones were discarded. Expansion of application, identification
of new illnesses and finding substitute treatments seemed to have been an
evolving process. Close to 2000 plants that were used in healing diseases
and abating symptoms were identified in these supplements.
Dridhabala in the 4th century revised the Charaka Samhita. The texts of
Sushruta Samhita were revised and supplemented by Nagarjuna in the 6th
century in a treatise called Upa-hridaya.
There developed eight branches/divisions of Āyurveda:
-
Kaya-chikitsa (Internal Medicine)
-
Shalakya Tantra (surgery and treatment of head and neck,
Ophthalmology and Otolaryngology)
-
Shalya Tantra (Surgery)
-
Agada Tantra (Toxicology)
-
Bhuta Vidya (Psychiatry)
-
Kaumara bhritya (Pediatrics)
-
Rasayana (science of rejuvenation or anti-aging)
-
Vajikarana (the science of fertility).
The dates of the authors are still very controversial. Some historians
place the lifetimes of Ātreya, Charaka and Sushruta in the Vedic period,
around 600 B.C. These are based on the references to the authors that seem
to have surfaced in earlier texts than the proposed dates mentioned in
this article. When the history is completely rewritten and there is no
more controversy, everyone hopefully can agree upon a constant date. Until
then we should not worry about the timeline and only admire the scientific
approach these ancient authors followed, striving to perfect the art of
healing that could rival a modern scientific research.
Many modern medications were derived from plants alluded to in Āyurveda
texts. The oft cited example is that of Rauwolfia serpentina that was used
to treat headache, anxiety and snakebite. Its derivative is used in
treating blood pressure today.
Two areas of contribution of Indian physicians were in treating snakebite
and prevention of small pox. Detailed account of steps to be followed
after a poisonous snake bite including application of tourniquet and
lancing the site by connecting the two fang marks and sucking the poison
out is described. A decoction of the medicinal plant Rauwolfia serpentina
is next applied to the wound.
A form of vaccination for small pox was commonly practiced in India long
before the West discovered the method. A small dose of pus from the
pustule of small pox lesion was inoculated to develop resistance. Such
methods of building immunity were practiced in other fields as well,
against other diseases in order to develop antibodies against the
infecting organism or a poison.
Charaka Samhita
Charaka was said to have been in the court of the Kushana king, Kanishka
during the 1st century A. D. Some authors date him as far back as the 6th
century B.C. during Buddha period. The sacred trust between physician and
patient was held in high esteem by Charaka and patient confidentiality,
similar to the Hippocratic Oath, was deemed the proper conduct for a
practicing physician. Charaka also told us that the word Āyurveda was
derived from Āyus, meaning life and Veda. Nevertheless, according to
Charaka the word Āyus connotes more than just life. Āyus denotes a
combination of the body, sense organs, mind and soul. The principles of
treatment in Charaka's teachings took a holistic approach that treated not
just the symptoms of the disease but the body, mind and soul as single
entity.
Compiled by Charaka in the form of discussions and symposiums held by many
scholars, Charaka Samhita is the most ancient and authoritative text that
has survived. Written in Sanskrit in verse form, it has 8400 metrical
verses. Following the Ātreya School of Physicians, the Samhita deals
mainly with the diagnosis and treatment of disease process through
internal and external application of medicine. Called Kaya-chikitsa
(internal medicine), it aims at treating both the body and the spirit and
to strike a balance between the two. Following diagnosis, a series of
methods to purify both the body and spirit with purgation and
detoxification, blood letting and emesis as well as enema (known as Pancha-karma)
are utilized. The emphasis seems to be to tackle diseases in the early
phase or in a preventative manner before the first symptoms appear.
Āyurvedic
diagnosis and treatment is traditionally divided into eight branches (sthanas)
based on the approach of a physician towards a disease process. Charaka
described them thus:
1. sūtra-sthāna, general principles
2. nidāna-sthāna, pathology
3. vimāna-sthāna, diagnostics
4. sharīra-sthāna, physiology and anatomy
5. indriya-sthāna, prognosis
6. chikitsā-sthāna, therapeutics
7. kalpa-sthāna, pharmaceutics
8. siddhi-sthāna, successful treatment.
Detailed accounts of various methods of diagnosis, study of various stages
of symptoms and the comprehensive management of debilitating diseases like
diabetes mellitus, tuberculosis, asthma and arthritic conditions are to be
found in the Charaka Samhita. There is even a detailed account of fetal
development in the mother's womb, which can rival descriptions of modern
medical text books. Charaka lists more than 500 remedies in his Samhita.
Charaka also wrote details about building a hospital. A good hospital
should be located in a breezy spot free of smoke and objectionable smells
and noises. Even the equipment needed including the brooms and brushes are
detailed. The personnel should be clean and well behaved. Details about
the rooms, cooking area and the privies are given. Conversation,
recitations and entertainment of the patient were encouraged and said to
aid in healing the ailing patient.
