Traditional Medicine in India: Less About Medicine, More About India
[A shorter version of this essay was published in The Hindu on July 11, 2023]
As someone in his late thirties, when I look back, I feel I have been lucky in the domain of personal health. Growing up, I never had any major recurrent or painful conditions or a chronic ailment. But then, age decided to play catch up. These days I often writhe in one of those ubiquitous adult ailments which a few years back I would have arrogantly dismissed as mythical: arbitrary bodyache. On occasion the pain is intense and overwhelming, and like millions of people around the world I reach out for that humble pain-relieving elixir — four-hundred-milligrams ibuprofen — confident that my body will ace the ache in no time. And it really works, like magic.
Now, as a healthcare professional, I am no stranger to the miracles of modern biomedicine. But it so happens that my recent experience with the power of the exceedingly modest ibuprofen has coincided with a surge in exceedingly immodest claims about Ayurveda and Indian traditional medicine (TM). Like many Indian kids I grew up seeing Mom M.D. subdue my cough with tulsi concoctions and bathe my wounds in the leaf-juice of a local shrub, but the ridiculousness of the present TM discourse was not something I was prepared for. As it turns out, my academic training in the humanities and social sciences came to the rescue, providing helpful factual and historical context to my exasperation.
One such common exasperating element of how people in India talk about TM is the complete disregard for the dynamism and complexity of social and cultural change. It’s important to acknowledge that any system of knowledge which persists for long in human societies, does so not by staying “pure” and constant, but through constant change and adaptation. Today we think of Ayurvedic volumes like Charakasamhita as standard textbooks which uniformly dictated how medicine was practiced in the past, though in reality the content of these treatises has always been in flux. Practitioners in the past, as practitioners today, were always open to the larger world of medicine around them, picking ideas from and offering insights to other knowledge systems: pulse-based diagnosis (nadipariksha), for example, entered Ayurvedic practice only after the thirteenth century. Let us also not forget that the Ayurvedic treatises have assumed their textbook-like physical form only in recent centuries through the use of mass printing: in the past, few vaidyas would have ever possessed and utilized an entire volume. In fact, variation between both the beliefs and prescriptions of different vaidyas was the norm.
Another exasperating element is the highly skewed focus on the Sanskrit samhitas as the very embodiment of Indian traditional medicine. Let’s not forget that Brahmanical caste injunctions in the post-Manusmriti world exerted significant influence on healthcare. Most vaidyas, being upper-caste, had access to medical writings, but usually avoided “pollution by touch”, staying away from stuff like surgery or tending wounds (and of course childbirth). But in the broader context of healing in South Asia, vaidyas were always small in number, and the vast majority of medical practitioners and care providers came from a diverse array of backgrounds, most with no access to literacy or the classical medical texts.
It is no wonder, then, that the celebrated procedure of nasal reconstruction witnessed by British officials in 1793 was at the hands of a Shudra surgeon. In the domains of childbirth and infant care, women from Dalit communities (daais) were the major practitioners and knowledge-makers. To many such everyday forms of care when we add the practice of hakims and shamans and the medical world of Adivasi and other communities, it is abundantly clear that throughout Indian history, the vast majority of healthcare on the ground has occurred outside the rarefied world of the Ayurvedic treatises like Charakasamhita and Sushrutasamhita.
Nevertheless, the absolute dominance of Ayurveda and its samhitas in the mainstream discourse makes it clear that in the eyes of popular TM advocates, some forms of TM are better and more important than others. This would perhaps be unremarkable, but for the fact that one of the most consistent complaints of Indian TM advocates is the superiority claims of “Western medicine” over “Indian medicine”. On the one hand we seethe, rightly, at derogatory characterizations of Indian knowledge-systems by those outside India, but on the other we look down upon the knowledge-systems of many Indian communities themselves, mainly from Bahujan backgrounds.
