India covers almost 3.3 million square kilometers in South Asia, and according to plate tectonic theory, can be visualized as more or less a large triangular landmass pushing upwards into the Asian continent. The base of the triangle is its northern edge: the focal area of impact between these two continents. This massive collision over millions of years has resulted in the towering Himalayas: huge sharp folds of land that once nursed an inland sea between India and Asia called the Tethys. The southern section of India juts into the Indian Ocean, with the island of Sri Lanka trailing along, the Arabian Sea lapping at its shores to the west, and the Bay of Bengal lying to the east.
India is a land of enormous geographic and ecological diversity: from the glacial streams and apricot orchards in mountainous Kashmir to the north; the beige-colored deserts and fields of mustard in Rajasthan in the west; the rice paddies and tumultuous rains of the Gangetic delta in Bengal to the east; and the cardamom and coffee plantations and the emerald greenery of tropical Kerala to the south. Very few nations can boast the same climactic diversity as India.
About 73,000 years ago a “mega-colossal” volcano called Mount Toba erupted in modern-day Indonesia, covering parts of the subcontinent of India in up to six meters of volcanic ash (Acharya and Basu 1993). While this super massive volcano is thought to have reduced the global human population to only several thousand individuals, the subsequent impact of this soil enrichment on the subcontinent, in addition to the mineral-rich waters that cascade down the slopes of the Himalayas, has ensured that India is an incredibly fertile land. Despite this fertility however, modern-day social injustices and economic inequalities perpetuate desperate poverty and starvation in this part of the world.
Ancient Indian civilization
The archeological record suggests that humans have lived in what is now India for well over 300,000 years, with evidence of human habitation even during the Mount Toba catastrophe (Haslam et al 2010). Paleolithic tools such as arrowheads and polished stone axes can be found all over the Indian subcontinent, from the barren mountains of Afghanistan down into the deep south of tropical India (Basham 1954, 10-11). Although the subcontinent of India has long been known throughout recorded history as an ancient center of learning and knowledge, the historical extent of its influence is still unfolding. The earliest archeological evidence of neolitihic civilization found thus far on the subcontinent dates back to 7000 BCE, mostly in the Sindh and Baluchi areas of southern Pakistan, representing ancient village farming communities and pastoral camps (Chegappa 1998).
In 1920, European archeologists uncovered engraved seals found near present-day Sahiwal in the Punjab region of Pakistan, in a place now referred to as Haṛappa. Further excavations at Haṛappa, and at a similar site called Mohenjodaro along the banks of the Indus river (near modern-day Sukkur, Pakistan), uncovered two ancient urban societies built upon a geometric grid, complete with aqueducts for in-home running water and a sophisticated system of sewers. Radiocarbon dating showed that these settlements reach back as far as the 3rd millennium BCE. Collectively, the discoveries at Mohenjodharo and Haṛappa yielded the first inklings of the enormity of what was initially called the Indus Valley civilization, home to the Haṛappan people of ancient India, Pakistan and Afghanistan. Subsequent archeological findings, supported by satellite imaging, have suggested that the heart of Harrapan culture may have been further inland, along what is the dry bed of the Ghaggar river and its tributaries, where close to 200 Haṛappan sites have been identified (Chegappa 1998). Some archeologists believe that this river is the one described in the Ṛg Veda as the Saravati River, giving rise to the moniker “Sarasvati Civilization,” or, if including the Indus river sites, the “Sarasvati-Sindhu Civilization” (‘sindhu’ being the original name for the Indus).
Altogether, the extent of the Haṛappan civilization appears to have encompassed 1.5 million square kilometers, an area larger than Western Europe, and was comprised of over 300 cities, dwarfing the size of ancient Mesopotamian and Egyptian civilization (Chengappa 1998). There are, however, some important components of Haṛappan culture that remain unsolved. The most important of these is the Indus script, a unique form of hieroglyphic writing that is displayed on many of the archeological specimens found at Haṛappan sites, but remains undeciphered. Until this script is deciphered, archeologists can only speculate on the complexities of this highly evolved civilization.
Haṛappan Health Care
As the Indus script remains undeciphered, archeologists and scholars can only speculate on what the health care practices of the ancient Haṛappans must have been. From what can be pieced together from the archeological evidence, it is clear that Haṛappan society was centered around religious ideas of fertility and abundance, manifested in their worship of archetypal Mother goddess. It appears that the ancient Haṛappans worshipped fire as the archetypal seed in the eternal cycle of life and death, contained in a ritualistic sphere as the hearth of the home, or the womb (Atre 1987). Although some of these religious concepts remain preserved in modern Hinduism, it is likely that this emphasis manifested itself in a social sphere as well, with no separation of spirituality based on gender as is found in modern India (Atre 1987).
