The Greatest Benefit to Mankind. Roy Porter

      The monastic rule which governed the lives of Buddhist monks, dedicated to acquiring the ‘peace of mind brought about by the abandonment of desire’, declared that among their meagre belongings should be included five elementary medicines: fresh butter, clarified butter (ghee), oil, honey and molasses. This list expanded in time to embrace a large pharmacopoeia and divers foodstuffs. Archaeological evidence from the fourth century AD shows that some Buddhist monasteries included a sick-room, which may have developed into a more distinct hospital, at around the same time as the emergence of hospitals in the Christian West. Initially, the monks’ healing activities were for fellow brethren, but, as in the West, the monasteries also served the lay community.

      In contrast to the earlier Vedic medicine, which is not at all similar to Ayurveda, there are striking resemblances between these Buddhist texts and later Ayurvedic texts on medicinal herbs and on specific treatments. In terms of origins and influences, the Ayurvedic texts are themselves misleading, since they claim a derivation from the Vedic tradition. The reality is that, while the situation is complex and controversial, they probably developed out of the newer ascetic milieu. Best scholarly opinion today holds that the ascetic communities of the fourth century BC onwards, particularly the Buddhist community, played a vital part in the evolution of Ayurveda.

      AYURVEDIC MEDICINE

      The archetypal system of Indian medicine is called Ayurveda – the knowledge (Sanskrit: veda) needed for longevity (ayus). Ayurvedic teachings amount to a code of life and consist of practical advice concerning all aspects of life, from washing to diet, from exercise to regimen, within a wider Hindu religious philosophy of rebirth, renunciation, and the maintenance of the balance of the soul. Their theoretical foundation lies in the notion of three basic bodily humours (dosas) – wind, bile, and phlegm – which reflect the macrocosmic forces of wind, sun and moon. There are also seven fundamental bodily constituents: chyle, blood, flesh, fat, bone, marrow and semen. The Ayurvedic pharmacopoeia is mainly herbal, prescribing an assortment of therapies including ointments, enemas, douches, massage, sweating and surgery. Though metallic compounds came into medical use from around AD 1000, these remained marginal; opium too was brought in, apparently from Islamic sources, to relieve dysentery. For achieving health, the canonical texts stress temperance in all matters – food, sleep, exercise, sex and medicines themselves. The healthy life is to be consonant with the harmonies of the universe and true religious teachings.

      Written in Sanskrit, the earliest surviving Ayurveda texts date from the early centuries of the Christian era; traditional claims among practitioners that Ayurveda dates back thousands of years are pious. Of the various Sanskrit writings that expound the Ayurveda, the earliest are the Caraka Samhita [Caraka’s Compendium] and the Susruta Samhita [Susruta’s Compendium], supposedly the work of the sages Caraka and Susruta. Very substantial in bulk, they form the cornerstone of Ayurveda. A third early text, the Bhela Samhita, survives only in a single damaged manuscript.

      The Caraka Samhita tradition is connected with north-western India, and in particular the ancient university of Taksasila; the Susruta Samhita was supposedly composed in Benares on the River Ganges. Their original composition date is a matter of speculation: earlier versions may derive from as far back as the time of the Buddha (early fourth century BC). Caraka may date to around AD 100; Susruta to the fourth century. The Sanskrit texts which became canonical represent the works in the form they had attained around AD 1000.

      There are other subsequent prominent Brahminic texts. These include the Astangahrdaya Samhita of Vagbhata (AD C. 600), which includes midwifery, the Rugviniscaya of Madhavakara (AD C. 700), the Sarngadhara Samhita of Sarngadhara (c. fourteenth century AD), and the Bhavaprakasa of Bhavamisra (sixteenth century). Madhavakara’s work broke new ground through rearranging medical topics according to pathological categories, thereby establishing the model of thematic grouping followed by almost all later works. Sarngadhara was the first Sanskrit author to introduce new foreign elements, including opium and metallic compounds, into the materia medica, and the use of pulse lore in diagnosis and prognosis.

