Dr. M.S. Valiathan
38th Founder Memorial Lecture 2002
Shriram Institute For Industrial Research, Delhi

Medical Professional, Eminent surgeon, Biomedical expert, Dr. M.S. Valiathan, Chairperson Health Care- Technology Vision 2020 document preparation  team speaks on Ayurveda
*     New Stirrings
*     Origins
*     Ayurvedic literature
*     Roots of Ayurveda
*     Branches of the Ayurvedic tree
*     Basic concepts : tridosha as an example
*     Disease recognition and treatment
*     Training of a physician
*     Human destiny and an Ethical life
*     Ayurvedic leads for current research
*     Epilogue

Lala Shri Ram was a many splendoured personality. He built the Delhi Cloth Mills into a vast industrial empire covering a wide range of products and technologies. But he was an extra ordinary industrialist. Way back in the 1930s, he introduced revolutionary practices such as profit sharing with employees and worker participation in management. He founded or was closely associated with a number of educational and research institutions which continue to excel in the field of higher education – the Indraprastha College, Shri Ram College of Commerce, Lady Shri Ram College for Women and of course, the Shriram Institute for Industrial Research. He advocated universal free and compulsory primary education and technical and vocational education for women. His varied experience was drawn upon by the Government of India who appointed him to be the Chairman of a number of committees and institutions dealing with industry, finance, agriculture and planning. He was one of the authors of the famous Bombay Plan which anticipated the liberalisation of the Indian economy more than 50 years ago. He took keen interest in medical issues, especially tuberculosis. When we commemorate Lala Shri Ram, we are celebrating the flowering of the human spirit.

In speaking on India’s medical legacy as a tribute to Lala Shri Ram, I would confine myself to Ayurveda because of my lack of familiarity with folk medicine, siddha and unani which are equally Indian in inheritance.

* New Stirrings
Ayurveda resembles a deathless tree that continues to bring forth flowers and fruits from the oldest times of India’s history. Its influence on the diet and daily lives of millions of Indians often escapes notice but is nonetheless palpable. Hundreds of colleges and traditional centres impart instruction in the discipline which forms the backbone of India’s rural health care. Ayurvedic herbs have become the target of search in India and abroad for bioactive compounds, and the object of rival claims for intellectual property rights. Therapeutic centres of Ayurveda have sprung up in Europe and America where an increasingly chemicals – weary population turns towards natural products during illness. The National Institute of Health in the U.S. have opened a new Division which gives high place to Ayurveda in its investigative agenda. The pharmaceutical, cosmetic and even tourism industries parade the Ayurvedic provenance of their wares. All this and more bear testimony to the vitality of a system which had flourished even when the Buddha was ministering to the people in India.

* Origins
According to the Charaka Samhita, the outbreak of diseases and people’s suffering were the theme of a conference of noted sages long ago in a Himalayan valley. The participants agreed that the remedy for the ills lay in Ayurvedic lore which had to be procured from Indra who had himself obtained it from Brahma. Bharadwaja volunteered for the mission to Indra, which succeeded and brought Ayurveda within human reach. Sushruta, Kashyapa, Bhela and other Samhitas narrate a similar event with variations here and there. Regardless of variations, the event highlighted compassion as the mainspring of Ayurvedic endeavour.

Charaka remarked that there was never a time when life and intelligent people did not exist. People knew about life, and all around them grew herbs in plenty. Ayurveda emerged from the substratum of interactive people and their verdant surroundings – it did not appear all on a sudden out of nothing. Charaka would say that there were always people who understood the science of life in their own way, and it was only with reference to its first systematic understanding or formulation that it could be said to have had a beginning. The ancient Tantras and Samhitas of Ayurveda marked that beginning.