Based on this supposition, it could be that ancient Haṛappan health care practices were not dissimilar from other, similarly goddess-orientated agrarian cultures like Mesopotamia. From the various artifacts that have been uncovered, it is likely that the healing techniques of the Haṛappans were shamanistic. This has been inferred from depictions of individuals wearing elaborate costumes such as a horned headdress, seated in what appear to be yogic postures. If persons such as these were relied upon for their healing skills, it is likely that it took some form of ritualistic magic, including elements of ecstatic dance, the recitation of certain mantras (incantations), exorcism, astral travel, and the use of certain herbs and amulets (Zysk 1998). Unique to Haṛappan culture, however was an emphasis on personal and public hygiene, as most Haṛappan cities included a bath and toilet in every dwelling, with a drainage system to remove wastes and covered sewers in the middle of the streets to carry the waste away from the city. Water was likely perceived as the source of all life, that which sustained the Haṛappan cultivation of barley and rice: the economic basis of this ancient agrarian civilization. In Mohenjodaro, one of the earliest Haṛappan sites uncovered, archeologists have speculated that the so-called “Great Bath” in the citadel area served as a place to perform religious ablutions in the sacred waters (Zysk 1998).
The Vedic Period
Based on the discoveries at Haṛappa and Moenjodharo, prominent European archeologists such as Max Müller believed that the demise of Haṛappan civilization occurred as the result of a series of invasions conducted by a group of Indo-European nomadic peoples who called themselves ‘Aryans’ (noble-born). Called the “Aryan Invasion Theory” (AIT), this belief has dominated the imagination of archeologists for decades despite the fact that the actual evidence of invasion is very weak. If the Aryans did indeed displace the Harrapans, it is likely that the Indus Valley civilization was already in a period of decline, and that the Aryans gradually and peacefully integrated themselves into Haṛappan civilization. Called the “Aryan Migration Theory” (AMT), this perspective has since superceded the AIT in academic circles. The AMT suggests that over a period of several centuries beginning in about the 19th century BCE, waves of Aryans migrated into India, established dominance and gradually imposed the caste system that is characteristic of Indian society today. The brāhmaṇa, or Aryan priests, were the highest caste, while the śudras, the farmers, were the lowest. The term śudras” can be translated variously as “black, coarse, and slave,” and as such, some have speculated that these were the original Haṛappans: the dark-skinned, sudroid (austral-negroid) people that are represented by the modern day Tamil people, as well as other indigenous tribal groups of India collectively referred to as the adivasi (‘original inhabitants’).
According to the AMT the Aryan brāhmaṇa perfected Saṃskṛt, the native language of the Aryans. By about 1400 BCE they had organized their many elaborate rituals and religious ideas into a body of scriptures called the Ṛg Veda. The text itself is comprised of 1028 hymns (sūkta) organized into ten chapters (maṇḍala), and is central to the practice of Hinduism. Since this time each generation of brahmin priests has spent countless hours committing these scriptures to memory, in turn passing this oral tradition on to succeeding generations in an unbroken lineage thousands of years old. The advent of the Ṛg Veda and its influence on Indian society marks the beginning of the Vedic period, conservatively dated from approximately 1400 BCE to 800 BCE. Proponents of the AMT suggest that it was during this time that the events described in the Rāmāyaṇa and Mahābhārata occurred.
Medicine in the Vedāḥ
While the Ṛg Veda is mostly a collection of hymns to various deities, the texts also make passing references to various diseases and healing plants, and to which deities were important players in health and wellness. One important substance mentioned throughout the Vedāḥ is soma, which, if taken literally, was an apparently psychotropic agent that gave the user a feeling of tremendous power and ability:
प्र वाता इव दोधत उन्मा पीता अयंसत । कुवित्सोमस्यापामिति ॥२॥
अहं तष्टेव वन्धुरं पर्यचामि हृदा मतिम् । कुवित्सोमस्यापामिति ॥५॥
हन्ताहं पृथिवीमिमां नि दधानीह वेह वा । कुवित्सोमस्यापामिति ॥९॥
Pra vātā iva dodhata unmā pītā ayaṃsata kuvitsomasyāpāmiti
ahaṃ taṣṭeva vandhuraṃ paryacāmi hṛdā matim kuvitsomasyāpāmiti
hantāhaṃ pṛthivīmimāṃ ni dadhānīha veha vā kuvi
“Like wild winds the draughts have raised me up! Have I been drinking soma? As the carpenter bends the seat of a chariot I bend this frenzy around my heart! Have I been drinking soma? I will pick up the earth and put it here or put it there! Have I been drinking soma?”
