Ayurvedic Medicine

Summary

Ayurveda is the classical medical tradition of South Asia, organized in Sanskrit treatises composed roughly between the third century BCE and the fourteenth century CE. The word means “the knowledge for longevity,” and its earliest definition describes it as the science of which substances, qualities, and actions enhance life. (Wujastyk, 1998) The system rests on a doctrine of three bodily humors (wind, choler, and phlegm) interacting with seven body tissues and the digestive fire. It teaches diagnosis by the senses and interrogation, treatment by diet, drugs, and surgery, and prevention by daily and seasonal regimen. Ayurveda became the standard taught curriculum of Indian medicine, traveled along the Silk Road into Central Asia, Tibet, and China, and was translated into Arabic in the medieval Middle East. It continues as a living tradition today.

The Disputed Origin

Ayurveda’s own texts trace the science to a divine genealogy: Brahma taught it to Prajapati, Prajapati to the Asvins, the Asvins to Indra, and Indra to the human sages Bharadvaja and Atreya, from whom it descended through the legendary author-figures Caraka and Susruta. (Zysk, 1991) Modern scholarship reads this lineage with caution. Zysk frames his study as an examination of Indian medicine in the period between roughly 800 BCE and 100 CE, the gap between Vedic magico-religious healing and the classical Ayurvedic treatises. (Zysk, 1991)

The traditional view, which dominates Ayurvedic teaching today, presents classical Indian medicine as a brahmanic science from inception. (Zysk, 1991) Against this, Kenneth Zysk has argued that the classical compendia were forged not within brahmanic orthodoxy but within heterodox ascetic communities. (Zysk, 1991) (Zysk, 1991) Unlike other Indian physical sciences, medicine was not part of brahmanic ritual and was excluded from orthodox brahmanic intellectual life. (Zysk, 1991) The compendia were only later given a brahmanic veneer to render them orthodox. (Zysk, 1991) (Zysk, 1991)

Late-Vedic ritual texts denigrate physicians as impure; the Taittiriya Samhita states that “medicine is not to be practiced by a Brahman, for he, who is a physician, is impure, unfit for the sacrifice.” (Zysk, 1991) Vedic-period physicians, denigrated by the brahmanic hierarchy as polluting due to their contact with the sick and dying, found acceptance among the heterodox ascetics who stood outside that hierarchy. (Zysk, 1991) Excluded from the ritual core of brahmanic society, medical practitioners gravitated toward the sramanas, who shared their alienation and possessed a penchant for empirical and rational explanation. (Zysk, 1991) Second, the Greek ambassador Megasthenes, writing around 300 BCE and quoted by Strabo, identifies physicians as a subgroup of the sramanas, second in honor only to forest-dwelling ascetics, treating mostly through diet rather than drugs and esteeming ointments and plasters. (Zysk, 1991) Third, the Pali Buddhist canon contains the earliest attested statement of the three-humor theory: the Buddha tells the wandering ascetic Sivaka that suffering has eightfold causes, beginning with bile, phlegm, wind, and their combination, which is the very etiology that would become central to Ayurveda. (Zysk, 1991)

Dominik Wujastyk reaches a similar though not identical conclusion. The medical material recoverable from the Vedic literature, he writes, stands out more for its differences from classical Ayurveda than for its similarities; there is no clear mention in Vedic literature of the three humors, one of the centerpieces of Ayurveda. The fact that Ayurvedic texts claim to derive from the Veda is “not evidence for medical history, but rather evidence of a bid by medical authors for social acceptance and religious sanction.” (Wujastyk, 1998) On the question of where wind entered the system, Wujastyk goes further than Zysk: since wind is not a humoral category in ancient Greek medicine and the tridosha theory is not obviously present in the earliest Vedic literature, the combination of wind with the hot-cold humors may be a specifically Indian and post-Vedic contribution. (Wujastyk, 1998)

