Written by Sebastian Pole
âAyurveda is declared to be eternal, because it has no beginning, because it deals with such things that are inherent in nature and because the nature of matter is eternal. For at no time was there a break either in the continuity of life or in the continuity of intelligenceâ
Charaka Samhita: Sutrasthana 30.29
Historical timetable of Ayurveda
1500 BCE (Before the Common Era) Vedic religion Rg, Yajur, Sama & Atharva Vedas: 125 herbal medicines mentioned in Atharva Veda.
c600 BCE Rise of heterodox traditions of Jainism, Buddhism. Also growth of what is now called Hinduism. Ayurveda as a codified system of medicine is also thought to have appeared at this time.
150 BCE-100CE Charaka Samhita: The earliest complete Ayurvedic treatise. Herbs are here classified by action and morphology. Again reformatted by Drdhabala circa 400CE.
c100-500 CE Sushruta Samhita: Detailed surgical text. Bhela Samhita.
500CE Dhanvantri Niganthu: An early compilation of herbs into certain functional groups based on the property of the herbs.
c600 CE Ashtanga Hridaya Samhita by Vagbhatta:A collated work on the essence of Ayurveda.
c650-950 CE Madhava Nidana (aka Rogavinishchaya): The first text committed solely to pathology.
C875 CE Siddhayoga by Vrinda: Early alchemical text.
900-1400 CE Goraksha Samhita: Early hatha yoga text where many Ayurvedic concepts are fused with tantric yogic practice.
1075 CE Chikitsasangraha/ Chakradatta by Chakrapani: Professional Ayurvedic handbook of the medieval era.
1100 CE Dravyagunasangraha. The first Nigantu written by Chakrapani.
c1300 CE Anandakada: An early alchemical treatise.
1374 CE Madanphal Nigantu: A further compilation of herbs and minerals.
1300-1400 CE Sharngadhara Samhita: collected work on Ayurvedic formulas and preparations. First record of pulse taking as a diagnostic method. A pivotal work linking early Ayurvedic thought with new Tantric alchemical techniques.
1449/50 CE Lakshmanotsva: A text describing pulse taking.
1474-1538 CE Jvaratimirabhaskara of Camunda. The first mention of ashtasthanapariksha, the eight methods of diagnosis (pulse, tongue, urine, eyes, face, faeces, voice and skin).
1596 CE Bhavaprakash Nighantu by Bhavamishra: The most important Ayurvedic materia medica treatise.
c1600 CE Ayurvedasutra. A text mixing Ayurvedic, yogic and tantric thought.
C1600 CE Rasaratnsamuccaya. A pivotal alchemical text compiling much earlier thought and theory.
1676 CE Yogaratnakara. A pivotal work reflecting the assimilative trait of Unani and European influences on Ayurveda.
1760 CE Rajvallabh Nighantu: Progressive materia medica.
1815 CE Sangrah Nigantu.
1893 Bhashajya Ratnavali: Govindadasaâs work listing numerous medical preparations and introducing different European diseases.
c1900 CE Nadiprakashan: Shankara Sen.
1924 CE Nighantu Ratnakar.
Ayurveda in context
This chapter gives a broad overview of ancient Indian culture and Ayurvedic history. It discusses some of the original concepts that developed out of this ancient culture that have had such a profound influence on Ayurveda. Modern Indian culture appears to be a unified tradition and many sources claim that it has always been so, but as you search deeper you find layers of different cultural influences woven together. For example, it appears today that Ayurveda and Yoga have always been a part of the same system but historical and textual evidence does not back this up. They may now be inextricably linked and even work very well together but, as we shall see, this link has not always been in place. I think that it is an error to claim that they have always been a part of the same system. Some authors and promoters of Ayurveda today claim that Ayurveda has always been a part of mainstream Indian culture. This also is not the case. Actually the one continual thread in Indian culture is the trait of absorption, cohesiveness and collection of ideas within mainstream Indian culture. This integrative tendency of absorbing diverse cultural elements is a recurrent theme throughout Indian history. And so it is with Ayurveda which is the result of assimilating different cultural strands and medical insights.
Culturally speaking, in India there was a competitive atmosphere between an orthodox religious tradition and a heterodox religious tradition. As everything in India had a relationship with religion Ayurveda has developed within this cultural friction. Early in Ayurvedaâs evolution there was tension between the superiority of ritual practices verses the scientific use of herbs. Which was the most effective medicine, ritual or science, the past tradition or new experience? The Ayurveda practised today is a result of this development in a paradoxically conservative yet progressive culture. These cultural tensions are clearly expressed in the texts as well as experienced in the clinic. Modern Ayurveda is also the result of scientific research into and experience of nature. The defining context is that Ayurveda is a medical tradition steeped in religious tradition as well as natural medicine and it is based on both tradition and experience.
How Ayurvedic tradition becomes a system of empirical medicine
Any history of Ayurvedic development requires discussing two different perspectives; a linear religo-historical approach and a circular organic expansion.