• Ṛg Veda, 10, 119:2, 119:5, 119:9
It appears that soma was drunk only during certain religious rituals, prepared with great ceremony during the course of the ritual, when the plant or material was ground between stones, mixed with milk, strained, and then drunk (Basham 1954). Its effects appear to have been fairly immediate, and there is no indication that it was a fermented beverage of any kind. Other writers have variously speculated that soma was the stimulant Ephedra sinica (Ephedra, Ma Huang), the inebriant Cannabis sativa (marijuana), the mildly psychotropic Rhazya stricta (Syrian Rue, Harmala), or the potent psychotropic mushroom Amanita muscaria (Fly Agaric), also used by the shamans of Siberia (Basham 1954, Riedlinger 1993). Other researchers, however, have concluded that soma was a gold-silver ore, which was purified to yield potable gold and silver after reducing and oxidizing the baser metals with the help of various plants and bones as reducing agents. This is based upon an analysis that the entire Ṛg Veda is in fact a metallurgical allegory — a secret text on the practice of alchemy (Kalyanaraman 1993).
Another Vedic text, compiled slightly later than the Ṛg Veda, is the Atharvaveda, the book utilized by the Aryan priests who were skilled in the ways of magic and fire worship (agnihotra) (Zysk 1998, Feuerstein 1997). The Atharvaveda contains an assortment of magical spells and incantations to achieve a variety of purposes: to gain protection from demons, to secure healthy children, and to succeed in battle. Disease was thought to be the result of malevolent demons, typically occasioned by the breach of certain taboos, or sorcery. The basis of Vedic healing practices was essentially the same as ancient Mesopotamian or Egyptian practices: internal, invisible disease was a manifestation of supernatural causes, whereas external, visible disease was the result of mundane causes (Zysk 1998). The Atharvaveda also contains many passages on health and healing however, including the mention of medicinal plants and herbal formulations, and sets the stage for the development of yogic practices such as prāṇayama (Feuerstein 1997).
Early Vedic healers classified internal disease according to two basic types: takman (‘fever’) and balāsa (‘consumption’). Takman or jvara (‘fever’) represented a condition of excess, in which the accumulation of morbid wastes disrupted the normal function of the body. In contrast, balāsa or yakṣma (‘consumption’) was a deficiency disease, characterized by wasting and weakness. Drawing upon the Atharva veda, practitioners of Āyurveda later expanded the number of diseases and their classification according to the tridoṣa theory. Diagnosis in ancient Vedic healing, unlike that of Mesopotamia and Egypt, did not include divination. Rather, the determination of the cause of disease was based upon the identification or the primary and recurring signs and symptoms, each of which represented a particular demonic influence (Zysk 1998). Treatment was carried out by the use or combination of amulets, herbal and animal-based remedies, and the recitation of sacred scripture (mantra).
The practitioners of Vedic medicine were the bhiṣaj (lit. “medicine” men), who practiced mundane functions such as bone-setting and remedy preparation in combination with complex and often elaborate healing rituals. Although the role of the bhiṣaj is mentioned in the Ṛg Veda, it is clear, at least in later centuries, that the physician was held somewhat in contempt by his priestly counterpart, if for no other reason except the nature of his profession. The bhiṣaj would consort with all people from all castes, unlike the Brahmin-priests who could be “contaminated” by associating with the lesser castes. Thus, these early physicians of the Vedic period in India appear to have existed outside the mainstream, and many of them, like the wandering rhizomotoki in ancient Greek medicine, would travel from place to place, sometimes outside the Aryan cultural milieu, earning their livelihood by attending to the sick and collecting their remedies from the wild. Their contact with non-Aryan culture, including the indigenous tribal peoples of India, as well as the exchange of medical information between wandering practitioners, probably initiated an empirical approach to healing that would be developed. The peripatetic nature of Āyurveda’s practitioners is also evident in the title of the Caraka saṃhitā, as caraka is a masculine noun of the root word car, which means, ‘to wander’ (Zysk 1998).
