ĀYURVEDA

ĀYURVEDA . The traditional Hindu system of medicine widely practiced in India, Āyurveda is based on authoritative treatises written in Sanskrit over approximately the past two millennia. Three major classical medical systems have flourished on the Indian subcontinent: Āyurveda among Hindus, Yunānī among Muslims, and Siddha among Tamils in South India. Their reliance on elaborate textual traditions distinguish these three systems from the assorted medical practices offered by astrologers, exorcists, priests, snakebite specialists, and kindred healers in the context of diverse folk traditions. In general, folk practices are associated with a magico-religious understanding of illness, whereas Āyurveda is associated with an understanding of illness that refers to the balance of three physiological principles suggestive of, yet distinct from, the Galenic humors. Such boundaries delimiting classical and folk traditions are not absolute, however, and humoral concepts pervade many folk practices just as magico-religious considerations have at times played a significant role in the practice of Āyurveda.

Texts

Major traditions evolving in the context of Hinduism frequently trace their roots to one of the four Vedic Saṃhitās, the earliest canonical texts, and Āyurveda is associated with the Atharvaveda. While all four Vedas demonstrate at least a peripheral concern for medical issues, they do so in the context of a decidedly supernatural worldview. At this early stage one finds barely a hint of the later humoral physiology among the charms, prayers, and propitiatory rites suggested for the relief of specified ailments frequently attributed to demons.

The tradition of Āyurveda holds that the medical doctrine was revealed through a series of deities and sages to human physicians who in turn composed the basic texts. According to the Suśruta Saṃhitā, the doctrine passed from Indra, chief among the gods, to Dhanvantari, who has come to be regarded as the Hindu god of medicine, and then to Suśruta himself, who composed this treatise. The Caraka Saṃhitās states that the doctrine passed to the sage Ātreya Punarvasu, who trained a disciple named Agniveśa, author of the Agniveśa Tantra (an Ayurvedic, not a Tantric, text). When this text subsequently fell into disrepair, it was partially restored first by Caraka and later by Dṛḍhabala. Both the Caraka Saṃhitā, as revised by Caraka, and the Suśruta Saṃhitā are believed to have been written during the first three hundred years ce, and the redaction by Dṛḍhabala is thought to have been made in approximately 500 ce. It is widely accepted that these texts are based on a medical doctrine that was followed for at least several centuries before it was committed to writing, and some scholars claim that the tradition extends back several millennia, although this assertion is disputed by many Indologists. Other major texts include the Aṣṭāṅgahṛdaya Saṃhitā of Vagbhata from approximately 600 ce, Mādhavanidāna of Mādhava from approximately 700 ce, and Bhela Saṃhitā, which may have been contemporaneous with the Agniveśa Tantra and hence is the oldest surviving text. The most often cited of these treatises are Caraka, Suśruta, and Vāgbhaṭa, collectively known as "the great three" (bṛhat trayī ).

Theory of Disease and Treatment

According to Āyurveda, most sickness results from an imbalance of one or more of three humors (tridoṣa ): wind (vāta ), bile (pitta ), and phlegm (kapha ). A patient's illness is determined by the character of the particular disease (vyādhi ), which is dependent on both the deranged humor and the body substance (dhātu, e.g., blood, flesh, fat, bone, etc.) or anatomical part that is affected. Such factors as dietary imbalance, physical and emotional stresses, suppression of natural urges, or the effects of deeds in a previous life (karmavipāka ) are said to cause the deranged humoral balance in a particular disease or subtype. Although this tridoṣa theory has been emphasized, a number of independent external factors are also recognized, including injuries, poisons, and supernatural agencies. Some early Ayurvedic passages employ references to these supernatural agencies as technical terms in order to develop meaningful diagnostic concepts while explicitly denying a supernatural conceptual frame of reference (see, for example, Caraka Saṃhitā 2.7.19–23). Other passages refer to demonic possession as it is more popularly understood. Specific classes of demons and deities, generically referred to as bhūtas, serve as paradigms for a range of character types and categories of mental disorder based on the well-known traits of devas, gandharvas, rākṣasas, piśācas, and others.

Therapy according to Ayurvedic principles is based on the premise that a humoral imbalance must be corrected by either pacifying or eliminating the excited humor. This is accomplished with preparations of herbs, animal products, and heavy metals; decoctions in clarified butter (ghī) ; dietary adjustments; or by other means. One type of treatment described in the early texts that became especially popular in South India is pañcakarma ; it involves emesis, purgation, sternutation, medicinal enema, and phlebotomy. Surgery is emphasized in the Suśruta Saṃhitā. The texts also specify ritual offerings, the recitation of sacred formulas (mantras), and other ritual procedures.

Medical and Soteriological Pluralism

The humoral theory of tridoṣa appears to have remained dominant throughout the course of development of the Ayurvedic tradition. In contrast, perhaps due in part to the growing influence of Tantra—the ritualization of otherwise socially unacceptable practices—in the culture at large from the middle of the first millennium ce, later Ayurvedic texts pay increased attention to magico-religious concepts and interventions that resonated with strains not only of Tantric literature but of the mystical aspects of Vedic literature as well. The number of classes of supernatural beings (bhūtas ) associated with insanity steadily grew from eight in Caraka and Suśruta to twenty in the thirteenth-century text Śārṅgadhara Saṃhitā (1.7.38–39).