* Ayurvedic literature
The foundational texts of Ayurveda are the Charaka and Sushruta Samhitas which follow the medical and surgical traditions of Atreya and Dhanwantari. The versions we have today are by no means the original texts which underwent many revisions and redactions over centuries. Charaka who lived in the 1st century CE and was reportedly the physician – companion of Kanishka states explicitly that he was no more than revising the tantra of Agnivesa which had been in existence for centuries and was available to Chakrapani Datta as late as the tenth century CE. The later chapters of the Chikitsa sthana and the entire Kalpa and Siddhi sthanas of the Charaka Samhita were however lost in course of time, and their restoration and further revision were accomplished by Dridhbala of Kashmir in the 8th century. The Charaka Samhita of today is Dridhbala’s text. Sushruta Samhita had a similar textual evolution. What was composed by ‘Vridha Sushruta’ in the sixth or seventh century B.C. underwent by Nagarjuna in the fourth century AD and became another rmajor landmark in Ayurvedic literature which abounded in commentaries of the ancient texts. Ashtanga Samgraha of Vagbhata the first and Madhava Nidana appeared in 6th or 7th century AD and followed the trail of Charaka and Sushruta. Madhava’s approach was original in so far as his entire volume was devoted to the diagnostic process in medicine. Ashtanga hridaya of Vagbhata the second – the popular favourite of Kerala – followed in the eighth or ninth century and became a model of lucidity and poetry in the presentation of Ayurvedic subjects. Sarangadhara Samhita which laid special emphasis on plants and ecology made its appearance in the fourteenth, and Bhava Prakasa which referred for the first time to syphilis and its treatment with mercury in the sixteenth century. Each of these major works stood out by the presentation of new information or approach or emphasis, and seemed to respond to the call of Vagbhata to update knowledge in tune with changing times. There are literally thousands of other Sanskrit texts on Ayurveda not to speak of a vast literature on the use of alchemy for medical purposes. As Charaka refers to many texts which existed in his times Ayurveda never seems to have suffered from the paucity of textual material.

* Roots of Ayurveda
Charaka urged the votaries of Ayurveda to be loyal to the Atharva Veda. The Atharva Veda consists of six thousand mantras and one thousand proselines, a major percentage of which deal with health, disease, and long life. These themes run as an unbroken thread from the Atharva Veda to the Samhita literature of Ayurveda.

The Atharva Vedic mantras attributed diseases such as fever, leprosy, epilepsy and jaundice to supernatural causes and prescribed ritual measures which were promotive (paushtika), curative (bheshaja), or destructive of the enemy (ghora). The chanting of mantras was obligatory at the rituals which included oblation (homa), purification (prayaschita), and the application of amulets. An Atharvan mantra claimed that hundreds of physicians and thousands of herbs could not achieve the results obtained by an amulet. Indeed guggulu, satawari, kushta and many other herbs that were used in healing were believed to work through supernatural, and not pharmacological action. The Atharva Vedic approach to therapy was diavavypasraya which assigned the causation and management of diseases to the domain of faith, miracle and rituals. But Atharva Veda had much else besides. Its enumeration and description of bones; or organs such as heart, lungs, gall blader, kidneys, liver, spleen, intestines, rectum, marrow, blood vessels and placenta; of the flow of liquid elements in the body; of the operation of air currents (prana, apana, vyana and samana); of the use of a reed as a urethral catheter to release retained urine and many other references became the forerunner of the more elaborate and more rational (yukti vyapasraya) system of medicine that appeared in the Charaka and Sushruta Samhitas. Dasgupta believes that the Atharva vedic concept of diseases being produced by wind, water and fire was the seed of the tridosha doctrine of Ayurveda.

The roots of Ayurveda go beyond the soil of Atharva Veda and draw upon the later domains of Indian philosophical systems. The philosophical concepts however, evolved and changed in their Ayurvedic incarnation even as the faith – ritual based medicine of Atharva Veda became rooted in empiricism and reason in Ayurveda. To illustrate, Vaiseshika, to which Ayurveda was much indebted, categorised substances (dravyas) as the five elements, manas, time, space and self – a classification which Charaka adopted. The position however changed in relation to properties or gunas which inhered in the substances. Charaka stipulated, and applied in practice, physico-chemical properties such as heaviness and lightness which were not mentioned in Vaiseshika. From the series of non-physico chemical properties beginning with para, apara etc. in Vaiseshika, several were left out by Charaka who also gave different meanings to terms such as para and apara to fit the tradition of medicine. Again, unlike the Vaiseshika, Charaka included phychological properties such as desire (ichha) and hatred (dwesha) in the non-physico-chemical list.