Mention of the practice of medicine is found in the great Indian epics including the Rāmāyaṇa and Mahābhārata, two philosophical treatises that are based on historical events that are thought to have taken place sometime during Vedic period, primarly centered around the Kuru Dynasty (1900-800 BCE). While some of the literature suggests a continued reliance on magico-religious practices, there is also reference to more mundane skills which suggests a high degree of medical knowledge. The Rāmāyaṇa recounts the life of the hero-king Rāma, and when fighting the demon king Rāvaṇa to rescue his wife, Rāma’s brother Lakṣmaṇa falls in battle. While Rāma laments his apparent death, his companion Suṣeṇa assuages his fear and commands the monkey-king Hanumān to:
“Proceed from this place with full speed, Oh gentle one, to the mountain called Auśadhi, which was already described to you previously by Jāṃbavān. Oh brave one! Bring here for restoring the great-souled and heroic Lakṣmaṇa to consciousness, the precious herb viśalyakaraṇi (that which expels arrows), savarṇakaraṇi (that which restores complexion), sandhānakaraṇi (that which restores consciousness) and the precious herb sañjīvini (that which unites bones).”
• Yuddha Kānda, 101:31-33
The Rāmāyaṇa also makes mention of Bharadvāja, the Vedic sage, who, according to tradition, received the knowledge of Āyurveda from Indra. Bharadvāja is an important figure in Hinduism, and is known as one of the saptarṣi, or seven great seers. While dates for his life vary considerably, by some traditional accounts Bharadvāja chaired a medical symposium in the 8th century BCE, and each āñga, or specialty of Āyurveda, was entrusted to a particular individual. General internal medicine (kāyacikitsā) was entrusted to Ātreya Punarvasu, who lived in Takṣaśilā, in modern-day Afghanistan, while surgery (śalyacikitsā) was carried forward by Divodāsa Dhanvantari of Kāśi, which is known today as modern-day Varanasi. The group of specialized pratices that concern treatment of the head and neck (sālākya tantra) was carried forward by Videhadhipati Janaka of the ancient city of Videha, in the modern day region of Janakapuri in Nepal. In this way, the teachings of Āyurveda were standardized and promulgated across the subcontinent of India. During this time the Kuru Dynasty, and hence the Vedic period, devolved into a confederation of kingdoms known as the Mahājanapadas, but places of higher learning like Takṣaśilā, Kāśi and Videha continued to be patronized and supported, attracting scholars from all over the world.
The rise of Buddhism
The tradition of the saṃnyāsin (ascetic) that wanders the Himalayan mountain range in search of enlightenment is as ancient as the Vedāḥ itself. In the Rāmāyaṇa and Mahābhārata, mention is made of such highly venerated ṛṣis (seers) including Bharadvāja, the first teacher of Āyurveda. There are few however that had the same kind of impact on Indian history as did one ascetic named Siddhārtha Gautama.
According to historical accounts, the person we know today as the Buddha was born as Siddhārtha Guatama in Lumbini, in present-day Nepal, some time during the 6th century BCE. As the prince of a Shakya king, Siddhārtha grew up in a sheltered and pampered environment, never learning of the trials and tribulations of the common people. One day Siddhārtha escaped the royal compound with a friend, and saw things he had never seen before, such as a person suffering from illness, another weak and frail with age, and lastly, a dead body. Seeing such things troubled him greatly, and he began to question his life, and the reason for this suffering and pain. Sheltered as he was, Siddhārtha grew disaffected with his life, knowing that despite his wealth and privilege, he was destined for the same fate as everyone else.
Early one morning Siddhārtha awoke before anyone had risen, and fondly kissing his sleeping wife and child goodbye, he sneaked out of the city. Contemplating his future on the edge of town, Siddhārtha cut his hair and vowed to find the answer to his question, and set forth to wander across India. One of his first encounters on his journey were forest-dwelling ascetics: ‘holy men’ (saṃnyāsin) who lived in isolation or in small groups far away from civilization. Like him, these ascetics were committed to finding the same answer that Siddhārtha himself yearned for, and in the succeeding years Siddhārtha developed himself through all manner of austerities, including intense fasting for extended periods of time.
