Author: Sunil Khilnani
Category: Nonfiction
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Speaking in the Constituent Assembly in July 1947, just days before India was due to gain independence and as religious killings spread across the country, Nehru moved a resolution to adopt a design for a national flag, which had at its center another Ashokan symbol: the chakra, or wheel, part of the lion capital. “I am exceedingly happy,” Nehru said, that “we have associated with this Flag of ours not only this emblem but in a sense the name of Ashoka, one of the most magnificent names not only in India’s history but in world history. It is well that at this moment of strife, conflict and intolerance, our minds should go back toward what India stood for in the ancient days.”
It’s not clear whether the ideas of the ancient Mauryan can in fact offer a resource for India’s continuing struggles to create a tolerant, secular state. Still, as Ashoka knew, symbols do matter. His four lions have become the currency—literally and metaphorically—of every Indian life. And his message, of moderation and restraint, remains in equal parts an admonition and an inspiration to Indians today.
6
CHARAKA
On Not Violating Good Judgment
Circa second century CE
Next to a cacophonous building site, where Indian laborers and engineers are working alongside international consultants to build a new station for Delhi’s world-class Metro, stands one of the grimy glass-and-concrete office blocks ubiquitous in urban India. But up its staircase, past the workspaces of outsourcers and traders and accountants, you’ll find an unexpected concern: a dial-in health clinic whose care is based on the thinking of a man who lived roughly two thousand years ago.
Though what is practiced here at the Jiva Institute, in Delhi’s industrial suburb of Faridabad, has a faddish following in the West, it’s part of an Indian tradition as old as the Buddha (1). Its leading figure was a man known as Charaka, who is sometimes pridefully referred to in India as “the father of medicine.” We know little about his personal story, but we still have his celebrated manual on the ancient medical system known as ayurveda. Veda translates as “knowledge,” and ayus means “long life” or “vitality,” and Charaka’s treatise is as much a guide to how to live as it is about how to get better.
Ayurveda is the best known of the three major South Asian medical traditions, along with siddha and unani. Charaka is thought to have set out its basic principles sometime in the centuries around the start of the Common Era. In the early twentieth century, the tradition became professionalized, and now it is part of government policy, with ayurveda and other old medical practices assigned a ministry of their own. Today, ayurveda is often blended into a potpourri of beliefs about individualized cure and personal attention. At a time when access to affordable, reliable Western medicine remains beyond the means of most Indians, it serves as a popular, if sometimes desperate alternative.
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The Jiva Institute’s interior is built with materials you might find in a rather beautiful village home: it has neem-wood counters, cubicles fashioned from bamboo cane, sinuously curving earthen walls. But its technology is very much of the twenty-first century. Its raft of teleconsultants dispenses ayurveda’s ancient wisdom to India’s young and wired through a state-of-the-art call center. A Muslim woman has just rung in, explaining how long she’s had a pain in her stomach. Another doctor’s assistant listens attentively to the symptoms of Ajay from Bihar. The institute claims it averages two thousand calls a day, on conditions from acne to cancer. The staff listens, consults Charaka and his successors, and prescribes.
The clinic’s main reference for ayurvedic knowledge is also our only source for Charaka’s biography: the Charaka Samhita, or “Compendium of Charaka.” The version that’s come down to us was composed sometime between the third and fifth centuries of the Common Era, a century or more after his lifetime. The text mentions Himalayan place names, and plants and foods found in the hills, so we can be pretty sure that he lived in North India. A Chinese source of the fifth century claims that Charaka was the physician to a Kushan king named Kanishka, whose mountainous realm, in the second century of the Common Era, stretched from Bactria to today’s Bihar. But it’s uncertain whether the name Charaka refers to one man or to the members of a school of thought—perhaps even to a clan or community of practitioners. Indeed, the Charaka Samhita encompasses multiple voices and a range of subjects, presenting the alternative views of more than one physician. Like Aryabhata (7), its author (or one of them) claims he received his knowledge from the gods—though that’s not much help in fixing his identity.
The Charaka Samhita is an “encyclopedic work,” says Dominik Wujastyk, a professor of Ancient Indian studies, who has been part of a research team at the University of Vienna working on a definitive edition. The treatise, he says, covers “all aspects of life”:
epidemics, heredity, the reasons why we live as long as we live, how lives can be made longer or shorter, from earthy topics like how you should immediately go to the toilet if you feel like it and not hold on, to sublime ones such as the nature of wisdom and why the abrogation or violation of wisdom causes all diseases, how to build and supply and run a hospital, and many, many other topics. So it covers everything: what time you should get up in the morning, what you should eat, the kind of people you should associate with, how to live a virtuous life.
The Charaka Samhita is written in Sanskrit, and like other texts from early Indian history, it was composed in a poetic style so that it could be chanted, memorized, and passed down across the generations.
Charaka’s model of the body and its functions was in many ways radically different from one we would recognize today, and his concepts don’t translate easily into modern terminology. There’s no circulating blood, for instance, no beating heart. Ayurveda’s operating principles are based instead on a conception of the body’s basic humors (vatta, pitta, and kapha, or “wind,” “bile,” and “phlegm”) and on the belief that if these elements are displaced from their proper bodily locations, illness follows.
