Medical heritage of Indian subcontinent
The medical heritage of Indian subcontinent has a long history spanning over centuries.The earliest authentic data about medicine and medical practitioners in India is available from 1500 BCE. During this period medicine was interwoven with religious beliefs and politics of the region.
Origin of Indian medicine -Vedic period
During vedic period physicians had to go through rigorous training in both medicine and surgery. Most physicians were multi-skilled general physicians . All of the physicins had to gain skill in elocution and debate also as they were supposed to address a population about health and disease. The insights into the medicinal practices of the Vedic period (1500-600 BCE) is gathered from the four Vedas along with their Brahmanas, Aranyakas, and Upanishads.
The healers of ancient India
The healers of ancient India hailed from different castes and classes. Ancient physicians were honored by all in the society and enjoyed state patronage. They were bound by the highest ethical standards of the time and were held under strict code of conduct.
Concept about disease origin in ancient medicine
During this period diseases were linked with divine or demonic forces and was complexly connected to religious beliefs. However, there were some rational ideas also prevalent, which mostly developed during the Later Vedic (1000-600 BCE) period. The Atharva Veda describes several body parts including bones and internal organs. This denotes that ancient physicians had some idea about human anatomy and skeletal system although it was not complete and comprehensive as in the current day medical practice.
Certain symptoms such as fever are classified in fair detail, and it is recognized that fever is the “sister” or “cousin” of other diseases. Diseases could also be caused by the derangement of phlegm, wind, or bile, due to seasonal changes, infection with germs or worms, and due to contaminated or unwholesome food. Hereditary diseases were also known.
Emergence of Ayurveda as a system of medicine
Medical observation, study and theorization in the Vedic period by ancient physicians of India laid the foundation for a more rational and methodical system of Indian medicine known as Ayurveda (the Science of Life) beginning from 600 BCE. The Ayurvedic practitioner was called vaidya, meaning a person of profound knowledge. Authentic data about medical practice in ancient India during the period from 600-200 BCE is derived from accounts of the contemporary Greek visitors to India, Buddhist texts, and Chanakya’s Arthashastra.
For Ayurvedic theory, most historians refer to the two Sanskrit medical texts dating from early centuries of Christian era, the Charaka Samhita (Charaka’s collection) and Sushruta Samhita (Sushruta’s collection).
Vagbhatta’s Astangahrdaya dated seventh century CE is regarded as yet another important text of Ayurveda. References to Ayurveda are also found in epics, Jatakas, travel accounts, and other literature dating to early centuries of Christian era.
The roots of Ayurveda lay in the Atharva Veda in its reliance on medicinal value of plants in the primitive state of emergence of the system. However, Ayurveda emerged as a fully developed rational theory of health and disease, purposefully veering away from magico-religious and empirical thinking.
The Charaka Samhita sought to teach the physician the foundational ideas of logic so that diagnosis and treatment could be based on valid observations and reasoning. However, Ayurveda did retain some of its Atharva Vedic roots in the form of a branch called Bhuta vidya (psychiatry and demonology).
Emergence of scientific temper in physicians
Ayurveda is regarded as an example of intellectual coherence – vaidyas applied its tenets consistently to the biological world of humans, animals, and plants. The concept of individualization was evident in their practice of Ayurveda. Vaidyas presumed that each individual as unique, and gave emphasis to the constitution of the individual.
Tridosha theory
Ayurveda proposed the tridosa or the three humoral theory of vata, pitta, and kapha, and all physical, physiological processes of the body and the pathological causations of diseases were explained in terms of the three dosas. Equilibrium of the three dosas manifested as health whereas the disequilibrium or disharmony of these three resulted in disease. The physicians or vaidyas believed that all diseases are the outcome of disharmony of thridoshas and each of the seven dhatus or constituents of the body could be affected by this disequilibrium.
Consultation in ancient period
The Vaidya meticulously observed the patient’s innate body functions mental state, and other individual factors such as age, food habits, and season of occurrence of disease. A thorough clinical examination using both direct perception (pratyaksa) and inference (anumana) was done by him. In addition, oral or written testimony of the personal experience of Ayurvedic experts was also accepted as a diagnostic tool (aptopadesa).
The vaidya would formulate questions to the patient in great detail (prasna), conduct a thorough physical examination using all his five senses (panchendriya pariksa), and confirm or negate his diagnosis through experimentation (yukti).
Pulse examination is not mentioned in the classical Ayurvedic texts. Therefore knowledge is lacking in that area in medical history of vedic period.
Methods of treatment during vedic period
Ayurvedic therapeutics of that era were based on both purificatory and curative methods. Purification, both internal and external, is achieved through a systematic procedure of panchakarma (five processes).
Curative methods involve various means and measures to restore the balance of the vitiated dosas.
The ancient Ayurvedic text book Charaka samhita chiefly discusses about therapeutics for treating diseases, while various surgical procedures have been described in detail in the Sushruta Samhita.
Diet and nutrition also had given emphasis in the treatment methods. The vaidyas prescribed a daily and seasonal routine as well as attention to nutrition for maintenance of a balanced state of health. They recommended harmony of body and mind, as a harmonious interaction between man and universe for a healthy life was crucial for freedom from diseases.
However, in some aspects of treatment spirituality played a role. Vaidyas resorted to spiritual therapy for diseases whose cause were unknown. The cure to the malady was proposed as appeasement of gods through prayers and offerings, recitation of mantras, and wearing of amulets and gems.
