[In this series I attempt to inform readers of the wonderful scholarship that exists on the history of Ayurveda, which is one among several of the premodern medical traditions of South Asia.]
In this first installment we will look at the work of two important historians: Kenneth Zysk and Debiprasad Chattopadhyaya.
Kenneth Zysk currently is affiliated with the University of Copenhagen. His book ‘Asceticism and healing in ancient India: Medicine in the Buddhist monastery’ was published in 1991, offering several new ways of looking at the history of Ayurveda.
Before getting into what Zysk found in his research, it might help to understand an important distinction that historians of medicine employ: the one between magico-religious medicine and rational-empiric medicine (there are often other terms used, but the basic concepts remain largely the same). For several millennia humans depended upon what can be called supernatural concepts to explain the world around them, including ill health and sickness. It is only in the first millennium BCE that more rational explanations began to be offered. Here’s a good description from an NLM webpage on Hippocrates, whose ideas are considered to be the first elaboration of rational medical thought in the Western world:
Hippocrates is generally credited with turning away from divine notions of medicine and using observation of the body as a basis for medical knowledge. Prayers and sacrifices to the gods did not hold a central place in his theories, but changes in diet, beneficial drugs, and keeping the body “in balance” were the key.
In this book Zysk tells us when and how sickness and ill health began to be described more and more in rational ways in South Asia. When he was working on this project in the 1980s, it was already known that “Ayurvedic medicine encompassed a sophisticated scholastic medical system recorded in specialized medical textbooks” in which we find ideas based on empiricism and observation. It was also known that several centuries prior to this Ayurvedic thought, early Vedic medicine was “characterized by demon-caused diseases and magical rituals involving the recitation of potent charms and the application of efficacious amulets to exorcise disease demons and ward off their further attacks.” Thus a major transition had occurred some time between the early Vedic period (1700-800 BCE) and the period when early Sanskrit Ayurvedic texts, like Charaka-samhita and Sushruta-samhita, were composed (around the turn of the millennium). It is the fascinating account of this transition that animates Zysk’s book.
To put it differently, the content of and concepts in Ayurvedic texts are vastly different from those in Vedic literature including the Atharvaveda (which, among the Vedas, consists of the largest number of medical references). So the immediate precursors of Ayurvedic concepts are not to be found in vedic literature, but in other writings. It is these writings – which gave birth to the rational ideas in the Ayurvedic samhitas – that Zysk deals with in his book. The Pali language foundational texts of Buddhism are the most important among these materials.
A close scrutiny of the sources from [around 800 BCE] to the beginning of the common era reveals that medical practitioners were denigrated by the brahmanic [Vedic] hierarchy and excluded from orthodox ritual cults because of their pollution from contact with impure peoples. Finding acceptance among the communities of heterodox ascetic renunciants and mendicants who did not censure their philosophies, practices, and associations, these healers wandered the countryside performing cures and acquiring new medicines, treatments, and medical information. A vast storehouse of medical knowledge soon developed among these wandering physicians, who, unhindered by brahmanic strictures and taboos, began to conceive an empirically and rationally based medical epistemology with which to codify and systematize this body of efficacious medical information.
This ‘vast storehouse’ off knowledge survives in, among other literature, the Buddhist canon (known as Tipitaka in Pali). To quote historian Dominik Wujastyk’s review of Zysk’s book:
The evidence is indeed compelling. The detailed parallels between the medical passages in the Pali Tripitaka and the Sanskrit Ayurveda treatises are inescapable. Especially fascinating are the comparisons Zysk draws between the medical ‘case histories’ embedded in the Tripitaka and the diagnoses and therapies described theoretically in the Ayurveda [samhitas]. This fills another lacuna in the history of Indian medical literature… [patients] The Sanskrit medical tracts are almost devoid of people, and the entire medical discourse is carried out in theoretical, abstract terms. Now, thanks to Zysk’s explorations in the Tripitaka, we have some case histories, and it is uncanny how the Pali descriptions of what particular physicians did for their patients are paralleled by the theoretical descriptions in the Sanskrit compendia.
