“India suffers today in the estimation of the world more through the world’s ignorance of her achievements than in the absence or insignificance of these achievements “, observes H W Rolinson.


The achievements of Indians not only in the field of medicine, but in many other fields, is imperfectly known to the world even this day. Most of the Indian classics were written in Sanskrit, therefore, were not easily accessible even to people in India, as the language was very difficult. There have been some attempts to understand the Sanskrit language and the Indian classics by western scholars; the leading figure among them was Mac Donnell. Mac Donnel considers the discovery of the Sanskrit literature by the West as the most significant event in the history of culture since the Renaissance. Now we have Sanskrit translations into English, German, French and Latin languages.



The concept that modern medicine started with the Greeks was due to the misconception of some historians led by Allbutt, who wrote “The medicine of Egypt and the East, extensive and intricate as it was, in so far as it is not Greek, did not contain even the rudiments of science to which western medicine owes virtually nothing. This belief led to the obsession of the historians that scientific medicine began with the Greeks. Neuramburger wrote that the medicine of Indians, if it does not equal the best achievements of their race, is at least nearly as good owing to its wealth of knowledge, depth of speculation, and systematic construction. It takes an outstanding position in the history of eastern medicine.



Let us look at the beginnings of western medicine. The philosopher who influenced Hippocratic medicine, the so-called western medicine, was Pythagoras. Hippocrates derived his doctrine of the four humors from Alcmaeon, who belonged to the school of Pythagoras. The Hippocratic emphasis on diet in preference to medicines in the treatment of diseases, again, is traced to Pythagoras. There is no doubt that the teachings of Pythagoras implied the introduction of a new spirit, which was not characteristically, Hellenic. “After a careful review of the points of contact and weighing, as dispassionately as possible, the historical evidence for and against the originality of Pythagoras, we are unable to come to any other conclusion than that this philosopher took his whole system indirectly from India ”writes Hopkins.2 The Hippocratic conception of the influence of the seasons on the fluctuations of the humors and the pre-dominance of certain diseases in certain seasons is very much like the views held by Charaka and Sushruta on the same subject.



Medical education in India in those days was based on two systems of training, the brahminical system and the Monastic system. Skilled practitioners, masters of their craft, have handed down most of the Indian medical lore through generations through the individual training of pupils. This was the brahminical system. But in the Monastic system, corresponding very much to our University training, the education had a particular pattern. It is stated that Bimbisara, a contemporary of Buddha was supposed to have been educated at the famous Taxila University under the professor of medicine, named Athreya, and it is stated that the course lasted for seven years. Even the selection of textbooks was given great importance. Charaka, discussing the various means of diagnosis, defined three important ones; Pramanas – i.e., instructions by the wise, apthopadesha – i.e., perception; Anumana – i.e., inference. Of these three he placed knowledge derived from the instructions of the wise as the most important. These instructions were found in various authoritative textbooks called Shashthras or Tantras.



The next duty of the future physician was to select a proper preceptor. Not everyone could become a medical teacher those days. Charaka again laid down the following qualifications for a teacher



“He should be one whose doubts have all been cleared in respect of medical scriptures. He should be possessed of experience. He should be clever. He should be compassionate towards those who approach him. He should be pure of conduct. He should have practised hand. He should have all the implements of his profession. He should have all the organs of sense. He should be conversant with the nature of health and disease. He should be conversant with the tendencies and acts of the healthy and of the deceased. He should be one whose knowledge of medical science has been supplemented by knowledge of other branches of study. He should be without malice. He should be without a wrathful disposition. He should be capable of bearing privations and pain. He should be one well affected towards disciples and disposed to teach them. He should be capable of communicating his ideas to the pupils that seek his instructions.”



Now there are certain qualifications to get into the training for medicine. The preceptor to accept his ward for teaching should first examine the student. To see that he possessed certain physical, moral, and intellectual endeavours. What were they? His eyes, mouth and nasal line should be straight. His tongue should be thin, red and unslimy. His teeth and lips should have no deformity. He should not have a nasal voice. He should not be defective in respect of any limb. He should have all his senses perfect. He should be of mild disposition. He should be noble by nature. He should not be mean in acts. He should be disposed for solitude. He should be free from hottiness. He should be of thoughtful disposition. He should be free from those faults, which go by the name of Vyasana. I.e., hunting, gambling, dice, sleeping during day time, speaking ill of others, infatuation with women, excessive addiction to singing, dancing, or instrumental music, purposeless wandering etc. He should be free from wrath.