Ayurveda adopted the Nyaya classification of the means of knowledge as the testimony of the wise (aptopadesa), perception (pratyaksha), inference (aumana) and reason (yukti). The definitions of logical terms and the classifications of philosophical disputation as tarka, vada, jalpa and vitanda were so fully and so authoritatively discussed in the Charaka Samhita that some scholars are persuaded that Nyaya Sutras had their origin in the elaborate logical formulations of Charaka! Ayurveda however parted company from Vaiseshika and Nyaya and adopted the Samkhya concept in relation to the subtle body (Ativahika Sarira). This view held that the subtle body composed of air, fire, water and earth in association with manas and soul, entered the womb by the power of karma and combined with semen and menstrual blood to form a fetus. Nyaya and vaiseshika had denied the existence of a subtle body. The Ayurvedic sages were like master craftsmen who took and shaped stones from different philosophic quarries to build a new edifice for the practice of medicine.

* Branches of the Ayurvedic tree
The tree was nameless with few branches in the Upanishadic times. The Chandogya Upanishad, among the various subjects for study, mentioned bhuta vidya and sarpa vidya but no other medical topics. The tree however ramified as illness and people multiplied and the healer’s profession grew in experience. By the time of the Charaka and Sushruta Samhita, Ayurveda had developed eight branches which were well differentiated as follows:
*     Surgery (Salya)
*     Treatment of the diseases of head (Salakya)
*     Treatment of the diseases of the body (Kaya chikitsa)
*     Treatment of children (kaumarabhritya)
*     Treatment of the effects of evil spirits (Bhutavidya)
*     Treatment of poisoning (Agada tantra)
*     Rejuvenation (Rasayana)
*     Enhancement of virility (Vajeekarana)

Specialisation was much in vogue and was obviously encouraged. Charaka and Sushruta Samhitas laid respective stress on medicine and surgery while Kashyapa Samhita highlighted the treatment of women’s and children’s ailments. Charaka recommended that patients, in certain conditions, should be referred to the experts in Salya. Physicians and schools became famous for their expertise in surgery and in the treatment of eye disease, mental illness, poisoning and women’s ailments. Numerous texts were written on each of these subjects and a student was left free to choose whatever did appeal to him for his career.

It is obvious that physicians and schools often differed in their views and approaches. Sushruta explicitly differed from the ‘followers of the Vedic School’ in enumerating and describing the bones of the body. Charaka mentioned the medical and surgical approaches to the treatment of piles only to recommend the medical alternative in view of the complications of surgical measures. The elaborate institution of Ayurvedic debates served as the academic forum for the presentation of themes and ideas and their trial through the fire of discussion which was not necessarily friendly. An entire chapter in the Charaka Samhita on the format, guidelines, method and end points of discussions makes it abundantly clear that scientific debate was the principal and vibrant mechanism for instruction and for interdisciplinary dialogue. Charaka held that such discussions enhanced the power of expression, removed doubts, reinforced conviction and added to one’s fame. New things could also be gleaned during the discussions in the assembly (Parishat).

* Basic concepts : tridosha as an example
Ayurveda is based on certain basic doctrines of which tridosha takes pride of place. However the popular notion that human pathophysiology is a manifestation of wind, bile and phlegm is an absurd caricature of the tridosha doctrine.

Body depletes and decays daily, and receives replenishments through food. The articles of food undergo digestion and give rise to two species of products – prasadas and malas. The prasada fraction goes on to build the seven dhatus of the body even though their exact pathway – whether sequential or simultaneous is unclear. The mala fraction includes tridoshas – vata, pitta and kapha – as well as kittas or excrements such as sweat and ear dirt. Both prasada and mala are important and their presence in the right proportion in the body is indispensable for health and well being. In the body economy, malas rank in importance with the seven dhatus and are themselves designated as mala dhatus. They become troublesome only when their right proportion is disturbed. Vagbhata, in fact, regarded the equilibrium of doshas – not only of dhatus – as the basis of good health. Equilibrium requires that the doshas are in the right proportion with reference to themselves as well as to the rest of the dhatus of the body. When they become deficient or excessive they are said to be perturbed, and perturbation (Doshavaishamya) denotes varied ailments. In Vagbhata’s language “as the waves, billows, and foam are, in reality, the same as the ocean, so are all the different diseases nothing but the three doshas in perturbed states”.

The three doshas are however not the exclusive products of food processing in the body. They have another source in the incessant operations of the dhatus of the body. Thanks to the operations, dhatus such as flesh, blood and bone give rise to dhatumalas as bye products which also contribute to the formation of the three doshas. No matter what their origin – food or dhatus – the three doshas have preferential locations in the body. Vata belongs to the lower abdomen, pitta to the middle of the body and kapha to the chest and head. Preference does not imply exclusiveness any more than the preferential location of blood in the heart and vessels rules out its presence elsewhere in the body.

