THE AMBASSADORS
THE AMBASSADORS
SELECTED STUDIES
Volume 1,
Issues 2
September 1998
Ancient Indian Medicine through the eyes of Al-Biruni & by reference to the two Samhita of Sushruta & Caraka.
Dr. David L. Wright, BSc, MSc, PhD (London), FCACB,
Senior Consultant Clinical Pathology, Toronto, London and Kuwait
I don't claim to understand a good deal of the rationale behind Indian medicine as described by the two Samhitas. It is enough, perhaps to point out that while we were still busy teaching one another to be better warriors [and, to give credit where it is due, perhaps devising a bluer type of woad], the Indians were thinking about the world they lived in. It is indisputable that they did a good deal of fighting on their own. It is also true that they were people who thought about the human condition and did their best to improve it.
Based on his or her early history lessons, it is obvious to
any thinking Western child that the world of the ancients was
full of holes. For instance, except for Cleopatra and perhaps
Boadicca, there were almost no 'Western' women who did anything
but bear and rear children. There were even bigger holes however.
China and India are mere names without historical substance.
They are words which crowd together with fabulous beasts to fill
otherwise
empty spaces on purportedly ancient maps.
In fact, what was then [and still is] the greater part of the human race peopled these spaces. They were born, lived their lives and wrought their own bodies of knowledge and elaborated their own systems of science and the arts and that of their hybrid offspring, medicine. We have tantalising hints of who they were from the tales brought back by Alexander the Great and others after him such as Marco Polo. Even I, educated in the 1940's and 1950's in what was then parochial Toronto, the 'City of Churches' knew that much.
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Living in Kuwait as I have done for the greater part of the last 18 years, I am out of touch with the educational system of Ontario. Perhaps all the young people know now what I could not have imagined fifty years ago. I hope that is true, but sixty-five years is a long time to collect hopes most of which end up in the 'forlorn' category…….The first indications of the existence of elaborate systems of medicine not based on that of the ancient Greeks are likely to have come to the Empire of Islam - the superpower of its age - from the city of Jundi Shapur. Originally founded by the Sassanid empire [3rd to 7th centuries AD] in what is now the Islamic Republic of Iran, it was meant to surpass fabulous Antioch.
The Sassanid rulers did their best to draw to it the savants of the age, and in this they were unwittingly assisted by Christian Byzantium, particularly during the early part of the fifth century when a doctrinal schism in the church led to the expulsion of Nestorius and his followers. They fled first to Edessa where the long arm of Byzantium was still able to reach them and then to more distant Jundi Shapur.
At its peak, the city of Jundi Shapur held learned men from what is now the Islamic Republic of Iran as well as others such as those from 'Al-Shams' [Jordan, Palestine, Syria, Lebanon] and those fleeing persecution such as the Jews and the Nestorians. In addition there must have been some from further east, from India and China.
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In 765 AD, Al-Mansur, the second Abassid caliph of the empire of Islam, succeeded in enticing an eminent Nestorian Christian inhabitant of Jundi Shapur, Jurgis bin Jibra'il bin Bukht Yisu to his newly built capital, three-walled Baghdad. As Julien Leclerc has written, "Jurgis came to Baghdad, and his presence was the spark that kindled the flame of learning in the Islamic world". He was to be the first of many to come. They established the firm foundations upon which was built the Arab efflorescence in the arts and sciences - and medicine.
One of the first intimations that this efflorescence derived to some extent at least from Indian sources comes to us from the writings of the great Islamic doctor, Abu Bakr Mohammed bin Zakariyya ar-Razi [Rhazes] (841 - 925 AD). He was one of the first to introduce inductive reasoning [the basis of 'Western' science] in his scientific studies and was the first to produce a treatise on smallpox and measles [Kitab al-Jadari wa'l Hasbah]. It was the habit of this great man to detail in his patient notes the sources upon which he based his treatment. His writings include the mention of the Indian surgeon, Sushruta, who lived in about the sixth century BC.
