The Age of the Samhitas

The systematic and codified knowledge of Āyurveda attained maturity in the classical texts of the samhitas. They are several texts and each of them is attached to the name of an ācārya, preceptor, such as Caraka, Suśruta, Bhela, Kāśyapa, and Hārīta. The knowledge and wisdom of indigenous healing and healthcare are explained in the samhitas with special references to a particular branch of the system of medicine. Thus kāyacikitsa, general medicine, is the subject of the Carakasamhita while śalyacikitsa, surgery, is the subject of the Suśrutasamhita. Bhēḷasamhita deals mainly with diseases and treatments for the mind, Kāśyapasamhita focuses on koumārabhṛtya, pediatrics, and the subject of the Hārītasamhita is gṛhabādha, demonology, and allied matters. What were preserved in preceding literature including the Vedas, the Brāhmaņas, and the Buddhist Pali canonical texts as seeds and seedlings are found fully grown in the samhitas, nourished by scholarly discussions at various levels. The indigenous medical system was designated as Āyurveda by the time of the samhitas. Topics such as qualities of a preceptor, qualities of a disciple, and qualities of the science are discussed in the various samhitas. Initiation of the disciples, knowledge of anatomy, procedure of treatment, and Modalities of treatment are discussed in great detail. The traditional method of the daivavyapāśraya (the divine or magico-religious) mode of treatment of the Vedic tradition was replaced by the yuktivyapāśraya (empirico-rational) method of therapy with the codification of the Carakasamhita. The emphasis of Caraka was on the process of investigation, which is essential for arriving at scientific truth and hence he repeatedly uses the word parīkṣa instead of pramāṇa.

Samhitas of Bhēḷa, Haritha, and Kasyapa, and Other Samhitas

Various Samhitas such as the Bhēḷasamhita, Kāśyapasamhita belong to this category. The one that is supposed to be ‘the original’ is obtained in a mutilated form in which the preface, conclusion, and some other parts are missing. The major theme of this work is kaumarabṛhtya, paediatrics. Bhēḷa, also a legendary personage and the celebrated author of the Bhēḷasamhita, is believed to be a disciple of the great acharya Āitreya and a colleague of Agniveśa. Bhēḷa’s study of mind differed from that of Caraka and Suśruta. He pinpoints the brain as the seat of mind, whereas Caraka and Suśruta studied it as connected with the heart. Hārīta is considered one of the disciples of Āitreya and a contemporary of Agniveśa. Two Āyurvedic texts—Aṣṭāṅgasaṅgraha and Aṣṭāṅgahṛdaya—are attributed to the celebrated scholar-physician Vāgbhaṭa. Both the Aṣṭāṅgasaṅgraha and Aṣṭāṅgahṛdaya follow closely the teachings of the great ācāryas including Caraka, Suśruta, and so on. At the same time what is historically significant is the evolution of the knowledge of Āyurveda in terms of its philosophical backgrounds. Rasāyana is rejuvenation while Vājīkarana is enhancement of virility, that is, sexual vigour. These are two integral parts of the programmes of treatment of Āyurveda. The rasāyana therapy is not an empty boast of advertisement but an effective procedure of treatment.

Ancient Indian Medical Education

Some Jātaka stories relate the story of how a bōdhisattva who studied at Taxila treated the king of Kāśi. Taxila remained a centre of excellence for several centuries until it was destroyed by the Huns who invaded India in the first century BCE. Towards the end of the Gupta dynasty there was a resurgence of the old tradition of universities as noticed and described by the Chinese traveller Hsuan-tsang. He has recorded an excellent account of the mahāvihāra and the university at Nālanda. According to Hsuan-tsang students from distant places came to Nālanda for higher studies in all subjects, including medicine, under great scholars. Teaching and learning were properly systematized during the time of the samhitas and this can be explicitly found in the Carakasamhita that lays specific rules and regulations for various stages of learning medicine. It is assumed that side by side with the university stream of education, the ancient gurukula system also flourished for the training of physicians and that mode of teaching and learning attracted great masters as well as talented students. It may be learnt from the description of the process of learning given in the section śisyōpanayanīya in the Sūtrasthāna that teaching was following the method of face-to-face instruction.