- The first perceives Ayurveda as a timeless system of medicine where its knowledge is perfect and divinely inspired.
- The second view is that Ayurvedic medical knowledge has developed out of ritualistic healing into an empirical medicine system that is grounded in clinical experience.
The introductory verses of Ayurvedic texts reflect the perspective that Ayurveda is an eternal revelation. They all start with a mythological account of the gods passing Ayurvedic knowledge down to humans. This divine stamp is a well-known Indian method of authenticating a text and making it orthodox (2). It is a way of bringing formerly untraditional and perhaps unaccepted ideas within mainstream culture. Much of the secondary and modern Ayurvedic literature also implies a consistent tradition that is divinely inspired and eternal (3). But, as you unweave the web of influences that have affected Ayurveda the evidence clearly reveals an expanding tradition that accumulates knowledge over time and through experience. This latter organic perspective holds that Ayurveda is a science of unfolding truth and as a path of discovery it has not and will not remain static (4). These developments are not necessarily mutually exclusive, but it is useful to understand where different Ayurvedic traits have come from.
The concept of a timeless tradition has great appeal, for the insights of Ayurveda are incredible and they do appear to be divinely inspired. How else have we learnt about the properties of so many herbs and minerals? How was it discovered, for example, that Brahmi (Bacopa monieri) is so effective at improving the intellect and Guggulu (Commiphora mukul) so useful at reducing tumours? How did the pioneers of Ayurveda learn to diagnose illness with only the five senses at their disposal? Having said this, the idea of human knowledge growing through experience, logic and insight has great value. Human development is firmly grounded in endeavour. For Indian minds this duality causes no conflict as Ayurveda can be two things at the same time: both divinely inspired and open to human adaptation. This is a powerful medium for expression of the truth as it is both reductionist and holistic.
Taking the first paradigm, whilst there is nothing inherently wrong with the claim of eternal divine origins there are some potential problems with this perspective. It could potentially stifle new ideas within Ayurveda as, in order to gain validity, there is a tendency for clinical experience to be referenced back to a divine eternal source. Humble that this approach is, new ideas are not easily propagated. There is an element of this attitude displayed by the core theoretical ground of Ayurveda remaining very similar over the last two thousand years. The relative lack of modern innovative Ayurvedic literature generating improved methods of treatment, in comparison to Chinese and Western herbal medicine, is perhaps partially a result of this. It may be that the inherent theories of Ayurveda are already complete, but effective clinical insights are always of benefit as new diseases and cultural habits arise. The insistence on divine origins has stagnated this process of valuing both clinical experience and theory.
It is not therefore surprising that as Ayurveda has recently (last 400 years) been under continual threat from certain Moghul, British and currently allopathic forces it developed a complex that has, in some quarters, meant that it felt the need to fall back on its ancient roots in order to validate and justify its presence. This has protected but also weakened Ayurveda. Her strength is really in her present clinical excellence and the Ayurvedic community should be harnessing powerful social forces and speaking with confidence about its ability to help our society. Albeit, this is made more difficult when Ayurveda is presently only recognised an adjunctive medical system where Ayurvedic doctors can only hold the position of a third medical officer at Primary Health Centres in India and complementary medicine the world over holds a similarly lowly position in the medical hierarchy. As a literature base of over 2,000 years, hundreds of thousands of expert physicians, millions of healed patients and numerous positive clinical trials attest to Ayurvedic treatment works and practitioners and professional registers should promote this, researchers should professionally publish clinical data and governments should enthusiastically support it. The past is where we have come from but the present is where we live. Ayurveda and Ayurvedic physicians deserve greater recognition than they receive today.
Another, and potentially more serious problem of relying on a doctrine that holds its origins as divinely and infallibly inspired is that it can and has resulted in right wing fundamental political doctrines utilising them to their own end. This is clearly the case in India today with the current rise in popularity of right wing fundamental Hindu groups and shows how the struggle for political supremacy can infect religion (and vica versa). If this insistence of the divine origins of Ayurveda ignores modern Indological historical knowledge then this attitude, wittingly or unwittingly, may reinforce this political doctrine. By this, I refer to certain quarters of the academic community promoting this ideology as though Vedic knowledge has remained eternally and statically predominant in all aspects of Indian culture for all time. The point is that whilst religion, medicine and politics are interrelated, caution must remain ever present when it comes to understanding the potential repercussions of ones ideology. In this case, pandering to extreme political causes that actually oppose the central tenets of Ayurveda: caring for all humanity.
Now moving to the second paradigm. In contrast to the belief in a divine past, the scientific dependence on empirical evidence can also be taken too far to the extreme with similar detriment. This has occurred within the modern medical paradigm of âevidence-based medicineâ requiring ethically dubious double-blind clinical trials and animal experiments with a heavy dependence on single active ingredients, synthesised medicines, separate chemical pathways and a reductionist methodology that has lost the holistic view.
Holding onto the primacy of either of these two paradigms means that the complete picture is missed. As we shall see, Ayurveda can offer a balance to these extremes as it contains both paradigms within it.