Sushruta Samhita
Sushruta was a surgeon in the Gupta courts in the 4th century A.D. He
followed Dhanvantari School of Surgery and is one of the earliest surgeons
of recorded history. Though Indian mythology is full of accounts of
healing through transplantation of head and limbs as well as eye balls,
Sushruta Samhita is the first authentic text to describe methodology of
plastic surgery, cosmetic and prosthetic surgery, Cesarean section and
setting of compound fractures. Sushruta had in his possession an
armamentarium of 125 surgical instruments made of stone, metal and wood.
Forceps, scalpels, trocars, catheters, syringes, saws, needles and
scissors were all available to the surgeon. Rhinoplasty (plastic surgery
of the nose) was first presented to the world medical community by
Sushruta in his Samhita, where a detailed method of transposition of a
forehead flap to reconstruct a severed nose is given. Severed noses were
common form of punishment. Torn ear lobes also were common due to heavy
jewelry worn on ear lobes. Sushruta described a method of repair of the
torn ear lobes. Fitting of prosthetics for severed limbs were also
commonly performed feats.
Sushruta wrote, 'Only the union of medicine and surgery constitutes the
complete doctor. The doctor who lacks knowledge of one of these branches
is like a bird with only one wing.' While Charaka concentrated on the
kaya-chikitsa (internal medicine), Sushruta's work mainly expounded on the
Shalya Tantra (surgery).
 The Samhita
contains mostly poetry verses but also has some details in prose. 72
different ophthalmic diseases and their treatment are mentioned in great
detail. Pterygium, glaucoma and treatment of conjunctivitis were well
known to Sushruta. Removal of cataract by a method called couching,
wherein the opaque lens is pushed to a side to improve vision was
practiced routinely. Techniques of suturing and many varieties of
bandaging, puncturing and probing, drainage and extraction are detailed in
the manuscript. Sushruta lists more than 700 herbal medicines.
Ashtanga Hridaya
Vaghbata in the 5th century compiled two sets of texts called Ashtanga
Sangraha and Ashtanga Hridaya. The latter of the two combines both the
Ātreya and Dhanvantari schools. It details the Kaya-chikitsa of Charaka
Samhita and the various surgical procedures of Sushruta Samhita.
Exhaustive descriptions of kapha, vayu and pitta are given. However, the
emphasis seems to be more on the physiological rather than the spiritual
aspects of the disease processes. Ashtanga Hridaya is written in prose
whereas the Ashtanga Sangraha is in poetry form.
The Ancient Indian Physician
Originally only Brahmins were practicing physicians. Later people from
other castes became well versed in the art of healing and a term Vaidya
came to be applied to the practitioners. Merely by their art and
knowledge, the physicians gained high social status regardless of their
caste of birth. The court physician was of political importance and sat on
the right side of the throne, an important symbolic place. Though the
physician, patient, the nurse and the medicine were all important in
curing a disease, the physician was thought to be the most important.
The codes of conduct for physicians and medical students were laid down by
the texts of Laws of Manu. The poor and downtrodden were to be treated
free of charge. Others were charged according to their ability to pay.
The physician was expected to behave in an exemplary manner, conforming to
the highest ideals of professional and personal life. His dress, manner
and speech were expected to be beyond reproach. Medical education was
arduous, consisting of many years of sacrifice learning the art of
healing. Visiting the sick, collecting herbs and preparation of drugs,
memorizing the Vedic texts of Āyurveda, performing procedures on dead
animals, melons, and leather bottles and bladders were part of the
training. These exercises helped refine both theoretical and practical
training of the student. When finally the student is deemed ready to
practice on his own, he is certified by the ruler. The system closely
resembles that of the Hippocratic Oath of Greece.
How much influence Greece had on Indian medicine is hard to say. We know
that astrology and astronomy were both greatly influenced by the Greeks
(solar calendar, for example). Most of the texts available to us were
written after the Greeks made their appearance (Alexander in 3rd century
B.C.) and stayed in the Northwest India for several decades. How much the
Indian physician learned from the Greek counterpart and vice versa is a
question not answered.
April 11, 2004
References:
1. Albert S. Lyons MD and R. Joseph Petruccelli MD; Medicine: An
Illustrated History
2. D.P. Agrawal; Sushruta: The Great Surgeon of Yore
3. Parveen Chopra; Āyurveda: A Healthy Revival
4. P.V. Sarma: History of Medicine in India
5. Sankaran P. S. and P.J. Deshpande; Sushruta
6. Internet Sources Disclaimer:
Information provided in this article is for the sole purpose of imparting education on
Ayurveda and is not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, please consult your physician.
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