One day, while looking at his reflection in a pool of water, he observed how his body had become so frail and weak, and that despite his deprivations, he had not achieved his goal. Although he did achieve some benefits through penance, he realized that these severe austerities were causing physical harm to his body, and did not lead to his goal of finding an answer to the cause of suffering. A passing maiden walked by, and in the Indian tradition of showing generosity to wayfairers (saṃnyāsin) on their spiritual journey, Siddhārtha was offered some food and water, which he gratefully accepted. After the maiden left, Siddhārtha then entered into a state of meditation, and fueled by his renewed energy and focus, his meditational state became deeper and deeper, and for an entire month he remained motionless in meditation. It is in this state of being – what in yoga is called samādhi or ‘blissful concentration’ – that Siddhārtha realized the answer to his question. Resting in a state of complete equanimity, he realized that his suffering arises because of an attachment to feelings, perceptions and thoughts, binding consciousness to the limitations of this impermanent and ever-changing physical and mental existence. Once bound to these limitations, each of us crave or revile certain experiences, people or things, causing imbalances in our thoughts, words and actions that ensnare us deeper and deeper within this endless cycle of suffering (saṃsāra). Nonethless, Siddharta recognized that this craving for life was fundamental to all beings:
“Whatever quarter of heaven I searched none did I find whom I loved better than myself. Just so are all others dear to themselves. Thus, wishing well to all, one should do harm to none.”
• Saṃyutta Nikāya, 3:8
At first Siddhārtha remained silent, understanding that very few people, if any, would have an appreciation for his insight. His first followers were the other forest ascetics, whom he counseled to give up their austerities, and follow the ‘middle way’: protecting the sanctity of the body and life while releasing one’s attachment to it. Over time his message grew, and as he began to wander across much of India, his teaching rapidly spread across the country. For eight months of the year, Siddharta would wander the Gangetic plains of India, silently begging for food, teaching and gathering disciples, and for the remaining four months of the rainy season, residing in one of the makeshift monasteries donated to him and his order of monks by wealthy land owners. Now called the Buddha, he continued this peripatetic tradition for more than 50 years, in a ministry that was unscathed by prejudice or persecution, until his death at the age of eighty (Basham 1954, 260). Before his death the Buddha reminded his community of followers called the saṃgha that there was to be no leader to follow him: the dharma (or doctrine) that he had preached was all there was to inspire them. He told them that they must be a light unto themselves, relying on no one else, looking for no refuge beyond the core of his teaching:
“Now, if it occurs to any of you — ‘The teaching has lost its authority; we are without a Teacher’ — do not view it in that way. Whatever teachings and rules I have pointed out and formulated for you, that will be your Teacher when I am gone.
• Dīgha Nikāya, Mahāparinibbāna Sūtta, 6
Shortly following the Buddha’s death his followers gathered together, and, relying upon the memory of his trusted companion Ānanda, his teachings were compiled and committed to memory by the saṃgha (Buddhist community). It is these teachings, plus a later interpolation called the Abhidhamma, that forms the Tipiṭaka or Pāli Canon, which is the oldest extant teaching of the Buddha. Within two hundred years, a second gathering of monks took place under the patronage of the Emperor Aśoka, to clarify certain rules of being a monk. By the first century BCE Buddhism had grown to become the dominant religion in India, with several different orders of practicing monks, and a growing body of lay followers that supported them.
While Buddhism is sometimes thought of as a religion, the Buddha was fundamentally concerned with nothing other than the end of suffering. In the Tevijja Sutta the Buddha debates with a group of Brahmins, and undermines their belief in ritualism and the supernatural. This spirit of rational inquiry is also found in the Kālāma Sūtra, which recounts the Buddha’s discourse with some villagers who are skeptical and uncertain about all the differing opinions they hear expressed by different teachers:
“It is proper for you, Kalamas, to doubt, to be uncertain; uncertainty has arisen in you about what is doubtful. Come, Kalamas. Do not go upon what has been acquired by repeated hearing; nor upon tradition; nor upon rumor; nor upon what is in a scripture; nor upon surmise; nor upon an axiom; nor upon specious reasoning; nor upon a bias towards a notion that has been pondered over; nor upon another’s seeming ability; nor upon the consideration, ‘The monk is our teacher.’ Kalamas, when you yourselves know: ‘These things are good; these things are not blamable; these things are praised by the wise; undertaken and observed, these things lead to benefit and happiness,’ enter on and abide in them.”
• Aṅguttara Nikāya, Kālāma Sūtta, 4 – 10
As liberation from suffering is a central tenet of Buddhism, there was commensurate emphasis upon health and wellness early on in its development, with compassion directed towards the sick and injured. Built into the rules of conduct for Buddhist initiates (called the Vinaya Piṭaka) was a provision for health care: that along with one meal a day (which was obtained through begging), clothing fashioned from discarded cloth, and sleeping at the foot of a tree (nuns excepted), monks could utilize cow’s urine as a therapeutic agent, a medicament mentioned extensively in Āyurveda in the treatment of a wide range of disorders. This initial provision for the prevention and treatment of disease was soon expanded to a broad array of medicinal herbs, minerals and foods, with the Buddha actively encouraging fellow monks and nuns to take care of each other. Thus, out of necessity, many Buddhists became skilled in the practice of medicine, and continuing in the tradition of the Vedic bhiṣaj, wandered the countryside, meditating, teaching, and tending the sick.
