ORIGIN AND DEVELOPMENT OF AYURVEDA 

(A BRIEF HISTORY)

courtesy

  • V. Narayanaswamy Former Professor,

  • College of Indian Medicine, Madras – India History of Ayurveda

         Ayurveda, the science of life, prevention and longevity is the oldest and most holistic medical system available on the planet today.      It was placed in written form over 5,000 years ago in India, it was said to be a world medicine dealing with both body and the spirit. Before the advent of writing, the ancient wisdom of this healing system was a part of the spiritual tradition of the Sanatana Dharma (Universal Religion), or Vedic Religion. VedaVyasa, the famous sage, shaktavesha avatar of Vishnu, put into writing the complete knowledge of Ayurveda, along with the more directly spiritual insights of self realization into a body of scriptural literature called the Vedas and the Vedic literatures The true history of Ayurveda starts from the time of the Holy books, the Vedas.

            Ancient mythology contends that the concept and essence of Ayurveda was revealed by the creator of the world himself

– Lord Brahma.

There are four Vedas. They are -Rigveda, -Yajurveda,-Samaveda, -Atharvaveda

                                     The Vedas date back to about five thousand years. They preach the philosophy of life. The Atharvaveda contains the principles of healing on which Ayurveda is based. 'Ayur' means 'life' in Sanskrit. Ayurveda is the most ancient science of healing which enhances longevity. It has influenced many of the older traditional methods of healing including Tibetan, Chinese and Greek medicine. Hence, Ayurveda is considered by many as the 'mother of healing.' The hymns, the mantras and the medical information contained in the Vedas were contributions of Rishis and munis or sages, over a period of time. Many of these sages were learned saints who devoted their life to understanding the world.

                                     Aryavarta, the native land of Aryans, covers a large area surrounding the Himalayas and is believed to be the place where the Rishis and Munis lived. At present it covers areas in countries like Nepal, India, Pakistan, Bhutan and Tibet. The civilizations of these countries are deeply influenced by the unique intellectual contributions of these Rishis and Munis.

Ayurveda is a complete or holistic system that integrates the mind, body and spirit. For a few centuries, the tradition of Ayurveda was dimmed due to the natural and human calamities and also by the invasion of foreign cultures into India. The sacred texts were either destroyed or stolen.

                                      However there were many ‘Vaidyas’ or doctors in India who managed to preserve some of the knowledge available in these Holy Scriptures. Divine plants that sustain long life and good health are now being rediscovered. Many renowned families of Vaidyas, who are specialized in certain branches of Ayurveda, have started functioning again in India. Today there is a revival of the ancient culture and traditions inherent to Ayurveda, which is a true gift of the ancient civilization to the modern world. Abstract:-History of medicine is a fascinating subject as it is a saga of man’s struggle against disease. As the civilization advances and as the disease pattern changes, the medical science also changes. Ayurveda is the system of medicine that evolved in India with a rationale logical foundation and it has survived as a distinct entity from remote antiquity to the present day.

The fundamentals on which the Ayurvedic system is based are essentially true for all times and do not change from are to age. These are based on human actors, on intrinsic causes. The origin of Ayurveda is attributed to Atharva Veda where mention is made several diseases with their treatments. Later, from the 6th Century BC to 7th Century AD there was systematic development of the science and it is called Samhita period, when a number of classical works were produced by several authors and during this period there is evidence of organized medical care.

                          Medicine is as old as life itself. The survival of the species demands that   simultaneously with the appearance of disease, all living things must have also evolved the means to combat disease. The higher animals are guided by instinct to seek remedies for illness in plants and herbs. Man with his superior intelligence must necessarily have extended the scope of this search for remedies. So if we discount the myth of a Garden of Eden which man had to abandon when he fell from grace, “the thousand ills that flesh is heir to” must have afflicted man from his birth and the dawn of medicine must have synchronized with the dawn of disease. Every human society must have developed a rudimentary system of medicine, whether based on material medica or in spells, incantations magic and rituals, which to us in this advanced age may appear meaningless. The progress from this primitive stage to a regular system of medicine has not been on the same lines everywhere. The development of a system of medicine depends on various factors; its form and content are decided by the civilization and the environment in which it is born. Present Address: 19, Tana street, Parasuwakam, Madras – 600 007

                                             Erly development of Ayurveda as a complete System: Ayurveda is the system of medicine that evolved in India and has survived as a distinct entity from remote antiquity to the present day. It would be interesting to study the history of Ayurveda, trace its origin along with other Indian Systems of sciences and thoughts to assess its achievement and its place in the corpus of world medicine.

