Healing and Medicine: Healing and Medicine in Āyurveda and South Asia
HEALING AND MEDICINE: HEALING AND MEDICINE IN ĀYURVEDA AND SOUTH ASIA
Āyurveda is one of several traditional medical systems that originate from the Indian subcontinent. It is now represented as the indigenous Indian medical tradition par excellence. As is the case with other Indian medical systems, the origins of Āyurveda long predate the formation of an Indian nation and are not necessarily set within its geographical boundaries. In the context of the history of medicine, therefore, "Indian" often denotes quite a large area within South Asia. A second great tradition of medicine, called Siddha, developed in the south of India. It is less well known outside of India, but of similar antiquity and authority to Āyurveda. Other medical systems, originating from countries outside the Indian subcontinent, have been integrated into its cultures and now form part of its medical traditions. The earliest, and perhaps most important of these systems to be imported and acculturated is Ūnānī medicine. Much later, but equally significant, additions were homeopathy and naturopathy. A different development has taken place in the case of Yoga. Here, an indigenous knowledge system has been reinterpreted as the focus has shifted from the philosophical tradition to the health-related aspects of postural and meditative Yoga practice. The developments within the old traditions with their long and varied histories, the addition of new traditions to the established ones, their interrelations and the interweaving of medical thought with a changing religious, political, and cultural climate, all form a rich and complicated pattern of medical and social history. The developments starting in the early twentieth century toward the modernization and professionalization of medicine have brought these and other medical systems into a common frame of health policy and legislation, as health has become the responsibility of the government. Thus, the more recent history of traditional Indian medicine is shaped by health politics. At the same time, the sphere of its influence has widened, as Āyurveda and other traditional medical systems have come to the attention of an international public, taking a position beside other complementary and alternative therapies.
The Textual Tradition of Āyurveda
The Āyurvedic medical tradition has a lively history of more than 2,000 years, during which it has continually developed. This development has been accompanied by continuous textual production, resulting in an enormous corpus of literature. Āyurvedic literature not only makes it possible to reconstruct the history of Āyurvedic thought and practice, it also adds to the general understanding of Indian history from its antiquity to the present. It encompasses a wide range of topics that go beyond simple medical instructions, constructing a complex worldview from philosophical, religious, political, and social perspectives.
Āyurveda's beginnings, as known from early classical Sanskrit treatises, are predated by instances of medical knowledge found in Vedic literature. Āyurvedic tradition postulates a direct lineage with Vedic medicine and refers to its medical system as an appendix to the Atharvaveda. Debiprasad Chattopadhyaya, in Science and Society in Ancient India (1977), was the first to contest the traditional view that Āyurveda developed directly from the medicine of the Vedas, pointing to strong conceptual and epistemological differences between Vedic and Āyurvedic medicine. Kenneth G. Zysk, in Asceticism and Healing in Ancient India (1998), has subsequently shown that Āyurvedic theory generally does not rely on Vedic medicine although Āyurvedic literature uses Vedic imagery and mythology to evoke a sense of continuity with the past and to establish legitimacy in a society dominated by Brahmanic ideology. According to Zysk, the roots of Āyurveda lie in the medical knowledge of wandering ascetics, most notably Buddhist monks. This is corroborated by the fact that Buddhist texts reveal the first glimpses of a systematized medicine similar to Āyurvedic theories expounded in the classical treatises.
The classical era of Āyurveda begins with the medical treatise of Caraka—the Caraka Saṃhitā —which is written in Sanskrit and dates to about the first century ce, though its foundations most likely go back to a much earlier time. Caraka (Sūtrasthāna 30.28) presents the first systematized medical theory of Indian antiquity, formally dividing medicine into eight branches (Skt., aṣṭāṅga ):
- Kāyacikitsā (devoted to general medicine).
- Śālākya (devoted to the surgical treatment of body parts above the shoulders).
- Śalyāpahartṛka (devoted to the removal of foreign bodies—surgery).
- Viṣagaravairodhikapraśamana (devoted to toxicology).
