No one knows exactly when civilization developed in India: all dating is arbitrary until the time of Gautama Buddha (563-483 BC). The earliest culture about which we have any useful data is that of Harappa, the Indus Valley civilization, which arose around 3000 BC and lasted for perhaps 1,500 years. Successors to Neolithic settlements of 5,000 years previously, the Harappans builts large cities, such as Mohenjo-daro, and traded with foreign lands via Lothal, their seaport. Their cities had wide, paved roads, aqueducts, public baths and extensive drainage systems. With such attention to sanitation, they almost surely also possessed a system of medicine, though no firm evidence yet exists to support this conjecture except for the discovery in Harappan remains of substances such as deer antler and bitumen, which are used in classical Ayurveda.
The Harappan civilization seems to have collapsed between 2000 and 1500 BC. Natural disasters may have been to blame, or the Harappan downfall may have been caused by nomadic Aryans from Central Asia, who, Indologists maintain, have frequently invaded the Indian subcontinent. The Aryans brought with them the Vedas, their ancient books of wisdom and sacrificial ritual. The Vedas took on their current form at some point during the second millennium BC, though this version, which has been carefully preserved by India’s priests, the Brahmans, is derived from much earlier versions, which are now lost. From the youngest of the Vedas, the Atharva Veda, developed Ayurveda, probably with the help of residual Harappan knowledge. At the turn of the first millennium BC the treatise now know as the Charaka sambita, the forst amd still most important of all Ayurvedic texts, the Susbruta Sambita, was also compiled around this time, the development of surgery being spurred by the need to treat injuries sustained in warfare, the version that has come down to us dates from much later.
Indian culture entered its Golden Age during this period and learning flourished. By the sixth century BC a ‘university’ had been established at Takshashila (Taxila), near what is now Rawalpindi in Pakistan. This institution apparently had no true campus but was rather a concentration of scholars and their disciples, who lived near one another to facilitate debate and the exchange of ideas. One of Takshashila’s products was Jivaka, the royal physician of King Bimbisara of Magadha (now part of the state of Bihar), who was appointed by the King to personally supervise the health of Gautama Buddha and his followers.
Ayurvedic medicine was already extensively developed by the time of the Buddha, a result, at least partly, of politics. Because the health of the king was equivalent to the health of the state, the services of a royal physician were essential to the state’s political stability. The physician had to protect his royal patron from poisoning, cure him of wounds accidental and military, and ensure the regal fertility, the queen’s safe pregnancy and delivery, and the royal progeny’s healthy development. The Buddha, who taught compassion for all beings, supported both the study and the practice of medicine, and was himself sufficiently aware of medical theory and practice to once speak of a disturbance of the humors in his own body and to ask Jivaka for a purgative to set him self right. He allowed his monks almost all the therapeutic measures advised in classical Ayurveda, including surgery (except for fistula, the operation for which is often unsuccessful and which is better treated by other means).
Jivaka was so famous that at one point most of the citizens of Magadha joined the Buddhist community solely to be able to avail themselves of his treatment; the Buddha consequently prohibited anyone who was ill from being accepted into the fold. Many are the stories of Jivaka’s amazing cures, and his studentship at Takshashila was apparently no less amazing. After seven full years of studies there, his guru handed him a spade and sent him out for his final examination: to search within a radius of several miles for any plant bereft of all medicinal value. Jivaka passed his exam when he returned unable to find any such substance, and it is still an article of faith in Ayurveda that nothing exists in the world that cannot be used as a medicine.
In 326 BC Alexander the Great invaded northern India. Though it is likely that Indian medical knowledge had already found its way to Greece before then, this was the first documented exposure of the two cultures to one another. Alexander was sufficiently impressed by Ayurvedic practitioners that he ordered all cases of poisoning to be treated by them alone. He carried some of these doctors away in his retinue on his departure.
In the third century BC Ashoka, the emperor of most of northern India, became a convert to Buddhism. Motivated by compassion for all sentient beings, as Buddha taught, Ashoka built charitable hospitals, including specialized surgical, obstetric and mental facilities, for both humans and animals throughout his realm. Numerous rock-cut edicts around India attest to this, and to the embassies and Buddhist missionaries he sent to many neighboring countries. These emissaries carried India science with them, which is probably how Ayurveda reached Sri Lanka. The Ayurveda now existing in Sri Lanka is almost identical to that in India except that it has been adapted to the requirements of the island and reflects basic Buddhist philosophies, as it might still in India had Buddhism not been exterminated there almost a thousand years ago.