Through time, and as Buddhism was shaped by the different cultures it spread into, the only portion of the Pāli Canon that remained unedited was the Vinaya Piṭaka. This massive text is usually thought of as a list of rules that both monks and nuns need to abide in order to participate in the saṃgha, but it also contains much other information and historical insights. In a chapter pertaining to rules of clothing for the saṃgha, the texts describe the life and career of a lay-physician named Jīvaka Komarabhacca, or simply, Jīvaka. According to this account Jīvaka was born the son of a courtesan, left to die shortly after his birth on a rubbish heap. Walking nearby and wondering what was attracting the attention of some crows flying around this pile of garbage, the King’s son Abhaya finds the baby boy still ‘living’ (jīvaka), and decides to adopt him as his foster son. Later when Jīvaka learns the truth of his humble birth, he decides to leave his privileged environs in search of a trade, deciding to study medicine with a famous teacher (disāpāmokkha) in Takṣaśilā, which had long been established as a center of Āyurveda. After spending seven years under the guidance of his teacher, he approached him with his doubts, wondering if he would ever complete his studies. His teacher replied:
‟ ‘Well now, good Jīvaka, take a spade and walk one yojana (~15 km) all round Takṣaśilā, bring whatever you should see that is not medicinal.’ ‘Very well teacher’, and Jīvaka Komarabhacca having answered that doctor in assent, taking a spade, walked one yojana all round Takṣaśilā, and did not see anything that was not medicinal. Then Jīvaka Komarabhacca approached his teacher and spoke thus: ‘Teacher, while I was walking for one yojana all round Takṣaśilā, I did not see anything that was not medicinal.’ ‘You are trained, good Jīvaka, this much is enough for a livelihood for you,’ and he gave him provisions for his journey forth as a physician.”
• Mahāvaggapāḷi, Cīvarakkhandhako, Jīvakavatthu 7
Later portions of the Jīvakavatthu contain a series of accounts that describe some of the treatments used by Jīvaka. In one account, Jīvaka cures a merchant’s wife that had suffered from a chronic disorder of the head by administering clarified butter (ghṛta) into her nose (i.e. nasya, p. 269). In another account, Jīvaka gains fame by curing a bleeding anal fistula of King Bimbisāra in just one treatment, and later tricks King Pajjota into drinking a medicated ghṛta compound to cure his jaundice. The Jīvakavatthu also recounts Jīvaka’s surgical skill, in one case cutting open the head of a patient to remove two parasites from his brain, and in another performing abdominal surgery on a young acrobat suffering from strangulation of the bowel. As a physician however, Jīvaka Komarabhacca attained his greatest fame by attending the Buddha, utilizing aspects of purification therapy (pañca karma, p. 255) to treat his malady and restoring him to good health. Jīvaka later honors the Buddha and the saṃgha by donating hundreds of thousands of pairs of the finest robes, given to him as reward by King Pajjota for curing his jaundice.
By the time Jīvaka had studied at Takṣaśilā it was already an ancient city with a long history as a center of great learning as far back as the Vedic period. By the 4th century BCE Takṣaśilā had become a major center of Buddhist learning, but was soon attacked successively, first by Alexander the Great, and later by a central Chinese people called the Kushan. In both cases however, this influence led to cultural cross-pollination, such as the development of a Grecian style of Buddhism represented by Gandhāran Buddhist art, and the spread of Buddhism and Indian knowledge northwards into China. In the 3rd century CE the Persian Sassanid Emperor Shapur I cut Takṣaśilā off from its cultural link with India, leading to a gradual decline of Buddhism in Northwestern India. Later invasions by the Huns in the 5th century CE and then Muslim invasions beginning in the 7th century CE, saw the eventual destruction of Takṣaśilā and the end of Buddhism in North-Western India.
