The title of the book signifies the traditional Indian concept of four aspects of lifelong learning- instruction by teacher, individual effort, learning from companions and wisdom gathered over a life time. The author of the book, Dr. M.S. Valiathan, is a National Research Professor who is known for his significant contribution in Ayurveda Biology. He has worked as a cardiac surgeon for over three decades. However, he shifted to Ayurvedic studies later on and has published 3 volumes on Charaka, Sushruta, Vagbhata and an introduction to Ayurveda as well. He has recorded a course of video lectures on “India's Ayurvedic Inheritance” for National Programme on Technology Enhanced Learning (NPTEL). This book is based on the general plan of these lectures, but it differs in its contents and style.
In the first 3 chapters, the author takes the readers on an evolutionary journey, visiting different realms of evolution of Ayurveda from folklore, Vedic era, Harappa, Mohenjo-Daro, Buddhist India and the Bruhattrayi in a sequential manner. The first chapter of the book, ‘Roots of Ayurveda’, describes in a sequential manner the evolution of Ayurveda including the faith-based (Daivavyapaashraya) practice of medicine in Atharvaveda, non-medical means of prevention of diseases in Harappa, Mohenjo-Daro civilizations, growth and spread of Ayurveda in India and abroad in the Buddhist period and the shifting of practice of medicine to the reason-based (Yuktivyapaashraya) practice in the period of Bruhattrayi.
The period of five centuries from Charaka to Vagbhata was arguably the golden period in the history of Ayurveda. However, there was a huge setback to Ayurveda after Vagbhata. Ayurveda stagnated for almost a 100 years and the great centers of learning and Gurukula system declined beyond any hope of recovery. However, Laghutrayee came into existence during this period of stagnation and they broke new grounds with innovative ideas like pulse, diagnostic processes, nidanpanchaka of newer diseases like syphilis etc. Another development during this period of stagnation was the growth of Rasashastra. After Vagbhata period, the surgeons performing cadaveric dissection and surgical procedures were socially classed as “low caste” and were denied the benefits of education and were subjected to social morbidity. As a result, cadaveric dissection and surgical procedures were removed from mainstream Ayurveda. Vaidyas no longer cared to perform any of these procedures. They were restricted to the illiterate men, who didn't know the how and why of a phenomenon.
Ayurveda faced cruel circumstances in 18th–19th century when British took initiative in setting up institutes for modern science and medical education and took special interest in study of medicinal plants. But they regarded Ayurveda as no more than traditional herbal therapy devoid of science and refused to promote its study or practice. In early 20th century, the professionals of Indian ethnomedicine were demoralized and crippled and western educated Indians looked down upon traditional Indian medicine as mere mumbo jumbo. However, during these dark hours as well, the spirit of Ayurveda was kept alive by pioneers like Gananath Sen from Kolkata, Lakshmipathy from Chennai, P. S. Varier from Kottakkal and many others. However, the author has missed to acknowledge the pioneers from Northern regions of India who stood up in these adverse times as well.
A salient feature of this evolutionary journey is the comparative study carried out by the author with reference to doctrines and philosophical ideas, treatment of diseases and medical procedures. The study showed that the doctrines and philosophical ideas were profound in Charaka Samhita, but received decreasing attention in Ashtang Sangraha and Ashtang Hrudaya. Medicine had become more of a practical art in these five centuries with less emphasis on philosophy. The clinical picture, prognosis, diagnostic criteria of the diseases changed a little, but significant changes had occurred in the treatment of diseases as modifications, additions and deletions in the formulations used. Also, there is a reduction in the number of formulations used for enema and some peripheral topics such as enema for quadrupeds have been eliminated in the due course of time. Therefore, the study concluded that, no major advances at the doctrinal or practical levels had occurred in the long period between redaction of Charaka Samhita and composition of Ashtang Sangraha and Ashtang Hrudaya.
The next 12 chapters are related to basic principles and practices of Medicine and Surgery in Ayurveda.
The author has given modern day examples for the age-old principles of Ayurveda, which are easy to understand for the modern day readers. For instance, the example of Pradnyaaparaadha is not taken from the classics, but a modern example of improper trade practices of selling wool of sick rodents causing plague in Manchuria has been described.
This book also explores the reasons behind the discrepancies in ancient Ayurvedic texts. The limited knowledge of anatomy has been attributed to a strong taboo against touching the cadavers in ancient India and the faulty techniques of cadaveric dissection in the absence of tools. Also, the book reveals the barriers between knowledge systems like Yoga and Ayurveda, which have caused non-transmission of knowledge in between them. The important knowledge in Yogic literature like respiration, linkage of consciousness with the brain and CNS was not at all noticed by Ayurveda due to the same reason.
At no point, the author has criticized the bizarre looking topics in Ayurveda. Unlike many modern medicine personnel, who always keep criticizing Ayurveda out of their prejudices, the author has an open-minded view towards these bizarre looking topics like terminal illness and signs of impeding dissolution (Arishta). He has called out for a re-appraisal of the fatal signs and physical-mental status of a dying patient, as this continues to be a topic of profound importance in today's era.
