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Indian Medicine and Ayurveda

Philipp A. Maas, University of Vienna
Authors pre-publication, pre-edited draft
Philipp A. Maas 2014
updated on April 30, 2015

To appear in Alexander Jones, Liba Taub (eds.), The Cambridge History of Science. Vol. 1. Ancient
Sciences. Cambridge etc.: Cambridge Univerity Press, scheduled for 2015.

1. Introduction
The cultural, intellectual, and religious heritage of South Asia comprises medical systems
that offer themselves as supplements or alternatives to modern bio medicine. Some of
these, namely Homoeopathy, Naturopathy, Yoga, Tamil Siddha medicine, gSo ba rig pa,
Unani Tibb, and Ayurveda, receive promotion from the Ministry of Ayurveda, Yoga and
Naturopathy, Unani , Siddha and Homoeopathy (AYUSH) of the Government of India
which supports ... [the upgrade of] educational standards, quality control and
standardization of drugs, improving the availability of medicinal plant material, research
and development and awareness generation about the efficacy of the systems
domestically and internationally.1
This agenda betrays a conceptional influence of modern bio medicine and its theoretical
foundations in so far as it can be read as an implicit response to a critique, according to
which complementary and alternative medicines (CAMs) are of unequal educational
standards, and apply non-standardized medicinal drugs, the efficacy of which was never
proved with standardizes tests, etc. In taking up this criticism, the Ministry of AYUSH
shows a far-reaching readiness to accept modern bio medicine as the scale against which
CAMs are to be measured, possibly in order to position itself in the ongoing debate of
whether the CAMs of South Asia are based on, or comply with, science in a modern
academic understanding of the word, or whether they should be labeled as pseudoscience. A final conclusion of this discussion, which has to be led from a multidisciplinary perspective to which practicing scientists, practitioners of CAMs,
1

http://indianmedicine.nic.in/ (accessed on 10 February 2015).

philosophers of science, social anthropologists and Indologists may participate, is not to

be expected for the near future, and even a summary of the main arguments of the
different camps falls outside the scope of the present chapter.
Although the Indian Ministry formulated its program vaguely, it leaves no doubt that it
regarded all the medical systems listed above as Indian medicine, presumably because
these CAMs are nowadays widely practiced in India and have a written textual tradition.
It could be argued, however, that this categorization is too narrow. It excludes, for
example, Indian folk medicine, shamanism, astrology and faith healing, because these are
partly based on oral traditions.
It could also be argued that the above outlined categorization of Indian medicine is too
wide, because not all of the medical systems practiced today in India were developed in
South Asia, or because they are not practiced in all parts of modern India.
Homoeopathy, to start with, was invented by the German physician C. F. Samuel
Hahnemann at the end of the 18th century. It was effectively introduced in South Asia by
the Transylvanian physician Johann Martin Honigberger, who worked at the court of
Ranjit Singh in Lahore from 18291833. From this time onwards, homoeopathy met with
great success in South Asia, and it is is nowadays widely practiced in India.2
Naturopathy, which was also developed in Europe, but about a hundred years later than
homoeopathy, became prominent in modern South Asia not only through the translation
of the foundational works of Louis Kuhne3 and others into English, but most of all
through Mahatma Gandhis strong advocacy of Nature Cure.4 The similarity of a number
of basic conceptions of naturopathy with conceptions of modern Yoga, led to the fact that
both systems became completely integrated, at least from the vantage point of
practitioners of Nature Cure and the government of India, if not, by any means, all
practitioners of Yoga.5
As Mark Singleton has shown recently, modern yoga developed from a blend of the
views of European bodybuilding and gymnastic movements with Indian nationalism and
political Hinduism as well as from obscure indigenous yoga traditions.6 These political

See Raekha Prasad, Homoeopathy Booming in India, The Lancet, 370, Nr. 9600 (November
2007), 167980.
3
See, for example, Louis Kuhne, Die neue Heilwissenschaft oder die Lehre von der Einheit aller
Krankheiten und deren darauf begrndete einheitliche, arzneilose und operationslose Heilung. Ein
Lehrbuch und Ratgeber fr Gesunde und Kranke. 2nd, enl. ed. (Leipzig: Kuhne, 1891).
4
See Joseph S. Alter, Yoga in Modern India. The Body Between Science and Philosophy (Princeton etc.: Princeton University Press, 2004), pp. 109 f.
5
Alter, Yoga in Modern India, p. 110.
6
Mark Singleton, Yoga Body. The Origins of Modern Posture Practice (Oxford: Oxford
University Press, 2010).

conceptions oscillated between a fascination for modern western ideas and a selfaffirming appraisal of the Hindu religious and philosophical traditions, among which the
philosophical ideas of Advaita Vednta played a prominent role. The association of yoga
with modern medical science, for which there is evidence as early as 1889 (Singleton
2010: 50), can be seen as an expression of the self affirmation of Indian intellectuals
against the ruling British colonial power, which tended to present the quickly developing
bio medicine as a sign for the general superiority of British or western culture.
Siddha medicine is a popular medical system in the south Indian sate of Tamil Nadu.7 On
a theoretical level, it combines tantric religious ideas with basic conceptions of alchemy
and classical Ayurveda (see Chapter 5). Its textual basis consists of a textual corpus
composed in the Tamil language, of which the majority of works exists only in
unpublished palm leave manuscripts, and even the primary sources of Siddha medicine
that have been published in print so far are not yet sufficiently researched. It appears,
however, that the oldest strata of Tamil Siddha literature were composed in the 16th
century CE. The tradition itself claims, however, to be of a much earlier date.
gSo ba rig pa, or Tibetan medicine,8 is in its various forms widely practiced in Central
Asian and Himalayan regions, some of which are nowadays part of the Republic of India.
As a consequence of the migration of Tibetan refugees to India and other parts of the
world, gSo ba rig pa, which in Tibetan means authoritative knowledge of healing, also
became popular in regions of India that are located south of the Himalayas and in
globalized societies outside Central and South Asia. The theoretical foundations of
Tibetan medicine developed from the seventh century CE onwards from a combination of
indigenous Tibetan medical knowledge with classical Chinese and ayurvedic medicine
(on which see Chapter 5) as well as of various Buddhist and alchemical sources.
Unanani Tibb is prominent throughout South Asia. It was introduced to the Indian
subcontinent in the middle ages (from the early eleventh century onwards) in the context
of Islamic invasions.9 The very name of this medical system, which means Medicine of
the Greek, indicates that this CAM developed from translations of the Greek works of
the Hippocratic School as well as of the Latin works of Galen into the literary languages
of Islam. In the course of its history, Unanani Tibb was further developed by a number of
medical authorities, among which Ibn Sina figured most prominently.
7