                                           The study of the genesis and evolution of ideas in any sciences is always interesting and often instructive. But it is not solely as an intellectual exercise that the study of Ayurveda is to be viewed. In spite of the spectacular results achieved by modern medicine, mainly through advances in the physical, chemical and natural sciences, there are vast areas of diseases which have eluded its therapeutic ambit and the study of a system of medicine that has stood the test of time may have a fruitful contribution to make in the overall alleviation of human suffering.

                                          All primitive societies have had a collection of remedies for common illnesses, evolved through trial and error methods, accident or by inspiration. But such remedies were purely empirical, and not based on any logical understandings of illness or of drugs. As late as the 17th Century, Moliere, referred to physicians as people, “who poured medicines of which they know little into bodies of which they know less”. The Indian system of medicine, Ayurveda, was evolved as a system with a rational and logical foundation. That its basic concepts were not re-examined in the light of the greater understandings of the human environment, that for centuries its methods of treatment underwent little change, and that there have been no addition to its literature for a long time, are charges made against the systems by its critics. It has to be admitted that after the 8th century A.D no book of outstanding merit was written and the literature from then on upto about the 16th Century consisted mainly of commentaries on the original texts. The last perhaps among the original books was Bhava Prakash, which is about 400 years old. The fundamentals on which the Ayurvedic system of medicine is based are essentially true for all times and do not change from age to age. These fundamentals are based on human factors on intrinsic causes, not extrinsic causes. Civilization may change, human habits may change, the environment may change but humanity remains the same. Changes in the environment, new modes of living, new avocations, all might contribute to certain modifications of a disease or the appearance of new diseases. But disease attacks the human hot, and as long as the human being is very much the same as his ancestor, the reactions to the disease, signs and symptoms would be same.

                                          The methods adopted to cure the disease may differ in their form but not in their essential approach. It is said that the originators of the Ayurvedic system of medicine did not base their practices on the experimental method if by this it is meant that there are no record of studies in anatomy, physiology, pathology and pharmacology, the criticism is not without meaning. But the development of surgery the classifications of disease, the observations on signs and symptoms, prognosis and the descriptions of the nature, toxicity and therapeutic value of drugs as described in the literature all clearly demonstrate high level of knowledge which would not have been possible for men without the scientific approach. One thing we should not lose sight of is the fact that the men who gave the system to the world were drawn from the highest intellectual and spiritual hierarchy.

                               Their motive was compassion. Their purpose as to alleviate human suffering and their recorded precepts were for their disciples whom they trained for the service of humanity. The emphasis therefore in the texts is on the practical aspects of medicine. It is also possible that these great seers through the practice of Yogic disciplines were endowed with the faculty of intuition which helped them to discover many truths. Students of chemistry will be familiar with the famous observation “Let us learn to dream; then perhaps we shall learn the truth”. We see that the experimental method has serious limitations, especially in the world of medicine. A medical journal of thirty years ago looks out dated and obsolete today. The so-called truths or findings given to the world yesterday with a wealth of experimental findings and statistical figures is controverted today with evidence which is no less impressive. While we should all believe in progress, we should fight the temptations to look on mere newness as a virtue. Nor should we under-rate the contributions made to human knowledge by seers endowed with intuition or some indefinable faculty that has enabled them to perceive the truth far ahead of their time.