He should be endured with excellent character, purity of behavior, devotion, cleverness and compassion for all. He should be free from cupidity. He should be without sloth. He should seek the good of all creatures. He should be prepared to obey all commandments of his teacher. He should be intelligent, free from pride, and endowed with large understanding. He should have a power judgment, and memory and a liberal mind. He should belong to a family, which has studied medical scriptures in the past.



The duration of the course was six years. The course was based on recognized textbooks. It consisted of two parts. Learning by heart the rules and axioms which were explained by the preceptor, and on practical instructions. Both medicine and surgery had to be mastered. When the student attends classes to receive instructions, he should be of purified body, dressed in his upper garment and sheet and his mind perfectly calm. The preceptor will teach him according to his capacity either one quarter, one half or an entire Shloka at a time. The pupil should repeatedly recite this. In this way each pupil should be taught separately and the preceptor should recite the entire shloka after his pupil. Learning by rote without understanding the meaning of what is thus committed to memory is like an ass carrying the load of sandalwood. After studying the shastras the art of healing had to be learned practically.



The student spends years of life with the preceptor becoming a member of his household; serving him and daily watching him as he treated his patients. His student assisted him in his pharmacy in preparing medicaments and the student became familiar with the various tools and procedures of the medical profession. With regard to surgical training, the preceptor was to show his pupil how to incise, divide, and extirpate etc., by performing these operations on flowers, fruits, watermelons, and cucumber etc. Training in puncturing, letting out fluids etc was to be given by performing the operations on leather bags or bladders filled with water and mud. Scarification was to be practised on stretched pieces of leather covered with hair. The operation of piercing as in opening of the veins was to be shown on the veins of the dead animals or the stock of water lily. Exploring by a probe was to be demonstrated on the worm eaten wood, bamboo, tubes, etc.



Extraction was to be shown on the jackfruit, and pulp of bell fruit and the teeth of the dead animals. The opening of abscess was to be demonstrated on the lump of wax applied to a piece of wood. Sewing was to be practised on the thick cloth, and on the edges of two pieces of soft leather. Bandaging was to be practised on the limbs of human figures made of wood or clay. The mode of bandaging the root of the ear was to be shown on a piece of soft flesh or the stock of the water lily. The application of the caustics and actual cautery was to be shown on the piece of soft flesh. The withdrawal of urine from the bladder or the extraction of pus from a pelvic cavity.



Sushruta, the chief of surgical training, insisted on a balanced practical efficiency. “Otherwise when it comes to treating the patient he will feel as insecure as a coward approaching the battle draw. He who is only trained in theory but is not experienced in practice knows not what he should do when he has a patient and behaves was foolishly as a new soldier at the battle field”, he wrote. On the other hand a physician who is educated practically but not in theory will not earn the respect of better men.



Thus trained, the physicians wielded tremendous power and influence. He gained access even to the rulers of the country. He was the priest, physician sorcerer, and the adviser to the king - all combined in one.



The Indian ethics of the medical profession are, if any thing, much more elaborate than the Hippocratic Oath itself. The following is the oath of the Indian physician.



* You must be chaste and abstemious, speak the truth, not eat meat;

* Care for the good of all living beings; devote yourself to the healing of the sick even if your life were lost by your work.

* Do the sick no harm; not, even in thought, seek another’s wife or goods; be simply clothed and drink no intoxicant; speak clearly, gently, truly, and properly; consider time and place; always seek to grow in knowledge.

* Don’t treat women except their men be present; never take a gift from a women without her husband’s consent.

* When the physician enters a house accompanied by a man suitable to introduce him there; he must pay attention to all the rules of behaviour in dress, deportment and attitude.

* Once with his patient he must in word and thought attend to anything but his patient’s case and what concerns it. What happens in the house must not be mentioned outside, nor must he speak of possible death to his patients, if such a speech is liable to injure him or anyone else.



* In the face of Gods and man you can take upon yourself these vows; may all the Gods aid you if you abide thereby; otherwise may all the Gods and the sacra, before which we stand, be against you;



And the pupil should consent to this, saying,



“So be it.”



The common misconception in the western mind is that India had no idea of the human Anatomy. In fact, the anatomy studied in India seems to be very advanced even in the ancient times. The existence of an anatomical tradition can be traced back to the Vedic period. In the Rg. Veda we find mention made of the lungs, the heart, the stomach, the intestine, the kidneys etc. The Attarvaveda evinces the thorough knowledge of the coarser anatomy of the human body.