- Bhūtavidyā (devoted to the treatment of possession by various supernatural beings).
- Komārabhṛtyaka (devoted to pediatrics).
- Rasāyana (devoted to the preparation of life-prolonging tonics).
- Vājīkaraṇa (devoted to aphrodisiacs and treatments relating to virility).
While later texts do not slavishly follow this division into eight general subjects, the term aṣṭāṅga thereafter becomes a synonym for medicine. Later works often refer to Caraka, and today the Caraka Saṃhitā is part of the curriculum taught in modern Āyurvedic colleges in India.
The Caraka Saṃhitā is chronologically followed by the Suśruta Saṃhitā, which probably reached its present form around the third century ce. Its most important addition to medical history is its information on surgical operations. These very advanced surgical methods are neither mentioned in the Caraka Saṃhitā nor in later Āyurvedic works.
The only other surviving treatise that belongs to this early period is the Bhela Saṃhitā, which is quoted in premodern Āyurvedic texts. However, only one manuscript of this work survives and its importance for the development of Āyurvedic thought does not parallel that of the treatises of Caraka and Suśruta.
Chronologically, next to be mentioned is the collection of medical and divinatory texts dated to the sixth century, now commonly referred to as the "Bower Manuscripts." The manuscripts were found buried close to a monastery situated near the old Silk Route trading stop of Kuqa, which testifies to the presence of Indian medicine in Inner Asia in the early sixth century ce.
A work of major importance was composed by Vāgbhaṭa in the early seventh century. Together with the two older treatises, it is part of the "great threesome" (Skt., bṛhattrayī ) of Āyurveda. Vāgbhaṭa's treatise, the Aṣṭāṅgahṛdaya Saṃhitā (The heart of medicine), is a summary of medical knowledge, extracting the essence of medicine, as its title suggests, from previous works in an attempt to synthesize, unify, and put into order their contents. This textbook soon gained great popularity and was widely disseminated throughout India and beyond. Foreign translations of the Aṣṭāṅgahṛdaya Saṃhitā were appearing within a century of its composition and copies of the medical textbook are found in abundance in manuscript libraries both in North and in South India. The Aṣṭāṅgahṛdaya Saṃhitā is in many ways the most important Āyurvedic text. Its doctrines are widely regarded as authoritative and form an integral part of modem Āyurvedic education and practice.
Three later works have similar status to that of the "great threesome" and are called the "lesser threesome." These are the works of Mādhava (c. 700 ce), Śārṅgadhara (c. 1300), and Bhāvamiśra (sixteenth century). Mādhava's work on the causes and symptoms of diseases was widely read and set the pattern for later systematic descriptions of diseases. It is cited by al-Ṭabarī in the Firdaws al Ḥikmah. Śārṅgadhara's compendium is one of the most successful Āyurvedic books ever written, as the great number of copies found in libraries across India testifies. More recently, the pharmaceutical industry has made use of its recipes in the manufacture of Āyurvedic products. Bhāvamiśra's work is innovative in several respects. It is perhaps most noteworthy that he introduced the subject of syphilis to Indian medicine.
Translations of passages in the above-mentioned works can be found in Dominik Wujastyk's Roots of Āyurveda (2003). However, this selection of medical works only forms the tip of the iceberg. To give just a few examples, further remarkable works include the numerous encyclopedias and dictionaries containing Āyurvedic material, such as the Mānasollāsa (twelfth century), the Lakṣmaṇotsava (fifteenth century), the Āyurveda saukhya of the Ṭoḍarānanda (sixteenth century), the Vīramitrodaya (seventeenth century), the Śivatattvaratnākara (early eighteenth century), the Vaidyakaśabdasindhu (late nineteenth century), and the Bṛhannighaṇṭuratnākara (late nineteenth to early twentieth century).
Julius Jolly's Indian Medicine (1994) is still a useful reference for the Āyurvedic textual tradition. However, Gerrit Jan Meulenbeld's History of Indian Medical Literature (1999–2002) offers the most comprehensive and thorough overview. This magnum opus is an invaluable source for Āyurvedic studies and certainly the most important work of its kind to date. Other reference works are written in Indian vernacular languages, as for example the Hindi Āyurved kā Vaijñānik Itihās (1975) by P. V. Sharma.