See Richard S. Weiss, Recipes for Immortality. Medicine, Religion, and Community in South
India (Oxford: Oxford University Press, 2009).
8
For a detailed overview of various aspects of Tibetan Medicine see Fernand Meyer, Theory
and Practice of Tibetan Medicine, in Oriental Medicine. An Illustrated Guide to the Asian Arts of
Healing, ed. Anthony Aris and Jan van Alphen (eds.) (London: Serindia Publications, 1995), pp.
10941.
9
For a more detailed overview of Unani Medicine in South Asia see Claudia Liebeskind, Unani
Medicine of the Subcontinent, in: Aris and van Alphen (eds.), Oriental Medicine, pp. 3965.

Any argument that the before mentioned CAMs are not actually Indian Medicine,
because they are not of South Asian origin, or because they are only practiced regionally,
would result from an essentialization of the attribute Indian that can hardly be justified
on a theoretical level. Any definition of Indian medicine should do justice to the
cultural, intellectual and religious plurality of Indian medical theories, believes and
practices by being as comprehensive as feasible.
Among the medical systems of South Asia there is, however, a single CAM with a long
(pre-)history in South Asia that can be largely reconstructed from written sources. This is
the medical system designated with the Sanskrit word yurveda, i.e. knowledge of
longevity. It is this CAM and its historical developments on which the following parts of
the present Chapter will focus.

2. Prehistoric Medicine in South Asia

In the absence of written records, all information about the pre-history of South Asia has
to be gathered from archaeological findings, the earliest of which are over two million
years old. This archaeological evidence suggests a long period of nomadic settlement in
the northwester part of South Asia.10 The most ancient indication for permanent settlements in this area are the remains of mud-brick houses that occur together with indication
for agriculture at ca. 6500 BCE in Mehrgarh in modern Pakistan. The archeological
findings from Mehrgarh do not allow for any conclusions on whether or not the religion
of Mehrgarh included the conception of religious healing. However, the people of
Mehrgarh apparently practiced an early form of dentistry already 9000-7500 years ago.11
This suggests that probably other medical practices were also employed in this early
phase of South Asian medicine.
The following stage of South Asian cultural history is represented by an early high
culture, the Indus Valley Civilization, which developed in the region of todays Pakistan
and western India from about 3000 BCE and reached a cultural peak between 21501750
BCE. From ca. 1900 BCE onward, this civilization declined. The reasons for this
development were presumably internal factors, reinforced by environmental changes that
led to a shift of the course of rivers.12

10

Jonathan M. Kenoyer, Ancient Cities of the Indus Valley Civilization (Karachi, Islamabad:
Oxford University Press; American Institute of Pakistan Studies, 1998), p. 33.
11
See A. Coppa, A. Cucina, D.W. Frayer, C. Jarrige, J.-F. Jarrige, G. Quivron, M. Rossi, M.
Vidale, und R. Macchiarelli. Early Neolithic Tradition of Dentistry, Nature 440, Nr. 6 (April
2006), 755756.
12
Kenoyer, Ancient Cities, p. 173.

As in the case of the prehistoric settlement of South Asia, nothing definite can be said
about the religion of the Indus Valley Civilization due to the absence of intelligible
written sources. In the archeological records, numerous seals depicting human beings or
anthropomorphic deities stand out. Quite a number of artifacts among them many
steatite seals bear symbols similar to a script. All attempts to decipher these symbols
consistently have failed so far, and it has been suggested that they do not constitute a
script that was ever meant to record a natural language.13 There is also virtually no
information available on medical believes, theories and practices. However, some of the
bronze razors, pins, and pincers that were found must have, according to Kenoyer
been the tools of a barber or a physician.14
This meager archeological evidence for medical believes, theories, and practices in prehistoric South Asia hardly justifies a treatment of this phase of South Asian cultural
history within a historical overview on Ayurveda, the medical concepts of which originate from the intellectual environment of a much later time.15 Although this can hardly
be disputed with historical arguments, we find the anachronistic claim in some currents
of modern Ayurveda that Ayurveda originated in the peak period of the Indus Valley
Civilization. The reason for this claim is the equation of antiquity with authenticity, on
which some modern forms of Ayurveda draw to create acceptance for their CAM in the
globalized world.16

3. Vedic Medicine
The next phase of South Asian cultural history began from about 1750 BCE, when
nomad tribes speaking the Indo-European language of Vedic immigrated in successive
currents to the north-western part of the Indian subcontinent. These tribes as well as
enculturated groups shared some civilizing accomplishments, a common language, and a
common religion. The Vedic religion was a polytheism, in which personified powers of
nature and ethical principles played an important role. Among these, the twin gods named
Avin-s are particularly connected with providing remedies in distressing situations of
life, and, accordingly, they also function as physicians of humans and the gods.17
13

Steve Farmer, Richard Sproat, and Michael Witzel, The Collapse of the Indus-Script Thesis:
The Myth of a Literate Harappan Civilization, Electronic Journal of Vedic Studies 11,2 (2004),
1957.
14
Kenoyer, Ancient Cities, p. 128.
15
See also Jean Filliozat, The Classical Doctrine of Indian Medicine: Its Origins and Its Greek
Parallels (Delhi: Munshiram Manoharlal, 1964), p. 187.
16
Kenneth G. Zysk, New Age Ayurveda or What Happens to Indian Medicine When It Comes
To America, Traditional South Asian Medicine 6 (2001) 1026, p. 23.
17
See Filliozat, The Classical Doctrine, pp. 8691.

