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Appendix 1 : The Medical Heritage of India N. H. Keswani

"On, East is East and West is West, and never the twain shall meet", has been disproved in this astronautical age. The closer we come to each other in the present century, the more we realize our common ancestry, our common heritage, the common fountainhead of our cultures, and the identity of our aims, aspirations and experiences as one man in one world. Shades of Wendell Wilkie? No! It is the spirit of scientific inquiry of this century. We no more live in ivory towers and no more recognize any international boundaries or intellectual barriers.
Medicine is as old as mankind; and the science of medicine, like any other form of knowledge, is better appreciated from the records of its evolution. A student of medicine cannot afford to lose sight of the discoveries of the ancient and their hypotheses that may appear to be erroneous today, were, nevertheless, the foundation of most of the scientific discoveries that we cherish today.
The primitive man, nay even the lower animals, instinctively found treatment for all their ailments and injuries. As the mind of man matured, the archaic medicine became a combination of religious, magical and empirical views and practices. Thus, in the ancient civilizations, extending from the Indus tp the Nile, where religiou formed an important part of their daily life, disease was considered as a punishment from the heavenly bodies, the spirtis, the demons and the witches. This led to the creation of various gods, demigods and mythical heroes, who probably had an earthly existence; and the powers to protect the people against evil and cure their ills were attributed to them.
The antiquity of achievements of the Hindus in analytical and creative thought is universally acknowledged. But skepticism still persists in many a mind with regard to our achievements in the natural sciences in ancient times, even when it is conceded that the genius of any race is indivisible and its accomplishments in any field of human endeavour are closely related to its spirit of analytical thinking and creative activity. This skepticism is partly due to the fact that the sacred lore, which also encompasses the Indian scientific thought, was transmitted from man to man, and finally when it was put down on parchment, the self-renouncing sages dedicated all their works to their ancient predecessors, whether mortal, mythological or immortal. Establishing the chronologyof our ancient and medieval texts has been beset with difficulties - at times insurmountable. The only way, therefore, left to us to ascertain the period in which a particular text was originally composed, is the internal evidence available in the text itself and its various commentaries written during later periods. This varies with the different scholars. These, at times, have been governed by consideration other than the objective approach based on sound philological principles.
Another factor which has proved to be a stumbling block in our efforts to establish the truth of the statements in biological sciences, made by our ancients, is the total absence of illustrative material in our ancient biological texts. Howsoever factual the description mentioned in the text, it is acknowledge on all sides that "one picture is worth a million words". It is more so when one is discussing the biological and medical sciences. Efforts have been made overa a period of years to probe into the physical evidences from the past which could throw some light on the science of medicine and the art of surgery, as practiced in India in that remote antiquity, and propogated by our ancestors.
There is some evidence available regarding the knowledge of anatomy during the chalcolitic (Copper Age) period, and the health conditions prevalent in prehistoric times, from which one can surmise the kind of medicine practised during that remote period in the history of India.
Many centuries before the advent of the Aryans into the Indus Valley, civilization flourished in this region, as evidenced by the excavations in Mohen- Jo-Daro in Sind, Harappa and other minor sites, which was closely related to the civilization of Elam, Sumer, and Crete. In the absence of any literary records of that period, one can only deduce from the archeological findings the kind of medicine the Indus Valley people practised in the fourth millennium B.C. Like other civilizations of the same period, their medicine must have been a combination of magical, religious and empirical practices. A few substances have been found in the ruins which form a part of the Ayurvedic pharmacopoeia even today and were probably used as drugs during those times. The public health facilities found in the ruins of the Indus Valley cities far surpass those found in the ruins of other ancient civilizations and indicate the high level of their achievement in the field of health and medicine.
When the Aryans entered the Indus Valley, they brought with them their gods and medical knowlwdge too. But, there is definite evidence to show that many elements of the Indus Valley culture were taken over and assimilated by them. The chief sources of the Aryan culture and medicine are the four Vedas. These are said to have been originally revealed by the creator, Brahma to the sages some six thousand years before Christian era, according to Indian traditions. The Western scholars, barring a few, believe that the oldest Vedas, was compiled during the second millennium B.C. The Rig Veda is considered by most of the scholars as the orginal source of Hindu medicine, and is comprised of hymns and prayers addressed to different deities whose medical and surgical skills are also extolled . The Sama Veda and the Yajur Veda are closely related to the Rig Veda and contain many hymns derived from the latter. These cinsist of collections of sacrificial prayers and ritual texts. But, the Atharva Veda which was composed at a later date, is replete with prayers, incantations spells and charms to protect people against all kinds of disease and natural disasters. It is to this Veda and to the practices provided by another later work of the Atharva Veda, the Kaushika Sutra, that we are indebted for our knowledge of medicine during the Vedic period. The texts of the Vedas were later organized into encyclopedic Samhitas, and commentaries were written and attached to each of these texts. Even in these purely religious texts we find a reflection of anatomical, physiological, pathological, psychological and therapeutic views which are rational even though they may have some symbolic orgin. Therein, side by side with the magico religious formulae, empirical and rational elements are evident, which show that the Vedic people knwe the sings and symptoms of the diseases and their treatment with drugs, and performed many a surgical procedure with skill and ingenuity. During the later Vedic and the Puranic periods much of the medical history got involved more and more with the mythological figures. The seers and sages, who might have had an earthly existence and contributed to the advancement of medicine during the early Vedic period, were raised to the status of divine beings. To sift and sort out the real from the mere creation of the mind of man, is a task that will have to await further historical evidence. Since the extant work available point out the contribution which the mortals as well as the immortals made to the science of medicine, mythology, like that of the ancient Greeks and Romans has become an integral part of ancient Hindu medical history.