In Charaka and Sushruta’s schools, anatomy was very carefully taught. In course of time this anatomical tradition crystallized into definite knowledge. With the rise of various schools of medicine, Indian anatomy entered on its scientific phase. Human dissection was practised in the time of Sushruta “ Anyone, who wishes to acquire a thorough knowledge of anatomy, must prepare a dead body and carefully observe and examine all its different parts. (Sushruta Samhita 3. 5. 49) But the method of dissection was curious and very crude. Sushruta always insisted that the knowledge thus gained from dissection is supplemented by observations gained from the practice of surgery. In both Sushruta and Charaka Samhitas there is a separate section on anatomy. It is called Sharira Sthana. In addition to anatomy, embryology and histology were also taught. The knowledge of the human skeleton in Indian medicine came from medical and non-medical sources. The non medical versions were derived from Yagnavalkiya’s Dharmashastra, Vishnu Smrithi and Agnipurana. Anatomic ideas of Charaka and Bela were identical and were based on the version of Athreya, which is contained in Charaka Samhita.



Charaka’s knowledge of the muscles was very rudimentary. In his count there were very few muscles in the body. Sushruta not only gives the total number of muscles but also their distribution. However, his knowledge of the muscles was much inferior to his knowledge of the bones.



From very ancient times, Indians possessed considerable knowledge of the heart and the blood vessels. In the Attarvaveda the heart is mentioned many times. The comparison of the heart with the lotus is very common in Sanskrit literature. Charaka did not add much to the knowledge but he had a lot to say about the various ducts which carry blood. He said that heart is the root of ten `dhamanies’ and these are run into every part of the body. He used all the three words, Dhamani, Siras and Shrothas to indicate ducts.



Sushruta gives a greater thoroughness into the heart and the blood vessels. He even wrote that the heart has a shape of a lotus, hanging with its apex downwards and he describes different kinds of ducts, vatha, pitha, kafa and rakta vahasiras. The knowledge of neurology, especially of the brain was not very much advanced in the Indian system of medicine. But splancnology was very much advanced. Attarvaveda mentions about the heart, the lungs, the gallbladder, and the kidneys, the liver, spleen, stomach, small intestines, rectum, large intestine, abdomen, colon, umbilicus, bone marrow and placenta. In the study of physiology the views of Indian medical writers has not been documented well. It was a mistaken notion that the physiology in India consisted of Vatha, Pitha, and Kafa, the three doshas.





The role of these in physiology is often exaggerated. Infact, it is not as important as in pathology. The above three only function as Dhathus. A careful study of the Indian classics reveals a vast amount of knowledge in physiology. References are scattered through out these. The Indian medical writers consider the body as a conglomeration of the five elements. earth, water, fire, air and the sun. The body functions properly so long as these dhathus are in proper proportions; Samayogavahin. Even in healthy persons their proportions are constantly undergoing fluctuations. This is the most important concept. The latest concept in modern medicine of the fluctuations in the internal environment as opposed to the ideas of Claude Bernard of the milieu interior.



Food is the very life of all living creatures. The description of food, its composition and qualities, its role in building a normal human system, a detailed description of digestion of food and also metabolism is given in the Indian medical writings. The waste products and metabolic waste products are of two kinds according to the Indian system. Those which pollute the system, the mala and those which sustain and nourish the system; Prasada. There is a graphic description of the urine as excreta and how its careful examination could give inkling into the patient’s disease. Then we have a very graphic description of the heart and its functions. As a matter of fact the first reference to heart diseases to the graphic description of its presentation was seen in Sushrutha Samhita.



The details of blood and its character and its functions are also seen and circulation of blood is described in great detail and the very word `Hridaya’ suggests that ancient Indians knew about the proper circulation of blood whereas in the West it was discovered only in the 17th century. The functions of the lungs and respiration are also very clearly described. Attarvaveda could describe the difference between the head and the brain. Now the physiology of length of life, the complexion of the body, strength, health, exertion, growth, luster, ojus, energy and all kinds of life breaths have all been said to be based on the digestive power or Jhataraagni. In fact, the concept of Aristotle that bile, urine, sweat, hairs, scales, feathers etc are formed from that part of the blood which is unfit for use closely resembles the views of Charaka on the production of waste products or malas, described above.