Medicine in the Vedas and Puranas:

                        References to medicine are found in the earliest texts including the Vedas. The legendary version of the origin of the Ayurvedic system is that Brahma reminded it to Prajapati, who handed it down to Atreya Punarvasu etc. In the Rig Veda there are reference to the first divine physician Rudra and of how the Aswini Kumaras cured Chyavana of senility. There are number of Riks addressed to Marut, Vayu etc, in which the reference to medicine is unmistakable. Although such references are found in the Rig Veda, as systematic and comprehensive treatment of medicine is to be found only in the Atharva Veda. The Atharva Veda is considered to have originated later than the Rig Veda, and contains a description of diseases and the cure of them. As an example, we might cite the ancient view of the disease consumption. It was characterized as a disease of not one organ but of several organs, heart, lungs, spleen, intestines, rectum, even of the bones and marrow. This surprisingly modern view appears in the form of a prayer – the form in which medical instruction appear in Vedic literature. An even greater degree of anatomical and other knowledge is displayed in certain Upanishads – particularly in the Yogapanishads, which of course belong to a later period than the Vedas. The tradition of medical knowledge is further carried during the period of the puranas. References to drugs, diseases and health care are to be found in the epics. Thus we see in the Ramayana, that expert physicians attended on kings and they were capable of preserving dead bodies. In the Mahabharatha there are references to surgeons attending on the wounded and the disabled with all the appliances and equipments in the battle field.

Beginnings of Systematic Development

                      We shall next consider the period when systematic development can be said to have taken place. This era is associated with a few illustrious names, the first of whom is Agnivesa. The Samhita written by him which is classic which has survived to this day has been made available to the world by Caraka, a redactor. Historically it would appear that during Caraka’s time the Agnivesa Samhita has fallen into discuse or partly perished, and Caraka undertook the great task of restoring the work, filing up the gaps and re-writing the parts of the work, which had become obscure. This will be evident from the subscription to each chapter in which the author states that he has redone the chapter (Pratisamakrita). The work has undergone a further revision by one Dridabala: at least the last 17 chapters devoted to Cikitsa and the whole Kalpa and Siddhi stanas have been re-written by Dridabala as stated in the colophon of each chapter.

Caraka Samhita: It is not known when Agnivesa lived. The book is written partly in verse and partly in prose and the language bears a resemblance to that of the Brahmanas. The text is the record of teaching by Atreya Punarvasu to his students and Agnivesa was one of them. Caraka is believed to have flourished in the sixth century B.C. There is a Hindu tradition that Caraka and author of Mahabhasya on vyakarana patanjali, are one and the same person. Many commentators, Vijnana Bhiksu, sivadasa and Bhavamisra, the author of the Bhavaprakasa, to name a few, suibscribe to this opinion. The student of early Sanskrit literature is often confronted with some confusion in the identity of names owing to their imprecise use by commentators. It has to be admitted that there is some uncertainty about the identity of Caraka. This however does not in any manner, detract from the greatness of Caraka Samhita. The popularity of the work continues to this day. No Ayurvedic physician of any repute would admit that he has not studied Caraka. The work is a complete compendium of medical information, dealing with medical aspects, as etiology, symptomatology, treatment and medical care in health and in disease.

Susruta samhita: Equal in importance to the Caraka Samhita is another treatise called Susruta Samhita. This work deals with surgical diseases, and diseases of the special organs such as the eye, ear etc. Just as by tradition Caraka Samhita is ascribed to Atreya Punarvasu. Susruta Samhita is ascribed to Dhanvantari Susruta has recorded the precepts of this puranic personage Dhanvantari, just as Agnivesa has recorded those of Atreya Punarvasu. The Dhanvantari of puranas is said to be one of the avatars of Vishnu. A historical personage by name Divodasa is also known as Dhanvantari, being an incarnation of Dhanvantari of Puranas. It is more likely that the name of Dhanvantari was given to Divodasa of Kasi who was a celebrated physician Susruta Samhita like the Samhita of Agnivesa, has undergone recensions. It is generally believed that the famous rasarcharya, Nagarjuna, re-edited the book and that the Utterasthana, the last portion of the book, was completely written by him. This theory is based on Dalhana’s statement in his commentary that Nagarjuna re-edited (Pratisamskarna). There is also an ambiguous reference from wich some critics have inferred that originally Susruta samhita consisted of only five cantos, and the sixth is a later addition. While enumerating the contents of the chapters and the cantos. Susruta mentions only 120 chapters in 5 cantos. There is no reason why he should have restricted himself to these numbers if the work really consisted of 180 chapters in 6 cantos. The 66 chapters in Uttarasthana are therefore evidently later additions by another author just as the last 17 chapters of Caraka samhita are additions by Dridhabala. The work was intended to be a inclusion of medical diseases would appear to be inconsistent with this purpose. It is true that in ancient systems of medicine, surgical and medical diseases were not divided into water-tight compartments, as they are found today. All the same, there was some specialization; Caraka remarks in many places; “Hereafter, hand the patient over to the Surgeons”. It is therefore quite possible that the sixth canto, which deals mainly with medical diseases and diseases of the eye, was not the work of Susruta, but was added to the Samhita by Nagarjuna. The age of Susruta is not known. It is generally believed that Susruta lived sometime around 600 B.C. Susruta Samhita could have undergone several revisions, the last of which was attributed to Nagarjuna Rajatarangini places him in the 3rd century B.C. The identity of Nagarjuna is also shrouded in antiquity. There appears to have been a number of physicians and alchemists with the name Nagaruna.