The Principles of Āyurveda
Far from comprising a uniform theoretical body, the various Āyurvedic sources differ considerably in their statements on the fundamental principles of Āyurveda. Given Āyurveda's large and varied literature, and that it is a living and changing tradition that looks back at more than 2,000 years of development, this is hardly surprising. New theories and treatment methods evolved, old ones were mostly recounted with respect, but sometimes openly disputed and sometimes silently replaced. The use of the materia medica changed due to the availability of plants and of other resources, and new environments and ways of living changed the basic assumptions of the older texts. Thus, though the sources certainly share common features that make it possible to define them as part of the Āyurvedic medical system, any overall definition of the basic tenets of Āyurveda is necessarily a selective construct. To arrive at more precise and coherent definitions of Āyurvedic theories, research often focuses on a certain period of time or on certain texts. Here, the main sources used to represent the Āyurvedic opinion will be the treatises of Caraka and Suśruta and Vāgbhaṭa's Aṣṭāṅgahṛdaya Saṃhitā, with a strong emphasis on the latter text. It should be kept in mind, however, that there exist other versions of the Āyurvedic doctrines presented here, as well as altogether different approaches.
The term Āyurveda translates as "the knowledge [Skt., veda ] of longevity [Skt., āyus ]." This name points to a fundamental characteristic of Āyurvedic medicine expressed in the classical texts, namely that its emphasis is on establishing ideal conditions for living a long life. Health is not only a goal in itself, but, perhaps more importantly, the means by which to achieve longevity. According to Caraka (Sūtrasthāna 1:15), a long life offers the human being the opportunity to fulfill the "four duties" (Skt., caturvarga )—namely kāma, artha, dharma, and mokṣa. The connections between the trivarga (excluding mokṣa )—or caturvarga —and medical theory are discussed by Arion Roşu in "Études āyurvédiques: Le trivarga dans l'āyurveda" (1978). The responsibility to fulfill these duties can be extended to maintaining health: each person is an active participant in establishing the grounds for a long life (or the reverse) by living (or not living) according to certain standards, which are defined in the Āyurvedic texts. The medical manuals not only provide the professional physician with specialized instructions on medical practice, but also offer the general public a wide range of practical advice on different aspects of life. The physician's role is complementary to the efforts made by those afflicted with disease and by the healthy alike. Ideally motivated by compassion for his suffering fellow beings, the physician's task is to alleviate bodily and mental discomfort and to help restore health through administering medicine or providing other forms of therapy. The other very important part of the profession would be to give advice on the prevention of disease: that is, on how to lead a good and healthy life, broadly understood.
Health is interpreted not only as the absence of illness but as a state of complete well-being. The individual's condition can only be fully understood within the context of society at large and of the person's environment. This has been discussed by Francis Zimmermann in his groundbreaking book The Jungle and the Aroma of Meats (1987). Caraka (Śārīrasthāna 5.3) defines the connection of humans with nature as one mirroring the other. The microcosmic human reflects the macrocosm of the universe and ultimately of all there is, and vice versa—a concept that already appears at an early stage of Vedic literature as the conceptual basis of sacrifice.