Buddhist scholarship and higher learning however continued in Eastern India, located in the modern-day state of Bihar, with an extensive network of learning centers all based around the famous Nālanda University. Like Takṣaśilā, Nālanda attracted scholars from all over the world, including the Chinese scholar Xuanzang, who traveled to India in the 7th century CE to study Buddhism. His accounts of Nālanda written in his famous autobiography Great Tang Records on the Western Regions (Da Tang Xiyu Ji ) recount it as paradise of higher knowledge:
“The richly adorned towers, and the fairy-like turrets, like pointed hill-tops, are congregated together. The observatories seem to be lost in the vapours of the morning, and the upper rooms tower above the clouds… The king of the country respects and honors the priests, and has remitted the revenues of about 100 villages for the endowment of the convent. Two hundred householders in these villages, day by day, contribut(ing)… rice, butter and milk. Hence the students here, being so abundantly supplied, do not require to ask for the four requisites (clothing, food, bedding and medicine). This is the source of the perfection of their studies, to which they have arrived” (Beal 1911, 111-113).
Nālanda was renowned as a center of Vajrayāna Buddhism (the path of the thunderbolt), an offshoot from the Mahāyāna tradition that is also referred to as Tantric Buddhism. Vajrayāna differed from the more ascetic schools of Southern (Theravāda) Buddhism by utilizing an elaborate system of rituals and mantras that were used as aids to meditation and the goal of enlightenment. Vajrayāna was also different in that, like Mahāyāna Buddhism, it described how an enlightened being may return after death, to be reborn as a ‘teacher’ (guru), who helps guide all of humanity attain Buddhahood. In this way, Vajrayāna is very similar to the rituals and practices of Hinduism, and probably evolved in Eastern India as a syncretic response to the revival of Vedic culture. Unlike the Hindu belief in God and a unique individuated soul however, Vajrayāna remained true to the core Buddhist teachings on impermanence (anicca), suffering (duḥkha), and non-self (anattā).
In the 9th century, Nālanda was home to a famous physician named Nāgārjuna. He is famous as a Buddhist scholar, but also as a surgeon and expert on rasa śastra, a form of chemistry that was concerned with the therapeutic use of inorganic materials. Among Nāgārjuna’s most important work was his Rasendramaṇgalam, which details sophisticated and elaborate methods to purify toxic metals such as mercury, rendering them suitable for use as a medicine when given internally. Nāgārjuna is widely hailed today by Indian physicians as one of the great contributors to the practice of Āyurveda, and for his unique contributions to the field of chemistry.
In his famous work The Wonder That Was India, A.L. Basham identifies the Buddhist period as representing the flower of Indian culture. While there were still wars and regional skirmishes, the Buddhist period was one of general peace in India, and was in large part based on egalitarian principles in which men and women were essentially equal (as both, since the time of the Buddha, could join the saṃgha and adopt the ‘holy life’). Cultural life during the Buddhist period in India revolved around the monasteries as places of great learning and social value. Besides Takṣaśilā and Nālanda University, there were other centers of learning, including Sanchi, Sarnath, Śrāvastī, Vaiśālī, Vikramaśīla, Somapura, Odantapurā and Jaggadala. Several medical texts from this period, including the Aṣṭāñga Sangraha and Aṣṭāñga Hṛdaya authored by Vāgbhaṭa (c. 6th cent. CE), clearly reflect a Buddhist influence, mentioning the Buddha in the invocatory verse, reference to Buddhist scholars, and the elaboration of specific Buddhist practices.
The success of Indian Buddhist society, as it was centered around monastic life, was also its eventual failing. Initially, monasteries closely followed the Buddha’s teaching, which included certain rules such as monks and nuns not being allowed to use money. Over the ensuing centuries, certain beliefs were inserted into the teachings, and different sects began to add new rules and make new allowances. This change in rules made monasteries ripe for all manner of corruption, and over time Buddhism began to lose favor among the common people. Based on the account of Xuanzang, Buddhism was already in decline by the 7th century CE. Nonetheless, its long monastic history and its emphasis upon non-violence and meditation shaped the popular resurgence of Vedic teachings. The great Hindu reformer Śaṇkarācārya (c. 8th cent. CE) for example, modeled his advaita vedānta (non-dual) philosophy after Buddhist teachings, while incorporating traditional Hindu beliefs and practices. Śaṇkarācārya also created a network of Hindu maṭhas (monasteries) modeled on the Buddhist monastery system, but reinstating the Buddha’s original vows of poverty and celibacy.