The word Ayurveda (in Sanskrit Ayu means life and Veda means to know) which means the knowledge of life or the knowledge by which the nature of life is understood and thus life prolonged, does not figure in the Vedic texts. The traditional Vedic medicine, that must have flourished for several centuries, was handed down orally from the master ot the pupil, and it is only at a much later stage that the traditional Hindu medicine was named Ayurveda. It may be noted that the anceints anticipated our attitude towards the practice of medicine and they did not name it as a science of therapy or cure, but as science which pervades all knowledge of the life. The origin of the healing art, as in other ancient civilizations, was traced back tomthe creator, brahma who became the fountain of all knowledge contained in the next of Ayur Veda. During the period of rational medicine which began around 600 B.C., the Ayur Veda became intimately associated with the Atharva Veda, and later it was raised to the status of the original Vedas, thus confirming on it necessary authority and sanctity.
Brahma, the first teacher of the universe, according to Hindu mythology, originally composed the Ayurvedic texts in 100,000 hymns divided into one thousand chapters," but, realizing the fact that it would be beyond the comprehension of the mre man, He abridged it and divided it into eight parts with medicine (Kayachikitsa), and surgery (Shalya Tantra) as the main subjects. Having propounded the science of healing, Brahma propagated this knowledge through Daksha Prajapati, who taught the science to the legendary Ashwini Kumars, the celestial physicians to the gods. The Ashwinis appear to the Vedas also under the names of Dasra and Nasatya. It may be pointed out that these and many other names of the Vedic gods appear in the documents found in the excavation in Boghaz Koyi in Cappadocia, northwest Mesopotamia. It is, therefore, believed that the Mitanian kings used to worship the Vedic gods as early as 1600 B.C. The Ashwins imparted the science of medicine to Indra, considered chief of the gods in heaven, who, in turn, is said to be the first god to hand over this knowledge to his mortal protagonists. According to the popular school of medicine represented by Charaka, the first mortal who received this science from god Indra was Bharadwaja. He then imparted it to Atreya and other great sages of whom Agnivesha seems to have been the first to compose the text of Ayurveda. Charaka in his text claims to have reproduced the actual words of his master, Atreya.
However, according to the old Dhanvantari School of Surgery, represented by the celebrated surgeon Sushruta, Indra favoured Dhanvantari with the entire knowledge of Ayurveda. Dhanvantari, who warded off death, disease and decay from the celestials, appeared in the form of Divodasa, the king of Kashi (modern Benares or Varanasi). On being approached by a group of sages who were moved by the human suffering, Dhanvantari agreed to admit them to his hermitage and delivered to them the science of healing. The sages selected Sushruta to be their spokesman who it is believed recorded the very words of Dhanvantari himself. but the South of India, like the South anywhere, has its own traditions; and it credits the sage Agastya, with the dissemination of the knowledge of Ayurveda during ancient times. It is unfortunate that the Ayur Veda is no more available in its orginal form, but the most of its contents are revealed to us by the Samhitas or the encyclopedic work of Charaka and Sushruta. These texts were originally written about 1000 B.C., and are sonsidered the most authentic and renowned representatives of the orginal Ayur Veda. They contain all the information regarding the status of medicine in the ancinet times. They, on the whole, have similar contents, analogous divisions, and corresponding theoretical and practical data; except for the fact that the Sushruta Samhita is richer in the field of surgery. These Samhitas contain an abundance of material in an extremely condensed form, and have a rational approach. The exception being the use of magic and the mantras (the holy incantations) in cases of delirium, in demoniac possessions, in some diseases of children, and in the ceremonies connected with birth. The state of health and of disease is explained on the basis of interplay of the constituent elements of the body, the general and alimentary regimen, and the influences of time and season.
Charaka, in his writings, has a combined role of a moralist, philosopher and above all a physician; whereas, Sushruta has tried to cast off whatever shackles of priestly domination remained at his time, and created an atmosphere of independent thinking and investigations, which later characterized the Greek medicine.
The Sushruta Samhita is acknowledged as one of the greatest of its kind in Sanskrit literature; and, is especially important from the surgical point of view (Sarton). The glory of first changing the art of surgery into a practical science, during the remote antiquity, must go to Sushruta, the author of the orginal Sushruta Samhita. In its revised and redacted version this original Samhita has been passed on to posterity by Nagarjuna (second century B.C.) in the form of the present Sushruta Samhita.
The Science of medicine received the greatest support and stimulus in India during the Buddhist period. The Buddha (563-477 B.B.), himself, was a votary of medicine and regularly attended on the sick disciples in his camp. When the Buddha declared tht this is the noble truth of suffering that "to be born is to suffer, to die is to suffer, and to fall sick is to suffer", his followers considered tending to the sick to be one of their religious obligations. The practice of surgery received the greatest setback in the later Buddhist period, and surgery completely receded into the background, since Buddhism put a stop to animal sacrifices and prohibited dissection. Yet, Jivaka (sixth century B.C.), the personal physician to the Buddha, practised surgery with success, and is known to have performed cranial surgery on many occasions. I-tsing, a Chinese traveller to India in the seventh century, quotes from a Sutra (text) on medicine, which, according to him, was preached by the Buddha himself (Takakusu).