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It is, however to al-Biruni [973 - 1050 AD], the greatest of the students of India during the golden age of Islam that the caliphate gained most of its knowledge of India
Abu al-Rayhan Mohammed ibn Ahmed al-Biruni al-Khwarazmi is said to have been born in 973 A.D. (on the 4th of September!) on the outskirts of the city of Kath. The latter information is used by some to explain his name, "al-Biruni", as deriving from the word, 'biruni', meaning 'exterior' (as opposed to 'duruni' meaning 'interior') in the language used there at the time (Z. Safa). Leclerc states, however, that it derives from the name of an Indian city he visited. He was taught by the mathematician, Abu Nasr Mansur bin Ali bin Iraq Djilani who was the "favoured friend of the caliph of Islam", and by Abd al-Samad al-Hakim (a peripatetic philosopher). He became multilingual; Z. Safa credits him with a knowledge of 'some Greek', Hebrew, Syriac, Sanskrit (learned later on in life), Persian and literary Arabic. Because he is known to have been fluent in Turkish in his infancy and youth, Mubahat Turker-Kuyal feels that his maternal language must have been a regional variant of Turkish and, hence, that he must have derived from Turkish stock. However, it has also been suggested that his deep knowledge of Hebrew and Jewish literature might indicate Jewish origins!
His writings were predominantly in Arabic, this being his personal preference. Other fields in which he excelled later include history, mathematics, astronomy, astrology, jewellery, geology, geodesy, medicine and pharmacology. He was to a considerable degree self-taught, with much of what he learned coming from personal research as well as personal practical work. His intellectual accomplishments earned him the name, "al-Ustath" (the Master).
He was seven years older than Ibn Sina [980 - 1037 AD], and the two corresponded extensively, particularly on the field of philosophy. There were some disagreements between the two during this correspondence chiefly because Ibn Sina took exception to being told by Al-Biruni that some of his ideas were incorrect. The former is said to have allowed his students to read out Al-Biruni's letters in a manner which tended to belittle him.
When he was still only twenty or so, Kath fell to the Ma'munids, and he was forced to flee from his birthplace, first going to Khurasan and then to Ray, where he spent two or three years in some misery, moving on from there to Mazandaran (south shore of the Caspian Sea). In 999, his fortunes began to improve. He joined the court of the Amir Qabus bin Washmgir Shams al-Ma'adi, and was able to continue his work there in Jurjanj. Safa notes that he finished his book, 'Al-Athar al-baqiya 'an al-Qurun al-khaliya' [Ancient relics from former ages], at this time. In a further move, he returned to Khwarazm, now ruled by the tolerant and intellectual Abu al-Abbas Ma'mun. This was the beginning of a period of security for al-Biruni which was to last till 1017 A.D. Ma'mun was much impressed by him and he became both Ma'mun's friend and his state counsellor for the last seven years of the ruler's rule.
This period ended suddenly, and a new and possibly more productive time began for al-Biruni when Ma'mun was assassinated in 1017. The ruler of a neighbouring state, Ghazna, the Sultan Mahmoud bin Sebuktigin, used the situation to take over Khwarazm, and with Khwarazm, he seized as well the intellectuals who had been in Ma'mun's court there. It would seem that of them all he prized al-Biruni most highly. They were all moved to Mahmoud's capital, Ghazna in what is now Afghanistan. The sultan Mahmoud's power continued to grow until it approached that of the Abbasids in Baghdad, but he pledged nominal fealty to Baghdad, and Baghdad allowed him to remain the real power in the East; a period of security began which was only disturbed with the arrival of the Seljuks.
Mahmoud had a great interest in India, and he made almost yearly military visits to it, taking al-Biruni with him. This preoccupation on Mahmoud's part was to open the science and philosophy of India to Islam. It was the time when al-Biruni was able to master Sanskrit and develop a very deep understanding of the knowledge of the Indians. His later passing on of this knowledge to Islam may perhaps be his most significant intellectual contribution. F. C. Auluck considers that he spent about ten years in India in all.