To the extent that this conceptual shift from a secular humoral theory toward a supernatural orientation is manifest in the later Ayurvedic compositions, it signifies a reaffirmation of certain aspects of the distinctly different worldview of the Atharvaveda, with which the mechanistic physiological theory of tridoṣa had made a definite break at an early stage in the development of Āyurveda. In the twentieth century, competition with Western-styled cosmopolitan medicine may have led some advocates of Āyurveda to ignore magico-religious aspects persisting in the tradition in favor of the systematic principles of the tridoṣa doctrine, and at the same time to focus on the issue of clinical efficacy of Ayurvedic therapies rather than the validity of the underlying humoral theory of other theoretical premises.

Hybrid ideologies that have emerged in the medically pluralistic setting of India presently complicate any analysis of the relationship between Āyurveda and other therapeutic options, both Western-styled and indigenous, since each system exerts some influence on the evolving conceptualizations of the others. Historically, Āyurveda has also stood in a complex relationship with coexisting traditions in its cultural context. However, it may be stated generally that healing is emphasized in Āyurveda, whereas other Hindu traditions such as Tantra, Yoga, and Indian alchemy (rasavidyā ), which are primarily concerned with spiritual attainments, have overlapping objectives. Anatomical and physiological principles provide a framework in Āyurveda for understanding sickness and health in the physical body, but in Tantra and Yoga provide a framework for understanding the mystical path leading to the attainment of spiritual objectives. Similarly, although Indian alchemy was concerned with the use of preparations of mercury, other heavy metals, and herbs to restore youth and promote health, such motives were secondary to the primary goal of liberation of the spirit.

A number of philosophical concepts are specified in the Ayurvedic texts, referring to ideas more fully developed in the orthodox systems of Hindu philosophy, mainly Sāṃkhya, but also Nyāya-Vaiśeṣika and the rest. Social and ethical issues are also considered. Medical students are instructed to pledge diligence and purity, in accordance with the traditional values guiding students of the Veda, as they commence training under a guru after a prescribed initiation ceremony. Professional standards for physicians are advocated not only in medical treatises but in other Sanskrit treatises as well, especially in the Nītiśāstra and Dharmaśāstra texts on polity and Hindu law.

Bibliography

Primary Sources

Translations of several Ayurvedic classics are available. The Caraka Saṃhita, 6 vols., prepared by the Shree Gulabkunverba Ayurvedic Society (Jamnagar, 1949), contains the Sanskrit text, translations into English, Hindi, and Gujarati, and an introductory volume. Caraka-Saṃhitā: Agniveśa's Treatise Refined and Annotated by Caraka and Redacted by Dṛḍhabala, 2 vols. (Varanasi, 1981–1983), is a critical edition and translation prepared by R. K. Sharma to facilitate further study of the text and its commentaries. The Sushruta Samhita, translated by Kaviraj Kunjalal Bishagratna (Calcutta, 1907–1916) has been reprinted (Varanasi, 1963), but it appears to be based on a Sanskrit text that varies somewhat from current printed editions. While only the first five chapters of Vāgbhaṭa's Aṣṭāṅgahṛdayasaṃhitā have been translated into English from the Tibetan version by Claus Vogel (Weisbaden, 1965), printed with the Tibetan and Sanskrit text, there is a complete translation in German by Luise Hilgenberg and Willibald Kirfel: Vāgbhaṭa's Aṣṭāṅgahṛdayasaṃhitā: Ein altindisches Lehrbuch der Heilkunde (Leiden, 1941). The work by G. J. Meulenbeld, The Mādhavanidāna and Its Chief Commentary: Chapters 1–10 (Leiden, 1974), is the only English translation to provide both an Ayurvedic text and commentary, and it also contains useful appendices. Sanskrit editions of all the major texts are available.

Secondary Sources

The classic survey by Julius Jolly, Medicin (Strassburg, 1901), has been translated by C. G. Kashikar as Indian Medicine, 2d ed. (Delhi, 1977), and it remains a useful source for access to a range of texts on a given topic. The Ayurvedic tradition with reference to its context in the Vedic literature and its relationship to Greek medicine has been analyzed by Jean Filliozat in La doctrine classique de la médecine indienne: Ses origines et ses parallèles grecs (Paris, 1949), translated by Dev Raj Chanana as The Classical Doctrine of Indian Medicine: Its Origins and Its Greek Parallels (Delhi, 1964). Asian Medical Systems: A Comparative Study, edited by Charles Leslie (Berkeley, 1976), contains several noteworthy articles on various aspects of the Ayurvedic tradition, including A. L. Bash-am's survey of the social history of medicine during the classical period, "The Practice of Medicine in Ancient and Medieval India," pp. 18–43, and Charles Leslie's essay on the modernization of Ayurvedic institutions through the nineteenth and twentieth centuries, "Ambiguities of Revivalism in Modern India," pp. 356–367. Yoga, Tantra, and Indian alchemy are discussed in contrast to the objectives of "utilitarian medicine" in Mircea Eliade's Yoga: Immortality and Freedom, 2d ed. (Princeton, 1969). A comprehensive study of Indian chemistry and its roots in alchemy, tracing its development from pre-Harappan times through Vedic, Ayurvedic, and Tantric epochs, can be found in History of Chemistry in Ancient and Medieval India, edited by Priyadaranjan Ray (Calcutta, 1956).