OVERVIEW OF INDIAN HEALING TRADITIONS

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).		The poor, those suffereing from disease and those afflicted by sorrow should be helped. Even insects and ants should be treated with compassion, just as one's own self.     (Ashtangahrdayam Sutrasthanam 2.23)
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 Great.		The Bower Manuscript, 4-6 CE Discovered in Central Asia (Bodleian Library, Oxford University)
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 Samhita urge 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.		Knowledge of medicinal plants and their identification should be gained with the help of cowherds, hermits, hunters, forest-dwellers and those who gather plants of the forest for food. (Sushruta Samhita, Sutrasthanam 36 V.10)
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.		Ayurvedic Man Nepalese 18-19C Welcome Library no.574912i
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 healthcare 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 the materia 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.		Detail,fig.4, Vol.11, Hortus Malabaricus Amsterdam, 1692
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.		“I feel bound to confess that it is not so valuable nor so certain as the herb which the Malabaris give….'' (Conversations on the Simples, Drugs and Materia Medica of India, Garcia da Orata, Goa, 1563)
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. A summary of our interviews with the Asthavaidya and our observations is given in the paper below http://www.jaim.in/article.asp?issn=0975-9476;year=2010;volume=1;issue=4;spage=245;epage=250;aulast=Menon		Hortus Indicus Malabaricus Title Page Vol.1 of 12 Amsterdam, 1678
References 1. Upinder Singh, Nayanjot Lahiri, Ancient India: New Research, Oxford University Press, India 2010 2. Zysk,K. Medicine in the Veda: Religious healing in the Veda Motilal Banarisidas, Delhi 1996 3. Zysk, K. Asceticism and Healing in Ancient India: Medicine in The Buddhist Monastery, Motilal Banarisidas, Delhi 1998