The most important religious practices documented in the early Vedic literature are
sacrificial rituals. These were performed to praise and to feed the gods as a sign of
gratitude for their support, and in order to make them favorably disposed toward ones
own clan. In the course of time, sacrificing became an increasingly complicated matter
that had to be performed by specialists, the Brhmaa priests. From the middle Vedic
period of ca. 1200-800 CE onwards, sacrifices were seen as quasi-mechanical tools with
which the sponsor of a sacrifice could accomplish for himself desirable results like
victory in battle, wealth in procreation, cattle and horses, well-being in this world, and
the attainment of heaven after death.
The Vedic literature consists basically of four collections of texts called g-, Sma-,
Yajur-, and Atharvaveda, which mean knowledge (veda) of the sacred hymns (c), melodies (sman), sacrificial formulas (yajus), and spells (atharvan).18 Each of these
collection comprises the three different text-types of (1.) sahit-s, containing mostly
metrical hymns for use in sacrificial ceremonies (dateable to ca. 1750-1200 BCE), (2.)
brhmaas, consisting mainly of interpretations of the sacrificial mechanics (dateable to
ca. 1200-850 BCE), and (3.) rayaka-s and upaniad-s that are either quite similar in
content to the brhmaa-s, or they contain religious-philosophical speculations (dateable
to ca. 850-500 BCE, with many works being several centuries later).
Textual material that is pertinent to Vedic medicine is mainly contained in the sahit-s
of the Atharvaveda and, to a much lesser extent, of the gveda.19 From these texts, it
appears that the anatomical knowledge of Vedic India resulted basically from chance observation during horse and human sacrifices, which led to the composition of lists of
parts of the bodies of horse and of man being preserved in the brhmaa-texts.20 The
actual medical practice of Vedic India can be characterized as being essentially of a
magico-religious nature. This means that [c]auses of disease are not attributed to
physiological functions, but rather to external beings or forces of a demonic nature, who
enter the body of the victim and produce sickness. The removal of such malevolent
entities usually involved an elaborate ritual . The principal figure in the rite was the
healer (bhij), .21

18

For more details, see Stephanie W. Jamison and Michael Witzel, Vedic Hinduism, in The
Study of Hinduism, ed. Arvind Sharma (Columbia: Univ. of South Carolina Press, 2003), pp. 65
113.
19
Kenneth G. Zysk, Religious Healing in the Veda. With Translations and Annotations of Medical
Hymns from the gveda and the Atharvaveda and Renderings from the Corresponding Ritual
Texts (Philadelphia: American Philosophical Society, 1985), p. 7.
19
Zysk, Religious Healing in the Veda, p. 5.
20
Zysk, Religious Healing in the Veda, p. 7.
21
Zysk, Religious Healing in the Veda, pp. 7f.

Within rituals, the Vedic healers employed medicinal plants and other substances. These
were classified according to their habitat and their morphological features and either
locally collected or acquired by trade. For their medical application in ritual contexts, the
substances were either processed into medicines that were to be drunk in a solution or
they were fashioned into amulets or talismans.22
In spite of the similarity in names, Ayurveda is largely unconnected with the Vedic
Religion. This becomes evident from the fact that basic theoretical concepts of ayurvedic
medicine are not mentioned in Vedic literature. Moreover, the early mythological
depictions of the Avin-s as twin physician-gods indicate that the medical profession was
not highly valued in the Vedic milieu. On the contrary: Physicians were regarded as
ritually impure and excluded from Brahmanical rituals, because of their occupation with
ritually impure substances. Therefore, medicine was not practiced widely, if at all, among
the members of the three higher classes of the Vedic societies.23

4. The Medicine of the ramaa-movements and Early Buddhism

A religious complex that was different from and largely independent of the Vedic
religion developed at the time of the second urbanization of South Asia around 500 BCE
in the eastern part of the Gangetic plain. This complex consisted of the so-called
ramaa- or ascetic religions of Greater Magadha, which were the ancestors of the
jvikism, Jainism and Buddhism. The early ramaa-religions shared a number of
common conceptions that were alien to the Vedic religion, as, for example the notion of
cyclical time and the idea of karmic retribution of actions happening in different realms
of rebirth.
This intellectual and religious environment is also the home of medical theories and
practices that developed into Ayurveda,24 as can be concluded from the fact that early
Buddhist works reflect medical conceptions similar to those of Ayurveda, whereas the
Vedic text corpus does not reveal comparable ideas. For example, the sermon of the
Buddha on the cultivation of mindfulness (Satipahnasuttam) of the Pali-canon contains
the following description of the human organism in the context of a meditation meant to
prevent Buddhist monks from identifying with their own bodies:

22

On the usage of herbs for Vedic healing see Zysk, Religious Healing in the Veda, pp. 9699.
See Kenneth G. Zysk, Asceticism and Healing in Ancient India. Medicine in the Buddhist Monastery (Delhi etc.: Motilal Banarsidass, 1998), pp. 224.
24
See also Johannes Bronkhorst, Greater Magadha. Studies in the Culture of Early India (Leiden,
Boston: Brill, 2007), pp. 5660.
23