Medical missionary activity continued long after Ashoka, as documented by the Bower Manuscript, written in the fourth century AD and found in Central Asia, where the missionaries had carried it. It contains recipes for various medicines and a long panegyric on garlic. In the later empires of the Guptas and the Mauryas state employed and private practitioners seem to have coexisted, and village physicians were maintained by the government through gifts of land and payment of salary. The state also planted medicinal herb gardens, established hospitals and maternity homes, and punished quacks who tried to practice medicine without imperial permission.
During this period of intellectual flowering three more famous Ayurvedic texts appeared. Ashtanga Sangraba (probably seventh century) and Ashtanga hardaya (about a century later) are both ascribed to one Vagbhata, though they were almost certainly written by two different people. These two texts are condensations of the works of Charaka and Sushruta, with some new diseases and therapies added. The eighth century also saw the appearance of the Madhava Nidana, a treatise on diagnostics. The Buddhists, who supported all forms of learning, set up true universities to teach Buddhism, Vedic lore and more secular subjects such as history, geography, Sanskrit literature, poetry, drama, grammar and phonetics, law, philosophy, astrology, astronomy, mathematics, commerce and even the art of war, as well as medicine. The most famous of these universities was that of Nalanda, also in Bihar, which was established during the fourth century AD and flourished until about the twelfth century.
Students came from all over the world to study at these universities. The best accounts we have of Nalanda are those of two Chinese travelers who visited India as students in the seventh century. We learn from them that only 20 per cent of all applicants could pass the entrance examinations that instruction was free to all, that senior students acted as teaching assistants and that teaching went on day and night. Some graduates elected to stay on as research scholars at Nalanda, whose campus covered half a square mile, housing as many as 10,000 pupils and 1,500 teachers at a time, with numerous cooks and support staff. ‘Nalanda brothers’ even had the same kind of old-boy network that old Etonians of alumni of Harvard enjoy today.
The Golden Age ended when waves of Muslim invaders inundated northern India between the tenth and twelfth centuries. Buddhism had developed as a reaction against the meaningless ritualization with which many of the members of the Vedic priestly class, the Brahmans, had polluted the Vedic religion. While the Hindus had responded to this reaction with both isolated violence against Buddhist temples and monasteries and a widespread reformist movement of their own, the Muslims slaughtered the monks wholesale as infidels, destroyed the universities and burned the libraries. Those who could escape fled to Nepal and to Tibet, where Ayurveda had first penetrated in the eighth century ad. Some Ayurvedic texts are thus preserved today only in Tibetan translation.
In spite of these catastrophes and of the import into India by the Muslim conquerors of their own medicine. Unani tibbia, Ayurveda survived. Unani (the word means ‘Greek’) was created by Arabic physicians by combining Greek medicine with Ayurveda, which they learned from texts translated into Persian in the early years of the modern era when the Sassanian dynasty controlled part of northern India. Unani medicine is thus closely related to Ayurveda, and while India’s Muslim rulers tended to support Unani, Ayurveda also prospered. In the thirteenth of fourteenth century a new treatise on medicine, the Sharngadhara Sambita, appeared, introducing new syndromes and treatments. During the sixteenth century Akbar, the greatest Mogul emperor and a remarkably enlightened ruler, personally ordered the compilation of all India medical knowledge, a project that was directed by his finance minister, Raja Todar Mal.
For centuries Europe had coveted Indian spices, which were used to preserve meat and to mask the taste and odour of putrefied meat. During the sixteenth and seventeenth centuries, with the opening of secure trade routes to the East to ensure a steady flow of spices, a European fascination for things Indian developed. An Indian massage therapist named Sake Deen Mohammed, known as the ‘Brighton Shampooing Surgeon’ (the Hindi word for massage, champana, metamorphosed into the English word ‘shampoo’, became the toast of that resort town in the late eighteenth and early nineteenth centuries with his ‘Indian Vapour Bagh and Art of Shampooing’. Lords and ladies flocked to him for both treatment and preventive care, and odes were written to his expertise.