Within the physical body of the human, health is understood as the proper functioning of certain processes that are based on the body's inherent structure of fluids and channels. The Āyurvedic view of the human body differs substantially from the biomedical understanding of anatomy. Thus, the Aṣṭāṅgahṛdaya Saṃhitā states that doṣas, dhātus, and malas are the root of the body (Sūtrasthāna 11.2). These three Sanskrit technical terms are used to describe the physical and (to a limited extent) the mental processes involved in the causing of health and disease. Their translation presents a set of difficulties, as their literal translation does not fully convey their meaning. The word doṣa, for example, is derived from the causative of the verb root duṣ, which literally translates as "to spoil" or "to corrupt" (Monier-Williams et al., 1899, p. 488). The negative connotation of something that causes damage is definitely inherent to the understanding of the doṣas, but as the above citation of the Aṣṭāṅgahṛdaya Saṃhitā shows, they are also positively interpreted as an essential part of the body. Translations often use the term humor for doṣa, as there are strong parallels (if also differences) between the doṣa theory and the Greek humoral system. Generally, a doṣa is a substance that flows or circulates within the body and fulfills particular functions within it. Āyurvedic theory usually speaks of three doṣas, namely wind (vāta), bile (pitta), and phlegm (kapha or śleśman), often also glossed somewhat more glamorously as wind, fire, and water, in analogy to their presumed properties. There are also occasional references to four doṣas, most notably in the Suśruta Saṃhitā (Sūtrasthāna 21.28), blood being added as the fourth. Each of these doṣas is located mainly in a particular area of the body, though they can also move around along special channels without causing damage. Thus, vāta is mostly situated in the large intestine, pitta in the navel, and kapha in the chest and above. Their functions are summarized in the Aṣṭāṅgahṛdaya Saṃhitā (Sūtrasthāna 1.1–3) as follows: Vāta gives the body strength, activates speech, body, and mind, induces the evacuation of the intestinal tract, supports the dhātus, and sharpens the senses. Pitta regulates digestion, body heat, sight, hunger, thirst, and appetite. It makes the body soft and supple. On a mental level it gives understanding, intelligence, and courage. Kapha gives the body firmness and smoothness and holds the joints together. Its psychological quality is patience.
Disease is often defined as an imbalance of the doṣas. However, this is only part of the picture and does not represent the full Āyurvedic explanation of how the doṣas cause disease, as a closer look at the specifications of the texts reveals. Vāgbhaṭa, for example, uses the metaphor of balance and imbalance, but explains that imbalance denotes a change in quantity as well as the dislocation of a doṣa. The quantity of a doṣa can both increase and decrease, which leads to various symptoms of disease. The increase of a doṣa is a process that evolves in two stages: its accumulation (Skt., caya ) and its subsequent surge (Skt., kopa ), in which the doṣa leaves its own area. The symptoms for accumulation are different from those for the surge, which causes a graver condition of disease that is more difficult to treat. Thus, the state of the doṣas —that is, whether they are increased or decreased, in a stage of accumulation, or in surge—is relevant for treatment, as they require different measures. However, differences in treatment based on distinctions between decrease and increase, accumulation and surge, are so subtle as to nearly justify the sweeping statement that the imbalance of the doṣas causes disease.
The second component the Aṣṭāṅgahṛdaya Saṃhitā names as the root of the body is the dhātus, literally "constituent parts" or "elements." In a medical context, these are defined as elements or essential ingredients of the body, namely chyle (i.e., food that has undergone the first process of digestion), blood, flesh, fat, bone, marrow, and semen. To this list of seven dhātus, hair, skin, and sinews are sometimes added. The dhātus are thought to evolve in succession from each other: semen from marrow, marrow from bone, bone from fat, and so on. Confusingly, the doṣas are also sometimes called dhātu, particularly to denote their positive quality of sustaining the body. This has been addressed by Hartmut Scharfe in "The Doctrine of the Three Humors in Traditional Indian Medicine and the Alleged Antiquity of Tamil Siddha Medicine" (1999), in which he argues that the usage of dhātu in lieu of doṣa goes back to an older understanding of the doṣas found in the Buddhist Pali canon, in which doṣa unambiguously denotes a negative force causing disease.
The dhātus shape the physical body but also have separate functions that are specified in the Aṣṭāṅgahṛdaya Saṃhitā (Sūtrasthāna 11.4) as follows: chyle causes the sensation of delight, blood is a stimulant and increases the life force, meat covers the bones, fat regulates the greasiness (for example of the eyes), the bones keep the body upright, marrow fills the bone, and semen is responsible for procreation. Parallel to the doṣas, the dhātus also can increase or decrease, causing various symptoms of illness. The increase or decrease of a dhātu effects the dhātu chain, one dhātu vitiating the next, which in turn leads to conflicting symptoms and complicates diagnosis. The treatment of dhātu -related illnesses is fairly straightforward in contrast to their diagnosis: an illness that is diagnosed as an excess of blood is countered with bloodletting; an excess of flesh, (e.g., a tumor), with its removal. The decrease of dhātus on the other hand, is counteracted with appropriate nutrition, based on the principle that what has been lost should be added again.
