It is widely accepted that Ayurveda came into existence long before the emergence of the historical Buddha and that the evidence for this can be found in Vedic literature, in particular the Atharvaveda, which, with a devotion to the removal of disease, was the principal source of medicine during the Vedic period of Indian medicine (p.118, Sharma, 1992; pp.1,14 Zysk, 1992).
Brahmanist-inclined traditionalists assert the continuity from Veda to Ayurveda; Ayurveda being seen as a timeless upanga or upaveda of the Atharvaveda. However, there is actually no mention of the word ‘Ayurveda’ in the Atharvaveda and the question has been raised as to whether Ayurveda really existed at the time of the creation of the Atharvaveda (p.12, Haldar, 1977). Wujastyk (1998, 2003) has argued that the Atharvaveda, does not form an obvious precursor to classical Ayurveda; the medical material within Vedic literature being ‘…remarkable, more for its differences from classical Ayurveda than for its similarities…’ (p.xxix, Wujastyk, 1998, 2003).
According to classical Ayurvedic texts themselves, the origin of Ayurveda is traced through a lineage of divine, semi-divine, and venerable transmitters; Hindu divinities being the ultimate fountains from which medical knowledge has issued:
'Bharadvaja, the ascetic of eminence, desirous of long life, having known (about Indra) approached Indra - the lord of immortals and protector of the devotees. Daksa got the Ayurveda as propounded by Brahma; from the former, the Asvins got it in its entirety and Indra got the whole of it from the Asvins; so as directed by sages, Bharadvaja approached Indra (CS.Su.I.4-5).
Such proclamations are not, however, universally accepted as the final word on the question of the origins of Ayurveda. According to Wujastyk (1998; 2003) such claims within Ayurvedic texts are not evidence for Vedic medical history, but rather evidence of a bid by medical authors for social acceptance and religious sanction. The argument of Zysk (1991) is that such origin myths are likely to have been superimposed on previously existing material in an intellectual endeavour to render a fundamentally heterodox science orthodox; to establish a body of knowledge as brahmanic through applying a ‘veneer’ of Hindu mythology that was told and retold in later Ayurvedic classics such as the Astangha Hridaya (AH) (p.5;8;117-8, Zysk, 1991):
'Brahman, remembering Ayurveda (the science of life) taught it to Prajapati, he (Prajapati) in turn taught it to Asvin twins, they taught it to Agnivesa and others and they (agnivesa and other disciples) composed treatise, each one seperately' (AH.Su.Su.I.2-3).
Despite the narrative of divine lineage presented within these origin myths, according to Zysk’s analysis, Indian medicine was not a product of an orthodox brahmanic intellectual tradition. The brahmanic hierarchy may have denegrated medical practitioners, excluding them from orthodox ritual because of their pollution through contact with impure people (pp.4-5, Zysk, 1991) and from the perspective of social and religious history, it is not within brahmanic orthodoxy, but early Buddhist literature, that clear evidence of the foundations of Ayurveda can be identified:
‘...the very earliest reference in Indian literature to a form of medicine that is unmistakably a forerunner of ayurveda is found in the teachings of the Buddha... As far as we know, it was not yet called ayurveda, but the basic concepts were the same as those that later formed the foundations of ayurveda...' (p.31, Wujastyk, 2003).
Early Buddhist literature (which describes health as the ‘highest gain’; Dp.XV.204), directly references known illnesses and treatments of the time and adopts technical terms such as ‘dhatu’ which may have been borrowed from respected contemporaneous medical traditions (p.246, Larson, 1987; p.42, Mitra,1985). Sik (2016) investigated ancient Indian medicine according to various versions of the chapter on medicine in the extant Vinaya Piṭakas. Illnesses examined in these texts include:
‘…autumnal disease, wind diseases, disorders of humours or elements, fever, gastrointestinal disturbances, headache, jaundice, snakebite, poisoning, ocular diseases, itchy lesions, carbuncles, wounds, other skin problems, perineal diseases, foot ailments, and insanity…' (Sik, 2016).
Liyanaratne (1999) has claimed that the Girimanandasutta of the Anguttara Nikaya precedes the earliest Ayurvedic treatises by five or six centuries (p.72, Liyanaratne, 1999). It describes forty-eight forms of disease according to their location, type, cause and nature. The Brahmajala and Samannaphala suttas of the Digha Nikaya are among the earliest authenticated Buddhist texts (p.65, Liyanaratne, 1999). They enumerate livelihoods (jivaka) which include a range of medical therapies prescribed within Ayurvedic treatises. In these suttas the therapies are described as ‘brutish arts’ and distained as means of wrong livelihood; however, in the Vinaya the practice of some of these therapies is explicitly allowed.