The doctrine of three doshas plays an important role in ancient medicine. It actually has a great resemblance to the theory of Hippocrates in modern medicine. The same process that is seen in the evolution of the Greek humoral theory is seen in Indian context. First some qualities were postulated like, hot and cold, warm and moist, and then they were materialized into humors. Air, fire and water were consumed first as powers. Then they were identified with Vayu, pitha and kafa. In this identification the medical schools were helped by their clinical experience. The three common diseases then known were Gastro- intestinal diseases, fever associated with burning heat, and chest disease associated with phlegm. Thus Vayu, Pitha, and Kapha came to be substituted for air, fire and water.



Sushruta added blood to the list of doshas. Having all these differences which, by their variety indicate that they belong to a theory without seriously affecting practice. There is one underlying common principal that health is the equilibrium of the Dhatus and disease is the change of that equilibrium. Charaka goes deep into the aetiology, classification, and pathology of diseases and he describes the various things like the climatic characteristics of disease. Attarvaveda classifies disease into five varieties.



1. Other than the ordinary diseases many diseases are produced by the possession of devils and evil spirits of which quite a large number were known then.



2. Diseases due to worms were very well known both in men and in cattle.



3. There were also diseases due to sorcery which played an important part as an offensive measure in Vedic India.



4. Many diseases were known to be hereditary.



5. Some people recognised a threefold classification of all the diseases; those produced by wind, water and fire. Charaka also divides all diseases into three kinds. Physical diseases, accidental diseases, and mental diseases. Sushruta has a similar classification but he adds another class to the above. He classifies diseases into four groups.



1. Traumatic or of extraneous origin.

2. Bodily diseases.

3. Mental diseases.

4. Natural diseases.



The Sankya philosophers classified diseases into three categories viz., Adhyathmika Dukha, Adi Bowthika Dukha, Adi Daivika Dukha and they also prescribed a treatment for all these; “Chitta Vrithi Nirodaha ” - keeping the cool of the mind without undulations (desires like greed, hatred, jealousy etc.)



Charaka defines disease as a disharmony of the Dhatus. There is a beautiful stanza which describes it all.



Samadoshah, Samagnishcha, Samadhatu, Malakriyaha,

Prasanna Atma Indriya Manaha, Swastha, ithya, videyathi



“When the doshas and dathus are balanced, when one has good appetite, bowel motion, if he keeps his mind, soul and senses pure; health is assured.





Charaka, Sushruta and other schools of thought in India also discussed diagnosis of diseases and the prognosis. But the prognosis, the art of prognosis, was most developed in the Indian medicine compared to many other civilizations. Astrology came into medical prognostication in a big way in those days. The life expectancy of a patient was inferred from certain signs and symptoms that are regarded as unmistakable prognostications of death.



Special mention was made about the dreams and detailed study of dreams could be found both in Charaka and Sushruta Samhitas. Pharmacology or materia medica was fairly well described. The collection of vegetables, animal, and mineral substances for the purpose of the treatment of diseases seems to be as ancient as man himself. The earliest records of materia medica dates back to the days of Tutancaman i.e., 2000 BC in the West but it go back to Attarvaveda which is probably three to four thousand years old. Vedic medicine was magico-religious, but did not distinguish between medicine and magic. Elsewhere in the Attarvaveda there are hymns that even describe physicians who had a very elaborate pharmacopoeia treating diseases with the drugs. Sushruta divides living objects into two classes; immovable and movable and subdivided them very logically.



The sole aim of Ayurveda is to advice diet, medicine and life style such that, if properly followed a normal healthy person may maintain the balance of the dhatus and one who has lost his, may regain. Treatment is adopted with a view to perpetuate the harmony of the Dhatus. . Daily ablutions, evacuations , cleaning of the teeth and the tongue, rinsing of the mouth, washing the face , application of the salves to the eyes and massaging the body with the oils, oiling the head, ears and soles of the feet, care of the mouth, care of the hair, beard ,and nails ,have all been very carefully looked into.



To be inserted in some other chapter.