The malas are called the third root of the body. Mala as a medical term denotes any bodily excretion or secretion—that is, urine, feces, and sweat, but also mucus, earwax, and tears. The Aṣṭāṅgahṛdaya Saṃhitā (Sūtrasthāna 11.5) explains that feces sustain the body, urine evacuates the fluids, and sweat holds the fluids inside. The treatment of mala- related illnesses corresponds to the treatment of the doṣas in that the malas increase and decrease, but also because the doṣas are seen as the underlying cause of the increase or decrease of the malas.
There are, however, also other forces at work on the body. One central concept is that of āma, which is the product of improperly digested food that has turned to poison in the body. As a poison, it vitiates the doṣas and the dhātus and causes the disruption of their course of flow or development. The descriptions of what the vitiation of a doṣa means or of how exactly the disruption of flow is effected are somewhat vague. The general concept is that āma can in various ways block the channels through which the doṣas are meant to move. Treatment aims at ridding the body of this unwanted substance and consequently focuses on cathartic procedures using purgatives, enemas, and emetics.
It has been mentioned above how the theory of the three doṣas affects treatment. An interesting aspect of Āyurvedic medical practice, however, is that treatment is in many cases not necessarily dependent on theory. An infection of the urethra, for example, will commonly be treated with turmeric. In modern Āyurvedic treatment, the identification of the urethra as the site of infection and the understanding of infection are based on modern medical conceptions that do not occur in classical Āyurvedic literature. However, stereotyped diagnosis and treatment disregarding the theory of the individual constitution also forms an intrinsic part of premodern Āyurvedic medicine, as Gerrit Jan Meulenbeld has pointed out in "The Surveying of Sanskrit Medical Literature"(1984; pp. 44–46). A urethra infection can be explained as the symptom of excess pitta and the use of turmeric as counteractive to the heat-related doṣa because of its cooling properties. This, however, does not influence the primary prescription that pain in the urinary tract should be treated with turmeric.
In short, Āyurveda offers more than one solution to medical problems. While the abundance of often conflicting material on Āyurveda is vexing for the historian or the sociologist trying to delineate Āyurvedic theory, the maxim "whatever works is right" seems to have been sufficient for the Āyurvedic practitioners who have continued and developed the tradition of Āyurveda from its beginnings.
The best overview of Āyurvedic theory and treatment procedures is probably still Jolly's Indian Medicine. Wujastyk's Roots of Āyurveda offers a good selection of translated texts pertaining to Āyurvedic principles and procedures and Guy Mazars in La médecine indienne (1995) gives a very concise and accessible introduction to Āyurveda. S. K. Ramachandra Rao's Encyclopedia of Indian Medicine deals with Āyurvedic theory in more detail. However, for an in-depth understanding of Āyurveda, the primary sources themselves, which are increasingly available in translation, are of fundamental importance.
The Politics of Āyurveda
In 1970 the Indian parliament passed the Indian Medicine Central Council Act (IMCCA), setting up a central council for the indigenous medical systems of Āyurveda, Siddha, and Ūnānī. The council is responsible for laying down and maintaining uniform standards of education and for regulating practice in these systems. It also prescribes the standards of professional conduct and etiquette, and the code of ethics for practitioners of Indian Systems of Medicine (ISM). The IMCCA of 1973 added homeopathy to the list, changing ISM to Indian Systems of Medicine and Homeopathy (ISM&H). Yoga and naturopathy (and a number of local health traditions) are recognized as ISM by the Indian government, but do not receive the same amount of funding and also are not centrally regulated by the Indian Medicine Central Council (IMCC). Yoga was included as a research subject by the Central Council for Research in Indian Medicine and Homeopathy (CCRIM&H), founded in 1969, and naturopathy was added as a research subject in 1978, when the CCRIM&H was divided into separate councils, isolating homeopathy and Ūnānī and coupling Āyurveda with Siddha and Yoga with naturopathy. S. K. Mishra outlines these developments in his article "Ayurveda, Unani, and Siddha Systems: An Overview and Their Present Status" (2001).