I think this inner debate between tradition and progression is mirrored in our everyday lives and specifically experienced when using natural medicine. It is a part of the question of how to respect your tradition whilst still integrating your personal experience. Internally it is a case of communication between heart and head where intuition and intellect are both valid. As we shall see, intuition and intellect are both essential for medicine to be, as Ayurveda is, truly holistic.
What is Ayurveda?
The term Ayurveda is used today as a generic term for traditional Indian medicine. Through combining organoleptic (sense based) empirical medicine with religious ritual perspectives, Ayurveda really is a complete medical system. It deals with health in all its aspects; physical health, mental balance, spiritual well-being, social welfare, environmental considerations, dietary and lifestyle habits, daily living trends, seasonal variations in lifestyle as well as treating and managing specific diseases. Ayurveda teaches respect for nature, appreciation of life and the means to empower the individual. It is holistic medicine at its best.
Indian culture and medicine before Ayurveda
To see the world from which Ayurveda developed cast your mind back 4000 years. Ayurveda is not yet established. Imagine a people living close to the cycles of nature. It is an agrarian society dependant on the abundance of the harvest and the bounty of water for its survival. It is also a world in which the people are subjected to the full force of the power of nature; the torrents of rain and the fierce heat of the sun as well as the reassurance of Spring returning and the joy of reaping a mature harvest. It is a society thriving along the banks of the river Indus. Subservience to the power that controls these natural extremes is at the centre of everyday life.
It is a religious world full of rituals. Regular fire sacrifices are carried out to supplicate the deities upon whose favour the world depends. Ritual performance is as central to maintaining health as eating enough food. Both are needed to live and flourish. To treat disease, herbs and potions are used alongside the incantations of the priests. In fact the priests are both doctors and religious specialists. Disease in these warm and humid climes spreads fast. Fear of illness and of the death of loved ones is an everyday reality. According to this belief system disease could be imposed from the spiritual world, from an accident or from the natural world. Here is the world in which the eternal tradition and the empirical experience of everyday life meet and intermingle.
It was out of such a cultural context that Ayurveda developed. Here was a fast changing society that was exploring its ideals of religion, royalty, leadership, law, medicine and family. Philosophical insight expanded as agrarian culture flourished. This is now known as the Vedic period (c15000-500BCE) (5).
The orthodox and heterodox traditions
With hindsight we can see that an orthodox religious tradition (astika darsana) and a heterodox religious tradition (nastika darsana) developed out of this milieu. In Indological terms âorthodoxâ means adhering to the Vedas and âheterodoxâ means not following the Vedas (like the Buddhists). The Vedas, includingthe Rg, Sama, Yajur and Atharva Vedas are the receptacles of traditional wisdom whose oral tradition goes back at least 4000 years. They codify ritual hymns, sacrificial rules, poetic metres and medical incantations. As we will see, Indian medicine faced many challenges to become a part of the orthodox culture.
Vedic medicine and the origins of Ayurveda
It is very difficult to place the exact origins of Ayurveda. Our first meeting with Ayurveda proper in a fully coherent and documented format is in the texts of Charaka, Sushruta and Bhela (150BCE-500CE). These texts were clearly codified long after Ayurveda was fully established and was thriving as an oral tradition. An earlier text is known to have been compiled by Agnivesha, the Agnivesha Samhita, but it no longer exists although the Charaka Samhita is said to be a revised edition of this work. There are of course medical facts found in earlier texts but they are not classical Ayurveda with dosha, dhatu and mala at the heart of their teaching.
Prior to this codification of Ayurveda as a complete medical system it seems as though two patterns emerged as Indian medicine developed. One represented the worship of and subordination to the supernatural forces whilst the other pattern was the development of ideas based purely on empirical experience. Two concurrent and interlinked medical traditions appeared from within the Vedic literature:
- Firstly there was the orthodox Vedic tradition full of elaborate religious rituals dedicated to the powerful nature divinities; Surya, the Sun god, Agni, the Lord of Fire, Indra, the Lord of Heaven and Thunderstorms. This was the ritual tradition where the gods were appeased through prayer, chanting, amulets and ritual offerings. These were also the healing tools used to treat disease.
- Secondly there was the heterodox tradition that was outside this ritual fold and was based on the direct experience of medical physicians where herbs, minerals and surgery were the healing tools.
These patterns were like two rivers running through the same Vedic land that later converged to form Ayurveda.
An example of these two patterns and how they were connected can be found in an ancient Vedic prayer. It includes both the ritual and the experiential approach where the priest-doctor is praying to the plant and the disease:
âHe through whom you plants creep limb by limb, joint by joint, you banish disease from him like a huge man coming between fighters. Fly away disease along with the blue jay; disappear with the howl of the wind, with the rain stormâ (6)
Here the invocator is both priest and doctor. Both the prayer and plant seem to play the same healing role.