As early as the 8th century CE waves of Turks, Persians and Arabs began to invade northern India. These excursions were quite brutal, and for a population that was predicated on the Buddhist notion of ahiṃsā, or non-violence, Indian society intially offered up little resistance. Compared to the relatively peaceful Buddhist period, the medieval period that emerged is stained with blood, with many battles and endless skirmishes. In 12th century Nālanda University was sacked by the Turkish general Bakhtiyar Khilji, destroying over six centuries of peace and tranquility. Inflamed with religious fervor, Bakhtiyar Khilji was ruthless, slaughtering thousands of unarmed Buddhist monks, taking as long as six months to completely burn down all of the libraries that had stored the ancient teachings on the practice of Buddhism, as well as other sciences including medicine, chemistry and mathematics. In one fell swoop many of the teachings of Nālanda had been destroyed and lost forever, as were many Buddhist sites across northern India. With Muslim rule, Buddhism went underground, and continued to survive as part of a secret hereditary tradition, in which a male heir would take on the responsibility of being a monk, but integrated himself among the common people by having a family. This practice later spread to Nepal, where the traditions of Nālanda University, including many ancient medical texts preserved from 12th century India, have been protected by the Newari people of Nepal, and survives to this day as the Bajracharya lineage of physician-priests.
The interaction between Islam and Hinduism was not always predicated on violence, and during the Mughal period in particular (16th cent. CE) a blend of Hindu and Islamic themes resulted in a unique style of architecture, such as the Taj Mahal in modern-day Agra. Through the commonplace of trade a great deal of knowledge was exchanged, with important texts such as the Aṣṭāñga Hṛdaya translated into Arabic, helping fuel the flowering of Islamic medicine, which in turn, supported the development of modern medicine in Europe. The medieval period in India is significant for several important texts and commentaries added to the corpus of Āyurveda, including the Bhāvaprakāśha (15th cent. CE), which incorporates herbs originating outside of India (e.g. Smilax chinensis, Cannabis sativa). The influence of both religions inspired the great Indian poet Kabīr (15th cent. CE) to blend Islamic and Hindu themes to win the veneration of both Hindus and Muslims alike for his straightforward spirituality:
“O Servant, where dost thou seek Me? Lo! I am beside thee.
I am neither in temple nor in mosque: I am neither in Kaaba nor in Kailash:
Neither am I in rites and ceremonies, nor in Yoga and renunciation.
If thou art a true seeker, thou shalt at once see Me,
Thou shalt meet Me in a moment of time.
Kabir says, O Sadhu! God is the breath of all breath.”
• Songs of Kabir, 1
In much of India, Muslim rule was repelled during the 17th century with the advent of Shivaji, a powerful Marathi king that employed highly effective guerilla tactics to oust the Mughals. Shivaji was in every respect the ideal Hindu king: powerful and daring in battle, yet penitent and charitable during times of peace. During his reign he helped to re-establish the teachings of the Vedāḥ, including the promotion of Saṃskṛt and the practice of Āyurveda.
This renaissance of Hindu ideals was short-lived, however, and with Shivaji’s death increasing European influence from the Portuguese, French and English destabilized India economically and socially during much of the 18th century. Acting through the powerful British India Company the English eventually established control over all of India by 1858, and after doing so, spent a great deal of time and effort trying to “reform” its populace, to eradicate the subcontinent of its “primitive” and “un-Christian” practices. Such practices included Āyurveda, which throughout its development had always relied upon the state to fund medical education, physicians, and hospitals. Neglected, deprived and in some cases completely oppressed, the status of Āyurveda was relegated to folklore, and many of its advanced techniques, such as the surgical operations described in the Suśruta saṃhitā, gradually became lost.
Due to the continued British influence, Western medicine became dominant in India during the 20th century, with the educated elite actively encouraging its populace to discard its time-honored traditions. This trend was countered in the late 1960s and early 70s under the government of Indira Gandhi, and Āyurveda and also Unani medicine began to receive the support of the central government. Since this time Āyurveda has been state-funded and regulated by the Indian Medicine Central Council Act of 1970. Today there are colleges of Āyurveda all over India, although the quality and content of the various programs can vary. In some areas of India however, such as in the remote southern province of Kerala, Āyurveda was preserved despite the centuries of Arab, Persian and European invasions into northern India. Kerala and its various hospitals, clinics, and colleges are one of the leading centers for the study and practice of Āyurveda. Beyond Kerala there are other unique traditions of Āyurveda, among the Siddhar alchemists of Tamil Nadu, as well as traditions localized in places such as Pune (Maharashtra), Jamnagar (Gujarat), Varanasi (Uttar Pradesh), Rishikesh (Uttarakhand), and Kathmandu (Nepal).