Natthukamma (Skt. nasya – nasal therapy) and sirovirecana (a specific form of nasya) distained as means of wrong livelihood in the Brahmajala and Samannaphala Suttas, are permitted according to the Vinaya: “I allow, monks, (medical) treatment through the nose” (Vin.I.204). Clearly any distain is towards the prospect of Buddhist monks receiving remuneration for the provision of those services, not the therapeutic interventions themselves (p.27, Zysk, 1992). In fact, of all the occupations during the time of the Buddha, the medical profession appears to have been valued the most by the Buddhists as in full keeping with the principle of right livelihood (samma ajiva) (p.228, Dharmasiri, 1997; p.118, Sharma). Medicine was always a significant part of Buddhism throughout the development of the religion (p.70, Zysk, 1992), and where prompted by compassion combined with charity, involvement with the practice of nursing or medicine was not distained by the Buddha, but is actively encouraged (p.17, Liyanaratne, 1999):
“Monks, you have not a mother, you have not a father who might tend you. If you, monks, do not tend one another, then who is there who will tend you? Whoever, monks, would tend me, he should tend the sick' (Vin.I.302).
It can also be observed that the Brahmajala Sutta explicitly mentions that sramanas as well as Brahmins were engaging in the practice of these therapies (natthukamma (Skt. nasya – nasal therapy) etc.). Consequently, Vedic influences (such as specific knowledge and healing approaches originating in the Atharvaveda) may have become more connected with some early medical traditions than others. This appears to be supported by the fact that whilst Susruta mentioned three hundred bones in the human body, both adherents of the Vedas and Cakara's school held them to be three hundred and sixty (p.13, Haldar, 1977). Whatever the remaining early Vedic influences within the various medical traditions, it appears likely that the earliest Ayurvedic practitioners operated among the sramanas, outside brahmanic restrictions:
‘…Unaffected by brahmanic strictures and taboos, these sramanic physicians developed an empirically based medical epistemology and accumulated medical lore from different healing traditions in ancient India. Ideally suited to the Buddha's key teaching of the Middle Way, this medical information was codified in the early Buddhist monastic rules, which gave rise to a tradition of Buddhist monastic medicine during the centuries following the founder's death' (p.117-8, Zysk, 1992).
Pandey (2015) emphasised that the traditional medicine in Buddhist India was ‘undoubtedly the forerunner of Ayruveda of today’ (p.472, Pandey et al, 2015), Laiyanaratne (1999) has recognised that the development of Ayurveda took place principally in a ‘Buddhist matrix’ with the Sangha playing a major role (p.xi, Laiyanaratne, 1999) and Dharmasiri (1997) has emphasized that ‘…Ayurveda medicine itself is primarily of Buddhist origin with substantial Buddhist contributions throughout its history...' (p.209, Dharmasiri, 1997). Both the AH and Astangha Samgraha acknowledge the contribution of the Buddha to medicine in their opening verses by paying homage to the Buddha both explicitly (in the AS) and surreptitiously (in the AH):
'Obeisances to the Buddha, who by the power of knowledge and spells has subdued the mighty serpent called citta (mind)…
…I bow my head in reverence to that One (rare, unique) physician, who has dispelled from this world, quickly, all the rogas (diseases) commencing with raga (desire, lust) etc...’ (AS.Su.I.1).
‘Obeisances be, to that Apurva vaidya (unique/unparallelled/rare physician) who has destroyed, without any residue, (all) the diseases like raga (passion/desire) etc…’ (AH.Su.I.1).
From the time of the earliest suttas, the Buddhist tradition has emphasised that it is ultimately not Brahma, but the Buddhas who are true source of knowledge and wisdom (DN.I.222), and in these texts, Buddha is recognised as ‘the principal teacher of medicine’ (p.8, Zysk, 1992). In Buddhist Sri Lanka and Tibet the Brahmanist mythological lineage through which the origin of Ayurveda is traced has been maintained but with variations which explicitly emphasise the Buddha as source. According to Tibetan tradition, the Buddha Kasyapa (see image above) is firmly identified as the principal teacher of medicine (p.49, Dash, 1976; p.47, Clifford, 1984), and in the Vaidyalankara, an Ayurvedic text written in Sri Lanka, it is explained that the historical Buddha made Ayurveda clear, by getting Jivaka to learn it (Jivaka was the Buddha’s own physician, but is not mentioned in Brahminist Indian tradition concerning the origin of Ayurveda) (pp.395-6, Liyanaratne, 1999).
On this basis, the early Buddhist sangha ‘soon became the principal vehicle for the preservation, advancement, and transmission of Indian medical lore' (p.38, Zysk, 1992), and Zysk (1992) suggested that ‘Buddhist monastic medicine represents the earliest extant codification of medical doctrines...’ (p.84, Zysk, 1992); however, early Buddhist texts do not possess the word ‘Ayurveda’. Instead, the word 'tikiccha' is used (pp.131-3, Narayana & Lavekar, 2005). The names of three Vedas, i.e. Rgveda, Yajurveda and Samaveda are occasionally referred to in Buddhist canonical works, but there is also no mention of the word ‘Ayurveda’ in these, or the Atharvaveda. The Chandogya Upanisad also does not include the term Ayurveda, but it does mention bhutavidya (which became a branch of Ayurveda), which is also mentioned in the Buddhist Digha Nikaya (DN.I.2.I). On this basis, it seems unlikely that the term ‘Ayurveda’ was deliberately excluded or displaced in early Buddhist suttas. As stated by Wujastyk (2003), although the teachings of the Buddha refer to a form a medicine that is ‘unmistakably a forerunner of Ayurveda… As far as we know, it was not yet called ayurveda’ (p.31, Wujastyk, 2012).