In modern medicine there are increasing appeals for a unified holistic approach to integrate the somatic and the psychological features of the patient with his or her medical disorder. However, we still frequently find a disturbing polarization of natural science oriented Vs psycho social science oriented medicine. This division has its roots in the traditional Cartesian division of Res cogitans (thinking substance) and Res extensa (extended or corporeal substance.) - The dualism of subject and object, mind and body. The psychosomatic problems have received much medical attention in the recent times especially in the nuero-sciences. The thoughts presented here, however, originated in physics. If medicine would incorporate the knowledge of modern physics more effectively a large stride forward could be taken to overcome the polarisation and conflicts caused by dualistic thinking. Common thinking in medicine up to now has been based predominantly on the natural science of classical rather than of modern physics, in which quantum theory has an essential role. Neils Bohr and other scientists of the new group of physicists recognised in the twenties and thirties that in modern natural science, because of quantum theory, the distinction between subject and object can no longer be made in all cases. Thorough discussions of new thoughts about the importance of quantum theory with regard to subject object relations have not been presented here. If analysis of the human body continues beyond the level of cells, molecules, and atoms the level of sub atomic structures or elementary particles the old concept does not work. Modern physics assumed that elementary particles can no longer be understood as corporeal structures in the sense of the Cartesian res extensa and res cogitans and could only be described without contradictions as mathematical structures. The physicist Heisenberg even referred to these mathematical structures as being closely related to Plato’s forms. Thus, in modern natural sciences the Cartesian concept of re extensa and res cogitans can no longer be consistantly maintained. Medicine must respond to the developments in its natural scientific base and reshaping its own position with regard to them. The traditional strict division between psychi and soma must be overcome and the unified wholistic approach to the patient should be encouraged.



Back to the original chapter.

The history of medical thought in the West has been a succession of errors in the ascending road of progress. Primitive medical concepts and practices began with the first man on earth and have not entirely disappeared today. 99% of man’s time on earth in excess of one million years ended at about 8000 BC and has been called a Paleolithic period. Surgery of the primitive people had an astonishing degree of technical efficiency. The most ancient instruments were but sharpened stones. Trefining of the skull was carried out among Neolithic people to remove splinters and fragments of fractured skull, for magical purposes to relieve the evil spirits etc. Thus mystic faith and empiric experience based upon seeing and believing were the first attitude adopted by the primitive physician. The ancient civilizations of the Egyptians in the valley of the Nile developed parallel to or perhaps independently of, the civilization in Mesopotamia. The Hellenic culture cannot be separated from the history of philosophy in Greece. The various other aspects of Greek civilization mainly in the cult of Aesculpion tempered medical thoughts.







Arabic medicine.



Prophet Mohammed founded the common wealth of Islam in 622 AD. Turkey had a university founded in 340 AD and in that university medicine flourished and has penetrated to India and China. Medicine of the Orient was also introduced. Avicenna represented the epitome of Arabic culture and learning. He was a physician, philosopher, scientist, and statesman and considered a genius of the caliber of Hippocrates. His canon codified all existing knowledge and was required as textbook at the University of 500 years later. It was translated to Latin. Chinese medicine is said have originated with three legendary Chinese Emperors. Fuhsi, Shennung and Huangti. Fuhsi created the philosophy of the Yang and Yin in nature about 2900 BC Yang was considered to be masculine element representing all positive qualities and Yin was considered to be the feminine element representing all negative qualities. Anatomical studies in Chinese medicine were based on the ideas of philosophy because they thought that the body was sacred and should not be touched. According to the Chinese anatomy the body had five organs to store nourishment. Heart, lung, kidneys, Liver and Spleen and three organs to eliminate the excreta, small intestine, gall bladder and stomach. Each organ corresponds to an element. The circulation was not understood but was considered to be motivated by Yang and to be completed 50 times every 24 hours. Dissection for the first time was mentioned in the Ling Shu around 1000 BC . Clinical diagnosis in Chinese medicine was related to the examination of the pulse. Largely the laws of Yang and Yin regulated medical therapy. Epidemics or small pox were known and patients were inoculated against small pox, yet this treatment is believed to be not Chinese in origin. Surgical therapy in China probably began around 2700 BC with acupuncture. Despite the fact that we have so much of evidence that anatomy was very much advanced in India and where dissection was mandatory, a western text book of medical history records that there was no anatomy and dissection in India at all. Christian medical practice mainly followed the thoughts of Aesculpion and the centre of such Christian civilization was. Byzantium..





References:



1. Rolinson HG (India in European literature and thought) page 36 in the legacy of

India published by the Clarendon Press– 1951.

2. Hopkins EW-Religions of India. Page 559.

3. Friedrich Wilhelm Schmahl and Karl Friedrich Fon Weizsaker, department

Occupational and social medicine, university of Dubingen. D- 72074 Dubingen,

Germany. Cross-references are Schmahl F W et.al. Problems and perspective of

Preventive and social medicine. Schattauer 1990

4.The quantum postulate and the recent development of atomic theory. Nature

1928;121:580-90. Hisenburg W. Physics and Beyond. Harper and Ro Newyork 1971.