The old Buddhist text of Mahavagga, belonging to the Mahayana sect of fourth century B.C., deals with the practice of medicine, as prevalent in those days. It is in no way different from the Ayurvedic medicine of the period, and speaks of Tridosha (three humours or elements), various drugs of the Ayurvedic materia medica, inclusive of nasal remedies, eye ointments, and asafoetida, formentations, and even laparotomy. Charaka is believed by some scholars to have been the court-physician of a Buddhist king. Kanishka (first century), whose wife he attended on as obstetrician during her difficult delivery. Nagarjuna (second century B.C.), the famous physician and alchemist, who revised the Sushruta Samhita was also a Buddhist, and the Samhitas of the Vagbhattas show traces of Buddhist influence in them. The famous Bower Manuscript found in a Buddhist stupa in Kashgar, and written in Indian Gupta script, probably by a travelling Hindu scholar-physician about 450, has several references to the Buddha as Bhagava and Tathagata. The later Mahayana Buddhists even raised one of the Bodhisattva Mahasattvas to the status of a god of medicine, the Bhaishajyaguru, who is China and Tibet is known as "Bhuguru" and in Japan even today is worshipped a Yakusha Niyorai. The ancient Ayurveda which travelled with the Buddhism everywhere, thus, flourished in the Buddhist viharas (monasteries), and they became the hub of medical education also. Hiuen Tsang (Yunan Chwang) and I-tsing, two ancient travellers from China, who stayed for years in India to study religion, philosophy and medicine during the seventh century, give an excellent account of these monasteries (Beal).
After the dealth of the Buddha, his son Rahul, and later his famous disciple Emperor Ashoka (died 232 B.C.), established charitable hospitals for animals and men. In the fourth century another Biddhist king, Buddhadassa of Ceylon (Shri Lanka), himself a physician, wrote a medical text Saratthasamgaha, and maintained physicians for both his troups as well as elephants and horses, and erected hospitals throughout his country (Mahavamso).
With the spread of Buddhism to the Asian countries, the science of Ayurveda also travelled far and wide, and found a congenial soil in these countries. Even to this day, the acient Ayurveda, in the garb of indigenous medicine, is being taught and practised in their native schools of medicine. More than 2,000 years ago, the Hindu culture and civilization reached Indonesia, and Ayurveda became the medicine of the Islands. Bali has preserved the rich Ayurvedic theory and practice. More than 250 medical texts in palm-leaf (lontar, in Indonesian) manuscripts are known to exist in the land including Ushada (in Sanskrit, Aushadha means medicine) and Trinadi (in Sanskrit, three channels). The medicine of Tibet, untouched by wars until the Chinese occupation of this land, is based on Ayurveda Several Sanskrit texts that were translated into Tibetan, including the Rgvud Bzhi (Four Tantras), whose original Sanskrit text is now lost, have preserved the rich heritage of the Indian medicine in Tibet. The Chakpori Medical College at Lhasa was one of the oldest instututions of its kind. From Tibet, Ayurveda travelled to Monogolia and distant Northeast Siberia; and all the Buddhist monasteries in these areas became great centres of medical learning. The medical college of the Kumbum monastery in Sinking attained special renown, as it was the birthplace of Tson-kha-pa, the founder of the yellow sect. It has in its possession a vast array of charts illustrating ancient Hindu medical texts. Another famous Mongolian medical college was at the Yung-Ho-Kung monastery, a monument to a great era ib Peking, where once the Mongol students from Urga, Kiakhta and Kobdo, the Buryats from the the Baikal Lake, the Kalmuks from the Volga, the Manchus from Tsi-tsi-Khar, the Tanguts from Koko-nor, and the Tibetans from Lhasa, repaired for medical training. One of the most famous physicians from these Mongolian medical schools, known for his Ayurvedic practice and success in this theraphy during the recent times in Leningard, was a ‘Siberian, n.N. Badmaev. he counted among his patients, some of the prominent Communist leaders, Bukhrin and Rykov, the famous writer Alexei Tolstoy, and even Joseph Stalin (Lokesh Chandra). With the gradual revival of the Brahmanism during the later Buddhist period the Elder Vagbhatta of Sind (second century B.C.). attempted to bring about reconciliation between the texts of Charaka and Sushruta in his text called the Ashtanga Samgraha. Later on, one of his descendents the Younger Vaghbhatta (? eighth century) wrote the Ashtangahridya Samhita , a lucid and versified presentation of the whole Ayurveda, with special reference to surgey as dealt with in the Sushruta Samhita, from which he had borrowed extensively. The wroks of Sushruta, Charaka and the Elder Vagbhatta later came to be recognized as authoritative texts of Ayurveda, and the three texts were reverently called Virddha Trayi, the "Triad of Ancients". The medical literature during the early medieval peroid (500-1200) became entirely receptive and passie. One work that deserves mention is that of Madhavacharya (eighth century) whose Nidana, leterally meaning pathology, occupied such an undisputed position of authority in Ayurveda for many centuries to come, that is was later ranked equal with the above "Triad of Ancients". As a matter of fact, there is a popular Sanskrit quote among the practitioners of Ayurveda, which states, "Madhava is unrivalled in pathology, Vagbhatta in principles Sushruta in surgery, and Charaka in therapy". This Madhava or Madhavakara, son of Indukara, made further advance in the enumeration and description of diseases, and listed them in 79 chapters (Nidhanas) under their causes, symptoms and complications. He devoted a special chapter to smallpox (Masurika) which was classified as only a minor disease by the earlier writers.
The Nidana of Madhava remained as standrad textbook for a long time to come, and is quoted profusely by the sixteenth century author Bhava Mishra in his Bhiva Prakasha, which was later translated into Arabic under various titles of Nidan, Badan and Yedan. The style of presentation in Nidana, which was a great improvement on the texts of Charaka and Sushruta, shows that it must have been composed for the guidance of students and practitioners of medicine; and that during the Puranic period, before the Arabs conquered Sind and the northern India, the training of physicians must have been very systematic and thorough.