Imagine the priest-doctor standing by the side of a patient racked with fever. The room is full of the heady smell of incense. The priest-doctor is chanting and praying. The smells and sounds waft towards the delirious patient. The priest-doctorâs incantation is directed at the healing of the bedridden patient. He is also preparing a medicinal brew of special herbs that are empirically known to cure fever. Whilst feeding the infusion to the patient he is also praying to the gods that the herbs cure the patient. This is ritual medicine; prayer, invocation, sound, smell and intention. It is intermingled with the empirical human based medicine as well as specific disease-based herbal knowledge.
Medicine falls out of favour with the orthodox
But this harmony was short lived and the role of the priest as doctor changed. At some time after the Atharva Vedic period (c1000BCE), medical practice fell out with religious ritual practice. The medical experience and perhaps clinical results of the physician started to supersede the authority of the priest and thus the priest became superfluous to the healing rite as it then was. The so called priest-doctor occupation divided into two roles to become individual priest and doctor. The dependance on the priest for maintaining the cosmic and social well-being guaranteed their position at the top of the social ladder. The doctorâs ideas and methods were pushed away from the centre to the outside. There was an evident paradigm shift from religious supernatural medicine being the modus operandi to a scientific observation based practice being the primary medical model. There were social, and cultural reasons for this as well as empirical.
It must be remembered that Indian society was strictly class based, dependent on a caste system with a clear division of labour and with rank determined by birth. It was a society governed by a system of ritual purity that was loosely governed by physical contact with people, wastes, food and water. Any transgression of the rules caused pollution and led to a state of ritual impurity, and this was a terrible place to be in as it meant that you could not experience Vedic healing rites and authority. As the higher priestly caste sought to enforce their identity as the holders of ritual power and this ritual purity became a more rigid definition of caste hierarchy it started to cause problems for the medical profession.
Because of the requirements of their job, physicians touched people from any caste, performed surgery and came into contact with bodily fluids. The higher castes started to consider them to be extremely polluted. Physicians were finally excluded from the soma sacrifice (an essential religious rite) and not recognised in the social hierarchy (7). The Manu Smrti, a text codifying Hindu custom, was positively aggressive in its exclusion of the physician from the sacrifices and asserted that food accepted from a physician was like âpus and bloodâ (8). Physicians were definitely out of favour and out of the orthodox fold. They were still doctors but, at this point, not included within the central social hierarchy.
Around this time (1000-600 BCE) Vedic religion moved into a further period of transformation as the authority of the priests was called into question. The growth in the influence of the wandering ascetic (parivrajaka) tradition, the Upanisadic awareness of the possibility of liberation from the perpetual cycles of birth and rebirth, and a growing disillusionment with the excessively elaborate Vedic ritual sacrifices led to branches of knowledge splintering from Vedic practice. These movements resulted in the growth of Jainism, Buddhism and Hinduism. These were dynamic and progressive traditions not content to rest on the conventions of the past. They sought explanations about life and the universe through direct experience, and especially through knowledge of nature and the self. This had a profound influence on the developments within Ayurveda by establishing its growth in the bed of empiricism and its acceptance by the orthodox. It is at about this time that Ayurveda as a complete medical system became codified.
Empirical medicine
Much of the evidence at this time points to the fact that the empirical based medical science of Ayurveda and the Indian ascetical tradition both grew up outside the orthodox religious hierarchy. Beyond the confines of ritual and convention, physicians explored the energetics of the natural world; the taste (rasa), energy (virya) andthe specific action (prabhava) of plants and minerals. Meanwhile the ascetics explored the inner realms of consciousness; the layers of the mind (buddhi, manas, citta), energy centres (cakra) and supernatural powers (siddhi). These two traditions met in the heterodox realm as they were united by their separation from the mainstream culture. It seems evident that early ascetics used plant medicine and possibly were amongst some of the pioneers of Ayurveda (9). Later however, these new developments were absorbed into mainstream culture as Ayurvedic physicians and ascetic yogis became accepted by the orthodox traditions (10).
Despite being heavily influenced by Buddhism, Ayurvedaâs primary reference point for the last 2500 years has been Hinduism (11). They have evolved within the same cultural framework. To summarise Hinduismâs worldview, orthodox Hindu culture perceives reality as an existence in which the nature of the Self (atman) is obscured by a veil of ignorance (avidya). Individuals are destined to play out the effects of their karma in a perpetual cycle of rebirths. Karma, the causal relationship that effects every action, has a reaction; the results of previous actions determine our present condition and, in effect, âtrapâ the Self in this physical world. This is seen as pure suffering. But, âfrom torment by three-fold misery (endogenous, exogenous and supernatural) arises the inquiry into the means of terminating itâ (12). Hence developed the purpose of finding a way out of this misery. In order to fulfill this purpose of life, to be liberated from ensnarement, the orthodox Hindu must pursue the four ends of life; these are wealth (artha), sensual fulfillment (kama), religious observances (dharma), and liberation (moksa). To ensure that these ends can be achieved Ayurveda embraces the health (arogya) of the body as its main aim.