Like other traditional medical systems, ayurveda sees the human body as part of a vast natural, even cosmic, system of causality. But within that system, individuals play an important role as moral actors shaping their own lives and trying to help sustain the order of the universe. The karmic effects of one’s actions on the next life have consequences for well-being in this life as well. Disturbances of the humors and other afflictions are often caused by our disregard of basic principles of well-being—what Charaka calls “violations of good judgement”:
The way to stop external diseases from happening is explained as follows: give up violations of judgement; calm the senses; be mindful; be aware of time, place and yourself; adopt a good lifestyle. To the extent that he wishes for his own good, the wise man will do all this in good time.
Dr. Partap Chauhan, the director of the Jiva Institute and one of its founders, began his practice in a garage some twenty years ago. He showed me an old, battered, and obviously very loved edition of the text—his ayurveda “Bible,” he said with a wink. “Yeah, I like this,” Dr. Chauhan said, turning a page and reciting in Sanskrit: “It’s a definition of ayurveda that focuses on … what is beneficial to life, what is nonbeneficial to life, what is a happy life, and what is an unhappy life. It also mentions longevity and how to live a long life. So it actually describes the fundamental principles of being happy and healthy.” Lately, Dr. Chauhan’s business on the back of Charaka has been very good. Phone consultations at Jiva are free, but consultants invariably recommend to callers some of “over five hundred classical and more than seventy proprietary authentic health care and beauty products” that Jiva sells.
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Ideas about good conduct proposed in treatises such as the Charaka Samhita do “not represent a completely unique ayurvedic point of view,” Dagmar Wujastyk, an Indologist at the University of Vienna (and Dominik Wujastyk’s wife), has written. Rather, they share a great deal with the general worldview conveyed in other Sanskrit Brahminical literature. But the Ch
araka Samhita diverges from that worldview in its more dialectic spirit. Charaka commends debate as the central method to advance knowledge about life and health. He sets out precise rules for “parleys of specialists,” and much of his treatise is in the form of questions and answers between a teacher and a disciple.
Dialogue is also the method used by ayurvedic practitioners, or vaidyas, who probe their patients with questions to get at the root of an ailment, rather than sending them off for diagnostic tests. At the Jiva telemedicine center, the consultants listen to each caller in great detail, noting their symptoms and developing an extensive medical history. That said, medieval vaidyas appear to have been as harried as many modern-day doctors, and ayurvedic clinics in India today are often crowded, unrelaxed places, the vaidyas rushing through their consultations.
The advice to be found in the Charaka Samhita can also be pretty blunt and generic. The Jiva teleconsultants receive regular call-ins about fertility issues—especially the question of how to produce a male heir. It’s an Indian obsession that has kept the life chances of girls far lower than those of boys, and has led to an abnormal, distressing ratio of males to females in the population. A feminist fertility counselor Charaka is not. As one scholar summarizes his advice:
To produce a son the parents are to copulate on even days after the onset of menstruation … The woman is cautioned not to lie prone or on either side lest the phlegm obstruct the passage of semen to the womb or the semen and blood be burned by bile. A woman’s overeating, excessive hunger or thirst, fear, disrespect, depression, anger, desire for sexual congress with another man, or ardent passion will render her unable to conceive or else her offspring will be lacking in qualities.
Some ayurvedic practices have been submitted to randomized controlled trials, with mixed results. But many Indians still see ayurveda as a valuable supplement to Western medicine. Dr. Sankaran Valiathan is one of them. A distinguished heart surgeon and former president of the Indian National Science Academy, he is the author of a book on Charaka—in other words, he is a man equally familiar with both the Western and the ayurvedic medical traditions. “Ayurveda is personalized medicine,” Valiathan says:
One of the fundamental concepts is what is called prakriti. At the time of conception, everyone’s prakriti is determined and it doesn’t change. This consists of a series of physical traits, mental traits, behavioral traits. These determine whether a man belongs to vatta prakriti, pitta prakriti, or kapha prakriti—the three primary constitutional types. In Ayurveda it is so important because you have to determine this in every patient who comes to you, because that determines the predisposition to diseases. Second, it determines the course of the disease. In certain people, they get tuberculosis and it’s a very rapid course, a violent course; in others it will keep on lingering for weeks and months. Most importantly, prakriti determines response to treatment. So the same treatment will not have identical effects on different constitutions.
Although the concept of prakriti enables practitioners to identify treatments for their patients that are nongeneric, it’s not exactly individually customized. As Dominik Wujastyk says, it’s quite a fine-grained diagnostic tool—but it shouldn’t be confused with New Age ideas of “treating the whole man, and not just the symptoms.”
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Texts such as the Charaka Samhita continued to be studied, and its ideas followed, by traditional practitioners right through the medieval period and into the nineteenth century. The emergence of ayurveda as a field of modern professional practice, however, dates back to the late nineteenth century, when Indian scholars started to publish print editions of the Charaka Samhita. This caught the attention of Western scholars, and resulted in an eruption of Charaka-mania in medical and Indological circles in the West during the 1890s.