The last revival of the orthodox school of Ayurveda in the sixteenth century, was mainly due the eminent physicians like Bhava Mishra, who practised and taught medicine in Kashi (modern Benares, Varanasi) and is considered by the later authors as "a jewel of a physician and the master of the Text". Bhava Mishra summarized the theory and practice of medicine as enunciated by all the well-known previous medical writers, in his universally acclaimed textBhava Prakasha (1558-59). This text is the first to mention syphilis (Firanga roga, literally meaning the Portuguese disease, since the Portuguese first introduced in into India) and discusses in detail its various stages and treatment.
The Arabs had contacts with India much before the birth of Islam, since the Indian products trekked along the trade routes passing through the Arabian countries. During the spread of Buddhism into Northwestern Asia, the Indian scholars travelled through Persia and Arab countires, which brought them still closer to Indain culture. Many words of Indain origin like kafoor (karapura in Sanskrit; comphor) and Zanjabil (Shringavera in Sanskrit; ginger) appear in the Koran. There is a tradition current among the Muslims in India that Adam descended from Paradise onto the Indian soil and received his first revelation in India. Some Indian scholar are believed to have been in the company of Prophet Mohammed himself, and it is reported that during the Prophet’s time a famous medical school flourished in Senna, in Southern Arabia, whose Principal Harith bin Kaladah had acquired his knowledge in India (Lassen). It is recorded that many Hindus were settled in Mesopotamia during the early part of the Umayyad regime, and when Sind was conquered by the Arabs in 636-37, and annexed to the Umayyad Empire many Arabs also settled there. The superiority of the Hindu civilisation astonished the Arabs, and the sublimity of the Hindu philosophy and the richness and versatility of their intellect were a strange revelation to them. Thus started a great influx of Indian men, materials and manuscripts in science and medicine into West Asia. The court of Baghdad extended its patronage to the Hindu scholars, and the second Abbasid Khalifa al-Mansoor (753-744) received emissaries from Sind, including Hindus pandits who presented him with two Indian books on astronomy. These were later translated into Arabic by al-Fazari, and also by Yaqub ibn Tariq. Another influx of the Hindu learning into Arabia took place during the regin of Khalifa Harun al Rashid (786-814), under the influence o f the Barmecides who had attained the highest position in the Abbasid court. These Barmecides were the descendants of the high priests (Pramukh, Arabhicised into Barmak) of the Buddhist temple at Balkh and had, therefore a special interest in Indian sciences. They encouraged the translation of Indian texts into Arabic, and appointed many Indians to run the Royal Barmecides Hospital in Baghdad. One of the first Indian physicians appointed was Manka (Manikya), a successful physician and a philosopher of saintly character, who had a profound knowledge of Persian and Sanskrit languages. The other was Ibn Dhan (a descendant of Dhana, Dhanvantari or Dhanapati), who was appointed the Director of the Royal Hospital by Yahya, the Barmecid. Both these scholars translated several Indian medical texts into Persian or Arabic. Another famous Hindu practitioner in Baghdad during the reign if Harun was Saleh bin Bhela (Shali, son of Bhela), who seems to have cured Ibrahim, a cousin of the Khalifa, after Harun’s personal physician Gabriel, an expert in Greek medicine, had declared Inrahim dead!
Among the various Sanskrit texts that were rendered into Arabic during the Abbasid period, the following medical works in Arabic were commonly used by the Arabs until the end of the ninth century; the Charaka Samhita known as Sharak in Arabic; the Sushruta Samhita as Sasrad and Susrud; the Ashtangahridaya rendered into Arabic by Ibn Dhan, was Astankar, Astagar and Asankar; and the Nidana of Madhava as Nidan, Badan and Yedan. The Siddhayoga also translated by Ibn Dhan, was known as Sindhastaq or Sindhahan; and there was a treatise on women’s diseases written in the eighth century by an Indain woman whose name appears as Rusa in Arabic texts.
With the coming of the Muslim conquerors to India, from the tenth century onwards, corruption grdually began to creep into the letter of the ancient Hindu texts. The glories of Ayurveda were on a rapid decline, and the Hindu medicine slipped down many grades for want of patronage from the rulers. Due to the peculiar aversion of the Brahmins to contact with blood, pus and the corpse, during the post-Buddhist and Muslim period, surgery was allowed to pass into the hands of lower classes, until bleeding was left to the barbers, bone-setting to the herdsmen and the application of blisters to anyone!
The medicine in India during the later medieval period was thus dominated by the Persian and Arabic influences which produced an amalgam of the Greek or Unani medicine, as it passed through the hands of the Persians and Ayurveda of the Hindus. The pattern of medical practice changed throughout the country from the days of Muslim dominance until the arrival of the Europeans on this subcontient.
Although there was an attempt at the revival of the ancient systems of medicine in India during Emperor Akbar’s time(1555-1605), and the Unani and Ayurvedic sysyems were being amalgamated, no real advance was made in the field of medicine similar to what was happening then in the West. The only significant achievement of this period of Indian medicine was the translation achievement of this period of Indain medicine was the translation of most of the medical texts written in Arabic into Persian, since Persian happened to be the court language of the period. By the time of Emepror Alamgir’s rule (1658-1707), all the Arabic texts that were being used by the Unani school of medicine were available in Persian also. During the later part of the nineteenth century most of these texts were again translated into Urdu, the language of the Muslim population in particular, in Northern India.