Astanga Samgraha and Astanga Hridaya

                     Next in the chronological order appeared another classical work, Vagbhata’s Ashtanga Samgraha. Vaghbeta probably belonged to the second century A.D. He has summarized both Caraka and Susruta and brought both medical and surgical diseases within the compass of a single treatise. Vagbheta follows the tradition of using both prose and verse, though there is more of verse than the prose in his work. From the stand point of analytical classification arrangement and exposition he excels other writers. The Astanga samgraha is for this reason more popular than other works among students and practitioners in the South. Vagbheta can claim to be the first author to have begun the syncretic school of bringing together information on all the branches of medicines within the ambit of a single work which as others he divided into eight parts (Astanga), and called it as such. The eight parts are general medicines, paediatrics, mental diseases, diseases of special sense organs, surgery, toxicology, gerontology and aphrodisiac. Ayurveda is the only ancient science where care of ole is described. There is another important work, similar in the name and content called Astanga Hridaya. It is written entirely in verse and its author also bears the name Vaghbeta. The opinion is held by many that, both Astanga Samgraha and Astanga Hridaya are the work of one and the same person. The method o presentation the classification of the subject under various chapter and even many of the Slokas are so strikingly similar in both works, that this view may be correct. After completing the first work, Samgraha the author must have summarized it in verse form and given it the name Hridaya. There are no tow opinions about the superiority of the book. Astanga Hridaya over most other treatises. Brevity and clarity of expression are the hall murk of this work.

Bhela Samita

               Among the works of great aniquity must be mentioned the Bhela Samhita. The main point of interest about this work is that is was probably written by a contemporary of Agnivesa. It is modeled on the pattern of Agnivesa Samhita. But it is a similar book than the former. Another book which has been published is Harita Samhita, which is claimed to have been written by one Harita, another contemporary of agnivesa. The claim is incorrect and this Harita probably belongs to later times.

Other Works:

                   Of lesser caliber than Caraka, susruta and vagbheta, but no less worthy of attention to the student of Ayurvedic medicine are Madhavakara, Cakra data, Sarngadhrara and Bhav misra. Madhavakara (8th Century A.D.) comes first in the chronological order. He has written Nidana which deals with aetiology, diagnosis, pathology ad prognosis of diseases. The work is not original but a compilation from various earlier texts. Its chief virtue is comprehensiveness. Brndamadhava is a treatise on medicine. (Brnda being the real name of the author) which contains a number of Siddha yogas or prescriptions which have been tried and found useful. Chakrapanidatta is wel-known not only as a brilliant commentator of both Caraka Samhita and portions of Susruta Samhita or Cikitsa Sara samgraha. It is a treatise on treatment which is widely read even to this day. He has also written a book on material medica with the title Dravya Guna Samgraha Cakrapaidatta belongs to the middle of the 11th Century A.D. Cakrasadatta Samhita follows the order of Madhava Nidana and Brndamadava. The Cikitsa sara Samgraha and the Dravya Guna samgraha have been the subject matter of brilliant commentaries by the gifted author Sivadasa Sena, who has clarified many abstruse passages in the texts. Sarangadhara who flourished in the 11th Century A.D. has also written a Samhita. It contains a number of useful prescriptions and is very popular among practitioners all over the country for its valuable definitions of technical terms, called paribhasa.