Zysk himself acknowledges that one piece of the historical reconstruction remains missing. While Indian medical empiricism is traceable to the sramanic traditions, the evolution of the three-humor etiology from empirical observation has not been documented; the Pali canon contains the earliest attested formulation of humoral causation outside the classical compendia, but how sramanic observation generated that systematic theory remains unclear. (Zysk, 1991) He rejects deriving the Indian three doshas from Hellenistic four humors on numerological grounds (the Greek system has wind plus two biles plus blood, while the Indian has wind, single bile, and phlegm), but the broader idea of disease as corruption of bodily elements is shared across Hellenistic, Indian, and Chinese medicine, and cross-cultural exchange among peripatetic physicians remains an open question. (Zysk, 1991)

The transition from earlier magico-religious healing was, in Zysk’s reading, real but incomplete. Vedic medicine was fundamentally magical in character: disease was caused by demonic forces or divine displeasure, and healing operated through sympathetic association and ritual rather than through physical reasoning. (Zysk, 1991) Its disease classifications distinguished internal conditions such as consumption (yaksma) and fever (takman) from external ones such as wounds and skin afflictions, with poisoning as a third category unto itself. (Zysk, 1991) Magical Vedic medicine never disappeared. It survived in classical Ayurveda for childhood diseases, ailments with Vedic parallels, and the elimination of malevolent entities, and the Caraka Samhita recognizes “recourse to divine entities” (daivavyapasraya, involving mantras, amulets, oblations, and pilgrimage) as one of three legitimate forms of therapy alongside reasoned treatment and what Caraka calls the triumph of good character. (Zysk, 1991) (Zysk, 1991) Zysk applies Kuhn’s model of scientific revolutions cautiously here: the shift from magico-religious to empirico-rational medicine was real, but unlike Kuhn’s account, the older practices were assimilated into the new framework rather than wholly replaced. (Zysk, 1991) The brahmanic redaction is visible as veneer rather than foundation: physician-quality lists in Caraka mirror Buddhist Vinaya conventions, while Susruta’s parallel lists employ stock brahmanic vocabulary like satya (truth), dharma (duty), and astika (pious), evidence of late Hindu shaping over an earlier shared codification. (Zysk, 1991) During the Gupta period, Hinduism assimilated the ascetic medical tradition wholesale, applying a brahmanic overlay that rendered Ayurveda an orthodox Hindu science, the endpoint of the process Zysk traces from early sramanic origins. (Zysk, 1991)

The Compendia

By the time the Chinese pilgrim Fa-hsien reached Pataliputra in the early fifth century CE, Ayurveda had already coalesced from a plurality of medical practices into a single unified body of doctrine, embodied in learned Sanskrit treatises and adopted as the basic curriculum for medical teaching. (Wujastyk, 1998) The three foundational works of this canon are traditionally called the brhattrayi (the Great Threesome): Caraka’s Compendium, Susruta’s Compendium, and Vagbhata’s Heart of Medicine. A later “Lesser Threesome” includes Madhava (c. 700 CE), Sarngadhara (c. 1300), and Bhavamisra (sixteenth century). (Wujastyk, 1998)

Caraka. The name caraka derives from the Sanskrit root car (to wander), designating a wanderer or itinerant ascetic; Chattopadhyaya has argued that the Caraka Samhita is therefore a compilation of the medical knowledge of ancient roving physicians. (Zysk, 1991) The Caraka-samhita is a composite text. Current scholarship places its earliest version around the third or second century BCE, with substantial additions by Drdhabala in the fourth or fifth century CE. (Wujastyk, 1998) Caraka’s central theoretical contribution is prajnaparadha (the violation of good judgment), which he names as the root of mental defects, of the discord that produces epidemics, and of the most fundamental kind of disease causation. (Wujastyk, 1998) Caraka also gives the earliest elaborated Indian description of a clinical facility, with strict architectural, staffing, and supply requirements. (Wujastyk, 1998) His “Oath of Initiation” for medical students requires celibacy, vegetarian diet, truth, freedom from envy, day-and-night care of patients, sexual restraint, and confidentiality of household information, and it has often been compared with the Hippocratic Oath. (Wujastyk, 1998) His chapter on epidemics traces them through corruption of the four conditions a population shares (air, water, locale, and time). (Wujastyk, 1998)