The so-called modern medicine was introduced into India by the Portugeses in the sixteenth century when Albuquerque (died 1515) conquered Goa in 1510, and founded the Royal Hospital, which was later handed over by the Portugese to the Jeuits in 1591. The Jesuits managed this institution remarkably well and in 1703 introduced a rudimentary form of medical training at the hospital with Capriano Valadares as its Master. In 1842, this was converted into School of Medicine and Surgery. Although the Portuguese first brought the modern medicine to India, it was the French and the British who later established and consolidated the modern medical system in India.
This succinct summary shows the hoary, glorious past of Ayurveda, its achievements and contribution to the civilization of the world, the inroads that other systems of medicine made into the body of Ayurveda, its progressive decline, its efforts at survival, and its ambitions today to contribute again to the restoration of health, rehabilitation of patients, prevention of disease and promotion of health. Ayurveda is still today a living science, since millions of people in India are being treated according to this system. A system that has survived through the centuries, cannot be lightly dismissed as being unscientific. Therefore, let us go back and take a look at the salient features of the ancient Ayurvedic system and study the content of its curriculum prescribed for a student of medicine in ancient times.
The curriculum for the training of a physician was comprehensive. The entire subject of medicine was divided into eight main fields, and the science of Ayurveda was therefore, known as the "eight-limited" (Ashtanga Ayurveda). The eight branches were (1)Kayachikitsa or internal medicine, which included principles of physiology and pathology; (2)Shalyachikitsa or surgery, including anatomy; (3) Shalakyachikitsa or eye, ear, nose and throat diseases; (4) Kaumarabhritya or pediatrics including obstetrics and embroyology; (5) Bhutavidya or demonology, which included psychotherapy and analysis of dreams, etc; (6) Agada Tantra or toxicology; (7) Rasayana or rejuvenation with reference to geriatrics; and (8) Vajikarna or virilification and use of aphrodisiacs Apart from these fields of medical science, the medical student was expected to know ten arts that were considered indispensable in the preparation and application of his curative measures, and in his undertaking of the clinical and experimental work. These ten arts were: distillation, operative skills, cooking, horticulture, mentallurgy, sugar manufacture, phrmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The curriculum, in general, had a clinical bias, and the basic medical sciences were not taught as distinct disciplines, as is being done in the modern schools of medicine. Proper emphasis on teaching of anatomy, physiology, pathology, microbiology and pharmacology was, however, laid during the teaching of relevant clinical subjects. For example, anatomy was included in the teaching of surgery; embryology formed a part of training in pediatric and obstetrics; and, the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines, particularly the internal medicine.
Sushruta laid great stress on direct at personal observation of anatomy of the body by a surgeon and gave details of dissection (Avagharshana). He directs that "Any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully observe (by dissecting it) and examine its different parts. For, a thorough knowledge can only be acquired by comparing the account given in various texts with personal observation". The dead body selected for dissection, he advised, should not be of a person who had lived up to 100 years , that is, not too old, nor of one who had died of any protracted disease or of poisoning. The excrements were first removed from the intrestines, the body was covered entirely with a sheath of grass, hemp or rope, then securely placed in a cage so that it was not a prey to the animals or fish, and finally left to decompose in the still waters of a solitary pool. After seven days, when the body was thoroughly decomposed, the student was instructed to scrape off the decomposed skin, etc., with a whisk made out of grass roots, hair, or strips of split bamboo, and carefully observe with his own eyes all the different organs, external and internal, beginning with the skin. Charaka also emphasized that a physician who knows the anatomical enumeration of the body, together with the description of all its members, is never a victim of ignorance. It appears from the methods employed for dissection, during the ancient times, that the details and the minuate of most of the organs were not know, nor were they needed then. However, the topographic description of the various organs, bones, joints, muscles, ligaments and nerves had been given with a fair amount of accuracy. As the method of dissection was not perfect enough to provide a precise knowledge of the regional anatomy, the medical scholars surmounted this difficulty by designating vital points, called the marmas, on the surface of the body; and warned the physician to approach these points with extreme caution and care. During the later times, the discontinuation of dissection due to the prevalence of stricter notions of purity, when touching a corpse became a taboo, proved fatal to the progress of surgery. Even the profession of physician, which during the early period of Hindu history was deified, began to be held in low esteem, and the doctor was considered as a defiler of the company at the dinner table! (Manu Smriti).
The detailed description of the marmas and the effects of injury at these viatal points, as observed by the ancient Hindus, right from the Rig Vedic times, give a good insight into their ideas, regarding the functions of various neurovascular elements and other important structures that lie close or deep to those marmas. The heart and the pelvic regions have been conisdered as among the most vital places of the body; and the "life-breaths" and all the special senses are said to depend on the head. The marmas are the sites where important vessels, nerves, tendons, muscles, joints, bony points and organs are situated at varying depth. A superfical or deep injury at these points on the body, gives rise to certain symptomatology; and as a corollary to these symptoms and sings the ancients hypothesized the functions of the structures lying in close proximity to these points.