Long story short, as Vedic society stabilized and the social structures and hierarchies in it became more rigid, healers/physicians began to be looked down upon. Zysk dates this to the later Vedic period (900-500 BCE). This denigration of healers by the priestly class in Vedic society, arose from their association with supposedly impure things/activities (like blood and pus) and with people from outside (e.g., the natives living in forests). The healers gradually dissociated from the mainstream and later came to be part of non-Vedic traditions like Buddhism. They “organized into sects, and roamed the countryside. They earned their livelihood by administering cures and increased their knowledge by keen observation and by exchanging medical data with other healers whom they encountered along the way.” While such sects of wanderers were numerous, it is among the Buddhists “in particular that medical knowledge became an integral part of religious doctrines.”
The dissociation of these physicians from the orthodoxy of Vedic ideology (associated with magico-religious medical concepts) catalyzed the beginning of the transition to more rational concepts.
The final part of the story is to understand how this non-mainstream medical knowledge re-entered the mainstream to finally become the classical Ayurveda that we know today (exemplified by the samhitas).
Buddhism played a key role in the advancement of Indian medicine through its institutionalization of medicine in the Buddhist monastery. The medical doctrines codified in the monastic rules probably provided the literary model for the subsequent enchiridions of medical practice, gave rise to monk-healers and to the establishment of monastic hospices and infirmaries, and proved to be beneficial assets in the diffusion of Buddhism throughout the subcontinent during and after the time of Asoka. The close connection between healing and Buddhist monasticism eventually led to the teaching of medicine as one of the five sciences (vidyas) in the large conglomerate monasteries of the Gupta period. Hinduism assimilated the ascetic medical repository into its socioreligious and intellectual tradition beginning probably during the Gupta period, and by the application of a brahmanic veneer made it an orthodox Hindu science. The earliest extant medical treatises, the Caraka and Susruta Samhitas, bear distinctive indications of this Hinduization process. Hindu monastic institutions also followed the Buddhist model and established infirmaries, hospices, and eventually hospitals in their monasteries.
It is important to note that some of the key arguments here were made by philosopher Debiprasad Chattopadhyay in the 1970s. His analysis helps us understand more comprehensively why healers/physicians were considered inferior by the priestly class (brahmanas) of the mainstream Vedic society despite the essential nature of the former’s services and knowledge.
According to Manu, certain modes of obtaining livelihood are too derogatory to be normally allowed to the dvija-s or members of the privileged classes. Only under exceptional conditions causing dire distress, the law-giver grudgingly allows the dvija-s to go in for these. Their list, as given by the law-giver, is : vidyā Silpam bhrtih sevå goraksam vipanih krsih,” i.e. learning, crafts, wage-earning, servitude, cattle-raising, shopkeeping, agriculture, etc.
Specially puzzling about this list is the item mentioned first, viz. Vidyā, which means “learning’ or cultivating some branch of knowledge. There is not much difficulty to understand why wage-earning, servitude, etc., are to be considered normally incompatible with noble birth. But what possibly is wrong about vidyā or learning, so that a dvija should be advised to avoid it normally, or to accept it only under conditions of dire distress?
The commentators Medhātithi and Kulluka Bhatta naturally feel that some clarification is necessary about this point. The clarification offered by both is quite striking. The word vidyā or learning is to be understood here in a specific sense. It is learning or ‘discipline’ in its non-scriptural or anti-scriptural form, i.e. in the form in which the physicians, logicians, poison-removers, etc., understand it. As Kulluka Bhatta very pointedly says: vidyā vedavidyā-vyatirikta-vaidya- tarka-visāpanayana-ādi-vidyā–“ by learning is meant here those specific forms of learning which are different from the learning of the Vedas, as for example the kind of learning cultivated by the physicians, logicians, poison-removers etc.” Two points about this clarification need specially to be noted. First, the kind of learning the physicians cultivate is not only characteristically different from scriptural learning but also derogatory from the standpoint of the latter. Hence, though the persons of noble birth are encouraged to cultivate learning in the scriptural sense, they are under normal conditions forbidden to study medicine.”
Classical Ayurveda thus has its origins in a wide variety of individuals and groups who separated early on from mainstream Vedic society, became wandering groups of healers, and then consolidated their accumulated knowledge in several ways including, most importantly, the Buddhist canon. The remarkable Sanskrit texts of Charaka-samhita and Sushruta-samhita derived their content from this consolidated knowledge and rational ways of thinking. Most of these developments occurred in the northern regions of the Indian subcontinent. In future posts we will see how this knowledge then spread throughout India and underwent further changes.