Again, O monks, a monk contemplates on this same body as being up to the skin
full of many kinds of ugly impurity: In this body occur hair of the head, hair of the
body, nails, teeth, skin, muscle flesh, sinew, bone, bone marrow, the kidney, heart,
liver, pleura, spleen, lungs, bowels, mesentery, stomach, excrement, bile, phlegm,
pus, blood, sweat, fat, tears, grease, saliva, snot, serous fluid, and urine. Again, O
monks, a monk reviews this same body, , as thus consisting of elements: In this
body there are the earth element, the water element, the fire element, and the air
element. Just as though a skilled butcher or his apprentice had killed a cow and was
seated at the crossroad with it cut into pieces; so too, a monk reviews this same body
as consisting of elements .25

This passage reveals that possibly as early as in the fourth century BCE its author,
who for believing Buddhists was the Buddha himself, had a quite advanced anatomical
knowledge and that his attitude towards corpses was unaffected by worries about ritual
pollution. In his final analysis, the author viewed the human body as consisting simply of
the four elements of matter. In this way, he exhibits the weltanschauung of ramaaphysicians, which is, according to Zysk, empirico-rational. This means that unlike the
Vedic practitioners, the ramaa-physicians emphasized direct observations, systematized the acquired data and analyzed them in a rational way that lead to the development
of theories about the nature of health and the causes of diseases.26
Moreover, in a sermon from the collection of Connected Discourses of the Buddha,
again from the Pali-canon,27 the Buddha answers the question of the non-Buddhist
renouncer Svaka of whether the view of some renouncers is true, according to which all
pleasurable, painful or neutral human experiences are instances of karmic retribution in
the following way:
Svaka, some feelings indeed arise as being caused by bile. Svaka, one can know by
oneself that here some feelings indeed arise as being caused by bile. Also the world
regards it as a truth that here some feelings arise as being caused by bile. In this
regard, Svaka, the non-Brahmanical and Brahmanical renouncers who proclaim and
who believe that whatever a human feels, whether it is pleasure or pain or neutral, is
caused by the [ethical value of] actions, these renouncers contradict what they
themselves have understood, and they contradict what is considered as a truth in the
world. Therefore I say that the view of these non-Brahmanical and Brahmanical
renouncers is wrong.

25

Bhikkhu namoi and Bhikkhu Bodhi, The Middle Length Discourses of the Buddha: A New
Translation of the Majjhima Nikaya (Boston: Wisdom Publications, 1995), pp. 147f., slightly
modified.
26
See Zysk, Asceticism and Healing, p. 29.
27
M. Leon Feer (ed.), Sayuttanikya. Part 4, Sayatana-Vagga (London: The Pali Text Society,
1894), pp. 230 f.

Then, the Buddha repeats the same wording for seven other possible causes of the
different kinds of feelings: phlegm, wind, a combination of the three before mentioned
substances, the changes of the seasons of the year, unsuitable care,28 acts of violence, and,
finally, karmic retribution. Accordingly, karma is just one factor out of eight that cause
well-being or otherwise of humans. Most of the first seven factors can be influenced by
human beings with suitable knowledge, as for example physicians. It was presumably this
attitude, according to which human suffering and disease are not exclusively the outcome
of former ethically objectionable actions on the side of the suffering individual that
supported the development of medical knowledge in Buddhist circles.
Bile, phlegm, and wind, the first three causes for human sensations, which occurred also
in the previously cited list of bodily constituent, play a prominent role also in the etiology
of classical Ayurveda. There, the same words designate the corruptions or humors (doa)
that determine individually or collectively the basic constitution and the degree of health
of human beings. As was shown by Hartmut Scharfe, the mentioning of these substances
in early Buddhist literature does not, however, justify the conclusion that classical
ayurvedic theories were already current at the time of the Buddha.29 In fact, it almost took
one thousand years before a multitude of similar but partly conflicting theories developed
into the more or less standardizes corpus of conceptions that characterizes classical
Ayurveda from the works of Vgbhaa (seventh century CE) onwards (see Section 5, p.
11).
The sources for tracing this development are not too rich with regard to the earlier
phases. Besides passages from early Buddhist canons, there is the possibly oldest
completely transmitted medical work in Sanskrit, the sixteenth chapter of the Mahayana
Buddhist Suvaraprabhsastra (Stra of Golden Radiance) that was translated into
Chinese between 416 and 421 CE.30 Ancient fragments of medical texts are the Qizil
fragment (written ca. 200 CE on leather) and the Bower manuscript (written ca. 525 CE
on birchbark).31

28

This interpretation of the two last mentioned Pali terms follows Richard F. Gombrich, What the
Buddha Thought (London, Oakville, CT: Equinox, 2009), p. 20.
29
Hartmut Scharfe, The Doctrine of the Three Humors in Traditional Indian Medicine and the
Alleged Antiquity of Tamil Siddha Medicine, Journal of the American Oriental Society 119,4
(1999), pp. 609629, p. 615.
30
See Johannes Nobel, Ein alter medizinischer Sanskrit-Text und seine Deutung (Baltimore, MD:
American Oriental Society, 1951).
31
Lore Sander, Origin and Date of the Bower Manuscript. A New Approach, in Investigating
Indian Art, ed. Marianne Yaldiz and Wibke Lobo (Berlin: Staatliches Museum Preuischer
Kulturbesitz, 1987), pp. 31323, p. 321b.