The functions of the three doshas are indicated by their very names according to Sushruta. Vata is derived from ‘Va’ which signifies movement; pitta from ‘Tap’ which means heating; and kapha from ‘kena phalati’ or amassing with water. In other words, the three doshas encompass three categories of functions – movement, heating or processing and building or amassing. These functions would cover everything a person does – conscious or unconscious, physical or mental. No wonder the equilibrium of the doshas was regarded as the condition of well being. Given the philosophic bent of the Indian mind, attempts were even made to find a parallel for doshasamya in the equilibrium of the three gunas – sattva, rajas and tamas – in the cosmos.

Of the three doshas, vata is dominant with the power to move, and the capacity of a tornado to destroy, everything. The disturbance of vata accounts for eighty disorders, that of pitta forty, and that of kapha twenty. The primary disorders have numerous subdivisions but an experienced physician could detect the characteristics of a disturbed dosha in each manifestation of a disease. This is the crux of the diagnostic process which involves careful listening to the messenger, patient and relations; using the five senses in examining the patient and his surroundings, and reflecting on what might have gone wrong. According to Charaka, a physician who fails to enter the dark interior of the sick body with the lamp of wisdom and reason can hardly hope to treat a patient. The three doshas affect the body as much as the mind because body and mind are a duo which are nothing without each other. However the effects of doshas are controlled by ones Karma in the ultimate analysis.

Tridosha is by no means the only basic concept in Ayurveda. There are others no less important such as the panchabhuta doctrine. But one cannot compress them into a single lecture.

* Disease recognition and treatment
Ayurveda laid great stress on determining the causation of disease (Nidana) before initiating treatment. The means of knowledge – perception by all senses, inference, reason and testimony of great physicians – were fully harnessed in recognising the cause and stage of a disease, but the primary intellectual instrument of the physician was inference. If the exposure to cold or rain is known to be followed by fever or indigestion in a patient should suggest the possible cause of the patient’s clinical state. The cause need not always be inferred from preceding events : It could as well be sported from a concomitant phenomenon like rigor. Over and above these types of inference, a physician could try an experiment based on the dictum that similar things produce similar effects or accumulation, while opposite things produce opposite effects or dispersal. Thus he could infer the cause of a fever as cold if the application of heat decreased it: or as a position if an antidote countered it. In any event a physician had to be proficient in the use of inductive methods to become a good diagnostician.

In the Charaka and Sushruta Samhitas the treatment of illness was based on reason (yuktivyapasraya). Resorting to oblations or amulets was not condemned but was seldom recommended in the mainstream of therapy. Daivavypasraya had silently yielded place to yuktivypasraya, and the old order had changed. The aim of treatment was no longer the propitiation of Varuna or Indra but the restoration of the equilibrium of doshas, which was achieved by administering substance including diet and medications with properties opposed to those of the disturbed dosha. Physical measures such as activity were prescribed on the same basis. Thus cold was treated with hot, hot with cold, acid with alkali and so on. The Ayurvedic properties of smanya (commonality) and visesha (particularity) laid down that substances would accumulate by the exposure to another substance with similar properties whereas it would deplete if the mixing substance had dissimilar properties. This was in fact the cornerstone in the choice of substances and physical measures for treatment. Afterall, diet and medications are composed as much of five elements – panchmahabhutas – as the human body and they would bring about increase or decrease of doshas thanks to their similar or dissimilar properties. These properties were taste (rasa), potency (virya), vipaka (taste following digestion) and specific effective action (prabhava) which were not fixed but varied from substance to substance, from time to time and from place to place. A substance could have different effects at different times of the year, in different places in the country or for that matter, different parts in the body. Just as the properties of a fruit would change with time and location so would those of the human body on both counts. A good physician had to be alert to all these possibilities. He had at his command an abundant formulary which included hundreds of medicinal plants, meats, wines and varied products of vegetable, animal and mineral origin. Instructions were no less elaborate on their preparation as decoction, paste, pills, powders and so on. Apart from the administration of the proper diet and medications, treatment involved physical measures such as lightening, building, lubrication, sweating, emesis, purgation, head purging and blood letting. Mild disturbance of doshas could be settled by simple measures (Samana) whereas serious perturbations would call for no less than the elimination of the perturbed doshas (Sodhana). The physician was obliged to follow detailed stipulations in implementing each of the procedures.