Bhavaprakasa:

              Bhavaprakasa, the last and perhaps the best work of the medevial age, is that of Bhavamisra. The period from the 10th to the 16th Century A.D. is singularly unproductive in the literature of Ayurveda. The stagnation is attributed to foreign invasions and internal turmoil. When Bhavamisra resumed the traditions of writing he reviewed the developments of the intervening period and incorporated in his work various new diseases and drugs. He is the first author to refer to the disease, ‘Phirangaroga’ which was evidently the contemporary name of syphilis. The word ‘Phiranga’ denotes Europeans in general and the Portugese in particular, in many of the Indian languages. The term ’Phiranga Roga’ must have come into use to describe syphilis, as the disease is believed to have been brought to India by Europeans. Another new introduction in his work is a chapter on Yakrt Pleehodhara, enlargement of liver and spleen, which is distinct from Yakrt and Pleehodhara Bhavamisra included in his material medica certain drugs of foreign origin, for example, Chop Cheeni, (Madhusnuhi) the root imported from China which is indicated in “Phiranga Roga”. He also mentions opium (ahiphena) and the method of its preparation, as also camphor from China and Parasika Yavani from Persia. He is the first to mention the use of mercurial compounds in the treatment of Phiranga roga. One important point that is illustrated by Bhavamisraa is that Ayurvedic medicines was not averse to adopting new theories and ideas and had no hesitation including medicines of other countries in its armoury. The sole criterion for the selection of any drug or method of treatment was its ultimate benefit to the patient. With changes in the environment as new diseases and conditions appear, new remedies are also necessary. Caraka himself has stated that if a truth is to be taken even from an enemy for the good of the patient, the physician should not fight shy of doing so, Bhavamisra is a true exemplar of progress. The history of medicine in India is not a history of uninterrupted development. The science and art of medicine existed from the vedic period and maintained a steady pace of progress during the early centuries of the Christian era. Thereafter, there was a decline in creative activity but revisions and commentaries of the earlier works continued to appear till about the 10th Century. The period from the 10th Century to the 16th Century there was a great lull till the appearance of Bhavaprakasha. There has been no major contribution to Ayurvedic literature after this new work.

The Organisation of Medical Care:

                 Side by side with the systematic development of medicines in ancient India, there was also organized medical help in the form of hospitals and dispensaries, and a certain measure of health propaganda. During the Buddhist period, monks travelled all over the country not only preaching religion and philosophy and dispelling ignorance, but also alleviating human suffering King Asoka and his edicts are famous. But even before Asoka’s time evidence of organized medical care was seen in Caraka Samhita. Vivid descriptions are found about the location, building, personnel and amenities of hospital-Aturalaya, a maternity home, Sutikargriha, a nursery-sisugriha and a pharmacy. It should be remembered that Ayurveda is not the science of health. Healthful living, prevention of disease, personal and social hygiene all come under its ambit, and not merely the cure of diseases. Archeological and modern genetic evidence suggest that human populations have migrated into the Indian subcontinent since prehistoric times. The knowledge of the medicinal value of plants and other substances and their uses go back to the time of the earliest settlers. The vast amount of medical knowledge that has come down to modern times is the result of long evolution through trial and error and exchange of know-how between diverse communities and regions. The process of exchange and assimilation continues, and today traditional medical practices are obliged to accommodate to the norms of modern biomedicine. However there is growing awareness among the scientific community and the general public about the intrinsic value of traditional medicine, and as a result Ayurveda, Unani and Siddha have entered the mainstream to compliment biomedicine. The challenge today is to integrate the best of the different healing traditions to meet the healthcare needs of contemporary society.