Thus, with the IMMCA of 1970, the Indian government for the first time officially recognized Āyurveda, Siddha, and Ūnānī as national systems of medicine, and at the same time it centralized their administration in order to set an all-India standard. The Central Council Act was the result of a series of discussions concerning Indian health policies that were made both before and following Indian Independence in 1947. Paul Brass has pointed out in "The Politics of Ayurvedic Education" (1972) that as early as 1946 a resolution had been passed by the First Health Ministers' Conference, giving recognition to indigenous systems of medicine by recommending that practitioners trained in these systems should be utilized in federal state health programs. State responses were varied, with some giving considerable support to the indigenous systems while others ignored the health ministers' recommendation, preferring modern medicine to the traditional systems. No state government, however, declared Āyurveda or any other indigenous system as its state system of medicine.
Debates on the role and position of indigenous medical systems within Indian health policy have a long history, which is interlinked with colonial health policies on the one side and Indian nationalism on the other. Among the indigenous medical systems, Āyurveda takes the first place (followed by Ūnānī), as measured by the number of its practitioners, institutions, manufacturers, and political bodies. While the well-developed infrastructure testifies to its success, the professionalization and institutionalization of Āyurveda has been a long and troubled process. In the first third of the nineteenth century, British health and education policy started to emphasize support for the modern system of biomedicine. This resulted in the patronage of modern medical colleges and hospitals and ultimately produced a number of practitioners with a medical reputation superior to that of traditional practitioners. The direct effects of British policy on indigenous medicine, however, date to a much later period, when Indians were admitted to the biomedical colleges and health services were extended to the Indian public. To meet the competition of the new system and to show the value of their science, traditional practitioners needed to (re)define the theoretical foundations of their medical system and to formulate their professional identity. In the case of Āyurveda this meant the birth of a new era, as Āyurvedic practitioners had never before organized themselves into one uniform body. The traditional education system, which is still predominant in religious teaching and in other disciplines in India today, had been that of pupilage; that is, the passing down of knowledge from teacher to one or several pupils, from father to son, or from uncle to nephew. This led to the formation of medical lineages or schools, as famous teachers could have quite a large following.
One step toward a modernized Āyurveda, therefore, had to be a break with the educational tradition of pupilage toward an expanded college system, in order to keep up with the growing number of graduates and license holders that the biomedical colleges were producing. Another was to form a unified theory of the Āyurvedic medical system, to present as the voice of Āyurveda at a political and ideological level and to shape the curriculum of the colleges. Following the Orientalist ideology that the "purest" and most original forms of Āyurveda must be found in the oldest texts, it was widely agreed among the advocates of Āyurveda that the traditional Āyurvedic treatises offered a reasonable basis for a common identity and a unified medical system. The goal, then, was to restore and to revive the ancient tradition and its presumed past glory rather than to maintain contemporary traditional practices, which were often labeled "degenerate." Accordingly, a distinction was made between an idealized Āyurveda based on the classical texts, and traditional practice based on later texts and folk medicine. While Orientalist rhetoric may have been a major component in revivalist ideology, it would not be true to say that it was the cause of the decision to present the teachings of the classical texts as the basis of Āyurvedic theory. Traditional families of Āyurvedic practitioners had been using these texts as the basis of their practice long before official debates on the theoretical foundations of Āyurveda started. However, Āyurvedic practitioners not only made use of the oldest treatises, but also of a multitude of texts that were composed after the classical texts. The wide publication of later Āyurvedic texts, edited from the late nineteenth century onwards by Āyurvedic scholars like Jīvānanda Vidyāsāgara Bhaṭṭācārya, Jīvarāma Kālidāsa Śāstri, Dattarāma Kṛṣṇalāla Māthura, and Yādavji Trikamji Ācārya, testifies that such texts were considered important.
