The Historical Evolution

4
The Historical Evolution of Medicinal

Tradition in Ancient India
Specialization into eight branches

The history of medicine in India spans a period of several
thousand years, definitely dating back to a few centuries before
the Common Era. There is evidence that the earliest textbooks
of Ayurveda like Caraka Saṃhitā (General Medicine), Suśruta
Saṃhitā (Surgery), and Kāśyapa Saṃhitā (Paediatrics) were
edited and revised several times over a thousand years. They
attained their current form in the first few centuries of the
Common Era. It is an amazing fact that so early, Sanskrit
texts were composed dealing exclusively with specialties
like Paediatrics, Surgery, Ophthalmology, ENT and so on.
In these texts, Ayurveda is already seen in a developed form
specialized into eight branches: General Medicine, Surgery,
Ophthalmology-ENT-Dentistry, Paediatrics, Psychiatry,
Toxicology, Rejuvenative Medicine and Reproductive Medicine.
Around the 6th or 7th centuries CE, the renowned physician
Vāgbhaṭa compiled the specialized knowledge of the eight
branches of Ayurveda into one compendium; the larger version
is known as Aṣṭāṅga Saṃgraha and the shorter version is called
Aṣṭāṅga Hṛdaya.
The tradition of surgery

The tradition of surgery in Ayurveda has a long history.
Researchers at the University of Missouri-Columbia discovered
that physicians in ancient India had developed technology to
The Historical Evolution of Medicinal Tradition in Ancient India 31
A mesolithic (15,000 – 6,000 BCE) rock painting from Bhimbetka, Madhya

Pradesh seems to depict surgery being performed on a subject’s head or eye.
drill teeth and remove decay 8,000 to 9,000 years ago. Study
of fossils from Mehrgarh, now in Pakistan, revealed tiny holes
drilled into teeth on the biting surface of male molars. Evidence
has also been unearthed from Harappa and Lothal revealing
an ancient surgical practice on a Bronze Age skull dating back
to nearly 4,300 years ago. Trepanation, a common means of
surgery practised in prehistoric societies starting with the Stone
Age, involved drilling or cutting through the skull vault, often
to treat head injury or to remove bone splinters or blood clots
caused by a blow to the head.
A folio from a manuscript of the Suśruta Saṃhitā, an Ayurvedic textbook

on various surgical procedures and surgical instruments. (Courtesy:
Wellcome Library, London)
32 Indian Contributions to Science
The saga of Indian surgery continued to flourish and

reached its acme in the time of Suśruta, who is believed to have
lived in the 2nd century BCE. Suśruta is now revered as the
father of surgery and advocated a thorough study of anatomy
by dissecting the dead body. He introduced the method of
sterilizing surgical instruments to prevent sepsis after surgical
procedures. The compendium of Suśruta describes hundreds
of sharp and blunt surgical instruments and many of them
resemble instruments used by surgeons today. Suśruta is
recognized for having developed innovative surgical procedures
like reconstruction of the nose or rhinoplasty through plastic
surgery, use of a specific species of ants as dissolvable sutures
to close the intestines, surgical removal of cataract, and surgical
management of urinary calculi.
Medical and surgical implements of 19th century origin from India.

(Courtesy: Science Museum, London)
This painting shows Suśruta’s disciples learning surgery by

working on vegetables
This painting by James Wales, commissioned in 1794 by two British

surgeons, was published along with the first known description of plastic
surgery in the West. (Courtesy: Wellcome Institute, London)
The Indian rhinoplasty technique was (re)discovered by

Western medicine in the 18th century, when the East India
Company surgeons Thomas Cruso and James Findlay witnessed
Indian rhinoplasty procedures at the British Residency in Poona.
The surgeons published photographs of the procedure and its
nasal reconstruction outcomes in the October 1794 issue of the
Gentleman’s Magazine of London.
An oculist treating a patient with specialized instruments.(Painting of

1825, courtesy The British Library, London)
Medical genetics in Ayurveda

In the Caraka Saṃhitā one comes across the earliest
reference to the genetic basis of diseases. Caraka points out
that the reproductive element is composed of seeds (bīja)
which are further divided into parts (bījabhāga) and subparts
(bījabhāgāvayava). Each part or subpart of a seed represents a

particular organ of the body and damage to the part can damage
the organ.
Inoculation for smallpox

In the 18th century, British officials and travellers
observed and documented the practice of inoculation for
smallpox, which was in vogue in India centuries before
vaccination was discovered by Edward Jenner. In an account
written for London’s College of Physicians, J.Z. Holwell,
who studied and himself practised the Indian method of
inoculation, testified to its great effectiveness in preventing
the occurrence of smallpox.
Microbiology and parasitology

There are references to microbial life in textbooks of
medicine like Caraka Saṃhitā dating back to several centuries
before the Common Era. Lower life forms were classified into
pathogenic and non-pathogenic. The pathogenic organisms
include microbes that cannot be seen with the naked eye.
Technical nomenclature was developed for different types of
microbes and their shapes and sizes have also been described.
How those physicians were able to provide such descriptions,
or even conceive of microbes, centuries before microscopes were
invented remains a mystery.
Communicable diseases and epidemics