That interest filtered back to a Western-educated and increasingly nationalist Indian elite, which was searching for aspects of its own history and tradition by which to counter British dominance. Mohandas Gandhi (38), though not himself an advocate of ayurveda—he favored naturopathy—saw the readoption of Indian medical principles as a way to recover autonomy, or swaraj. Of all his books, the best seller remains A Guide to Health, a self-help book based on his principles of health, fasting, and dieting. This is practical advice, but it also has a political dimension; in Hind Swaraj, Gandhi’s coruscating text on Indian self-rule, he attacks Western medicine and doctors for undermining self-control:
Doctors have almost unhinged us … I have indigestion, I go to a doctor, he gives me medicine, I am cured. I overeat again, I take his pills again. Had I not taken the pills in the first instance, I would have suffered the punishment deserved by me and I would not have overeaten again. The doctor intervened and helped me to indulge myself.
Indians’ pride in, and claims about, their ancient medicine sometimes spill over the top. Inaugurating a private hospital in Mumbai, one filled with state-of-the-art Western technology (and named after the wife of the country’s most successful industrialist, Dhirubhai Ambani [50]), Prime Minister Narendra Modi cited the example of the god Ganesh as a pioneering instance of plastic surgery. Ganesh’s elephant head, Modi claimed, was medically grafted onto a human body. At the same time, the country faces a host of public health challenges that remain unresolved: it has an extraordinarily high rate of premature deaths from preventable illnesses, a major lack of qualified doctors and nurses, a weak health safety net that forces more than sixty million people into poverty every year, and a meager public health budget.
Ironically, the stress and ill health created by increasing wealth, rapid urbanization, and aggressive competition for jobs at all levels of the economy have helped ayurveda flourish in contemporary India. The software engineer has to minimize physical uncertainties in order to keep working twelve-hour days—uncertainties that can be severe given the country’s poor public health. In this often isolating environment, ayurveda can seem like a motherly presence, watching over your eating habits, cajoling and reassuring you.
So perhaps it’s no surprise that ayurveda has adapted to mass media. Dr. Chauhan now has a television show in addition to his call-in center—with the telephone number of the clinic flashing on the screen. When the show airs, the Jiva Institute receives a surge of incoming calls. Those who lack the privacy to ring from work or home about their complaints (including those of work-life balance, naturally) can turn to the institute for an online consultation instead.
Ayurveda may not be capable of miracles; nor can it hope to solve India’s public health crisis. But as medical care becomes more and more like an assembly line in fiscally strapped health systems around the world, as doctors read genetic codes for predispositions instead of looking at the patient on the table, the idea of staying away from a medical-industrial complex that is annoying for the rich, expensive for the middle class, and devastating for the poor can be compelling. People turn to ayurveda because it seems to promise them more recognition as individuals. Perhaps it does—but only in the quite specific sense of placing on each of us a greater responsibility for our health, enjoining us to live as Charaka teaches: with a little more judgment.
7
ARYABHATA
The Boat of Intellect
476–c. 550 CE
In 1975, India launched its first satellite into space, a moment of great pride for a nation determined to stake its claim as a global power. Here was evidence that a country long seen in the West as backward belonged to the modern age. Yet the bundle of technological wizardry India sent into orbit had a name that evoked an older claim to scientific genius: that of the mathematician Aryabhata.
In the West, this name may not rank with those of Euclid or Ptolemy, but it should. At the end of the fifth century, Aryabhata, a young man, produced the first systematic compilation of mathematical and astronomical knowledge known to Indian history. “By the grace of Brahma,” he claimed, “the precious sunken jewel of true knowledge has been rescued by me, by means of the boat of my own intellect
, from the ocean which consists of true and false knowledge.”
Aryabhata salvaged some significant findings. He worked out a very close approximation of the value of pi; perfected the “rule of three,” which is still used to calculate ratios; and, using trigonometry, expounded a scientific explanation for solar and lunar eclipses. He also put forward, a millennium before Copernicus and Galileo, the argument that the earth rotates on its axis. Though some of his ideas were not accepted in his own day, they provided a springboard for the subsequent evolution of Indian classical astronomy.
Aryabhata’s reputation is based on a single treatise, the Aryabhatiya. Composed in Sanskrit sutras (aphoristic rules expressed in verse), it is the only work of his that has survived. It contains a medley of scientific riddles, big ideas, and mathematical results—many ingenious, some woefully wrong. Taken together, these insights and errors represent perhaps our most important window into the way that early Indian science conceived of its relationship to the world.
The Aryabhatiya also holds out the tantalizing promise that we are merely at the threshold of our understanding of early Indian scientific thought. The treatise is among the fraction (just a tenth or less) of the trove of many thousands of fragile Indian scientific manuscripts that have so far been published and closely studied. According to the acclaimed eleventh-century central Asian astronomer al-Biruni, classical Indian mathematics was like “a mixture of pearls and dung.” It’s possible that there are many more pearls to be discovered—though perhaps few may be as impressive as those produced by Aryabhata.