The Europeans brought to India syphilis, which was first described in Ayurveda in Bhavaprakasha, a sixteenth-century text, under the name of ‘the foreigners disease’ in honour of the Portuguese, who imported it. They also imported their own intellectual bigotry, which gradually superseded their fascination. Sir Praphulla Chandra Ray in his History of Hindu Chemistry cities an essay by a Briton in which the author endeavoured to prove that the entire Sanskrit literature as well as the Sanskrit language itself was a ‘forgery made by the crafty Bhahmans on the model of Greek after Alexander’s conquest’. This denigration of traditional wisdom reached its zenith in 1835, when Lord Macaulay settled the controversy over whether the government should support indigenous or Western learning by ordering that European knowledge should be exaclusively. Encouraged in all areas governed by the East India Company.
Before 1835 Western physicians and their Indian counterparts exchanged knowledge; thereafter only Western medicine was recognized as legitimate, and the Eastern systems were actively discouraged. Since living traditions are lost when experts die without being able to teach others, vast quantities of indigenous expertise evaporated during the next several decades. Even during these years of persecution, however, Ayurveda generously contributed to modern medicine. During the nineteenth century the Germans translated from Sushruta’s treatise details of an operation, which now appears in modern textbooks as the pedicle graft, led to the development of plastic surgery as an independent specialty, and today Sushruta is regarded by plastic surgeons around the world as the father of their craft. Skin grafting and operations for cataract and bladder stone were still being performed by Ayurvedic surgeons in India as late as the eighteenth century.
Many writers on Ayurvedic history decry the evident decline of Ayurvedic surgery after the Classical age. Often blaming the Buddhists and their doctrine of non-violence for discouraging willful injury to the body. It is more likely, though, as Debiprasad Chattopadhyaya argues in Science and Society in Ancient India, his excellent study of Ayurveda’s struggle in the Vedic and Classical eras, that it was the ritual ‘impurity’ involved in surgery, the close physical contact that a surgeon must have with blood and other bodily substances, that discouraged its practice, since the Buddha himself did not object to surgical intervention when it was necessary.
With the assertion of Indian nationalism at the dawn of this century, interest in Indian art and science was reawakened and Ayurveda began a gradual renaissance. Today it is one of the six medical systems in India that are officially recognized by the government, the others being allopathy (also known as modern, cosmopolitan or biomedical medicine), homeopathy, naturopathy, unani, siddha (a variety of Ayurveda practiced by the Tamils of southern India) and yoga therapy. The practitioners of these six systems must compete for patients with each other and with a profusion of practitioners of other medical skills, including itinerant tonic sellers, pharmaceutical representatives, village cures, bone-setters, midwives, exorcist, sorcerers, psychics, diviners, astrologers, priests, grandmothers, wandering religious mendicants, and experts in such maladies as snakebite, hepatitis, infertility and ‘sexual weakness’.
Today’s developmental planners, who often seem to be Lord Macauly’s spiritual descendants, tend to think of traditional systems like Ayurveda as archaic and dysfunctional, and so non-progressive (all the while ignoring the clear evidence of obsolescence and dysfunction in the practice of biomedicine). Believing, as do many foreigners, that ‘traditionalism’ has kept India backward, they would prefer for most ancient traditions, including the medical ones, to disappear. Many practicing allopaths agree, ostensibly because traditional medicine is not ‘scientific’, but practically because elimination of alternative medical systems would reduce their competition. Social scientists have noted that allopaths derive their social status less from their medical ability than from the culture of modernity and ‘progress’ that they represent; when in distress, most Indians seek out any practitioner of any system who can cure them, and many allopaths use Ayurvedic preparations and dietary or lifestyle advice in their own practices.
Political patronage has been an important factor in the spread of allopathy in India, and the government of India spends more money on allopathic medicine than on all other systems of medicine combined. Politics is not foreign to Ayurveda – like other colleges my alma mater, the Tilak Ayurveda Mahavidyalaya in Poona, was founded as a direct result of a political agitation – and there is still an ongoing tussle between those who support the practice of ‘pure’ Ayurveda and those who wish to integrate Ayurveda into allopathy. In Sri Lanka the term ‘Ayurveda’ has already come to signify ‘integrated’ medicine; the pure form of Ayurveda exists there under a different name. Though this is not yet the case in India, the majority of students who study in and graduate from Indian Ayurvedic colleges do, desiring enhanced social status and income, go on to practice a sort of medicine that is basically allopathic in nature.