The other domain of treatment was surgery which was regarded by Sushruta as the most ancient and most efficacious of the eight branches of Ayurveda. Even though cauterisation, the application of a reed to release retained urine and some other procedures had figured in the Atharva Veda, surgery crystallised as a well defined discipline at the time of Sushruta. He classified surgical procedures into eight distinct types such as incision (chhedya), excision (bhedya), scraping (lekhya) etc. and recognised three phases in surgical treatment – pre (poorva karma), intra (pradhanakarma) and post operative (paschatkarma). He described a series of techniques such as abscess drainage, repair of nose and ear, removal of bladder stone, removal of dead foetus and many others. He discussed the management of fractures and dislocations in great detail with emphasis on manipulation (Anchhana), pressure (pidana), immobilisation ((Sankshepa) and bandaging (bandhana) and gave special instructions on treating fractures of the hip, neck etc. He described one hundred and one blunt instruments (yantras) and twenty sharp instruments (sastras) and commented on their fabrication and quality assessment. Apart from these highly technical sections, Sushruta also discussed anatomy, basic concepts, professional ethics and all else that an accomplished surgeon had to know. How the surgical heritage of Sushruta faded and managed to survive in the hands of hereditary practitioners in India is another story.

* Training of a physician
It would appear that two modes existed in ancient India for the training of physicians. The Gurukula system flourished, and the echoes of the Guru-Sishya discussions resound through the pages of the Charaka Samhita. The qualifications prescribed for the guru were no less stringent than those for the pupil, and involved tough requirements in terms of physical, intellectual and mental abilities. The training commenced following a ritual initiation which signaled a sacred contract between the teacher and the pupil. The ceremony was witnessed by fire, other teachers and students. The following extract from the admonition of the teacher to the pupil during the ceremony gives us a flavour of the training process.

“You should be a celibate, speak truth, abstain from meat and carry no weapons. You should never disobey me, except when it incurs the wrath of the king or involves the possible loss of life or great unrighteousness. You should surrender to me and live with me as my son, servant and suppliant. You should collect things sought by me and move about with my permission: when trained as a physician you should think of the welfare of all living beings and provide care to the patients by every means. You should not think ill of patients even at the cost of your life, covet other’s women or property. Your words should be measured, sweet and truthful. You should shun the company of the wicked and traitors, and decline to accept food offered by women except in the presence of their husbands or guardians. While entering a patient’s house, you should take a person known to the family with you, and never disclose what you see or hear outside the house. You should not bast even when you have learnt much…..”

The training was both theoretical and practical because a person trained in one aspect of medicine alone, Shshruta noted, was handicapped like a one-winged bird. Theoretical training was carried out largely through discussions (Sambhasha) among the pupils with the teacher in the chair. Charaka Samhita is, in fact, a compilation of many such discussions under Atreya’s supervision, with the chapters and discussions probably representing the disclosures of Atreya. The discussions were vigorous and provided opportunities for serious debate and consensus development. Practical training involved domiciliary visits, attendance on patients, identification of plants, preparation of medications and above all, the inculcation of the high values that ennobled Ayurveda. For the surgical aspirant, Sushruta described a whole series of experimental procedures in plants, trees, fruits, dead animals, cadaver etc., that stimulated incision, excision, suturing, tapping, etc. On the completion of training the candidate was obliged to obtain royal permission for starting independent practice.

Side by side with the Gurukula system, the training of physicians excelled in the universities. Takshasila was noted as a foremost centre of medical education in the Buddhist annals which recount the fascinating story of the training of Jivaka-Buddha’s physician – in that university. Students were enrolled at 15 or 16 years provided they passed a critical examination by the dwara pandithas of the univeristy. The residential training covered the theory and practice of medicine as well as related sciences. We read about the ‘salaka’ and other tests including practical ones at the time of the student’s graduation after six or more years, when he was required to discuss a given topic before a learned assembly. Takshasila was not alone in imparting medical instruction – Nalanda was not far behind.