5. Classical Ayurveda
The main sources of Ayurveda in general are large compendia written in Sanskrit. The
study of these works is still in its infancy, because neither critical editions nor annotated
scholarly translations that could serve as the basis for further studies have yet been
published.32 A monumental research tool on many works and aspects of Ayurveda and
their treatment in secondary literature is Gerrit Jan Meulenbelds History of Indian
Medical Literature,33 whereas Dominik Wujastyks, The Roots of Ayurveda contains a
recommendable introduction to the topic and a selection of fine translations from the
original sources.34
The sources of classical Ayurveda are mainly six text collections in the Sanskrit language
(and the rich tradition of commentaries on these works) that bear titles referring to the
names of their respective compilator-authors, namely the Compendium of Caraka
(Carakasahit), the Compendium of Suruta (Surutasahit, which was composed a
short time after the Carakasahit), the Compendium of Bhela or Bhea (Bhela- or
Bheasahit, dateable to the time span between ca. 400 and 750 CE),35 the
Compendium of Kayapa or Kyapa (Kyapasahit, ca. fourth to sixth century CE),36
the Compendium being the Heart of the Eightfold Science [of Ayurveda]
(Agahdayasahit) of Vgbhaa,37 and the Summary of the the Eightfold Science
(Agasagraha),38 which is also attributed to an author named Vgbhaa.39
Of these, the Compendium of Suruta is famous for its section on surgery,40 which
depicts this branch of medicine in a far more advanced and professionalized stage of
development than previous as well as later ayurvedic sources. Apparently, surgery
ceased to be part of the professional practice of traditional physicians and migrated to
32

A critical edition and annotated English translation of a part of the oldest of the treatises, the
Carakasahit, is currently under preparation by research team at the Univerity of Vienna,
which is directed by Karin Preisendanz. See www.istb.univie.ac.at/caraka/.
33
Gerit Jan Meulenbeld, A History of Indian Medical Literature. 3 vols (in 5 parts) (Groningen:
Forsten, 19992002).
34
Dominik Wujastyk, The Roots of Ayurveda. Selections from Sanskrit Medical Writings. Translated With an Introduction And Notes. 3. ed. (London, New York, etc.: Penguin Books, 2003).
35
For the date of Bhelas compendium see Meulenbeld, A History of Indian Medical Literature.
Vol. II A. Groningen: Forsten, 2000, pp. 2224.
36
See Meulenbeld, Indian Medical Literature. Vol. II A., pp. 2541.
37
See Meulenbeld, Indian Medical Literature. Vol. I A., pp. 391474.
38
See Meulenbeld, Indian Medical Literature. Vol. I A., pp. 475594.
39
See Meulenbeld, Indian Medical Literature. Vol. I A., pp. 595686.
40
The Suratasahit was probably composed a little later than the Carakasahit. For different
dates assigned to this work, see Meulenbeld, A History of Indian Medical Literature. Vol. I A, pp.
342344.

10

practitioners of the barber-surgeon type41 shortly after the composition of the Surutas
work, probably in the second century CE.
The most influential work in the history of ayurvedic medicine is Vgabaas Heart of
the Eightfold Science, which is a summary of previous works, such as the compendia of
Caraka, Suruta and Bhela, that was composed at the beginning of the seventh century.
Vgabaa successfully created a standardized form of Ayurveda in his well-organized and
structured metrical composition.42 His work was and still is memorized by medical
students all over South Asia, especially in the modern State of Kerla, and it exists in
written form not only in numerous printed editions but also in thousands of unpublished
manuscripts. Moreover, the Tibetan translation of the Agahdayasahit from the
time of 10131055 contributed to the development of Tibetan medicine (on which see
Section 1, above.).43
The oldest of the classical ayurvedic compendia is probably that of Caraka, which is
usually dated to a time span of 100 B.C. and 200 CE,44 but assuming a date of composition around the year 50 CE may be the best educated guess. Carakas work was revised and supplemented by a redactor named Dhabala at some time between 300 and
500 CE.45 In the course of its transmission in manuscripts, this version of Carakas work
as consisting of 120 chapters (adhyya) in eight books (sthna) developed into the
multiple versions that are today current in manuscripts and printed editions.46 The eight
books of the Carakasahit are entitled as follows: The book of stanzas, or the book on
the essentials of medical knowledge (loka- or Strasthna), on diagnose (Nidnasthna), on precise judgment (Vimnasthna), on what is related to the body (rrasthna), on the omens for death (Indriyasthna), on therapy (Cikitssthna), on pharmacy
(Kalpasthna), and on medical success (Siddhisthna).47
The number of books in the Carakasahit agrees with the number of areas of medical
knowledge, although the medical branches differ thematically. They are: internal
41

Wujastyk, The Roots of Ayurveda, p. 66.

On the theoretical foundation of classical Ayurveda from Vgbhaa onwards, see Julius Jolly,
Medicin (Strassburg: Trbner, 1901), pp. 3942.
43
See Claus Vogel, Vgbhaas Agahdayasahit. The First Five Chapters of its Tibetan
Version. Ed. and Rendered into English (Mainz: Deutsche Morgenlndische Gesellschaft
Wiesbaden: Steiner (in Kommission), 1965), p. 21.
44
According to Meulenbeld, Indian Medical Literature. Vol. I A., p. 114.
45
According Meulenbeld, Indian Medical Literature. Vol. I A., p. 141.
46
Fro a more detailed account of the structure of the Carakasahit see Meulenbeld, Indian
Medical Literature. Vol. I A., pp. 93f. On the later textual history of the Carakasahit see
Philipp A. Maas, On What Became of the Carakasahit After Dhabalas Revision, eJournal
of Indian Medicine 3.1 (2010), 122.
47
See Meulenbeld, Indian Medical Literature. Vol. I A., pp. 792.
42

11

medicine, medical treatment of the supraclavicular region, the extraction of foreign