Prehistory

                  Excavations at different sites suggest that medical interventions such as dentistry and trepanation were practiced as early as 7000 BCE in the Indian subcontinent. Organized forms of agriculture practiced by the people of the Indus civilization, the importance they gave to certain medicinal plants and trees and the emphasis on hygiene and water sanitation suggest an advanced awareness of health management. Trade routes linked the Indus valley civilization to other parts of the subcontinent and westward to Persia, Mesopotamia and the Arabian Sea, and northward to Central Asia. It is highly likely that botanical and medical commodities and knowledge were among the prized items of exchange. Recent archaeo-botanical excavations give evidence for the use in the Middle Gangetic region of medicinal plants since the 2nd millennium BCE that are still used by Ayurvedic physicians and folk healers

 

(1). Vedic Period

The Vedic hymns of the migrant Aryan tribes are the earliest literary source of information about healing practices in the sub-continent. These hymns provide insights into diseases prevalent during the period and their perceived causes. Most ailments, both physical and mental, were attributed to malevolent spirits and cures consisted of rituals, charms, mantras, medicines and surgical intervention. The hymns in the Atharva Veda, the last of the four Vedas, and largely composed after the Aryans were well settled in the sub-continent, indicate that indigenous non-Aryan healing practices had influenced the Vedic Aryan healers

 

(2). Post-Vedic Period

 

                 The Sanskrit-speaking Vedic Aryan influence eventually spread eastward from the Punjab and Doab region towards the Middle Gangetic plains, which had its own socio-cultural and linguistic context. This was a period when diverse cultures were interacting in small kingdoms and urban centers and there was growing awareness of the influence of life-style and regimens on health and well-being. In such a context, in the region east of the confluence of Ganga and Yamuna, Buddhism, Jainism and other new ascetic and philosophical movements arose. Many of these movements promoted free spirit of enquiry and experimentation in all fields of knowledge, especially in medicine. We find early Buddhist and Jaina texts in Prakrit (Pali and other vernacular languages) describing the use of medicines, surgical procedures, trepanation, purges and emetics, practices consolidated from all levels of society. The early texts also recognized the importance of cultivating compassion and humanistic values as being essential for health and well-being

(3).Buddha

 

         himself was seen as the “healing guru” (Bhaishajyaguru) and healing practices were part of the Buddhist monastic tradition. Medical centers privileging humanistic values that were attached to Buddhist monasteries catered to monks and lay persons. Buddhist monks disseminated Indian medical knowledge westward to Persia and Central Asia, to China and to South-east Asia. Buddhism also took with it medical knowledge to southern part of the sub-continent and Sri Lanka, especially during and after the reign of Ashoka the

Emergence of the Ayurveda

                                 Tradition The spirit of scientific enquiry influencing the intellectual world since the time of Buddha led to old belief systems being questioned and tangible proofs being sought after. In this cultural milieu in the Indo-Gangetic and lower Himalayan regions, tribal and wandering healers, learned physicians, ascetic and yogic traditions such as Buddhism and Jainism, and philosophical schools such as Samkhya, Visheshika and Nyaya all contributed to the emergence of a formal scientific culture of healing that became Ayurveda. Sanskrit, which is the language of the Vedas and Brahminical culture, reemerged as the dominant scholarly medium around the beginning of the Common Era. The earliest works on Ayurveda probably dealt with one specific branch of medical practice. The fundamental concepts and practices of Ayurvedic healing continued to be elaborated and refined over centuries and were codified during the early centuries of the C.E. in treatises composed in Sanskrit. The earliest available works are Caraka Samhita, Sushruta Samhita,Ashtangahrdayam, Ashtangasamgraha, Bhela Samhita and Kashyapa Samhita, the latter two in incomplete versions. These works are compilations of medical practices composed in a systematic manner and define principles, therapeutic methods and moral guidelines for medical practitioners. Ashtangahrdayam (circa 6-7 century C.E.) organized the theory and practice of Ayurveda in a coherent fashion and is considered to mark the culmination of the classical period. While these works set the norms for the future of Ayurveda, other works, some specializing in particular branches of medicine were also composed during this period. The multi-cultural origins of Ayurvedic knowledge that we alluded to earlier are revealed in the classical texts themselves. Both Charaka Samhita and Sushruta Samhitaurge physicians to seek the help of cowherds, hunters and forest-dwellers for procuring medicinal plants. In the Charaka Samhita, we notice the participation and contribution of a Central Asian physician in one of the assemblies of scholars gathered to formulate the principles of Ayurveda. While the three major classical texts attribute the origin of Ayurveda to Vedic divinities, they give importance to Buddhist moral values, and Vagbhata, the author of one of the classical texts (Ashtangahrdayam), was a Buddhist.