      The Caraka Samhita and the Susruta Samhita stem from a common intellectual tradition. The Caraka Samhita is marked by long reflective and philosophical passages, including discussions of causality and so forth. The Susruta Samhita for its part contains extensive descriptions of sophisticated surgical techniques: eye operations, plastic surgery, etc., which do not appear in the Caraka Samhita at all or only in less detail. Both are huge compendia of medical teachings on subjects such as a balanced diet; the powers of plants and vegetables; the causes and symptoms of various maladies; epidemic diseases; the right techniques for examining patients; the parts of the body; conception, pregnancy and the way to take care of foetuses; diagnosis and prognosis; stimulants and aphrodisiacs; the nature and treatment of fever, heated blood, swellings, urinary and skin disorders, consumption, insanity, epilepsy, dropsy, piles, asthma, coughs and hiccups and scores of other conditions; cupping, blood-letting, the use of leeches, and many other treatments; the right use of alcohol; the properties of vegetables, nuts, and other materia medica; the use of enemas – and all alongside incantations, omens and fears of sorcery.

      The medicines described in the Caraka Samhita and the Susruta Samhita comprise a rich menu of animal, vegetable, and mineral substances. For dealing with the 200 diseases and 150 other conditions mentioned, the Caraka Samhita refers to 177 materials of animal derivation, including snake dung, the milk, flesh, fat, blood, dung, or urine of such animals as the horse, goat, elephant, camel, cow and sheep, the eggs of the sparrow, pea-hen and crocodile, beeswax and honey, and various soups; 341 items of vegetable origin (seeds, flowers, fruit, tree-bark and leaves), and 64 substances of mineral origin (assorted gems, gold, silver, copper, salt, clay, tin, lead and sulphur). The use of dung and urine are standard; since the cow is a holy animal to orthodox Hindus, all its products are purifying. Cow dung was judged to possess disinfectant properties and was prescribed for external use, including fumigation; urine was to be applied externally in many recipes.

      The Caraka Samhita praises the virtuous healer: ‘Everyone admires a twice-born [brahmin] physician who is courteous, wise, self-disciplined, and a master of his subject. He is like a guru, a master of life itself.’ Quacks, by contrast, are roundly condemned: ‘As soon as they hear someone is ill, they descend on him and in his hearing speak loudly of their medical expertise.’ In respect of the true physician, the Caraka Samhita tenders an Oath of Initiation, comparable to the Hippocratic Oath. A pupil in Ayurvedic medicine had to vow to be celibate, to speak the truth, to adhere to a vegetarian diet, to be free of envy, and never to carry weapons. He was to obey his master and pledge himself to the relief of his patients, never abandoning or taking sexual advantage of them. He was not to treat enemies of the king or wicked people, and had to desist from treating women unattended by their husbands or guardians. The student had to visit the patient’s home properly chaperoned, and respect the confidentiality of all privileged information pertaining to the patient and his or her household.

      The diagnostic and therapeutic aspects of Ayurveda depended on knowledge of the canonical Sanskrit texts. The good physician (vaidya) memorized material consisting largely of verses which specified the correlations between the three humours (wind, bile and phlegm), and the various symptoms, complaints and treatments. He conducted an examination of his patient which took into account the symptoms, in the process recalling verses applicable to the patient’s condition. These would trigger remembrance of further verses containing the same combinations of humoral references, all of which would lead to a prognosis and a proposed therapy.

      The Ayurvedic schemes of substances, qualities and actions offered the vaidya an effective combination of solid learned structure and freedom to act. The practice of Ayurveda depended heavily upon oral traditions, passed down from master to pupil, in which a huge magazine of memorized textual material was recreated to fit particular circumstances, while remaining faithful to the fundamental meaning of the text. (The role of precedent within English Common Law offers a parallel.)

      The Susruta Samhita is distinctive for its wide-ranging section on surgery, which