Ayurveda absorbed by the orthodox culture
What is now known as Ayurveda is the blending of a tradition that has contained elements of purely ritual medicine as well as empirical practice. Ayurveda becomes Ayurveda âproperâ through its association with the respected philosophical systems of Nyaya-Vaisesika, Samkhya-Yoga and to a lesser extent with Vedanta-Mimamsa. The Nyaya-Vaisesika philosophy is concerned with perspectives of logic and analysis, Samkhya is an ontological system that deals with the metaphysical nature of being, Yoga with the soteriological methods to attain liberation, Mimamsa with the knowledge of Vedic rituals and Vedanta deals with the esoteric nature of reality and its expression as an experience of both unity and duality or what is known as ânon-dualâ.
Ayurveda has the classical philosophies of Indian culture at the root of its principles. These philosophies infuse Ayurveda with a solid theoretical structure that shape its practical framework; the ideas behind the development of matter (prakriti), the formation of the five elements (panchmahabhuta), how consciousness (purusha) pervades reality and the various methods of gaining knowledge (pramana), so essential to diagnosis, are all found in the Indian philosophical tradition (sat darshana). In fact Ayurveda is an embodiment of these philosophies; it makes the theory real. Its codification in Sanskrit in the Charaka and Sushrita Samhitas confirms its absorption by conventional tradition.
The philosophical view of Ayurveda is infused with this culture of attempting to understand reality. Poignant throughout later and more classical Indian philosophy is the theory of duality propounded through the Upanishads and Vedanta philosophy. What we perceive as reality is really just an illusion or maya. We experience reality as separate from ourselves and it is our ego nature that causes this duality. This representation of duality is seen in the mythology of shiva and shakti, the two poles of masculine and feminine energy that together hold all the opposites of life together. Our self identity fragments this unconditional unity of Brahman into segmented parts. Hence we feel separate from the whole and as a result lead a life in self-perpetuating ignorance that results in us accruing numerous karmic bonds that tie us to endless lives of rebirth in the wheel of life, known as samsara. Taking steps to alter this world view and âunifyâ our individual consciousness with the universal consciousness is the goal of all Indian philosophical systems. They offer the path to enlightenment and the means to get there.
This experience of undivisible unity is meditated on as âtat tvam asiâ meaning âthat art thouâ. It cannot be described as it is âneti, netiâ or ânot this, not thatâ.
The Isha Upanishad says
âIt moves, It moves not,
It is far and It is near.
It is within all this,
And it is outside all of thisâ.
The result is a tension between the individual experience and the ritual experience, between individual consciousness and social hierarchy. The journey through Indian philosophical literature mirrors our own journey through our perception of our experiences; a deep search for truth, peace of mind and undivided bliss.
The struggle between tradition and innovation in Ayurveda
This tension that occurred in a broad sense within Indian culture also occurred in the development of Ayurveda as a whole. This is shown in the earliest extant sources of Ayurvedic theory and practice, the Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya Samhita. Their content clearly displays the continual efforts to assimilate empirical experience within the divinely revealed Vedic tradition. This creates theoretical tension as well as confusion over some Ayurvedic principles.
For example, the Charaka Samhita starts with revered salutations to the divine propounders of Ayurveda, Lord Brahma, the Asvins and Lord Indra. The tradition says that when Brahma awoke to create the universe he also generated the wisdom that is Ayurveda. He passed this onto Lord Draksha-Prajapati (the protector) who then taught it to the Ashvin twins (the physicians to the Gods) who taught it to Lord Indra (the Lord of the universe). When human suffering had become so unbearable Lord Indra met with the great Himalayan sages and through his student Bharadvaja passed this knowledge onto these enlightened beings. Hence the great student Agnivesha came to study Ayurveda, under Atreya, and eventually compile this wisdom in the now lost Agnivesha Samhita that is said to be contained in the Charaka Samhita.This marks Ayurvedaâs claim to divine origins and its connection to an eternal tradition for, as we know, all Indian traditions that have sought recognition by the orthodox have invoked the authority of the Vedic deities as an expression of their allegiance.
But as you compare it with the other texts clear inconsistencies in this premise arise.Divergent theoretical opinions appear, thus disqualifying this attempt at seeking an eternal and divine foundation. For example, Charaka and Sushruta (13) differ in their opinions of the post-digestive effect of the flavours (see chapter three on Ayurvedic pharmacology). Sushruta only lists sweet and pungent as the flavours that remain after the process of digestion whereas Charaka also includes sour. There were also differences in the understanding of human physiology; were there three or four humours (dosha)? Is blood actually a dosha or not? (14) Another example is the discussion over the energetic nature (virya) of herbs; are there two primary energetic classifications of herbs or eight? Is it just hot and cold or hot-cold, unctuous-dry, heavy-.light and soft-sharp? The texts seem to differ (15).
This is the difficulty in determining the meaning of the texts: on one hand they are divinely inspired knowledge and on the other they are evolving human debates that are seeking to unravel the nature of nature and develop a medical system that is accurate and effective. What emerges later is a collective opinion drawn together by commentators and practitioners.