Buddhist India contributed much to the spread of Ayurveda through the support of King Asoka (ca. 269-232 B.C.E.) who was an enormously influential convert to Buddhism:
'Asoka, Beloved of the Gods, issues the following proclamation: For more than two and a half years, I have been a lay disciple [upasaka] of the Buddha. More than a year ago, I visited the Samgha [the Buddhist religious orders], and since then I have been energetic in my efforts...’ (Maski Rock Edict).
Ayurveda was taken to all those countries where Asoka sent his Buddhist missionaries. It spread to Sri Lanka, China, Southeast Asian countries, Tibet, central Asia and beyond (p.168, Varier, 2005). The second rock edict of King Asoka (ca. 269-232 B.C.E.) at Girnar proclaims that everywhere in the kingdom medical treatment was to be provided to both humans and animals:
'...Medicinal herbs, suitable for men and animals, have been imported and planted wherever they were not previously available. Also, where roots and fruits were lacking they have been imported and planted. Wells have been dug and trees planted along the roads for men and animals' (Rock Edict II).
But despite Asoka’s support for medical treatment, he is also reported to have called for reprimanding those who wrongly handle surgery (p.168, Varier, 2005). It is possible that this was a consequence of potentially harmful surgery being undertaken for profit where safer and less invasive (but also less profitable), treatments were available; however, Varier (2005) has claimed that these reprimands along with the ‘Buddhists aversion in experimenting surgery in animals’ were detrimental to the practice of surgery (p.168, Varier, 2005). Dash and Kashyap (1987) made similar criticism by claiming that Buddhists ‘prohibited the practice of surgery among several other professions’ and thereby gave a ‘death blow to the medical practitioners’ (p.ix, Dash & Kashyap, 1987). A case recorded in the Vinaya, where a monk got a fistula operated by a surgeon called Akasagotta might appear to support a Buddhist rejection of surgery:
‘“Monks, one should not have lancing done within a distance of two finger-breadths of the private parts nor a clyster-treatment. Whoever should have either of these things done, there is a grave offence”’ (Vin.1.216).
But as Talim (2009) argued, it is ‘not proper’ to ascribe the decline of traditional surgery and medicine in India to Buddhism (p.93, Talim, 2009). The ‘rejection of surgery’ by the Buddha seen in the Vinaya (Vin.1.216), was of a specific surgical procedure, made in a specific context in which the lancing of an ulcer by Ākāsagotta, a monk who was a surgeon before joining the Sangha, was a failure, and the patient suffered. Surgery requires ongoing practice and a monk cannot play with the life of other monks on the basis of his previous experience (p.92, Talim, 2009). The Buddha made clear: “The skin, monks, is tender at the private parts, a wound is hard to heal, a knife hard to guide” (Vin.1.216). Jivaka was also a disciple of the Buddha who was a surgeon, but unlike Ākāsagotta, remained a householder. He maintained his surgical practice but was never advised by Buddha to discard surgery (p.92, Talim, 2009). Barring the example given above from the Vinaya, the Buddha had not objected to surgery and certainly never discouraged surgeons who were householders. A positive and intimate familiarity with surgery and the training of surgeons within Buddhist circles is evidenced within the Visudhimagga (Vis.136):
'Again, when a surgeon’s pupils are being trained in the use of the scalpel on a lotus leaf in a dish of water, one who is too clever applies the scalpel hurriedly and either cuts the lotus leaf in two or pushes it under the water, and another who is not clever enough does not even dare to touch it with the scalpel for fear of cutting it in two or pushing it under; but one who is clever shows the scalpel stroke on it by means of a balanced effort, and being good at his craft he is rewarded on such occasions' (Vis.136).
With the rise of Mahayana Buddhism, medical study (chikitsa-vidya) became one of the five sciences (vidya) for bodhisattvas, either monk or lay, to acquire for healing the sick, and medicine had become identified as one of the means (upaya) to liberation (p.67, Zysk, 1992). Eventually, many Mahayana monastreries in East Asia operated clinics, dispensed medicines and ran medical institutions and colleges (p.22, Zysk, 1992). The symbiotic relationship between what are now known as Buddhism and Ayurveda facilitated the spread of Buddhism in India, led to the teaching of medicine in the large Indian conglomerate monasteries, and assisted the acceptance of Buddhism in other parts of Asia (p.6, Zysk, 1992).