Similarly, psychic therapy was applied to diseases of the mind. The vaidya prescribed various methods at his discretion, to keep the mind away from harmful thoughts.
Status, privileges and restrictions of Physicians of vedic period
There is conclusive evidence to show that vaidyas of this era were well paid and respected by the society. For example, in the sources physician Jivaka is described as very wealthy. The physicians in state service received lucrative salaries.
The ancient texts drescribe that a vaidya should not take fee from the Brahmins and should provide them with medicines. He is advised not to treat criminals, bird-snarers, huntsmen, and the opponents of the rulers.
License from the state was a prerequisite for taking up medical practice. Fines were imposed for the incorrect treatment of patients. Yet, the vaidya had a lot of privileges as the law codes advise not to argue with physicians.
However, certain legal texts of the period prohibit the physicians from common dinning and bar them from ceremonies. This exclusion might be due to the dread of communicable diseases to which vaidyas are predispose as they come in contact with many people. Another speculation is that their coming in touch with blood of patients was regarded as impure. or due to their contact with people of all social backgrounds and strata.
Vaidyas were critical of the quacks. Efforts were made to check their growth by promoting standardization of Ayurvedic training and practices
Renowned vaidyas or physicians of ancient India
One of the renowned physicians of ancient India was a physician named Charaka at the court of Kaniska. It is probable, but not certain, that this physician wrote Charaka Samhita. Dridhbala was a Kashmiri scholar-physician, who later revised and redacted the Charaka Samhita.
Other great physicians include Sushruta, who composed Sushruta Samhita, Nagarjuna who revised and enlarged it, and Vagbhata who wrote the Ashtangahrdaya.
Several Buddhist monks were proficient in Ayurvedic medicine. The most renowned physician of ancient India was Jivaka, to whom numerous stories and legends are attributed. Buddhist references place him in the retinue of Gautama Buddha.
Women chose medical practice very rarely during vedic period. The only mention of a female vaidya is that of Rusa whose work on Ayurveda was translated into Arabic on the order of Abassid caliph Harun al Rashid in the eighth century. As medical education usually began after the age of maturity, women students could not pursue them as they were got married much earlier in cchildhood.
Qualities prescribed to be a physician during vedic period
According to Sushruta, a vaidya should possess resolve, courage, memory, good speech, and peace, whereas quacks lack these qualities.
Sushruta Samhita prescribes the dress code of white or brownish yellow clothes for the vaidya.
He was to educate the people about health and disease, and be able to communicate with the public as well as scholars. This required wisdom and skilled communication. Therefore, an adept Ayurvedic physician was supposed to involve himself in an exclusive study of philosophical topics, participate in professional discourse, and become proficient in the art of public speaking.
Patient- physician relationship
The ancient texts talk in detail about the doctor-patient relationship. A vaidya was expected to be friendly and sympathetic toward his patients to eliminate any kind of fear in the patient . However the Vaidya had to adopt a practical approach: He had to pay attention to the curable and be indifferent to those likely to die. Charaka recommends that the vaidya keep his conclusions to himself to avoid potential harm.
Ayurvedic texts prohibit physicians from private conversations or indulging in jest with women.
There are specific instructions regarding the conduct to be followed during a home visit. When a doctor visits the patient in his house, he must be respectful and dress appropriately. He should focus on curing the illness, and refrain from discussing domestic affairs or from announcing the impending death of a patient.
Medical education in ancient India
Medicine as separate discipline appeared by the second century BCE. Medical education was pursued after finishing the basic education. Medical training was imparted by the teachers in their ashramas.
The University of Taxila was a highly reputed centre for the study of medicine in ancient India, students trained here were held in high regard.
Ayurvedic pupils belonged to different castes and classes during vedic period.
Charaka says that the purpose of studying medicine varied for different castes. Brahmins studied medicine out of empathy, Kshatriyas wished to keep people safe, whereas Vaishyas did it for monetary gains. Sushruta Samhita says that Sudras could also pursue medicine if they came from a good family.
No references or mention about families of physicians are available . According to Charaka Samhita, students hailing from such families were preferentially admitted. However, at the same time, Charaka asserts that it is training, not birth, that makes a vaidya.
Sushruta Samhita describes in detail the internal character and external built of a pupil who is to be admitted as a medical student. This admission process was very stringent. A medical student was expected to be honest, humble, temperate, generous, and hard-working. He was not supposed to be enamored with women or engage in gambling or hunting. His memory and academic performance were also given importance.
The medical student was admitted via a proper ceremony. He was expected to follow a strict code of conduct and behavior. The legend of Jivaka tells us that medical training was acquired over a lengthy duration of 7 years. Rote learning being an integral part of medical education, students were expected to memorize the classical texts and their commentaries. They were also encouraged to study popular beliefs, folklore, and Bhuta Vidya.
Practical training was an important part of Ayurvedic studies. Watching their teacher curing the ill, and aiding him in the preparation of drugs resulted in a lot of learning.
As part of their surgical training, Sushruta advises Ayurvedic students to practice surgical procedures on vegetables, fruits, and body parts of animals. For anatomical knowledge, Sushruta recommended careful observation of a dead body. Charaka also suggests learning how to identify herbs.
After finishing medical education, the pupil was to improve upon his enunciation, conversational skill, and understanding.
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