Susruta. The Susruta-samhita began as a surgical text some centuries BCE and was heavily revised before 500 CE; its sixth section is generally thought to be an addition by the editor. (Wujastyk, 1998) It preserves a school of professionalized surgical practice that was, in Wujastyk’s judgment, almost certainly the most advanced school of surgery in the world of its day. (Wujastyk, 1998) Susruta describes a method of practical training on substitutes (gourds for cutting, leather bags for splitting, dead animals’ ducts for piercing, soft meat for cautery), recognizing that textual study without practice produces ineptitude in the operating room. (Wujastyk, 1998) He gives detailed accounts of splinter extraction by fifteen named methods including sepsis and magnet, ear-lobe surgery in fifteen named patterns including a vascularized cheek-flap graft, and the celebrated rhinoplasty whose lineal descendant (the “Indian rhinoplasty” performed in Poona in 1793) would transform European plastic surgery after Carpue’s 1816 publication. (Wujastyk, 1998) (Wujastyk, 1998) (Wujastyk, 1998) The Susruta Samhita’s dissection method is itself evidence of non-brahmanic origins. A corpse was wrapped in grass, placed in a flowing stream for seven nights, then scraped layer by layer to reveal underlying structures, a procedure requiring contact with extreme ritual impurity that could not have originated in brahmanic settings. (Zysk, 1991) After Susruta’s time, Wujastyk argues, surgery effectively migrated out of orthodox vaidya practice and into barber-surgeon castes; as the caste system rigidified through the first millennium CE, taboos against intimate physical contact made cutting into the body increasingly incompatible with the status pretensions of learned physicians. (Wujastyk, 1998)

Vagbhata. The Astangahrdaya-samhita (the Heart of Medicine) was composed about 600 CE, probably in Sind, by an author whose teacher bore the Buddhist name Avalokita and who may himself have been a Buddhist. (Wujastyk, 1998) Vagbhata succeeded in synthesizing Caraka and Susruta without compromise, presenting the full richness of the tradition in well-organized verse across 120 chapters in six sections: Sutra (30 chapters), Sarira (6), Nidana, Cikitsa (22), Kalpa, and Uttara. (Wujastyk, 1998) (Wujastyk, 1998) Within a century of its composition, the work was being translated into Tibetan, Arabic, and other languages; the Chinese pilgrim I-Tsing, traveling in India between 672 and 688 CE, reported that all physicians in the five parts of India practiced according to it. (Wujastyk, 1998) The Heart of Medicine became the supreme medical authority of Asia.

Sarngadhara. Composed about 1300 CE, the Sarngadhara-samhita is openly pedagogical: its author states that the work is intended for “short-lived, dim-witted people” who lack the time or training to read the full canon, and the commentator Adhamalla agrees that the older works “make hard reading because they set out all the various arguments for and against everything at great length.” (Wujastyk, 1998) Sarngadhara’s brevity allowed him to canonize practices that had crept into medieval clinical use without ever appearing in the older treatises: pulse diagnosis; the systematic medical use of metals; and the medicinal use of opium, datura, strychnine, mercury, and cannabis (whose narcotic effects Sarngadhara is the first Sanskrit medical author to notice). (Wujastyk, 1998) (Wujastyk, 1998) His recipes are still used today by the Indian Ayurvedic pharmaceutical industry. (Wujastyk, 1998)