Ayurveda and Yoga
The development of Ayurveda continued alongside the growth of the mystical tantric and yogic traditions, each fulfilling their different roles. Whilst Ayurveda concentrated on the âhealthâ of the body, yoga was mindful of the state of âconsciousnessâ and tantra with the deification and immortality of the body. Yoga is a tradition of mental and spiritual refinement; the art of joining your individual-self (atman) with the universal-self (Brahman). It rejects the first three goals of Hinduism (wealth, sensual pleasure and religious duties) in preference of seeking the ultimate goal of life, spiritual emancipation (moksa).
As with many Indian traditions, philosophical differences were often overcome by a broadening of perspective on either side. Hathayoga, growing out of the tantric yogic tradition, seems to have adopted many Ayurvedic principles, notably the âpurificationâ of the body. The hathayoga pradipika is full of references to the dosha and techniques to remove phlegm, bile or the winds (16). With hathayoga becoming filled with Ayurvedic practices and Ayurveda adopting yogic attitudes the two traditions connected. The body became a priority in order to attain the goals of liberation and health. Yoga, after centuries of interest in the mind and self, became fascinated with the body. Hathayoga adopted an Ayurvedic language, as well as similar practices, to facilitate this new focus on the body. There is a very close similarity, in activity and intention, between the cleansing practices of the yogic shatkarma and the purification of Ayurvedic panch karma. This movement from yogic spiritual practice to physical purification of the body has been significantly termed âcorporealisationâ (17). The body, as it became the terrain of spiritual experience, became the focus of spiritual interest.
Ayurveda also adopted insights from this yogic realm. It began to incorporate the tantric practice of using various mineral substances (notably mercury, gold and silver) and re-emphasised its objectives from merely maintaining a long and healthy life to that of virilisation (vajikarana) and rejuvenation (rasayana), which is, potentially, immortality. These concepts essentially oppose the mortification of the body and seek a long life filled with rejuvenative potential. Thanks to these yogic influences the body is no longer considered to be mortal! Today Ayurveda and Yoga are practically synonymous in the pursuit of good health and a calm mind.
Here we can see that Ayurveda continued to display the wonderful Indian trait of absorbing everything around it, even if that meant broadening and modifying its own perspectives.
Modern times
Modern day Ayurveda, as practised in India today, is based on a resurgence that occurred around the 17th century. The causes are varied. One may be the increased competition that Ayurveda faced by the coming of the Moghuls and the rise in use of Unani medicine. Another may be the new energy Ayurveda felt from the synthesis that occurred between Ayurveda and yogic-tantric thought. Two fundamental new techniques that arose from this synthesis were the introduction of pulse diagnosis and the use of new mineral remedies. They are both central to the practice of contemporary Ayurveda. Pulse taking seems to have arisen from the Shaiva yogic tradition that thrived in South India under the guidance of the Tamil Siddhas. It later arose in North India with such works as the Sharangadhara Samhita, Nadivijnana  and Nadichakra adding to this theoretical base (18). The Unani hakimâs were also useful teachers in the art of pulse taking. The mineral remedies (mercury, gold, silver ashes) are very potent and revolutionised the Ayurvedic pharmacopoeia. These additional techniques greatly enhanced the efficacy of Ayurveda and this gave impetus to its resurgence.
The 19th and 20th centuries saw a further revival with the building of new Ayurvedic colleges (approximately 100 in 1983), the creation of the Central Council for Ayurveda in 1970 to overseeing standards and practice and the establishment of Ayurvedic pharmaceutical companies. Its patronage by the Indian government now gives it some form of nationally recognised status but this really needs to be more proactive and supportive. The 21st century really is a time of challenges and opportunities for Ayurveda. As Ayurveda spreads throughout the world it is facing many challenges to the traditional way in which it has been practised. There are legislative, environmental, educational, clinical and culturally based challenges that are stirring the winds of the Ayurvedic community. It really is a time to act or be acted upon, meaning that the Ayurvedic community must unite and speak up to express its needs or will face legislation on which it has had no influence.
The reason the global Ayurvedic community is facing many challenges is due to;
- Political patronage: The fact that Ayurveda is considered a second rate medical system by the Indian authorities with a poor professional standing given to Ayurvedic doctors. This results in a weak image projected from its native country to the rest of the world and does not send a supportive message to other national governments looking to India for guidance.
- Cultural: The fact that Ayurveda contains cultural traditions that differ to the rest of the world potentially causing conflict when they mix with other cultures with different agendas. The complexities of defining how Ayurveda should be taught and practised outside India reflect this..
- Scientific: The competition between western science and the traditional medical paradigm practised by Ayurveda. The lack of evidence based research and clinical trials is hindering its acceptance by mainstream medical institutions and practitioners. Whilst there are many respectable research institutes in India many of the clinical trials that are carried out are not available in easily accessible journals and some do not meet rigorous research standards.
- Conservation: A lack of environmental awareness amongst Ayurvedic practitioners about the pressures that harvesting herbal medicines from the wild is placing on herbal supplies.