Sultan Mahmoud died in 1030, and al-Biruni then served at the court of his successors, Mohammed, (ruled a few months only), Mas'ud (1030 - 1040), and Maudud (1040 - 1048). The date for his death is not as certain as that for his birth. Safa puts his death at 1048, but others have claimed he was still alive in 1055. He himself noted towards the end of his life when he was working on his pharmacology book that he was over eighty (lunar) years of age; he must therefore have lived till at least the age of 78 (Gregorian calendar). The consensus seems to be that he died 'after 1050'.
Al-Biruni's book, 'Fi Tahqiq ma lil Hind', (On the affirmation of what is in India) is of interest to everyone, recording as it does the times and customs of the people he met on his many trips to the sub-continent in the retinue of the sultan Mahmoud. One stimulus to the writing of his book on India was the attitude of Abu Sahl at-Tiflisi, who urged him to write down all he knew. Fuat Sezgin quotes al-Biruni: (translation) "In the East, there is no people which tends towards science except for the Indians. But in these subjects (i.e., medicine) they have laid down a very secure foundation which contrasts with the usual rules of the western lands. Moreover, contrasts are made prominent between us and them in language, religion, manners and customs, while their extreme scrupulousness with regard to cleanness underlines the similarities."
Auluck notes that in addition to its being a work on the science of India, Fi Tahqiq ma lil Hind is also a comparative study of Indian, Persian, Greek and Arabic thought.
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At this point I will move on to deal with what I have picked up from the two Samhitas of Sushruta and Caraka. What follows derives from the English translations of the Sushruta Samhita of Kaviraj Kunjalal Bhishagratna. and of Caraka Samhita of P. V. Sharma. The word, Samhita, means a collection [of writings].
Sushruta
Most evidence now points to Sushruta having lived and worked in the sixth century before Christ. He was predominantly a surgeon, a man of the race of Vishvamitra and therefore a Brahmin. For any other information on Sushruta, one must read between the lines, so to speak, in the Samhita. This in itself is a hazardous undertaking, because one can never be sure that what one is reading comes from the pen of Sushruta. According to Kunjalal, "we have no means of ascertaining what the Samhita was like as originally written by Sushruta, the present being only a recension, or rather a recension of recensions, made by Nagarjuna". He further explains the almost total absence of any information on the man himself by noting that "In a country like India where life itself was simply regarded as an illusion, the lives of kings or commoners were deemed matters of little moment to the vital economy of the race."
Although the claim is made by the ancient Aryans that their knowledge of medicine (and other matters) derived from the gods by direct revelation, as Kunjalal points out, Indian medicine is probably the outcome of collecting and organising the knowledge of individuals over eons.
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THE EIGHT BRANCHES OF AYURVEDIC MEDICINE
In the first part of the Samhita, Sushruta describes the Ayurveda (the science of life) as being divided into the following eight branches:
1. Salya-Tantram - Treatment of ulcers, removal of foreign bodies; in short, surgery, cautery and the use of alkaline substances.
2. Shalakya-Tantram - diseases etc. occurring above the clavicles
3. Kaya-Chikitsa - general diseases (not restricted to nay particular organs) [e.g., fever, dysentery, haemoptysis, insanity, hysteria, leprosy, unnatural discharges from the urethra, etc.
4. Bhuta-Vidya - Demonaical diseases (exorcism of evil spirits, etc)
5. Kaumara-Bhritya - paediatrics (also treatment of mothers' milk etc.)
6. Agada-Tantram - toxicology; treatment of bites from snakes, spiders, venomous worms and their characteristic symptoms and antidotes; elimination of poison whether animal, vegetable or mineral (resulting from incompatible combinations) from the system of a man overwhelmed with its effects.
7. Rasayana-Tantram - the prolongation of human life, invigoration of memory and the vital organs of man. It deals with recipes which enable a man to retain his manhood or youthful vigour up to a good old age, and which generally serve to make the human system invulnerable to disease and decay.
8. Vajeekarana-Tantram - science of aphrodisiacs "in short, it deals with things which increase the pleasures of youth and make a man doubly endearing to a woman"
Surgery is given pride of place in medicine as being the oldest of its branches and the one which has the advantage that "instantaneous actions can be produced with the help of such appliances as, surgical operations, external applications of alkalis, cauterisation, etc. and secondly inasmuch as it contains all that can be found in the other branches of the science of medicine as well".