Theory: The Three Humors and Their Reading

The doctrine of the three humors (tridosha-vidya) teaches that three semi-fluid substances regulate the body: wind (vata), choler (pitta), and phlegm (kapha or sleshman). (Wujastyk, 1998) These interact with seven basic body tissues (chyle, blood, flesh, fat, bone, marrow, and semen) and with the body’s waste products. (Wujastyk, 1998) The doshas are not abstract elements. In the technical treatises, they are specific waste products of digested food, occurring in greater or lesser quantities than required for normal health, and they vitiate the dhatus (body tissues), which are themselves modifications of the five basic elements: earth, air, fire, water, and ether. (Zysk, 1991)

Wujastyk has argued that this physical reading of the doshas is being displaced in modern Ayurvedic literature by readings he considers anachronistic. Some modern authors hold that the doshas are not humors in the classical sense but biochemical substances, or “ghostly” entities that work through physical organs but are themselves spiritual. (Wujastyk, 1998) The Sanskrit texts, Wujastyk insists, describe the doshas as physical substances with particular textures, colors, tastes, and bodily locations; the discourse is not different in kind from the humoral writing of pre-modern Europe. (Wujastyk, 1998)

A second translation dispute concerns the formula “disease is caused by an imbalance of the humors,” a phrase, Wujastyk writes, “repeated numbingly without exception in all secondary sources on ancient Indian medicine.” Disease etiology in the classical texts turns more on misplacement and irritation of doshas than on simple imbalance: a humor collects in the wrong part of the body, becomes prakupita (literally “angered”), and causes disorder there. The reduction to imbalance is, in his reading, a Greek-influenced reading of Hippocratic and Galenic thinking back into the Indian sources. (Wujastyk, 1998)

Wind has a special place in the system. Susruta presents vata in strikingly theological terms (“this holy wind is God … eternal and omnipresent”) and gives it primacy over choler and phlegm, producing what Wujastyk calls a “two-plus-one” structure: wind added to a more tightly-bound duality of choler and phlegm. (Wujastyk, 1998) Sarngadhara later teaches that “choler is lame, phlegm is lame, the impurities and body tissues are lame; they go wherever the wind takes them, just like clouds.” (Wujastyk, 1998) The hot/cold polarity that runs through Indian medicine, visible in materia medica classification, in seasonal regimen, and in modern Indian common-sense ideas about “hot” and “cold” foods, rests on a Vedic cosmology of the contest between Agni (fire) and Soma (water), which Susruta and Vagbhata cite directly: the whole world, on this view, is a combination of Agni and Soma. (Wujastyk, 1998)

The body’s central process is digestion, conceived as cooking by the digestive fire (agni). (Wujastyk, 1998) Food is cooked in the belly into the first body tissue, chyle (rasa); choler then transforms chyle into blood, blood into flesh, and so on through the chain to the highest essence, semen, a sequence that Wujastyk notes assumes a male body, since the chain has no obvious female analogue. (Wujastyk, 1998) Ojas, drawn from all parts of the body, is the motive force and source of strength: a material substance described as cold, oily, and solid, the quintessence of the seven body tissues. (Wujastyk, 1998)

Diagnosis and Therapeutics

Susruta names six methods of diagnosis: the five senses plus interrogation. Touch determines cold, heat, smoothness, hardness; sight determines body growth, age signs, and changes in color; taste examines particular flavors of urine in urinary disorders; smell detects the smells of approaching death; hearing detects the sounds of bodily processes; interrogation elicits what only the patient knows. (Wujastyk, 1998) Pulse diagnosis at the base of the thumb is a later addition, first set out in learned Sanskrit ayurveda by Sarngadhara around 1300 CE. (Wujastyk, 1998)

Caraka divides medicine itself into three forms. The first depends on the sacred: mantras, herbs, jewels, fasts, sacrifices, pilgrimage. The second depends on reasoning: diet, medicines, and drugs. The third he calls the triumph of good character, the turning of the mind away from things that are not good for one. (Wujastyk, 1998) His system of disease causation operates at three levels. At the level of behavior, disease arises from the underuse, overuse, or abuse (mithyayoga) of the senses, of action of body, speech, and mind, and of time. (Wujastyk, 1998) At the level of root cause, all three of those failures derive from prajnaparadha, the violation of good judgment. (Wujastyk, 1998) At the level of populations, epidemics (janapadoddhvamsa) are caused by corruption in four shared conditions: air, water, locale, and time. (Wujastyk, 1998)