bodies (such as arrows), treatment of intoxication, demonology, treatment of women
during pregnancy and thereafter as well as pediatrics, life extension, and aphrodisiacs.48
At the time when the Carakasahit was composed, medical practitioners had affiliated
themselves with early Hinduism to such a degree that only members of the first three
classes of society, i.e. of Brhmaa-s, of the warrior nobility (katriya-s) and of the class
of free working men (vaiya-s) were admitted to practice Ayurveda.49 This affiliation was
successful to such a degree that the memory of Ayurvedas origin in the milieu of the
ramaa-religions was completely lost in the medical tradition.
Additional strategies for securing acceptance in a society committed to Brahmanical
norms were, for example, using Sanskrit as the medium of codifying medical knowledge,
and modeling the initiation into medical studentship in accordance with Vedic rituals.50
Moreover, the early medical authorities traced the origin of ayurvedic knowledge in
origination myths to late Vedic and Vedic gods. According to the account of the Carakasahit, the sequence of the transmission of ayurvedic medicine began with the allknowing god Brahm, who imparted it via the gods Prajpati, the Avin-s, and Indra to
the human seer Bhradvja, who then instructed treya Punarvasu. This seer taught a
group of six medical authorities, each of whom composed his own medical treatise. One
of these works is entitled The authoritative teaching of Agnivea (Agniveatantra). This
work, of which nothing else is known, was later and this appears to be historically
reliable information revised by a redactor named Caraka into the Carakasahit.
The fact that, according to this myth, Ayurveda is of divine origin reflects the basic attitude of the early classical medical authorities towards their medical knowledge as being
in principle perfect. According to this view, Ayurveda, just like virtually all other systems of authoritative knowledge (stra) in pre-modern South Asia, is beyond any need
or capacity of being improved by means of the discovery of what has never been known

48

According to Carakasahit Strasthna 30.28 in: Jdavji Trikamj crya (ed.), Caraka
Sahit by Agnivea. Revised by Caraka and Dhabala. With the yurveda-Dpik Commentary
of Cakrapidatta. Repr. of the ed. Bombay 1941 (Varanasi: Krishnadas Academy, 2000), p.
189a. See also Meulenbeld, Indian Medical Literature. Vol. I A., p. 26.
49
See Carakasahit Strasthna 30.29, p. 189b.
50
See Karin Preisendanz, The Initiation of the Medical Student in Early Classical yurveda.
Carakas Treatment in Context, in Pramakrti. Papers Dedicated to Ernst Steinkellner on the
Occasion of his 70th Birthday, Vol. 2, eds. Birgit Kellner et al. (Wien: Arbeitskreis fr Tibetische
und Buddhistische Studien, Universitt Wien, 2007), pp. 629668, p. 634 and p. 649, where
Preisendanz announced to deal with the relationship between ayurvedic and brahmanical rituals
of initiation in a forthcoming article of hers entitled Medicine and Brahminical Orthodoxy in
Ancient India: On Some Ritual Elements in the Carakasahit.

12

before. All that the authorities can aspire for is a recovery of what was known in full in
the past.51 However, this search for the recovery of primordial perfection left room for
developments that from a historical perspective appear as discoveries and innovations in
ayurvedic theory and practice throughout its history.
A further strategy to implement the medicine of the ramaa-religions in the culture of
early Hinduism was to establish a relation between Ayurveda and the Atharvaveda (see
Section 3), which on the side of Ayurveda involved the inclusion of religious methods of
healing, such as giving gifts, invocations of blessings, food offerings, auspicious
ceremonies, fire oblations, self restrictions, penances, fasts, and the application of
mantras.52 This faith in the efficiency of medical rituals was based on the belief that in
some cases diseases may result from destiny (daiva) or from ethically bad actions
(karman) that the diseased person has committed either in a previous birth or earlier in
his or her present life.
However, afflictions were also treated with non-ritual means designed to clean body and
mind, or to pacify a corruption. These therapies may or may not involve the application
of medicinal substances. Treatments without medical substance consists of, for example,
pointing out a dangers to the patient, or in surprising, making forget, agitate, delight,
threaten, strike, or put him or her to sleep, whereas non-religious medical treatment by
means of medicinal substances consists of diverse methods. Among these, the five
therapies (pacakarma), i.e. emesis, purgation, two kinds of enema, and the evacuation
of the head, figure prominently not only in the Carakasahit 53 but also, partly
modified, throughout the later history of Ayurveda.
The ayurvedic therapies mentioned and described in the Carakasahit are theoretically
grounded on a variety of partly supplementary and partly contradictory medical theories
that were current around the time of the composition and compilation of this work. One
account of such a theory occurs in the first book of the Carakasahit:
In this regard food becomes an essence, called pure matter, as well as waste, called
impure matter. Sweat, urine, feces, wind, bile and phlegm, impure matter arising
from the ears, eyes, nose, mouth and the pores of the skin and parts such as the hair
of ones head, the beard, the hair of ones body, the nails, etc., thrives from waste,
whereas chyle, blood, muscle flesh, fat, bone, marrow, semen and strength (ojas)
develop from the food essence . When they are thriving from the [food] essence
and from impure matter, all of these bodily constituents called impure matter and
51

Sheldon Pollock, The Theory of Practice and the Practice of Theory in Indian Intellectual
History, Journal of the American Oriental Society, 105,3. Indological Studies Dedicated to
Daniel H. H. Ingalls (Jul. Sep., 1985), 499519, pp. 512 ff.
52
See Carakasahit Strasthna 30.21, p. 186b translated into English.
53
See Carakasahit Vimnasthna 8.87, p. 275a.

13

pure matter conform to their individual measure in accordance with age and
body. Thus, when [food] essence and impure matter keep their individual measure,
they maintain the suitable ratio (smya) of constituents belonging to a body [which
can thus be regarded as] having constituents in a suitable ratio (i.e. to be healthy).54