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It is perhaps not surprising to read in Sushruta's Samhita that when the disciples of the holy Dhanavantari, incarnated in the form of Divodasa, king of Kasi, were invited to choose that part of the Ayurveda they wished to be taught, they chose surgery, and they further elected Sushruta as their spokesman..
There were three 'physiological factors' or Doshas which control the body:
The Vayu [nerve force] - Bishagratna states that it is "the primary cause - an all-in-all that governs our organic as well as our cognitive faculties". It maintains the necessary balance between the effects of Pittam and Shleshma.
The Pittam [internal fire] - Kunja lal equates it to the idea of metabolism current in 1907 when he performed the translation. Perhaps it might for the most part correspond to catabolic processes.
The Shleshma or Kapham [the cooling principle] - It is seen as the factor responsible for counteracting the effects of Pittam which, uncontrolled, would lead to the body's being consumed. This might be equated with anabolic processes.
Food which is "ingested is fully digested with the help of the internal heat and ultimately assimilated in the system, giving rise to lymph chyle and forms the essence of the assimilated food." During its progress through the body, its colour is changed by the normal heat of the body, and it becomes blood. He notes that the 'seats' of blood are in the liver and the spleen. "Blood is the origin of the body. It is the blood that maintains vitality. Blood is life. Hence it should be preserved with the greatest care."
Blood causes the formation of flesh, and flesh in turn produces fat which then contributes to bone formation. This then leads to marrow being produced; marrow causes the formation of semen.
Disease is defined as follows: "The Purusha (man) is the receptacle of any particular disease, and that which proves a source of torment or pain to him is denominated as a disease."There are four types of disease:
FOUR TYPES OF DISEASE
Agantuka - Traumatic (of extraneous origin) - [i.e., a blow or hurt]
Sharira -Bodily [diseases due to irregularities in food or drink, or incidental to a deranged state of the blood, or of the bodily humours acting either singly or in concert]
Manasa - Mental [ excessive anger, grief, fear, joy, despondency, envy, misery, pride, greed, lust, desire, malice etc.]
Svabhavika - Natural [hunger, thirst, decrepitude, imbecility, death, sleep, etc.]
The treatment of disease is based on four factors, cleansing, pacification of whatever imbalance is causing the disease, and proper management of diet and conduct.
Chapter 38 of the Samhita concentrates on drugs and categorises them according to their therapeutic effects. there are 37 categories. Many have differing effects on the three physiological factors, Vayu, Pittam and Kapham; others are more specific. For instance some destroy fat, combat dysentery, cure stones in the bladder, cure leprosy and correct seminal disorders. The following chapters go into much detail on particular groups of drugs.
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Sushruta was obviously a practised surgeon, and a man who used dissection to acquire the knowledge necessary for such a profession despite the religious rule that required the cremation of any body greater than two years of age. He wrote, "The different parts or members of the body as mentioned before including even the skin cannot be correctly described by any one who is not versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully observe (by dissecting it) and examine its different parts."
His instructions for the preparation of such a body - leaving it to decompose in water for 7 days - might however be considered counterproductive. He did however instruct that the intestines be evacuated and that it be wrapped in grasses and the like. Perhaps there was also something else included which has not been written down.
Bishagratna quotes Sushruta as follows concerning the need for practical experience: "theory without practice is like a one-winged bird that is incapable of flight".
He deals with cautery and the use of alkalis which seem to be equivalent to surgery, although less radical. With respect to the latter he writes: "An alkali administered by an ignorant physician is to be dreaded more than poison, fire, blows with a weapon, thunderbolts, or death itself; while in the hand of an intelligent physician it is potent enough to speedily subdue all serious diseases in which its use is indicated"
He states that the use of leeches is the gentlest type of bleeding that can be devised and advocates its use for those not strong enough to undergo surgery. He divided surgical procedures into eight categories: incising excising, scraping puncturing, searching or probing extracting, and secreting fluids suturing
Sushruta states that there are 101 surgical instruments, normally made of iron, of six types and designed to the aims of the 8 procedures listed above. He states that the following are commendable features in such instruments: "Instruments that are fitted with handles of easy grip and made of good and pure iron, well shaped, sharp, and are set with edges that are not jagged and end in well formed points or tops should be deemed the best of their kind." He adjures the surgeon to design his own to fit the circumstances.