* Human destiny and an Ethical life
The Yoga Vasistha insisted that our fate is in our hands and all our experiences could be controlled by a determined effort of the human will. This view or Paurusheya claimed that human will was all-powerful, and fate could be overcome. At the other end of the specturm, several schools held that fate (daiva) controlled our actions and human destiny was no more than its plaything. Charaka took an intermediate view which was novel in Indian philosophy. According to him, while the effects of acts of enormous wickedness could not be prevented by good conduct, those of all others could be countered or modified by conscious action based on good conduct. An illness which resulted from one’s improper Karma could be prevented or cured by non-moral actions such as proper health care. One could not contend that relief from illness under those circumstances had nothing to do with health care, and that it was a consequence of one’s past good deeds. If the effort of the patient and the physician could achieve nothing and the entire course of life was predestined, the endeavour of Ayurveda would lose purpose and significance. It was reasonable to claim that ‘fate’ came into play only when one’s best efforts failed to arrest the consequences of abominable actions. Vagbhata too echoed the Ayurvedic belief in the possibility of the triumph of human action over fate.

The motivations of all human actions are the desire for long life, the desire for wealth and the desire for the future life. In adopting this clear-cut view, Charaka differed from the traditional systems of Indian philosophy. The Vaiseshika looked upon the attraction to pleasure and aversion to pain as the motivations for human action; Nyaya went beyond attraction and aversion and traced their mutual source to delusion (moha); yoga of Patanjali held that virtuous actions arose from the tendency towards emancipation and sinful actions from ignorance and egoism; Advaita Vedanta insisted that all actions arose from ignorance (avidya). Charaka departed from all these views which identified false knowledge as the cause of all our troubles and upheld the realisation of the higher truth as the ultimate answer to the pain of existence. He urged that evil and suffering arose through our errors in judgement and imprudent conduct (Prajnaparadha) which had no philosophical significance. It was entirely within our non philosophic capability to give up errors and adopt virtuous conduct (Sadvritta). Ayurveda – the science of life – was always more than medicine and spoke of life which is good (hita) or bad (ahita), happy (sukha) or unhappy (dukha). A good and happy life is nothing without good health, but it is far more: it demands prudent and virtuous conduct that is conducive to the good of the individual, his surroundings and the society of which he is a part.

* Ayurvedic leads for current research
For a long period, efforts were made to identify therapeutic compounds from Indian medicinal plants which number over a thousand in Charaka Samhita alone. Hundreds of papers were published but, other than the products from Rawolfia serpentina and Commiphora mukul, no drug of importance emerged from the work that spanned fifty years. Even serpasil and guggulip could not claim to have had a global impact. The unfocused work on drugs from medicinal plants received a jolt from two western events in the recent past. The thalidomide tragedy changed the attitude of people in Europe who became averse to the use of chemically derived drugs and demanded natural products. Secondly, MNCs who led the R&D programmes for drugs at the cost of millions of dollars took note of the chemophobia in Europe and agonised over the huge damages awarded in class action suits against the adverse effects of chemically derived drugs. As a result they turned their attention to medicinal plants which had been used for thousands of years in folk medicine and the traditional system of medicine in India, China, Africa and South America. In the mean time, advances in organic chemistry and molecular biology, the advent of new technologies such as rapid through put screens boosted the developmental process of drugs from plants. Though late, India has woken up to this reality and begun to put her act together for identifying compounds from Ayurvedic plants and transferring them for production as a collaborative effort of modern laboratories, centres of traditional knowledge and drug companies. The stakes are high and the promise vast in this joint endeavour. Drugs of Ayurvedic provenance against malaria, tuberculosis, cancer, diabetes and for ageing related disorders are likely to emerge from the ongoing efforts as these conditions were recognised and treated with herbal remedies in the Ayurvedic tradition.

The pragmatic approach to drugs apart, Ayurveda throws up a host of interesting questions for the investigator. What was the disease pattern in ancient India? Was it similar to the present profile of diseases? Would it be possible to draw a picture of the epidemiologic scene of long ago from the number of references in ancient texts in view of the ease of computing the references from digitized texts? Might the status of diseases in the remote past and their current statistics give us clues to the natural history of diseases?