Regional Developments

The Major Rock Edict II of Asoka makes a categorical statement showing that he made arrangements for two kinds of treatments, that is, treatment for humans and for animals in the territories of the yavana king Antiokhia, in the areas of the Cōḻās, the Pāndyas, and the Keralaputras, and beyond these, upto the river, that is, Sri Lanka. A distinctive stage in the history of Āyurveda is discernible in Tamilakam during the medieval period. The source material for understanding this new development is in the form of inscriptions engraved in archaic characters, generally found in temples, mostly situated in rural villages. These were centres of learning meant for medical education. Epigraphic documents of medieval period refer to medical institutions in Thiruvaduthurai. Among the persons to be fed in the maṭha of that place were students of medicine and grammar and as well as those who studied medicine. Śaiva and Vaisnava maṭhas were engaged in imparting education in the medical sciences. Medicines were prepared, stored, and distributed in some villages. The Velan medicine-men as functionaries in the village community of Kerala were practicing physicians with a knowledge of indigenous medicine. Their womenfolk as rural midwives used some instruments and small blades in their profession.

Suśrutasamhita

Suśruta is widely known as the author of the Suśrutasamhita, the authentic text of surgery in Āyurveda. Suśruta probably lived around sixth century BCE. At the same time his treatise Suśrutasamhita, the classical text of surgery, in its present form appears to belong to a much later date. This is a logical inference based on the subject matter of the text. The Suśrutasamhita in its present form is a huge text with 186 chapters arranged in six sthānas. The text is composed in a mixture of long and short portions in prose as well as in verses composed in various metres. The sthānas and the chapters are Sūtrasthāna, Śārīrasthāna, Nidānasthāna, Cikitsasthāna, Kalpasthāna, and Uttaratantra. Since the emphasis of the text is on surgery, a descriptive account of the various aspects of surgery is given including the surgical techniques, instruments and appliances, practical training, duties of the surgeon, battlefield surgery and so on. Among these, battlefield surgery is important since its emphasis is on the urgent medical services to be provided to soldiers for fatal wounds and other ailments. The rhinoplastic surgery as prescribed by the ācārya Suśruta continued to be practiced in India for several centuries. The surgical tools designed by Suśruta included one hundred blunt instruments and twenty sharp ones. The Suśrutasamhita lays down specific procedures for studying the science of surgery.

Experiment with Modernity

Scholar-physicians were engaged in various activities for promoting the cause of Āyurveda. A common pattern is discernible in the programmes and projects of these renaissance personalities who walked at the forefront of the resurrection of the indigenous science of Āyurveda. Almost all of them either studied modern medicine formally or got training from competent medical practitioners. Proficiency in the textual knowledge of Āyurveda and the resultant competence in commenting on the classical texts, and keenness in propagating the science of Āyurveda to the new generations were two other qualities. There was not a single walk of life that was not encouraged and enthused by the call of the National Awakening. Almost all scholars contributed richly by teaching or writing books.

Towards Scientific Foundations of Healing

Historians have observed that the thread of social protest winding through these heterodox teachings was indicative of a perception of change. Central to this awareness of change is the law of causality and it was around this that much of Buddhist doctrine revolves, claiming to derive from rational arguments and examples. The whole problem of causes of diseases was propounded by Gauthama Buddha. The concept of the peccant humors which is central to the Āyurvedic aetiology, which was most probably formulated in Buddhist monasteries. Keen observation of the decomposing bodies combined with the knowledge of anatomy of animals gathered from the butcher-house helped the early Buddhist monk-physicians develop an understanding of the internal and external structures of the human body. The earliest codification of medical knowledge in India is perhaps in the Buddhist canonical works. Buddhist monasteries and their medicinal services were probably instrumental in spreading the knowledge and practice of medicine to regions outside of the sub-continent. We hear for the first time about this cultural expansion from Mauryan sources. The major Rock Edict II of the Mauryan emperor Asoka speaks about this historical event. Monks including those with knowledge of medicine must have been visiting in these institutions for various purposes.

Early Historic Phase

An enquiry into the Indian tradition of healing and healthcare has to be traced back to the proto-historic Harappan culture. The main source for understanding the socio-economic and cultural developments in the Vedic society is the corpus of Ègvedic hymns. More details about medicine, treatment, and physicians are available in the Aithareya Brāhmaņa and the Śatapatha Brāhmaņa. The Vedic art of healing can be understood as belonging to two distinctive ages. This art of healing consisted medicine supplemented by magical rites with incantations of hymns. The specialization of the bhiṣaks, physicians, in the Vedic medical lore presupposes some amount of systematic organization of the knowledge of the science of medicine accumulated over a long period. Medicinal knowledge of the bhiṣaks was supported and supplemented by auxiliary knowledge of human anatomy, probably from experience in sacrificial rituals. There was a trend of objective and rational explanation of diseases and their healing in the existing texts that was further supported by the heterodox philosophical thinking of the Jains and the Buddhists. This element of rational thinking was instrumental in bringing about a radical change, a paradigm shift, in the indigenous knowledge of the science of Āyureveda.