According to this theory, digestion transforms food into two substances called pure
matter and impure matter, respectively. These two substances are further transformed
into bodily waste products and bodily constituents. Health is the result of a suitable ratio
of bodily constituents and waste products, whereas an unsuitable ratio causes disease.
The three waste products wind, phlegm and bile are most important among the listed
constituents, because quite a number of passages of the Carakasahit (as well as of
later ayurvedic literature) stress their ratio as the decisive factor for health and disease. In
the context of their etiological potential, these elements are frequently termed corruptions (doa-s), i.e. pathogenetic substances or humors.
The physician can treat the ratio of the humors in the human body, because the amount of
humors in the human body depends to some degree upon the tastes (rasa) of substances
that the patient consumes. Carakasahit Vimnasthna 8.1.48 provides a general
outline of the relationship between tastes and humors:
4. First of all, there are six flavors: (1.) sweet, (2.) sour, (3.) salt, (4.) pungent, (5.)
bitter, and (6.) astringent. Used properly, they support the body, but used wrongly,
they agitate the humors. 5. The humors, for their part, are three: (1.) wind, (2.) bile,
and (3.) phlegm. In their natural state, they benefit the body. If, however, they are
modified, they torment the body with manifold diseases. 6. In this regard, three
flavors generate, and three flavors pacify a single humor in the following way: The
pungent, bitter, and astringent flavors generate wind, but the sweet, sour, and salt
flavors pacify it. The pungent, sour and salt flavors generate bile, but the sweet, the
bitter and the astringent flavors pacify it. The sweet, sour and salt flavors generate
phlegm, but the pungent, bitter and astringent flavors pacify it. 7. However, if flavors
and humors are in combination, flavors increase humors with identical or largely
identical properties. Flavors having opposite properties or largely opposite properties
pacify, if they are regularly consumed. Because of this relation, it is taught that
uncombined there are six flavors and three humors. 8. The number of options for
their combination is infinite, because there are infinite options.55

54

Carakasahit Strasthna 28.4 as translated in Philipp A. Maas, The Concepts of the Human
Body and Disease in Classical Yoga and yurveda, Wiener Zeitschrift fr die Kunde Sdasiens
51 (2007/2008), 125162, p. 136.
55
Carakasahit Vimnasthna 8.1.48, pp. 231a232a, translated into English. Unlike the
number of options for combination, the number of combinations is not infinite but exactly sixtythree. On this combinatory problem see Dominik Wujastyk, The Combinatorics of Tastes and
Humours in Classical Indian Medicine and Mathematics, Journal of Indian Philosophy 28
(2000): 479495.

14

The theory underlying this relationship of tastes and humors is an early South Asian
philosophy of nature, which holds material entities including medicinal substances to be
modifications of the five gross elements space/ether, air, fire, water, and earth. The six
flavors inhering in medicinal substances derive from these elements. A high amount of
water causes the sweet taste, whereas a predominance of fire and earth produce a sour
flavor etc. The flavors, which are properties of the substances, are metaphorically said to
possess certain qualities or properties, namely the ten pairs of being heavy or light, hot or
cold, unctuous or dry, sluggish or sharp, immobile or flowing, soft or harsh, gross or fine,
viscid or liquid.56 In this regard they resemble the three humors that also are modifications of the gross elements and have similar properties. However, the theory of the
gross elements as the basis of the flavors suffers from a lack of explanatory force with
regard to the properties and actions of the tastes It is especially hard to understand the
relationship postulated between substances of a particular taste and specific disorders.57
The difficulties of understanding ayurvedic pharmacology as a consistent theory are
aggravated by the fact that the efficiency of any medicinal substances depends not only
on its flavors but also on its post digestive flavors (vipka), its potencies (vrya), and on
its specific action (prabhva).58
In contrast to the flavors, which are six, the post digestive flavors (vipka) are only three,
i.e. sweet, sour, and pungent. The reduction of number from six to three happens during
the digestive transformation when salt becomes sweet, and bitter and astringent become
pungent. This theory is apparently based on two observations; first, on the fact that some
substances produce medical effects that cannot be explained on account of their flavors,
and second, the fact that food changes its properties in the course of digestion, as can be
directly experienced in the case of vomited substances. One of the problems resulting
from the combination of the two theories of flavors before and after digestion is that it
leaves the question unanswered of how salt, bitter and astringent flavors can be medically
efficient at all, if they are in any case transformed into sweet and pungent flavors.
The theory of potencies (vrya) maintains that medicinal substances independently of
their flavors are endowed with special properties that, according to the dominant view

56

See Gerrit Jan Meulenbeld, Reflections on the Basic Concepts of Indian Pharmacology, in
Studies on Indian Medical History: Papers Presented at the International Workshop on the Study
of Indian Medicine Held at the Wellcome Institute for the History of Medicine, 24 September
1985, eds. G. Jan Meulenbeld and Dominik Wujastyk (Groningen: Egbert Forsten, 1987), pp. 1
18, p. 8, n. 19.
57
Meulenbeld, Basic Concepts of Indian Pharmacology, pp. 6f.
58
The following account of post digestive flavors (vipka), potencies (vrya), and specific actions
(prabhva) is based on Meulenbeld, Basic Concepts of Indian Pharmacology, pp. 517.

15

already at Carakas time,59 may consist of eight of the twenty above mentioned properties, namely of either being soft or sharp, heavy or light, unctuous or dry, and hot or
cold. The potencies are held to resist the digestive fire, because they possess a special
strength, so that they even may dominate the efficiency of the flavors and the post digestive flavors. The theory does not explain, however, why potencies consist only of a part
of the so-called properties of flavors, and how the flavor-properties that do not survive
the digestive fires are medically efficient.
The final pharmacological concept that is met with in the Carakasahit and later works
of Ayurveda is that of specific action (prabhva). This concept is evoked in cases in
which medicinal substances produce effects that are unpredictable on account of their
flavors, post digestive flavors and potencies. In other words, the specific action, which is
seen as the result of the nature of the respective substance, serves as a joker to be drawn
in order to explain otherwise inexplicable pharmacological effects.
The efficiencies of the four pharmacological factors described above differ from each
other.60 In cases of equal power, the specific action outweighs the three factors of
potency, post digestive flavor, and flavor. Moreover, potency is stronger than both post
digestive flavor and flavor, and, finally, the post digestive flavor is more efficient than
flavor.
A large amount of the materia medica mentioned in the Carakasahit consists of
various parts of a variety of plant substance. The botanical identification of these plants is
a difficult task requiring expertise in the diverse fields of knowledge of Ayurveda and its
regional varieties, botany, pharmacology, Sanskrit philology and the cultural and medical
history of South Asia. Although sometimes the identification of plants mentioned by
Caraka and later authors appears to be an easy task, there remain many problematic
cases.
Besides plants and their various parts, Caraka prescribed the use of mineral substances
and metals.61 Moreover, his pharmacopeia contains animal products such as the milk,
blood, urine and meat of sheep, goats, cows, and other animals as well as, in certain
cases, alcoholic beverages. This is remarkable, because the Brahmanical dietary prescriptions prohibit the consumption of meat and alcohol in virtually all cases. However, since
in the view of Ayurveda health is the ultimate condition for achieving any aim in human

59

See Carakasahit Strasthna 26.64, p. 147b.