Persian and Arab Influences

                        Trade and exchange of medicinal plants and knowledge of their uses have gone on for centuries between the Indian subcontinent, West Asia and the Indian Ocean world. From the end of the first millennium C.E. physicians coming from Persia and neighboring regions brought their healing practices to the subcontinent and influenced local healers and Ayurvedic practitioners. In turn Ayurvedic treatises were translated into Persian, Arabic, Tibetan and Chinese.

 Unani, Rasashastra, Siddha and Sa-Rigpa Traditions

                        There are other formal systems of medicine such as Unani, Rasashastra, Siddha, and Sa-Rigpa that have been practiced in the subcontinent. Unani is an Arab medical tradition that has its origin in the Greek Ionian medicine (the word Unani being an Arabic adaptation of the word Ionian). During its development in India, Unani incorporated elements of indigenous materia medica from Ayurvedic and folk sources. It is still practiced and popular in India and Pakistan. Rasashastra is an ancient tradition of healing that uses medicines incorporating metals, especially Mercury and gold, purified using complex procedures. The tradition maintains that Rasa formulations in association with yogic and tantric practices give extraordinary powers like arresting the process of ageing. Certain Rasa medicines were incorporated into Ayurveda and Siddha. The Siddha tradition is an ancient south Indian system that developed especially in the Tamil speaking region and continues to be popular there. It integrated elements of Ayurveda, Rasashastra, Yoga and Tantra and uses alchemically prepared metals along with medicinal plants. Siddha system is said to have been influenced by contacts with Chinese and Arab medicine. The Sa-Rigpa tradition practiced in Tibet and Himalayan regions is an amalgam of Ayurveda derived from Vagbhata’s Ashtangahrdayam and folk practices along with a strong influence of Tibetan Buddhism.

 Regional Folk Practices

                        Even before medical knowledge was codified into the canonical texts of Ayurveda, there were abundant sources of medical knowhow in the subcontinent. Healing is practiced by people from all levels of society who live and work in intimate relation with their environment. They range from home remedies related to nutrition and treatment for minor illnesses, to more sophisticated procedures such as midwifery, bone setting and treatment of snake bites and mental disorders. There were also specialists in blood letting, experts in physical medical practices and others with intimate knowledge of medicinal plants. All these areas of folk practices have their particular folklore that preserved and transmitted such knowledge. Some healing practices were considered to be sacred and were associated with rituals that helped safeguard them. It is interesting to note that in folk traditions there is considerable overlap between healing plants and sacred plants, and certain healing plants were venerated. Traditionally Sanskrit-based Ayurvedic practice was limited to certain segments of society, folk healers came from all levels of society. Although folk practitioners from the lower strata of society lack the scholarly aura, many who specialize in specific healing practices are held in high esteem. For example, it is not uncommon for scholarly Ashtavaidyas to seek the help of folk healers in pediatric care, poison therapy or diseases of the mind. Classical Ayurveda has been enriched over centuries through such interactions and exchange with regional folk practices.

 Traditional Indian Medical Writings

                      Literature on Indian medicine is vast and there are large numbers of manuscripts in private and public collections and libraries that still need to be documented and studied. They include not only works on Ayurveda in Sanskrit and vernacular languages, but also works on Unani in Urdu and Persian, and on Siddha medicine in Tamil. Vernacular writings helped those literate healers who were not Sanskrit savvy to inform themselves about the theory and practices mentioned in classical works on Ayurveda. Tribal medical traditions from populations who had historically relied on their forest environments for health care have made invaluable contributions to the materia medica of traditional medicine. Region specific materia medica of classical and folk medical traditions owe much to the tribal healing traditions. From around the 8th century C.E. texts called Nighantus dealing exclusively with themateria medica of Ayurveda were composed. Many of these works helped to enlarge the repertoire of medicinal substances by incorporating knowledge of local practitioners and from foreign sources. A few well-known Nighantus are Madanapala Nighantu,Bhavaprakasha Nighantu, Dhanvantari Nighantu and Sodhala Nighantu. Until very recently, it was common for Ayurvedic physicians to memorize a Nighantu of special relevance to their region or practice.