Before many therapies the patient is prepared by being ‘oiled and sweated’: oil taken by mouth, by enema, by nasal drop, or by anointing, and sweating. (Wujastyk, 1998) These open the channels and liquefy the humors so they can flow out or return to their proper locations. (Wujastyk, 1998) Caraka’s seasonal regimen calls for clearing accumulated humors at the start of spring, the rainy season, and autumn, by emetic and purgation, followed by enema and nasal treatment. (Wujastyk, 1998)

Ayurvedic empiricism generated a distinctive epistemology: taxonomy is folded into pharmacy rather than separated from it, so that classifying a plant and determining its therapeutic use are a single operation. This differs from Greek empiricism, which generated natural history as a discipline largely independent of therapeutics. (Zysk, 1991) Drug action is described in the canonical schema rasa-virya-vipaka-prabhava. Every substance has a savor (rasa, of which there are six kinds), a potency (virya, hot or cold), a post-digestive savor (vipaka, sweet, sour, or pungent), and a special power (prabhava). (Wujastyk, 1998) The combinatorics of the six savors yield exactly sixty-three combinations, a problem Vagbhata works out and which appears explicitly in the twelfth-century Sanskrit mathematical text Lilavati by Bhaskara, evidence of cross-fertilization between Sanskrit medical and mathematical traditions. (Wujastyk, 1998)

Caraka treats meat as a normal food and recommends it medicinally, taking its use entirely for granted; only later commentators like Cakrapanidatta felt the need to defend the practice against ahimsa concerns, and they did so by separating medical health (the proper goal of medicine) from religious virtue (dharma). (Wujastyk, 1998) The ayurvedic texts also emphasize moderation in food, sleep, exercise, sex, and dosage, which parallels the Buddhist Middle Way. (Wujastyk, 1998) They further teach that natural urges (urine, feces, semen, wind, hunger, thirst, tears, sleep) must not be suppressed, while greed, grief, anger, and pride must be suppressed. (Wujastyk, 1998)

Transmission Outward

Ayurveda traveled outward along the trade routes that carried Buddhism. Indian medicine was assimilated nearly verbatim in Central Asia and Tibet, but in China it had to be modified to fit the Chinese framework: the tridosha theory was overlaid with a four-element etiology, and traditional Chinese acupuncture, moxibustion, and pulse lore were added as a second therapeutic class. (Zysk, 1991) By the seventh century CE, Hsuan-tsang and I-tsing reported that Nalanda’s monastic curriculum included medicine as one of the five sciences, alongside Buddhist sastras, Vedic learning, logic, and grammar. (Zysk, 1991) Tibetan Buddhist monasteries adopted Vagbhata’s Astangahrdaya as a principal medical text, translated from Sanskrit into Tibetan; the Tibetan principal medical treatise, the Rgyud-bzi (Fourfold Tantra), is a composite work incorporating Chinese medical elements within an Indian framework. (Zysk, 1991)

To the west, transmission was equally deliberate. Megasthenes’ Greek-language report on Indian sramana physicians around 300 BCE is one of the earliest external testimonia to the system. (Zysk, 1991) Portions of Susruta’s chapter on poisons were translated almost word-for-word into the medieval Arabic Kitab as-Sumum (Canakya’s Book of Poisons), with manuscripts spread across Cairo, Istanbul, Baghdad, Damascus, Beirut, and Jerusalem. (Wujastyk, 1998) The Indian “Venomous Virgin” (a girl raised on poison from birth so that her touch and breath kill) appears in Susruta and Vagbhata, then crosses through Arabic into Latin translations of the Secretum Secretorum and into the medieval European Gesta Romanorum as a stock character of European medical and religious lore. (Wujastyk, 1998) In the sixteenth century, Bhavamisra became the first Sanskrit author to describe syphilis, which he correctly attributed to intercourse with strangers from the West and treated with mercury and sarsaparilla, a remedy probably learned from the same foreign physicians. (Wujastyk, 1998)