See Carakasahit Strasthna 26.72c73b, pp. 148b149a.
61
On inorganic substances in the Carakasahit, see Meulenbeld, Indian Medical Literature.
Vol. I A., pp. 104 f.
60

16

live, the ayurvedic authorities considered medical prescriptions more important than
following social and religious norms (dharma).62
As outlined in the eight chapter of the Carakasahit Vimnasthna, medical treatment
in early classical Ayurveda was based on a complicated process of reasoning, in which
the physician had to draw into consideration ten topical complexes consisting, among
other things, of the qualities of the practicing physician himself, the medicine, disease,
the geographical region, time in general, with special reference to the season of the year
and with reference to the condition of the patient , and finally the patient himself from
the perspectives of, for example, his or her natural constitution, vigor, size, affinities,
character, bodily fitness and age.63

6. Medieval and Early Modern Ayurveda

The medieval and early modern period of Ayurveda is characterized by a large literary
production of original works and commentaries that mirror conceptional innovations.
From the 19th century onwards, three medieval works became to be designated as the
shorter triad (laghutary), namely the Rogavinicaya or Mdhavanidna (ca. 8th
century), the rgaharasahit (14th century), and the Bhvaprakaa (at some time
between 1550 and 1590) of Bhvamira. In this way, these compendia were juxtaposed to
the longer triad (bhattray) of classical works consisting of the before mentioned
Compendia of Caraka and uruta as well as of Vgbhaas Heart of the Eightfold
Science.
The Mdhavanidna is largely a compilation of passages from earlier works belonging to
the classical period of Ayurveda that deals with etiology, prodromes, symptomatology,
therapeutic diagnosis and pathogenesis. It stands out for its innovative arrangement of
topics related to disease that were previously dealt with in various passages scattered
throughout the literature. More specifically, Mdhava invented a new scheme for the
classification of diseases that became the standard for many later works on Ayurveda, in
the context of which he mentioned and described a number of diseases that had not been
known or recognized before.64
The rgadharasahit is remarkable not only because of its clarity and the well
structured arrangement of topics, but also because of its innovativeness. For example,
62

On the problem of meet eating in Ayurveda see Dominik Wujastyk, Medicine and Dharma.
Journal of Indian Philosophy 32, Nr. 5 (2004): 831842.
63
See Carakasahit Vimnasthna 8.68151 (pp. 272b286a) as thematically analyzed in
Preisendanz, The Initiation, pp. 659660.
64
For mor details, see Meulenbeld, Indian Medical Literature. Vol. II A., pp. 6177.

17

rgadhara simplified ayurvedic theories by reducing the number of medically relevant

qualities to five, and the number of potencies in medicinal substances from eight to two.
In addition, he introduced pulse diagnosis as a new means to determine the nature of
diseases. rgadharas pharmacopeia included opium, mercury for internal use, and his
recipes frequently contain cannabis.65
The Bhvaprakaa contains, among many other innovative features, the earliest
ayurvedic description of syphilis. Bhvamira classified this disease into three types that
he said to result from contact with foreigners from Western countries. His treatment of
syphilis draws mainly on mercurial drugs.66

7. Modern and Global Ayurveda

The encounter of traditional South Asian medicine with modern bio medicine from the
time of the British colonization onwards led to major and unpreceded challenges of
Ayurveda. Ayurveda became politically, commercially and conceptually dominated by
modern bio medicine, which called the very validity of ayurvedic medical theories,
practices and courses of medical education into question. This process triggered the
development of the two new kinds of Ayurveda that in recent academic writing are
designated as Modern and Global Ayurveda.67
Modern Ayurveda is geographically located in South Asia. It is characterized by its
adaptation to the standards of modern bio medicine with regard to the institutionalization
of medical education, and the standardization of medical practice and pharmacology (cf.
the agenda of the Indian Ministry of Health cited in Chapter 1). Moreover, it deemphasizes (or even eliminates) the magical and religious aspects of Ayurveda.
The term Global Ayurveda refers to the diverse phenomena of ayurvedic medicine that
are were originally developed outside South Asia, such as, for example of New Age
Ayurveda,68 Ayurveda as mind-body medicine, Maharishi Ayur-Ved,69 and the modern

65

For mor details, see Meulenbeld, Indian Medical Literature. Vol. II A., pp. 196207.
For mor details, see Meulenbeld, Indian Medical Literature. Vol. II A., pp. 239247.
67
See, also for the following part of this section, Frederick M. Smith and Dagmar Wujastyk,
Introduction, in Modern and Global Ayurveda: Pluralism and Paradigms, eds. Dagmar
Wujastyk and Frederick M. Smith (New York: SUNY Press, 2008), pp. 128.
68
See Kenneth G. Zysk, New Age Ayurveda or What Happens to Indian Medicine When It
Comes To America, Traditional South Asian Medicine 6 (2001) 1026.
69
See the contributions of C.A. Humes, F. Jeannotat, and S. Newcombe in Wujastyk and Smith,
Modern and Global Ayurveda.
66

18

continuation of traditional Ayurveda in urban settings.70 These spin-offs of a traditional

South Asian medical system have in recent years become popular expressions of live
style in the urban societies also of India.

70

See the contributions of A.S. Chopra and M. Tirodkar in Wujastyk and Smith, Modern and
Global Ayurveda.

19