Modern Āyurvedists needed not only to overcome sectarian and regional differences (including language barriers and diverging religious identities) in search of a uniform identity, but were also confronted with new educational methods and technology for diagnosis and research introduced to India by the British. The dominant form of Āyurvedic education that developed from this background at the end of the nineteenth century was an integrated or concurrent education system, which included both Āyurveda and modern medical subjects in varying proportions. The basic education in modern medicine was meant to enable students to play a role in public health programs. The question of the proportional distribution of Āyurveda and modern medicine within the curriculum—that is, which system should be the main focus of education and which should be taught as the complementary system—had from the beginning been a bone of contention among the supporters of the integrated system. Furthermore, the concept of the integrated system, as such, received heavy criticism both from biomedical advocacy groups and from other factions within the Āyurvedic movement as having produced practitioners qualified in neither system of medicine. The defects of the integrated system, made apparent by recurring student strikes and low enrollment numbers, and by divisions within its support group, strengthened the case of the rivaling interest group arguing for a śuddha (pure) Āyurveda that would be true to its tradition and ideologically free from Western influence.
Charles Leslie has pointed out in "Interpretations of Illness: Syncretism in Modern Āyurveda " (1992) how these issues became increasingly politicized, as the Āyurvedic movement divided into two main advocacy organizations: the Āyurvedic Congress, founded in 1907 and representing the śuddha faction, and the Council of State Boards and Faculties of Indian Systems of Medicine, founded in 1952 as a result of a split in the Āyurvedic Congress and representing the integrated view. As a voluntary advocacy organization, the Congress was constituted of individual practitioners and of local, provincial Āyurvedic associations. Its leading personality was Pandit Shiv Sharma. The council on the other hand was a "semi-official agency, whose members include[d] the heads of the Āyurvedic Colleges, the members of the state faculties and boards of Indian medicine, and the directors of Āyurveda in the health administrations of the several states"(Brass, 1972, p. 358). The leading personalities of the integrated system were Kaviraj Gananath Sen and later Chandragiri Dwarkanath. The council therefore represented the established educational system, which would seem to suggest it was the more powerful organization. However, the members of the Congress also had considerable political influence and powerful support in the central government. Thus, in 1962, Pandit Shiv Sharma was able to exert his influence as the appointed honorary advisor on the decisions made at the annual meeting of Central Council of Health. The resulting Vyas Committee report advised that Āyurvedic education and practice be developed on "purely ayurvedic lines, involving deep and intense study of the Classical Ayurvedic literature including its materia medica and pharmacy" and not to include "any subject of modern medicine or allied sciences in any form or language"(Brass, 1972, p. 360). Although the government of India and the state health ministers ultimately accepted the recommendations of the Vyas Committee, the implementation of the new policy did not proceed smoothly, due to inconsistent policies regarding the use of modern technology, resistance on part of the state governments, and the low enrollment numbers of students.
The debate on the educational system of Āyurveda (and of the other Indian systems of medicine) and its implementation into public health schemes is far from resolved even today. Despite all decisions from the government as recorded in the various IMCC acts, the failure of the Āyurvedists to agree among themselves on the goals to be pursued and on the appropriate standards for education, practice, and research has so far led to the inability of Āyurveda to compete with modern medicine and to fulfill its potential as a national system of medicine.
Overviews and more detailed surveys dealing with the politics and epistemological context of Āyurveda, its eminent advocates and opponents, and the modernization of traditional medical systems in general can be found in Mishra (2001); Gupta (1998); Leslie (1992, 1983, 1975, 1998a); Brass (1972); Jeffery (1988); Shankar (1995); Stepan (1983); Taylor (1998); Zimmermann (1992); Zysk (2001), and Phillips (1990).
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Dagmar Benner (2005)