- Legislative: Increased popularity of herbal medicine throughout the world resulting in fears about safety issues which is leading to further herbal legislation regulating the prescription and sale of herbal remedies.
Some examples of this are:
- The legislative threats to the use of certain medicinals such as Vidanga (Embelia ribes) being banned for use in the UK. The illegality of using many bhasmas (oxidised metallic and mineral preparations) that are often considered to be the mainstay of internal treatments is another challenge.
- The environmental pressures on many species used in Ayurvedic remedies is serious. For example, Chandan (Santalum album) and Kushta (Saussurea lappa) face increased demand on the domestic and international markets whilst natural populations dwindle.
- There are also pressures on the educational front as different countries define in law how Complementary and Alternative Medicine (CAM) as a whole can be practised.
How Ayurveda meets these challenges will steer its fate in the future.
The primary Ayurvedic texts and treatise on medicinal substances (Dravyaguna shastra)
The central works of Ayurveda, The Great Triad (brihad trayi), includes Charaka Samhita, Sushruta Samhita and Ashtanga Hridaya Samhita, The Lesser Triad (laghu trayi) includes the Madhava Nidana, Sharangadhara Samhita and the Bhavaprakasha Nighantu (or Yoga Ratnakar according to some authorities). The growth of the Ayurvedic materia medica is clearly displayed in these texts. The increase of âalchemicalâ medicine and developments in chemistry are included from the 12th century onwards with the introduction of Rasa Shastra, or alchemical literature, in such texts as Anandakanda, Rasaratnasamuccaya and Ayurvedaprakasha. From here onwards metals, gems and mercurial medicines are included in the Ayurvedic pharmacopoeia.
One of the difficulties facing Ayurvedic pharmacology today is the botanical identities of many of the Sanskrit named plants. Many are lost to history. The translation of their Sanskrit name gives a tantalising indication of their potential. For example, jivaka, âthe life giverâ, still remains unidentified. The precise identification of many Ayurvedic plants has been a source of continual frustration, debate and botanical challenge. Having said this many do remain in the herbalistâs realm. Although the Vedas mention around 260 plants (19) the first insights to the Ayurvedic pharmacopoeia are found in the Charaka Samhita. Here we find the beginning of a pharmacopoeial trend of collating substances (dravyas) into specific classes; herbs, cereals, liquids, fruits, metals, gems, vegetables, meats, cow products, flowers, salts, oils, alcohols, sugarcanes, sources of water and urine.
In the Charaka Samhita herbs are classified into fifty groups (varga) of ten according to their primary actions (20). For example, herbs that are jeevaniya or life-giving include the well known Licorice or madhuka (Glycyrrhiza glabra) and the group that is brmhaniya or strength promoting includes Ashwagandha (Withania somnifera).
Sushruta has also classified herbs according to groups with specific actions (21). But instead of being titled with a specific action they are named after the most representative herb. For example, the pippalyadi varga (meaning âthe pippali etc groupâ) describes the group of herbs that have a similar action to pippali or Long Pepper (Piper longum). This is a digestive, warming, carminative group of herbs that also includes Black Pepper, Cardamom, Asafoetida and Calamus. Interestingly, there are also groups of herbs classed together because of their cleansing (shodhana) effects: emetics, purgatives and vata pacifying herbs.
The Ashtanga Hridaya Samhita also looks at groups of foods and herbs. For example it mentions five types of liquids; water, milks, oils, sugarcanes and alcoholic drinks. The Ashtanga Hridaya Samhita follows the herbal classification of Sushruta by grouping the substances according specific actions.
Sanskrit plant names are sometimes used to generically cover various botanical species. Whilst the Latin nomenculture that I have used in this book to define the equivalent for the Sanskrit name is based on the works of numerous scholars, common clinical practice and accepted norms it cannot represent hard and fast scientific certainty. The discovery of the Ayurvedic pharmacopoeia is a work in progress that shall continue for many years to come.
Later texts consolidated this trend of classifying groups of herbs based on their action. Again the group title is usually named after the herb that is renowned for that groupâs primary action. The Dhanvantri nighantu (c500CE) lists the first group as guduchyadi vargaâ or the âTinospora cordifolia etcetera groupâ. All the herbs in the group have the dual action of removing the aggravated dosha from the body as well as rejuvenating the system, just as guduchi removes pitta as well as rejuvenating the blood and reproductive fluids.
The Bhavaprakasha is the most commonly used materia medica today. Written by Bhavamishra around the 16th century it is a compilation of many earlier texts. The Bhavaprakasha lays out the rules and guidelines for collecting herbal materials and understanding the language of the pharmacopoeia. For example, âwhen there is no mention of the part of the plant to be used, the root is to be usedâ. There are some wonderful descriptions of how to identify herbs, how to collect the fresh plants and what the ideal growing conditions are. Specific pointers to quality are mentioned; â Haritaki (Terminalia chebula) which has a small seed inside, more fruit and which sinks in water is considered the best form for all purposesâ. It includes a very useful section on what to replace an unobtainable herb with; âIn the absence of tagara (Valeriana wallichi) kushta (Saussurea lappa) should be used by the wise physicianâ. The text is also full of invaluable insights into the nature of the tastes, gunas and pharmacological properties of the herbs. There are twenty four groups of herbs and minerals listed in the Bhavaprakasha and it is actually very systematic as only the herbs that should be in each group are actually listed (not always the case in other pharmacopoeias!). For example, only flowers are found in the flower group (puspa varga)andonly aromatics are in the Camphor group (karpooryadi varga). It is a must for any serious student of Ayurveda.