There are 107 such points marked on the body, 11 in each extremity, 12 in the thorax and abdomen, 14 in the back, and 37 in the head, face and neck region. The marmas are classified according to the damage caused by the injury. The injury to some of these marmas is fatal immediately. These are called sadyah-pranahara marmas. Injury to others results in death after some time. These are designated Kalantara-pranahara marmas. The injury with foreign bodies lodged at some of the marmas does not cause much damage, until attempts are made to dislodge the foreign body, which may then result in severe hemorrhage and consequent death. These marmas are called vishal-yaghna. The marmas where injury causes permanent loss of a limb or its activity are called vaikalyakara (deforming or maiming) marmas. The remaining marmas, when injured, cause intense pain and are called rujakara marmas
It may not be out of place to illustrate some of the marmas and the effects of injury to them to grasp the idea how the ancients inferred the function of various structures and organs from the study of the marmas. It is recorded that the bilateral injury to the vitapa marma, which lies between the scrotum and the groin on each side, results in loss of sexual activity in the male. By inference, therefore, the ancients knew the function of the vas deferens which is situated at this point. The injury to hridaya marma, it is stated in the medical Samhitas, causes death immediately, since this is the point just above the pit of the stomach between the two breasts where the heart lies. The injury to stanamula marma which is situated immediately below each breast, it is emphasized, fills the thoracic cavity, with the deranged kapha (phlegm) and gives rise to cough difficulty in breathing, and death. In the neck region, the change in the voice to hoarsences and dumbness, sometimes accompained by the loss of taste, was observed to occur if the injury was inflicted on nila or manya marmas; which are situated respectively anterior and posterior to the larynx (kanthanadi). In the head, an injury to the simanta marma, which are situated at the juncitions of the sutures of the calvaria, results in mental excitement, fear, loss of intellect and ultimate death.
The Indian medical scholars considered the human body as a conglomeration of the modified five elements (panchmahabhuta), which are prithvi (earth), ap (water), tejas (light, fire or heat), vayu (air or motive force), and akasha (space, vacuum or either). The five elements in various proportions combine to form seven basic tissues (dhatus) which uphold the body. These tissues are rasa (plasma), rakta (blood), mamsa (flesh), medas (fat), asthi (bone), majja (marrow), and Shukra (semen). The decrease and increase in the basic tissues (dhatus) in the body causes deteriorating changes in it. Rasa, for example, if decreased causes heart disease, trembling, a feeling of emptiness and thirst; and its increase causes nausea and salivation. The quintessence of all these elements is called the ojas (vitality) or bala (power), which governs the functions of all the external and internal organs of the body. Ojas is described as an oily, white, cold, soft fluid that permeates the whole body. It is demolished by injury, grief, exhaustion, hunger, etc., and its derangement is manifested in three stages, the worst of them leading to death. From all the attributes characteristics of ojas it appears this term was appiled to the tissue fluid in the body.
The Ayurvedic theory of tridosha or tridhatu meaning three elements or humors, namely vayu or vata (air), pitta (bile), and kopha (phlegm), on which the whole of physiology and pathology of the ancient Hindus was based, has been misunderstood by many scholars to mean literally the elements of air, bile and phlegm. The ancients used these terms in a very broad sense, with variable meanings depending on the context in which they were used. The term vayu or vata, for example, comprehends all phenomenon of motion that come under the function of life, the cell development in general, and the functions of the central nervous system in particular. Pitta does not essentially mean bile alone, but signifies the functions of metabolism and thermogenesis, including digestion and the formation of blood, various secretions and exretions (mala), which are either the means of the endproduct of tissue combustion. The term Kapha does not mean mere phlegm, but is used primarily to imply functions of cooling, preservation and thermo-taxis or heart regulation; and secondarily to denote the process of production of protective fluids like mucus, synovial fluid, etc. The imbalance of these elements (dhatus) beyond normal variations was considered to cause bodily disfunction and disturbance.
The personality of an individual would depend on the predominance of the above three humors. For example, those with predominant vata are usually alert, varacious, atheist, lovers of music, witty, and enjoy sports, and are, in general, extroverts. They can also be unstable, disaffectionate, thin, tall, weak, miserable creatures with trembling voice. The persons with predominance of pitta on the other hand are cultured, clean, intelligent, prudent but coward individuals. They do not easily fall in love with nature or with opposite sex. These individuals perspire much, have brown hair on the head, very little hair on the body and become prematurely grey, etc. The kapha type of individuals are intelligent, trustworthy, faithful, truthful, patient and grateful. They are vey fertile, with high forehead and thick dark hair etc.
The functions of vital organs like liver (yakrit), spleen (pitha), heart (hridaya), and brain (mastishka) were explained on the basis of the flow and exchange of the tissue elements in the body. The heart was considered as the chief receptacle of the three most important fluids of the body, rasa (plasma), rakta (blood), and ojas (tissue fluid). The plasma which is considered as the end-product of digestion of food, is according to them, converted into blood in the liver and spleen, from where it goes as arterial blood to the heart. The heart, in turn, gives rise to many vessels and ducts, which carry the blood, the lymph, as well as the nervous impulses. The various terms for the blood and lymphatic vessels and ducts arising from the heart were used indiscriminately, although some of the authorities feel that the terms vata-vaha, pitta-vaha, kapha-vaha and rakta-vaha should be identified with the nervous cords, venous, lymphatic and arterial channels respectively. The Ayurvedic scholars did not distinctly delineate venous from arterial system, nor was pulmonary system well understood by them, although they did speak of two kinds of blood, the red and the blue. Charaka, some authors claim has clearly described the systemic circulation, in his staement that "from the great center (the heart) emanate vessels which carry blood into all parts of the body -- an element that nourishes life of all animals, and without which life would be extinet. It is that element which goes to nourish the fetus in the uterus, and which flowing into body returns to the mother’s heart". (Sen). The ancient medical texts describe many dusts or canals (srotas). Among them they assign two each for breathing, for ingestion of food, and for drinking water; and two each for carrying each of the various materials like chyle, blood, flesh, fat, urine, feces, sperms and ova (Jolly). Although right (? kloma) and left phupphusa lungs have been mentioned in various texts in different contexts, their function as respiratory organ has not been clearly stated. The word ‘Chest’ (uras) has been used instead, whenever the respiratory movements are described. The trachea, along with its dusts, has been clearly mentioned as one of the ducts (srotas) close to the heart, which forms with it the root of all dusts that carry the "life-breaths" (pranavaha).