Suśruta Saṃhitā describes communicable diseases and
explains that disease can be transmitted from one person to the
other by close contact, through air, sharing of clothes, sleeping
together and so on. Fumigation is mentioned as a measure to
prevent infectious diseases from spreading. Caraka Saṃhitā
devotes an entire chapter to epidemiology and prescribes
methods to prevent epidemics as well as manage the outbreak
of epidemics. During the period of King Aśoka, an efficient
public healthcare system was established.
An evolving pharmacopoeia
The practice of medicine in Ayurveda is based on the
principle that there is no substance in the world that does not
potentially have medicinal property. The evolution of Ayurvedic
pharmacopoeia represents a continuous and unfinished quest
for discovering new medicines from natural resources. About
1,500 medicinal plants have been described and formulated into
thousands of medicines in the tradition of Ayurveda. Hundreds
of animals and animal products have also been mentioned in the
texts. Around the 6th century in the Common Era, the branch of
medicine specializing in the use of minerals and metals known
as Rasaśāstra developed and established itself, especially in
the North of India. The older tradition of herbal medicines
continued to be practised in India’s southern states. In Tamil
Nadu, the system of Siddha medicine (traditionally regarded as
having been founded by eighteen ‘Siddhars’ or realized beings,
but in practice similar to Ayurveda) added to its pharmacopoeia
drugs metallic and mineral components.
Pluralistic approach to healthcare

Ayurveda nurtured a pluralistic approach to healthcare
in India. From ancient times, healthcare in India developed in
This painting shows an Ayurvedic surgeon attending to a wound with his

surgical instruments. (Courtesy: Wellcome Library, London)
the two streams of the folk and classical expressions. India has
a rich tradition of folk medicine, which was organized into a
paramedical force of health practitioners, bonesetters, poison
healers and birth attendants who delivered primary healthcare
for the people. Many of these traditions have survived into
modern times. Today India is perhaps the only country in
the world that officially recognizes a pluralistic healthcare
system patronizing medical systems like Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homoeopathy.
Cross-cultural interactions
Ayurveda benefited from cross-cultural interactions and
spread out of India into neighbouring countries like China, Sri
Lanka, Tibet, Thailand and Indonesia. Buddhism played a major
role in the spread of Ayurveda outside India. When Alexander
the Great invaded India in 325 BCE, he was so impressed by the
snakebite healers and Ayurvedic physicians that he invited them
to Greece. There is historical evidence indicating interactions
between the physicians of Greek medicine and Ayurveda.
Important textbooks of Ayurveda like Caraka Saṃhitā, Suśruta
Saṃhitā and Aṣṭāṇga Hṛdaya were translated into Tibetan,
Persian and Arabic languages in the Middle Ages.
Travellers from China and the Middle East narrated in
their accounts the advanced state of medical practice in India.
A dynamic literary tradition

The history of Ayurveda reveals the evolution of a vibrant
and dynamic medical tradition with compendia, medical
lexicons, pharmacopoeias, handbooks, manuals of treatment
and so on being composed at important chronological and
geographical landmarks. For example, in the 8th century CE,
a treatise devoted exclusively to diagnostics was composed
by Mādhava known as Mādhava Nidāna. In the 11th century,
a new treatise was composed on dietetics by Viśvanātha
Sena called Pathyāpathyaviniścaya. In the 13th century the
Śārngadhara Saṃhitā was composed on the subject of pharmacy
and pharmaceuticals, providing the first description of the
physiology of respiration. When pulse diagnosis was introduced
in Ayurveda, independent treatises were composed on the
subject. This tradition of constant updating and documentation
of medical knowledge continued without a break right up to
the colonial period. In the 19th century, Ayurveda suffered
a setback when unfavourable policies and regulations were
enforced by the colonial rulers. However, with the publication
of the main Ayurvedic texts, a revival set in around the turn of
the 20th century, with a few leading Indian scholars coming out
in defence of the discipline.
Global resurgence of Ayurveda

In the post-independence period, Ayurveda’s resurgence
continued, and in recent years it has been gaining prominence
as a whole system approach to healthcare under the banner of
Complementary and Alternative Medicine. Although it is not
the West, Ayurveda is taught and practised in many countries
like Germany, Italy, United Kingdom, Austria, Netherlands and
so on. There are many schools of Ayurveda in the United States.
Contemporary status Ayurveda

Continues to manage a wide range of conditions effectively
like chronic degenerative diseases and life style disorders and
is being sought after by people around the globe. As the world
is moving towards an integrative approach to healthcare,
Ayurveda continues to inspire visions of healing that is holistic,
pluralistic and integrative at the same time through a tradition
that has exhibited remarkable continuity, resilience and
adaptiveness to the vicissitudes of time.

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4

The Historical Evolution of Medicinal

Specialization into eight branches

The tradition of surgery

A mesolithic (15,000 – 6,000 BCE) rock painting from Bhimbetka, Madhya

A folio from a manuscript of the Suśruta Saṃhitā, an Ayurvedic textbook

The saga of Indian surgery continued to flourish and

Medical and surgical implements of 19th century origin from India.

This painting shows Suśruta’s disciples learning surgery by

This painting by James Wales, commissioned in 1794 by two British

The Indian rhinoplasty technique was (re)discovered by

An oculist treating a patient with specialized instruments.(Painting of

Medical genetics in Ayurveda

(bījabhāgāvayava). Each part or subpart of a seed represents a

Inoculation for smallpox

Microbiology and parasitology

Communicable diseases and epidemics

Pluralistic approach to healthcare

This painting shows an Ayurvedic surgeon attending to a wound with his

A dynamic literary tradition

Global resurgence of Ayurveda

Contemporary status Ayurveda

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