And so we can clearly see that Ayurveda has grown out of a dynamic tradition that has survived and thrived in the face of much intervention, influence and change. As a medical tradition existing in Indian culture it has faced a complex task: that of fitting into the orthodox fold whilst also remaining true to its holistic aspirations and prioritising its ultimate goal of the health of the patient. These requirements were not always compatible but Ayurveda has managed to grow organically into the respected position that it holds today. Ayurveda is now experiencing a worldwide revival and it faces many challenges as it blends with the legal, social and climatic conditions of different cultures. Ayurvedaâs main challenge is whether it can thrive as a global medical system.
References
- I have relied heavily on Jan Meulenbeldâs works for categorising dates. Notably âA History of Indian Medical Literatureâ 1999-2002. Whilst the dates that I have given are the commonly decreed historical dates of authorship Indian Indologists often place these dates of the early Ayurvedic texts significantly earlier (c4000-1000BCE). This is a contentious issue and reflects some of the different perspectives on history, origins and tradition that exists between certain European and Indian medical historians.
- D Wujastyk. The History of Ayurveda in The Science of Medicine OUP 2003
- For example, see Dr Frawley and Dr Svobodaâs insightful books on Ayurveda.
- Jan Meulenbeld first introduced this idea in âReflections on the basic concepts of Indian pharmacologyâ from Studies on Indian Medical History 1987. His contribution to the study of Ayurveda is unsurpassed and his massive âA History of Indian Medical Literatureâ is testimony to this. I am indebted to his work.
- SW Jamieson & M Witzel, Vedic Hinduism 1992.
- Rg Veda 10.97 Translated by Wendy Doniger OâFlaherty.
- Taittiriya Samhita 6.4.9.1-2.
- Manu Smriti 3.108, 152; 4.212, 220.
- There is some evidence for this; c.f. Brahmajalasuttanta of the Dighanikaya 1.1.27 and 1.12 confirms that the sramanas (wandering mendicants) used various medical techniques to earn a livelihood. A Greek writer, Strabo (c. 64 BCE-21 CE), in his Geography, refers to Megasthenesâ comments that these sramanas were known as physicians. See K. Zyskâs works on Indian medicine.
- The Sanskritisation of early hatha yoga texts, ie. Gorakshshataka (circa 1300CE), is a good example of this.
- See K Zyskâs study on âAsceticism and healing in ancient India: medicine in the Buddhist monasteryâ.
- Samkhya Karika 1.1 Edited by S Radhkrishnan and C Moore.
- Charka Sushruta Sutrasthana 26.57-58 Sushruta Samhita Sutrasthana 50.10-12
- See Jan Meulenbeld, The Characteristics of a dosha. Journal of the European Ayurvedic society 2 (1992) for a thorough discussion of the definition of a dosha. Also refer to Charaka and Sushruta for a more detailed debate on this matter
- Charaka Samhita 26.64-65 and Ashtanga Hridaya Samhita 9. 12-13 from Jan Meulenbeld Studies on Indian Medical History 1987
- The hathayogapradipika is a seminal work on hatha yoga that represents the contemporary approach to spiritual liberation using physical, breath and meditative techniques.
- âWhen fat or mucus is excessive then the six cleansing procedures (shatkarma) should be practised before pranayama. Others in whom the dosha are balanced, should not do them.â Hathahogapradipika 2.21.
- âNauli is the foremost of the hathayoga practices. It kindles the digestive fire, removing indigestion, sluggish digestion, and all disorders of the dosha and brings about happinessâ Hathayogapradipika 2.34.
- âPerform exhalation and inhalation rapidly like the bellows (of a blacksmith). This is called kapalabhati and it destroys all mucus disorders.â Hathayogapradipika 2.35
- âSurybheda is excellent for purifying the cranium and destroying imbalances of the wind dosha and eliminates worms.â Hathayogapradipika 2.50
- Translated by Swami Mooktibodhananda Saraswati and Swami Satyananda Saraswati
- Sir Dr J Mallinson âThe Khecarividya of Adinatha: A Critical edition and Annotated Translation.â Unpublished Oxford University Doctorate 2002.
- Jan Meulenbeld, A History of Indian Medical Literature, Dr. Upadhyaya, Nadi Vijnana.
- V.Gogte Ayurvedic Pharmacology.
- Charaka Samhita Sutrasthana 4.
- Sushrita Samhita Sutrasthana 38 & 39.