King Asoka’s second rock edict at Girnar (ca. 269-232 BCE) proclaimed kingdom-wide medical treatment for humans and animals, with provisions for importing and planting medicinal herbs, roots, and fruits, and digging wells and planting trees along paths. (Zysk, 1991) Caraka’s prescription of a clinical facility with strict architectural, staffing, and supply requirements is among the earliest detailed prescriptions of an organized medical institution. (Wujastyk, 1998) Fa Hsien’s early-fifth-century AD account of charity-and-medicine houses in Pataliputra describes an organized civic hospital system, one of the earliest such descriptions in world history. (Wujastyk, 1998)

The Limits of Modern Knowledge

Wujastyk has cautioned that the textual foundation of contemporary Ayurvedic scholarship is more partial than commonly recognized. The printed editions on which all twentieth-century work has been based are vulgate texts: books printed from a small number of manuscripts from a single regional tradition, normally Bombay or Calcutta, where the publishing industry was concentrated. None of the major treatises has been the object of a critical edition based on systematic comparison of all surviving manuscripts. “In the absence of such editions,” he writes, “we cannot really say that we know the foundations of ayurveda.” (Wujastyk, 1998) Susruta’s text was already so unstable a millennium ago that the medieval commentator Candrata composed a Sushruta-pathasuddhi (“Correction of the readings in Susruta”) at around the turn of the eleventh century, addressing variant readings on nearly every verse of the wind chapter. (Wujastyk, 1998)

The translation of technical vocabulary is a further hazard. Wujastyk warns that rendering Sanskrit medical terms with modern biomedical vocabulary risks systematic anachronism: it imports a world in which the heartbeat is connected to blood, breath to the lungs, contagion to germs, and consciousness to the brain, none of which obtained for the authors of the classical compendia. Older English medical terms such as flux, septic, pipe, and sinew better preserve the historical mindset. (Wujastyk, 1998)

Contemporary Status

Sarngadhara’s compendium remains in active use by the modern ayurvedic pharmaceutical industry, as illustrated by a bottle of punarnavasava from 1995 that explicitly attributes its formula to the Sarngadhara Samhita. (Wujastyk, 1998) Similarities between Buddhist and ayurvedic medicine most often occur in chapters on foods and drinks, suggesting the earliest classification of drugs was based on ancient Indian culinary traditions. (Zysk, 1991) Sarngadhara introduced pulse diagnosis, the systematic use of metals in compounds, and the medicinal use of opium for the first time in learned Sanskrit ayurveda, legitimizing practices that had previously crept into practice. (Wujastyk, 1998)

The contemporary historiographical situation is one in which Zysk’s sramana-origin thesis and Wujastyk’s more philologically cautious position both stand as serious modern scholarly interventions, neither superseded. They agree that the brahmanic-Vedic genealogy in the classical texts is a later overlay and that the early sramana milieu is critical to the system’s formation. They diverge on how much of the technical doctrine was already in place before the brahmanic redaction, on the precise weight given to Buddhist sources, and on what degree of primary-text reconstruction is currently available given the unstable textual foundation.

See Also

• buddhist-monastic-medicine
• kenneth-zysk
• dominik-wujastyk
• charaka-samhita
• susruta-samhita
• unani-medicine
• hippocratic-corpus
• panchakarma
• tridosha

Sources

• Zysk, K. (1991). Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery. Oxford University Press. [zysk-asceticism-healing-ancient-1991]
• Wujastyk, D. (ed. and trans.) (1998). The Roots of Ayurveda: Selections from Sanskrit Medical Writings. Penguin Classics. [wujastyk-roots-of-ayurveda-1998]