The Forgotten Buddhist Origins of India’s Ayurvedic Medicine
And how the history of Ayurveda intersects with the history of caste
In 1991, historian and Sanskritist Kenneth Zysk, currently affiliated with the University of Copenhagen, published a book titled Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery. This was a ground-breaking book at the time, offering several new, fascinating insights into the history of Ayurveda and the history of medicine in South Asia. (The book is available free to read on Google Books, here.) This essay is primarily based on that book.
But before getting into what Zysk discovered, it might help to understand an important distinction that many historians of medicine employ when discussing premodern medical ideas: the distinction between “magico-religious” medicine and “rational-empiric” medicine. (There are often other terms used, but the basic concepts remain largely the same.) Early in human history, for several millennia, people utilized what can be called “supernatural” concepts (like divine wrath) to explain the world around them, including ill health and sickness (magico-religious). Around the first millennium BCE, however, more rational explanations began to appear in the human historical record (rational-empiric).
Here’s what the National Library of Medicine says about Hippocrates, whose ideas are considered to be an early elaboration of rational medical thought in the European world: “Hippocrates is generally credited with turning away from divine notions of medicine and using observation of the body as a basis for medical knowledge. Prayers and sacrifices to the gods did not hold a central place in his theories, but changes in diet, beneficial drugs, and keeping the body ‘in balance’ were the key.”
Magico-religious Vedic ideas
Somewhat similar to that, Zysk tells us when and how sickness and ill health began to be described, in South Asia, in more and more rational-empiric ways. As many of us know, classical Ayurvedic medicine is based on important, exalted texts that contain ideas that were often a mix of empiricism/observation and supernatural concepts. These classical, Sanskrit-language texts are generally dated to around the early centuries of the first millenium CE.
Several centuries prior to this compiled Ayurvedic thought, (what are now) northern India and Pakistan were habitated by the Vedic society. When Indo-Aryan speaking peoples (who later formed the Vedic communities) migrated to this region beginning 2000 BCE, they brought along a ritual-based, hierarchical society. They began composing the famous Vedas soon after, in which the Atharvaveda consists of a number of references to healing and curing. This has given rise to a common misconception that Ayurvedic (not to be confused with the vedas) ideas originate in the classical Vedic writings.
It must be noted that in the Vedas, the medical and healing world was primarily one that invoked magical rituals like the recitation of potent charms and the application of amulets to exorcise demons (who were considered important causes of ill health then). Thus, Vedic healing ideas were a form of magico-religious medicine. But, as mentioned earlier, the classical Ayurvedic texts are predominantly rational-empiric (with some forms of supernatural ideas included). So, clearly, a major transition occurred in South Asian medical thought some time between the early Vedic period (1700–800 BCE) and the period when Ayurveda, especially its texts like Charakasamhita and Sushrutasamhita, were compiled (the first centuries CE). It is the fascinating account of this transition that animates Zysk’s book.
Medical practitioners as outcasts
A significant reason why rational-empiric medicine could not develop in Vedic society was its notoriously hierarchical nature and the huge emphasis on Brahmanical rituals:
A close scrutiny of the sources from [around 800 BCE] to the beginning of the common era reveals that medical practitioners were denigrated by the brahmanic [Vedic] hierarchy and excluded from orthodox ritual cults because of their pollution from contact with impure peoples. Finding acceptance among the communities of heterodox ascetic renunciants and mendicants who did not censure [them], these healers wandered the countryside performing cures and acquiring new medicines, treatments, and medical information. A vast storehouse of medical knowledge soon developed among these wandering physicians, who, unhindered by brahmanic strictures and taboos, began to conceive an empirically and rationally based medical epistemology with which to codify and systematize this body of medical information.
This “vast storehouse” of knowledge survives in the Buddhist canon (known as Tipitaka in Pali). That is, the immediate precursors of Ayurvedic concepts are to be found not in Vedic literature, but in other contemporaneous thoughts and writings, the Pali language foundational texts of Buddhism being the most important among these. To quote historian Dominik Wujastyk’s review of Zysk’s book:
The evidence is indeed compelling. The detailed parallels between the medical passages in the Pali Tripitaka and the Sanskrit Ayurveda treatises are inescapable. Especially fascinating are the comparisons Zysk draws between the medical ‘case histories’ embedded in the Tripitaka and the diagnoses and therapies described theoretically in the Ayurveda [samhitas]. This fills another lacuna in the history of Indian medical literature… [i.e., patients] The [Ayurvedic] Sanskrit medical tracts are almost devoid of people, and the entire medical discourse is carried out in theoretical, abstract terms. Now, thanks to Zysk’s explorations in the Tripitaka, we have some case histories, and it is uncanny how the Pali descriptions of what particular physicians did for their patients are paralleled by the theoretical descriptions in the Sanskrit compendia.
Long story short, as Vedic society stabilized and the social structures and hierarchies in it became more rigid, healers/physicians began to be relegated to the “lower” strata. Zysk dates this to the later Vedic period (900–500 BCE). This denigration of healers by the elite, priestly groups in Vedic society originated in the Vedic ideas of purity and impurity, and in the association of healers with supposedly impure objects, activities, and people (like blood and pus, and the natives living in forests).
The denigrated healers then gradually dissociated from the Vedic mainstream and came to be part of non-Vedic traditions and ways of life. They “organized into sects, and roamed the countryside. They earned their livelihood by administering cures and increased their knowledge by keen observation and by exchanging medical data with other healers whom they encountered along the way.” While such sects of wanderers were numerous, it is among the Buddhists “in particular that medical knowledge became an integral part of religious doctrines.”