The nutritive power of various foods, the ancients believed, depends on various qualities (gunas) of food susbtances; and the taste (rasa) was considered the most important of these qualities. The different varieties of taste, according to them, are sweet, sour, saline, pungent, bitter and astringent. This quality of food depends upon the preponderance of different basic elements (bhutas) which go to form each article of food, and each modality of taste is responsible for producing different physiological effects. The other qualities of the food are heavy or light, cold or hot, wet or dry, mild or sharp, soild or fluid, soft or hard, smooth or rough, etc. The digestion of food is done by "digestive fire" (pachakagni). the food is brought through the agency of one of "life-breaths" or motive forces (vayu) called prana, to the stomach (amashaya), where it is churned into liquid from. Another motive force called samana, stirs another "fire" and digests the food, converting it into chyle (rasa) and excretions (mala). When the food is half-digested, it passes out into the beginning of the small intestine where it meets with the biliary secretions (pitta). Finally, the food comes down towards the last part of the intestine where it is dried up by another "fire" and converted into a compact mass, which is voided as feces.
The digested food material in turn, is converted into several tissues (dhatus) by process of "cooking" (paka) through the agencies of five different types of "elemental fires" (bhutagnis) and seven tissue fires" (dhatvagnis) which respectively act on the constituent elements (bhutas) of the food, or on the various tissues (dhatus) like the plasma, blood, flesh, fat, bone-marrow and semen.
The products of metabolism are of two varieties. The part of the food substances (prasada) which nourishes as sustains the body, and the remaining portion that is converted into various excretions (malas), which also include some secretions. The waste products among the excretions (malas), when present in the body in normal quantity, do not damage; but if they increase or decrease in quantity they cause derangement in the body and can ultimately destroy it. The by-product or the waste materials (malas) of the digested food are the feces and urine; of plasma is the mucus; of blood is the bile; of flesh are the excretions of eye, ear, nose, skin-pores and genitals; of fat is the sweat; of bones are the nails and the hair; and of marrow are the oily secretions of eyes and skin.
"Vayu is the support for the function of the body. It has five forms: prana, udana, samana, vyana and apana. It stimulates all the senses, and carries all the sense impressions to the mind. It holds together the various elements of the body in proper proportion; and maintains the cohesive unity of the body as a whole. It is the promoter of speech; basis of sound and touch; it is the origin of joy and enthusiasm; the kindler of fire (agni) the drier of the elements which cause derangement (doshas); and expulser of the waste products. It divides the microscopic (sukshama) and the macroscopic (sthula) channels of the body. It is the maker of the embryonic form, and stands as an evidence of existence of life when not excited". (Charaka Samhita, 1.12.7).
Vayu or Vata, as Charaka has explained above, was the term applied to the motive forces in the body, particularly the nervous impulses. Functionally these motive forces are classified as:

  1. Udana which acts in the region of the throat, causes vocalisation and is responsible for speech, music etc. The derangement of this "life-breath" is responsible for the disorders which occur in the region of the neck and head (shalakya).
  2. Prana, located in the region of the heart, propels the food from mouth into the gastrointestinal tract. The derangement of prana is responsible for asthma, hiccup and similar disorders.
  3. Samana, which resides in the gastrointestinal tract, carries out the digestive functions and coverts the food substance into various elements. If samana is deranged, there is poor digestion, dearrhoea and edema of the body.
  4. Apana, situated in the pelvic region, is the driving force for defecation, micturition, ejaculation, menstruation and parturition. The disturbance of this "life-breath" gives rise to dangerous diorders of the rectum, urinary bladder, reproductive system, and suprisingly to diabetes!
  5. Vyana, which pervades the whole body, causes the flow of the tissue fluids, lymph and blood, the secretion of sweat,and the various movements of the eyes. The later authors consider all motility in the various organs within the body under the overall control of vyana, and therefore, its derangement afflicts the whole body. With the simultaneous derangement of all the above five "life-breaths" (vayus) the men ceases to exist (Bhava Prakasha).

The brain (mastishka) as different from the head (shiras) has been mentioned even in the Atharva Veda (X. 26.8.26). The heart, in the early texts, was the centre of manasa (mind); but Bhela, who is as old as Charaka, considered the brain to be the centre of mind, which he said is "the highest of all senses and has its seat between the head and the palate. The brain knows all the sense objects and all the tastes which come near it". The Bhela Samhita distinguishes between manasa (mind) which is recorded as the cause of all cognition, with its seat in the brain; the chitta (consciousness) as the cause of all activities, feelings and judgement, with its seat in the heart; and buddhi (intellect) which is considered as a special function of the chitta (consciousness).
Sushruta, even though he does not attach significance to the brain, however, considers head as the centre of all special senses and describes certain cranial nerves connected with specific sensory functions. he describes two nerves lower down the back of the ear (vidhura), which, if cut, produce deafness; a pair of nerves (phana) situated inside the two nostrils, which if cut, cause anosmia; a pair of nerves below the outer end of the eye-brow, near the external corner of the eyeball (apanga) which, if cut, cause total blindness.