At the experimental level, what are doshas which constitute the central doctrine on which diagnosis and treatment are based in Ayurveda? Charaka says in no uncertain terms that doshas are substances. As they have never been chemically identified, there have been suggestions to regard them as concepts. This may be a mistake and giving up on an ancient doctrine too soon. Plant formulations which oppose the properties of the three doshas are well known and used regularly for Ayurvedic treatment. If the plants with properties opposed to each dosha could be characterised in terms of biological activity – antimitotic, antioxidant, anti-inflammatory, immuno-modulatory etc., and they showed characteristics fingerprints, the first step in identifying the doshas might have been taken. These are merely examples of the kind of exciting work which calls out to be done in what could be called Ayurvedic nosology and biology.

* Epilogue
Ayurveda is a jewel in the crown of India’s cultural and scientific legacy. It has a continuous tradition reaching back to the Atharva Veda which talked of hundreds of vaidyas. It was an integral part of education in ancient India where the daily lives of people and the treatment of the sick and wounded were governed by its concepts and methods. It flourished during the time of the Buddha who was not only treated by Jivaka but was himself no ordinary physician – the apurvavaidya so revered by Vagbhata in the memorable invocation of Ashtanga Hridaya. The Arabic, Tibetan and Chinese translations of the Charaka, Sushruta and Vagbhata Samhitas exerted no little influence in distant lands as early as the first half of the first millennium. Navanitaka – the famous manuscript discovered by Col. Bower in the nineteenth century – established beyond doubt that Ayurveda was much in vogue in Central Asia in the early years of the Christian era.

For the high water mark of the Buddhist and early period up to the time of Vagbhata in the 9th century, Ayurveda declined and stagnated over subsequent centuries. The decline is undeniable because Sushruta’s surgery virtually disappeared during this long period when one no longer encounters Charakas or Vagbhatas. May be ancient science could not remain at the peak forever any more than music could stay on the high note throughout a long performance. The reasons for the long stagnation of Indian science including Ayurveda from the ninth century are yet to be determined. To make matters worse, unlike other sciences Ayurveda received no support or encouragement from the Government during the colonial rule.

The ancient tree has however received much-needed nourishment in free India. New sprouts have appeared and inspired hopes of a rich harvest. As the concepts of a healthful diet and life style, herbal therapy and techniques such as panchakarma from the Ayurvedic tradition take on new forms in the practice and formularly of modern medicine we may be witnessing the most far reaching contribution that Ayurveda would make to the progress of medicine in the world. The emerging dimensions of the East-West encounter in medicine would please Charaka who regarded the entire world as the teacher for a wise physician.

* Biodata of Prof. Dr.M.S. Valiathan

A 1956 Medical Graduate of the Kerala University, Dr. Valiathan received his surgical training in London and the University of Liverpool Hospitals in U.K. and obtained the Fellowship of the Royal College of Surgeons and Master of Surgery degree from Liverpool. Subsequently he specialised in cardiac surgery at the Johns Hopkins and Georgetown Universities in the U.S. and became a Fellow of the Royal College of Surgeons of Canada in Cardiovascular and thoracic surgery.

Dr. Valiathan has served on the surgical faculties of the Georgetown Medical School, Washington DC and Post graduate Medical Institute, Chandigarh. He was a visiting professor in biomedical engineering at the IIT, Madras before moving to the Chitra Tirunal Institute, Trivandrum where he remained Professor of Cardiac surgery and Director for 20 years. It was under his leadership that the Institute developed and commercialised a series of devices such as a prosthetic heart valve and blood bag and became an Institute of National Importance by an act of Parliament. Dr. Valiathan’s monograph and over 90 scientific papers relate to cardiac surgery, a heart muscle disease of the tropics and cardiovascular technology.

Following the long tenure in Trivandrum, Dr. Valiathan served as Vice-Chancellor of the new University in Manipal. At the end of his 5 years’ tenure, he was awarded the Homi Bhabha Senior Fellowship which gave him the opportunity to Study the Charaka Samhita in the original. His book on the Legacy of Charaka is expected to be published later this year.

Dr. Valiathan is a recipient of many honours, honorary degrees and Awards from learned societies, academies, universities and professional associations in India, U.K., France and the U.S.A. He is a Padmabhushan awardee and currently the President of the Indian National Science Academy and Chief Scientific Advisor the Government of Kerala.

For further information, please contact: Dr. M.S. Valiathan, Honorary Adviser, Manipal Academy of Higher Education, Madhav Nagar, Manipal - 576 119,