The dissociation of these medical practitioners from the orthodoxy of Vedic ideology (which continued to adhere to magico-religious medical concepts) catalyzed the beginning of the transition to more rational medical ideas in South Asia.
Hinduizing a Buddhist medical knowledge-system
The final part of the story is to understand how this non-mainstream medical knowledge re-entered the Vedic (and later Hindu) mainstream to finally become the classical Sanskrit-based Ayurveda that we know today (exemplified by the samhitas).
Buddhism played a key role in the advancement of Indian medicine through its institutionalization of medicine in the Buddhist monastery. The medical doctrines codified in the monastic rules probably provided the literary model for the subsequent enchiridions of medical practice, gave rise to monk-healers and to the establishment of monastic hospices and infirmaries, and proved to be beneficial assets in the diffusion of Buddhism throughout the subcontinent during and after the time of Asoka. The close connection between healing and Buddhist monasticism eventually led to the teaching of medicine as one of the five sciences (vidyas) in the large conglomerate monasteries of the Gupta period.
Hinduism assimilated the ascetic medical repository into its socioreligious and intellectual tradition beginning probably during the Gupta period, and by the application of a brahmanic veneer made it an orthodox Hindu science. The earliest extant medical treatises, the Caraka and Susruta Samhitas, bear distinctive indications of this Hinduization process. Hindu monastic institutions also followed the Buddhist model and established infirmaries, hospices, and eventually hospitals in their monasteries.
One important example of this “Hinduization” is the introductory passages in the Sanskrit texts like Charakasamhita which claim their origins in the Vedas. Debiprasad Chattopadhyay (see below) explains this by saying: “The fact that ayurvedic texts claim to ‘derive from’ the Veda is not evidence for medical history, but rather evidence of a bid by medical authors [of that time, i.e., of the early centuries CE Gupta period] for social acceptance and religious sanction.”
Classical Ayurveda thus has its origins in a wide variety of individuals and groups who separated early on from mainstream Vedic society, became wandering groups of healers, and then consolidated their accumulated knowledge in several ways including, most importantly, in the Buddhist canon. The remarkable Sanskrit texts of Charakasamhita and Sushrutasamhita derived their content from this consolidated knowledge and rational ways of thinking.
It is important to note that some of the key ideas we see in Zysk’s book were also shared by philosopher Debiprasad Chattopadhyay writing in the 1970s. His analysis helps us understand more comprehensively why healers/physicians were considered inferior by the priestly class (brahmanas) of the mainstream Vedic society, despite the essential nature of the former’s services and knowledge. Below are relevant excerpts from his remarkable book Science and Society in Ancient India.
According to Manu, certain modes of obtaining livelihood are too derogatory to be normally allowed to the dvija-s or members of the privileged classes. Only under exceptional conditions causing dire distress, the law-giver grudgingly allows the dvija-s to go in for these. Their list, as given by the law-giver, is : vidyā Silpam bhrtih sevå goraksam vipanih krsih,” i.e. learning, crafts, wage-earning, servitude, cattle-raising, shopkeeping, agriculture, etc.
Specially puzzling about this list is the item mentioned first, viz. Vidyā, which means “learning’ or cultivating some branch of knowledge. There is not much difficulty to understand why wage-earning, servitude, etc., are to be considered normally incompatible with noble birth. But what possibly is wrong about vidyā or learning, so that a dvija should be advised to avoid it normally, or to accept it only under conditions of dire distress?
The commentators Medhātithi and Kulluka Bhatta naturally feel that some clarification is necessary about this point. The clarification offered by both is quite striking. The word vidyā or learning is to be understood here in a specific sense. It is learning or ‘discipline’ in its non-scriptural or anti-scriptural form, i.e. in the form in which the physicians, logicians, poison-removers, etc., understand it. As Kulluka Bhatta very pointedly says: vidyā vedavidyā-vyatirikta-vaidya- tarka-visāpanayana-ādi-vidyā–“ by learning is meant here those specific forms of learning which are different from the learning of the Vedas, as for example the kind of learning cultivated by the physicians, logicians, poison-removers etc.”
[Clearly] the kind of learning the physicians cultivate is not only characteristically different from scriptural learning but also derogatory from the standpoint of the latter. Hence, though the persons of noble birth are encouraged to cultivate learning in the scriptural sense, they are under normal conditions forbidden to study medicine.”
So while the orthodox Vedic society denigrated individuals and groups that indulged in healing work, the unorthodox “shramana” groups, including especially Buddhist communities, recognized their value and aided in the documentation and codification of their accumulated knowledge. During the classical Gupta period, this codified knowledge underwent the process of Sanskritization and Hinduization, giving rise to the early forms of what we now know as Ayurveda. Of course, there were elements in the Sanskrit Ayurvedic texts which were new and not simply derived from the earlier Buddhist texts. Nevertheless, the Gupta era and later texts failed to acknowledge their heterodox, non-Vedic and non-Hindu origins.
To quote Wujastyk: “Texts which were originally dedicated wholly to the accurate observation and description of disease, and to healing by whatever means were effective, [were] recast in the framework of a dialogue between certain primeval Hindu sages and gods, and a pedigree [was] clumsily prefixed to these works which traced the descent of the science of medicine [Ayurveda] back to the gods themselves.”