The five special senses, and sense perception have been well described in the medical Samhitas. The five special senses mentioned are vision, hearing, smell, taste and touch. The five elements (bhutas) pervade all these senses, but one of these elements predomintes in each of the senses. For example, earth predominates in the sense of smell, water in taste, light or fire in vision, air in touch, and ether in hearing. The Sushruta Samhita states: "Ten nerves maintain the functions of the body by carrying impulses of sound, touch, vision, taste, smell, respiration, sighing, yawning, hunger, laughing, speech and crying. A pair of nerves each responds to sound, touch, vision, taste, and smell. Yet with other two man speaks with two makes sound, with two he goes asleep and with two be wakes up. Stimulation of two of them causes lacrimation, of other two causes lactation in the female and ejaculation in the male (?)." (3.9.4)
Charaka states that : "The memory is caused by the following eight: impressions, their similarities and dissimilarities, co-oedination of the mind, practice, consciousness, concentration, repetition of sight, hearing or perception (as tasting and smelling) (4.1.117-118).... The man sleeps when sense organs cease to operate, being tired by the fatigue of the mind". (1.21.35).
The later Tantric School considered cerebrum as the seat of soul, and the spinal cord as the centre for vital functions of the body. The whole of the nervous system, according to this School, is divided into various plexuses (Chakras), which extend from the root of the vertebral column upwards into the cranial cavity. These centres (Chakras) are inter-connected by and give rise to numerous nerves which are approximately 72,000 in number. These centres control the physical and mental activity of the body; and are located at the points on the body deep to which, according to modern concepts of neurology, different autonomic ganglia and plexuses are situated. The functional significance of these plexuses also corresponds, to some extent, with our modern concepts. The Indian scholars have tried to correlate the natural phenomenon with the powers attributed to various gods in the Hindu pantheon, who in turn, have been associated with various centres (Chaakras) within the nervous system. The centres have symbolic names, and from sacral region cranialward, they are (1) the muladhraa chakra, corresponding to the sacral plexus, which is associated with the autonomic functions of the pelvic organs including the genitals, (2) The svadhisthana chakra, corresponds to the hypogastric plexus, (3) the manipura chakra to the epigastric plexus, (4) the anahata chakra to the cardiac and pulmonary plexuses, and (5) the vishuddha charkra to the various plexuses in the neck. (6) The ajna chakra which corresponds to the hypothalamo-hypophyseal axis in its action, is situated between the eyebrows. (7) The highest sahasra padma chakra (thousand-petalled lotous) is situated inside the cranial cavity, and is concerned with the special senses of hearing, touch, sight, smell and taste, and sleep, or the absence of all these. It is also concerned with all the higher functions, and with emotions, memory, etc.
The practice of Kundalini yoga, a special technique of breathing and physical exercises, which goes back to primitive pre-Aryan antiquity, is aimed at establishing these centres within consciousness and thus bringing them into active play.
The science of embryology was matter of considerable speculation and controversy in the various schools of philosophy and medicine. One entire Upanished has been devoted to the speculations with regard to the formation and development of the human embryo (Keswani 1962, 1965). This Garbha Upanishad, literally a brief treatise on embryo, is considered to be of greater antiquity than the rest of the Upanishads of the class to which Garbhopanishad belongs. There are ample references to the development of the human embryo in the Vedas themselves. It is suprising to read in them and the various medical texts, the ideas of the ancient Hindus regarding the biological evolution, reproduction, generation, preformation and spontaneous regeneration, which at a first glance appear to be borrowed from a modern text on embryology!
The derangement of three humors (tridosha) was the basis of pathogenesis of all the disease. On this basis, sushruta divided all the diseases into 1120 types, whereas Charaka considered them to be innumerable. the disease so caused is called a nija disease, as compared to the conditions caused by external factors, called agantuka, which include mental afflictions. An other classification, based on the etiological factors, divided the diseases into seven categories: (1) the hereditary conditions caused by the diseases ferm cells (adibalapravratta); (2) the cogenital disease (janmabala-pravratta); (3) diseases dur to disturbance of humors (doshabalapravratta); (4) injuries and wounds (Sanghatabalapravratta); (5) seasonal diseases caused by change in weather (kalabalapravratta); (6) diseaes due to the divine will (daivabalapravratta); and (7) the natural conditions, like hunger (svabhavabalapravratta).
In the field of materia the properties of drugs and foods were investigated. The drugs were described by a terminology, which when transliterated, does not fail, in many instances, to give correct insight into their therapeutic uses. The drugs of the Hindu materia medica, have found a prominent place in the Hippocratic and Arab medicine. The Ayurvedic works of the later period have incorporated, in their own materia medica, some of the foreign drugs which were found by them to have valuable therapeutic properties, like rhubarb, opium, jamaica, sarsa, etc. (Bhava Prakasha)
The diagnosis, it was enjoined, was to be made by the five senses supplemented by interrogation. The basis of diagnosis was built on (1) cause (nidana), (2) premonitary indiciations (purvarupa), (3) symptoms (rupa), (4) therapeutic tests (upashaya), and (5) natural history of the development to the disease (samprapti). Sushruta declares that "The physician (bhishak), the drug (dravya), the attendant or the nursing personnel (upashata), and the patient (rogi) are the four pillars on which rests the success of the treatment". And the physician, with a profound understanding of the science of medicine, was considered the first and the strongest pillar of the therapy. The different methods of treatment, based on the diagnosis of the case, were outlined, and the drugs were classified into seventy-five (75) types according to thier therapeutic effects. The whole doctrine of medical care was considered to consist of the following factors, which are to be kept in mind in achieving successful results: (1) the organism (sharira), (2)its maintenance (vritti), (3) cause of disease (hetu), (4) nature of disease (vyadhi), (5) action or treatment (karma), (6) effect or result (karya), (7) time (kala), (8) agent or the physician (karta), (9) the means and instruments (karana), and (10) the final decision on the line of treatment Previous