All ancient civilizations of the world developed their own medicinal systems, but the ancient Indian system of medicine is considered to be the most methodical and the most holistic system, both in its ideas and its curative measures.
Starting from the nineteenth century, Western and Indian historians have done extensive work to carve out the philosophical foundations of Ayurveda and its methods and the dating of Ayurvedic texts. The origin, science, materia medica, evolution, and decline of Ayurveda have been studied in detail. Ayurveda has also been studied in comparison with the ancient Greek system of medicine, and its relationships with ancient Chinese and Tibetan medicine have been explored.
Clearly missing from the historical analysis of the period is a discussion of the individuals involved in the practice of medicine. In this paper, I try to turn the focus from systemic studies to the study of individuals. Who were the physicians in this period, what kind of training they had, what was their status in the society, and what kind of behavior was expected of them, are some of the questions that I am going to explore in this paper.
I have searched for relevant secondary research on medicine of ancient India through various means, including online search engines, libraries, and personal communication with other experts in the field. During these readings, a few common themes have emerged, which are presented in the following sections.
Plants and their products formed the major portion of the materia medica of the Vedic healers.[2,4,5] The Rig Veda says, "for a knowledgeable healer, the herbs rally together akin to an army of kings." There were individual sages and schools of herbalists who are considered to have identified, described, and propagated the use of particular plants that were often named after the sage. Thus, Kanva was credited with the discovery of the plant apamarga as a medicine, which was then known as Kanva's plant.
Other materials included cow's milk and its products, water, and soil from various sources, powdered shells, and rock salt. The Vedic priest would spiritualize the medicine through hymns and sacrifice. Some foods were used as vehicles for certain medicines. In addition to oral medicines, inhalation, fumigation, and topical application of ointments were also done. Certain plants were used as amulets.[1,4] The medicines were administered at specified places and times.
Evidence for the medicinal ideas and practices of India in 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 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 and other matter. 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. Ayurveda did retain some of its Atharva Vedic roots in the form of a branch called Bhuta vidya (psychiatry and demonology).
Ayurveda grew as a scientific discipline through discourses and discussions among the sages of the time in symposia and conferences. In fact, discussions and exchange of ideas were very much encouraged among the vaidyas, to help standardize the Ayurvedic theory.
Ancient texts place a lot of emphasis on the vaidya's knowledge of drugs. While prescribing a drug, a vaidya was supposed to keep in mind both its therapeutic and adverse effects.[6,9] The vaidya collected the herbs and other ingredients at auspicious times, spiritualized them with the recitation of mantras, and used them to prepare his own drugs.
Vaidyas laid equal emphasis on the cure of disease as well as prevention and health promotion. They prescribed a daily and seasonal routine as well as attention to nutrition for maintenance of a balanced state of health. They advocated harmony of body and mind, and a harmonious interaction between man and universe for a healthy life.
Vaidyas resorted to spiritual therapy for diseases whose cause were unknown. These were explained in terms of a patient's actions in his previous births. The cure involved appeasement of gods through prayers and offerings, recitation of mantras, and wearing of amulets and gems.[1,6] 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.
Medicine for the vaidyas was a full time profession. There were individual practitioners, vaidyas attached to hospitals, and vaidyas employed by the state.[11,12] There is also mention of itinerant vaidyas, who moved around looking for patients and of vaidyas visiting the patient's house for treatment.
There is mention of eight divisions of Ayurveda in the classical texts, but references to specialist vaidyas are rare.[7,11,12] A vaidya was expected to be proficient in all fields of medicine including surgery.
There is evidence to show that vaidyas were well paid. For example, in the sources physician Jivaka is described as very wealthy. The physicians in state service received lucrative salaries. vaidyas were paid in both cash and kind. Nonpayment to a vaidya was disapproved, as it was understood that the vaidya needed to spend money to collect herbs and other essentials.
There were many checks on the vaidyas. 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 autonomy as the law codes advise not to argue with physicians.
Vaidyas were critical of the quacks.[1,6,12] Efforts were made to check their growth by promoting standardization of Ayurvedic training and practices. Charaka blames laxity on the part of state for the existence of quacks.[11,12] Sushruta Samhita prescribes harsh penalties to check these impostors.
Among 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.[1,3,6] Others include Sushruta, who composed Sushruta Samhita, Nagarjuna who revised and enlarged it, and Vagbhata who wrote the Ashtangahrdaya.[1,3] Several Buddhist monks were Ayurvedic pioneers. Perhaps, 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.
Absence of female vaidyas is noteworthy. 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 began after the age of maturity, women students could not pursue them since they were married off by this age.
Ayurvedic preceptors conceived the role of a physician as much more than mere treatment of diseases. He was to help an individual reach the ultimate spiritual goal of self-emancipation, which would not be possible without a healthy mind and body. He was to educate the people about health and disease, and be able to communicate with the lay public and the scholars alike. 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.
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.
Ayurvedic pupils belonged to different castes and classes. 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.
One hardly finds references to families of physicians.[12,14] 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.
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.[1,8,12,14] Charaka also suggests learning how to identify herbs.
After finishing medical education, the pupil was to improve upon his enunciation, conversational skill, and understanding.
Medicine in ancient India evolved from the magico-religious Vedic medicine to the highly systematic Ayurvedic therapeutics. The physicians had varied social backgrounds. Highly respected and honored, they were expected to uphold strict moral standards. Medical education was intensive, and produced physicians who were as skilled in medicine and surgery as in public speaking and communication.