The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

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       CHAPTER VI INDIAN MEDICINE

      EACH AREA OF THE GLOBE has created a medicine of its own. The neolithic revolution in India and China produced civilizations comparable in complexity and achievements to the developments discussed in the Middle East, the Levant and the eastern Mediterranean, like these, founded upon an agrarian economy sustaining, and sustained by, political overlords and large urban settlements. In the great Asiatic empires social hierarchy and the consequent division of labour facilitated the emergence of specialist healers, together with priests, wise men and bureaucrats.

      The consolidation of writing encouraged learned traditions which helped to give permanence to particular corpuses of medical (as well as religious and philosophical) erudition. As with the writings of Hippocrates and Galen in the West, the result tended to be a glorification of tradition, and the associated belief that a fixed, permanent and perfect medicine had, in a quasi-divine manner, been handed down from some far-distant origin. It was the duty of successors to uphold such a tradition, protecting and purifying it against the threat of corruption. Such values imparted into Asian medical systems a great durability; they certainly gave no encouragement to innovation. Indian and Chinese medicine alike proved tenacious and encouraged myths of an essential unchangingness – though this was actually belied by developments. The consequence was that both traditional Indian and traditional Chinese medicine continued in place; yet both experienced in due course a tense and ambiguous encounter with western ‘scientific medicine’, which left them compelled to take aspects of it on board.

      EARLY INDIA

      As in many other parts of the world, the first settled agricultural communities in India appeared at the end of the last Ice Age about ten thousand years ago; around 3000 BC, as archaeology reveals, developments took place around the Indus river leading to elaborate civilization. Excavations of the imposing Indus cities of Harappa, Mohenjo-daro and Lothal have revealed what must have been a complex urban social order, with well-defined social and occupational hierarchies. As well as priests, healers must have existed: perhaps the function was twinned. Remains of great public water tanks in these cities suggest communal bathing and hence cleansing rites, perhaps linking ritual to hygiene.

      Around 1500 BC, this Indus civilization seems to have fallen into decay; the explanation for this may lie in climatic and environmental changes affecting the water courses. Meanwhile, the Indo-European peoples were migrating into south Asia, and their civilization achieved a position of dominance in the subcontinent. Brotherhoods of hereditary priests (brahmana) grew powerful, becoming the masters and guardians of Sanskrit religious teachings called veda (the knowledge). Though there is no distinctive ‘Vedic medicine’, such religious writings shed some indirect light on contemporary beliefs about health and healing.

      It seems that a magico-religious outlook on illnesses and treatments became established which broadly parallels Mesopotamian or Egyptian practices. Distinctive healing powers were associated with particular deities, it being believed that diseases could be produced by wicked spirits or by happenstance. The deities who brought disease visitations were to be propitiated by rites involving mantra (incantations), supplications and expiation. Herbs were valued for their therapeutic powers, while injuries and broken bones were attributed to everyday causes; but some diseases – conditions like yaksma (perhaps consumption) and takman (fevers associated with the monsoon season) – were judged to be signs of demonic and magical interventions. Beliefs about the body and its workings came from various sources. Vedic rites involved the use of animal and human sacrifice, and the ceremonial texts contain some listings of anatomical parts. Some basic forms of surgery were also recorded, cauterization being employed to stanch wounds, and reeds were used as catheters to relieve the retention of urine. Vedic writings speak of the value of water, whether to be bathed in, drunk or ritually applied.

      From perhaps 1000 BC, Veda constituted the main faith of north India. Other groups also were appearing, seemingly dedicated to making religion a more spiritual matter and placing emphasis upon the need to lead a life of moral uprightness. Alongside many individual ascetics, the chief and best known of such groups was the Buddhist community, founded by Gautama Sakyamuni (the Buddha, 563–483 BC). Others included those subsequently called the Jains. These gatherings gave rise to new medical practices.

      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 СКАЧАТЬ