Such double standards explain why our TM discourse is replete with efforts to valorize the invisible entities of “prakriti” and “dosha” from Ayurvedic texts, while the tangible skills of Dalit midwives are ignored. Or why during early Covid our elites could only conjure up “namaste” as a non-touch greeting to sell internationally, while greetings like salaam were sidelined. Or why, despite people in modern-day Pakistan, Bangladesh, Nepal, Sri Lanka, and India all sharing the same histories, we insist on calling Ayurveda and other forms of knowledge as “Indian” rather than “South Asian” or something similar.
It is clear that Hindu and Brahman exceptionalism permeate our TM discourse today. And when this discourse and its advocates venture outside India, Hindu exceptionalism masquerades as Indian exceptionalism. I was quite taken aback when I came across such a characterization in an academic journal article (The Journal of Family Medicine and Primary Care). It stated that “all ancient civilizations of the world developed their own medicinal systems, but the ancient Indian system of medicine is considered to be the most methodical and the most holistic system, both in its ideas and its curative measures,” with the only citation for that grand claim being a book written by an Indian.
Weirdly, on the global scale, Indian TM advocates predominantly compare themselves to only white Euro-Americans, as if the rest of the world does not exist and never existed. The sample claim in this domain goes something like: Our ancient rishis had already decoded the secret to life when Westerners were still living like barbarians.
Such claims display racist binaries as well as a disappointing ignorance of human history. Let’s say one were indeed to make a comparison between what was happening in South Asia and the European region around the turn of the first millennium. What one notices is that both regions displayed more similarities than differences in how people approached healthcare. For instance, both regions had a few elite male practitioners whose names have endured (Sushruta, Charaka, Hippocrates, Galen), and whose celebrated works were composed and compiled by multiple authors over several centuries, often erasing the inputs from women and from exchange or pilfering of ideas with other cultures and non-elite communities.
A major point of difference between Ayurveda and “European medicine” in our TM discourse is the former’s “holistic” nature emphasizing disease prevention and lengthening of life. However, here it has been forgotten that a holistic approach to health and medicine is not an Indian or Hindu invention, and was in fact common across societies and civilizations globally including in the so-called “Western” world too. Many TM advocates will concede this point when pressed, but sadly such a, well, holistic look at history seldom marks their writings and speeches.
It is also commonly forgotten that while mainstream modern biomedicine has for long suffered from a reductionist approach, — famously exemplified by the character of Dr J. Asthana in Munnabhai M.B.B.S. — many contemporary preventive “holistic” interventions in healthcare (e.g., chlorinated water supply, nutrition science) derive from modern understandings of the body and its interactions with the environment. In a highly tragic irony, tens of millions of Indians remain undernourished and without basic health amenities like clean water, etc., even as the politicians and elites around them, already with access to all that, wax eloquent about “holistic” Ayurveda and its life-enhancing properties.
In summary, much of the public discourse on traditional medicine in India is historically agnostic, factually inaccurate, and frequently hypocritical. Increasingly, it is becoming less about medicine and more about India, mirroring the erstwhile (and still often dominant) tall and arrogant tales of Euro-American scientific and technological supremacy.
But there are better, more inclusive and egalitarian ways of thinking about the past, with the focus being on people not their labels. An oft-neglected fundamental fact about humankind is that wisdom and skill were not selectively distributed following modern categories of nation and religion, but are basic human attributes which have been concretely present in all societies and civilizations across time. Historians of science and medicine have shown us that people and cultures across the world have spoken with each other, and exchanged ideas and practices, for millennia, and such exchange only intensified in the past few centuries. Instead of thinking narrowly in terms of the history of Indian or Chinese etc. medicine, scholars are nudging us to think in terms of the history of human knowledge, or of “knowing the world”, as the title of an introductory history of science course at Harvard University goes. This dynamic history has been marked by vibrant, global plus regional plus local flows of ideas, though of course these flows were rarely symmetrical or on equal grounds.
Such methods of researching and writing the history of science and medicine make for a far more authentic and fascinating history than the currently popular nationalistic or supremacist approaches. In India, we have for too long misused history in our mindless hunt for boast-worthy points or to find futile answers to who was better and who was there first. These are comic, childish endeavors, and we absolutely need to change course before all that remains of history for us is self-concocted hollow, desolate bombast.