Amongst the surgical procedures described are the following: removal of bladder stones rhinoplasty, 'couching' of cataracts amputations, treatment of wounds caesarian section, fistula repair splinting of fractures, removal of arrows etc. midwifery, and treatment of ascites extraction of dead foetus
As a final comment on the Sushruta Samhita, one cannot help but be perplexed by the propensity of the translator to decline to use English equivalents for much of the subject matter. Would that I knew a bit of Sanskrit!
Caraka
As an individual, Caraka seems, if anything, even more nebulous than is Sushruta. The name is considered by many to have possibly been assigned to a line of savants all of whom worked on the topic of Ayurvedic medicine. V. P. Sharma argues that he probably lived between the fifth century B. C. and the second century A.D.
G. Morgenstierne sees al-Biruni as a pioneer in the comparative study of human culture. He quotes al-Biruni as follows: "I like to confront the theories of one nation with those of another simply on account of their close relationship, not in order to correct them."...."The mutual assistance of civilised people presupposes a certain difference among them in consequence of which one requires the other. According to this principle, God has created the world as containing many differences in itself." As A. Bausani points out in contrasting the approach of al-Biruni with that of Ibn Rushd to the Christian concept of the Trinity, "the scientist (Biruni) tries to understand objectively (apart of his theological judgement) what the Christians mean by Trinity, the philosopher (Ibn Rushd) tries to teach the Christians what they should mean by Trinity!" By this I understand that al-Biruni's approach is the superior one because it unshackles him from the "one-way vision" of the missionary (who may see an act on the part of someone from another culture as unacceptable because if he - the missionary - were doing it its significance to him would make it unacceptable) and frees him to search out the true meaning of whatever he is studying. He did abhor the "hideous fiction and superstitions of the Hindus", but at the same time he realised that the Hindu lower castes were in fact barred access to the Veda. There was one religion for the intellectuals and another for the untutored. He is known to have translated Indian works into Arabic, one such being the 'Kalab yarah' on septic diseases.
Further Readings:
Auluck FC. Al-Biruni and Indian astronomy. In: The commemoration volume of Biruni International Congress in Tehran. B. English and French papers. High council of culture and art. Centre for research and cultural co-ordination. Tehran, Iran 1976: 513-33
Bausani A. Christian Trinity in al-Biruni and Ibn Rushd: scientific vs. philisophical method. In: The commemoration volume of Biruni International Congress in Tehran. B. English and French papers. High council of culture and art. Centre for research and cultural co-ordination. Tehran, Iran 1976: 479-93
Bhishagratna, Kaviraj Kunjalal. An English translation of the Sushruta Samhita [3 vols]; Chowkhamba Sanskrit Series Office, Varanasi (Benares) 1991
Leclerc L. Histoire de la medecine Arabe. Tome premier. Ministere des habous et des affaires Islamiques (re-edition of work originally published 1876) Rabat, Morocco Royaume du Maroc 1980
Morgenstierne G. "Al-Biruni, the founder of comparative studies in human culture". In: The commemoration volume of Biruni International Congress in Tehran. B. English and French papers. High council of culture and art. Centre for research and cultural co-ordination. Tehran, Iran 1976:1-9
Safa Z. Biruni, ses oevres et ses pensees. In: The commemoration volume of Biruni International Congress in Tehran. B. English and French papers. High council of culture and art. Centre for research and cultural co-ordination. Tehran, Iran 1976: I-XXXV
Sezgin F. Geschichte des arabischen Scriftums Band III, Medizin-Pharmacie-Zoologie-Tierheilkunde bis ca 430 H. Leiden E. J. Brill 1970
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