Indian Medicine During Pre-colonial and Colonial Periods

                                         As mentioned previously in this introduction, over centuries Indian indigenous medical systems were renowned for skilled physicians, sophisticated medical therapies and for the extensive materia medica. While interplay of myriad complex factors was responsible for the outcome, there is no debate about the fact that traditional medicine entered a period of decline during the colonial era. However, during the pre-colonial period early Portuguese and Dutch settlers relied on the thriving medical systems they found in India for their healthcare needs. There were very few physicians among the early European settlers, and they did not have the medicines or the knowledge needed to combat tropical diseases. During this period it was official policy of the Portuguese and Dutch governments in India to actively seek out and document Indian traditional medical knowledge. Several books on Indian medicine written during this period introduced Indian medical knowledge to European medical schools, and botanical medical knowledge of India was tremendously influential in the the global context. Works on Indian botanical medical knowledge, by Garcia da Orta (1568), Christoval Acosta (1578) and the 12 volume Hortus Malabarius (1678-1693) compiled by Aadrian Van Rheede, became reference books for tropical botany and medicine for a hundred years or more. During the early days of the British East India Company, Indian medical knowledge and “native physicians” were important resources for the colonial establishment. The skills of Indian physicians to treat regional diseases and the rich materia medica of traditional medicine put them at an advantage over the newly arrived British doctors, struggling to deal with diseases unfamiliar to them. Later as the British East India Company established itself in India, many British physicians assumed broader scholarly roles as botanists, foresters, zoologists, geologists and European medicine came to be looked upon as the dominant medical knowledge system. By mid 19th C. British official colonial policy marginalized indigenous medicine to secondary status. And later as the Indian Medical Service opened to accept Indian nationals, students from upper classes as well as Christians and Muslim entered modern medical colleges and European medicine became the official health care system.

Indian Medical Traditions Since The 20th Century

                Even though during the British colonial period official status of Ayurveda and other traditional healing systems were relegated to secondary roles and western medicine became dominant, Ayurvedic colleges offering diplomas were created and the study of classical texts in Sanskrit were initiated in many centers around India. Many of these institutions integrated Ayurveda education with biomedical education curriculum and western concepts of disease and wellness. Pharmaceutical companies also began to manufacture Ayurvedic and other forms of traditional medicines on a large scale to deal with the diminished capability of practitioners and patients to make medical preparations. After Independence, the government of India made efforts to recognize Ayurveda, Siddha and Unani as being on par with allopathic biomedicine. In 1964 a government body for setting norms for the manufacture and the control of the quality of traditional medicinal preparations was formed. In 1970 the government of India passed the Indian Medical Central Council Act to standardize Ayurvedic teaching institutions, their curriculum and their diplomas. More recently the government created the Deparment of AYUSH (Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) to support research and development of traditional medicine, and to set standards and regulate the activities related to practice. Today the general trend is to comply with the norms of modern biomedicine. In traditional medical schools the vocabulary and diagnostic tools of modern medicine are replacing traditional terms, and techniques and students are increasingly becoming unfamiliar with classical references and methodologies. In the last few decades there has been growing interest in alternative forms of therapy globally. In addition, attempts by devotees of New Age culture to ascribe new layers of meaning to the concepts of Ayurveda have propagated a simplified and modified version of Ayurvedic culture and practice. While this has stimulated the development of tourism for well-being, leisure Ayurveda, in India, with spas and hotels offering different kinds of simplified treatments, for many in India and abroad these commercialized variants have come to represent Ayurveda. There are attempts by biomedical and Ayurvedic researchers to correlate Ayurvedic understanding of the nature of disease with modern biomedical concepts. The materia medica of Ayurveda has attracted the attention of researchers and commercial concerns in India and abroad interested in identifying active molecules and manufacturing commercial versions of traditional formulations. These novel demands along with renewed popularity traditional medical practices within India itself have created conflicting conditions for traditional medicine in general and for Ayurveda in particular. The hereditary Ashtavaidya Ayurveda physicians of Kerala are among the small group of traditional medical practitioners who have endeavored to retain the scholarly study and practices of their ancestors. With changing social structure and the norms imposed by the government regulations, Ashtavaidyas too are striving to adapt their practice to contemporary standards. The interviews that we conducted over the last few years with the remaining Ashtavaidyas of Kerala highlight the issues that traditional medicine faces in such a modern context.