The book is designed nicely with a good use of pictures, charts and diagrams wherever necessary, for easy understanding of the key elements. Tabulation of appropriate topics has made the material look easy and has classified the stuffs in a simple manner. The pictorial presentation of Aadan Kaala and Visarga Kaala in a single picture is very appealing. Also, the diagrammatic presentation of various types of fractures, bandages and three sphincters of anorectum is substantial. The depiction of fracture bed (Kapaata Shayana) for immobilization of the fracture is a very innovative one.
The book mainly contains references from ancient texts of Bruhattrayi. This is very justifiable as the author has already published volumes on Charaka, Sushruta, Vagbhata and has contemplated on their creations. However, other Ayurvedic texts like Sharangdhar Samhita, Kautilya Arthashastra etc. have also been used for reference when required. The books of modern great scholars like P.C. Ray, S.N. Dasgupta etc. have also been referred to find the related information regarding the subject. Some research papers published in reputed peer-reviewed journals have been taken into consideration and these researches have been added to this book in various chapters.
The language of the book is simple, yet very artistic. The imaginative narration of the subject has made the reading of this book very interesting. For instance, the decline of Sushruta's legacy has been artistically narrated as – “The springs of surgical texts simply ran dry. The sun had set on Sushruta's surgical legacy too soon.” One more peculiarity regarding the language of this book is its creative presentation in medical terms. The decline of surgery has also been attractively described as – The palmy days of surgery developed “atrophic changes of unknown origin”.
This book includes good discussion about the mechanism of action of various Ayurvedic procedures and therapies like Panchakarma, Rasayana etc. The author admits that the Ayurvedic texts have made exaggerated claims like Vaak Siddhi (happening of events as predicted by someone) etc. on the effects of Rasayana and Vajikarana. However, he has explored the possibilities that the classics might have reflected the popular beliefs uncritically or an imaginative and unscrupulous physician could have inserted the fanciful descriptions in the ancient classics of masters.
The book makes a good application of logic to derive certain inferences. The asking by Kashiraj Divodas to his disciples about their wish of learning the branch of Ayurveda logically specifies towards specialization in one of the branches of Ayurveda only after basic training. This logically implies an ancient anticipation of present day graduation and postgraduate specialization in medicine.
The 16th chapter named “A Science Initiative in Ayurveda (ASIIA)” is the best chapter of the book. This chapter portrays the development of research in Ayurveda since the period of 16th–17th century, when the Portuguese and Dutch physicians took interest in India's wealth of medicinal plants. In 20th century, pharmacological studies based on medicinal plants have been pursued vigorously. However, the fact remains that none of the plant derived drugs like codeine or atropine have ever emerged from India. For clinical trials of drugs in traditional systems, WHO has suggested a new set of guidelines in the year 2000. However, despite of these liberalized guidelines, no clinical trials have been conducted in compliance with them in India.
In biomedical science research, basic sciences like modern biology, immunology, and biological chemistry have been applied to research in Ayurveda in recent years. Further, a “Task force in Ayurvedic biology” has been set up to use state-of-the-art tools of science in Ayurvedic research. The published results of these studies resemble new sprouts in an age-old tree, which will before long be covered with fresh sprouts all over!
The 17th chapter “Musings of Ayurveda” is written for pondering on the philosophical, ethical, biomedical and pedagogical practices and principles of Ayurveda. It's just a recollection of the basic principles of Ayurveda. The last chapter of the book consists of 32 quotations from the classical texts of Bruhattrayi. These quotations have been written in two scripts i.e. Devnagari script and Transliterated script, to suit the liking of most of the readers. Their meaning has also been given in English language. The appendices include a table of botanical names of the plants described in this book and a glossary of Ayurvedic terminologies used in the book alongside their meanings in English language.
This book is mainly intended for the students of engineering colleges, participating in the online course of video lectures on “India's Ayurvedic Inheritance” for National Programme on Technology Enhanced Learning (NPTEL), conducted by Indian Institute of Techhnology (IIT), Madras (Chennai). Therefore, the basic principles and practices of Ayurveda have been explained at a very rudimentary level, which may not be admired by the people of Ayurvedic fraternity. However, one should accept that the students of engineering colleges need such basic knowledge of Ayurveda only and it has been delivered by the author very promptly. This book and the video lecture series which is the basis of this book are useful for international medical students, who are not very well acquainted with Ayurveda except the word. It is a good read for such beginners.
The most attractive feature of this book though, is the excavation of history of Ayurveda. The author has gone digging into the past of Ayurveda vey deliberately and has extracted the facts regarding the evolution of Ayurveda right since the Vedic period and folklore. He has stretched the course of this evolution right up to the recent years, and has depicted the evolution of Ayurveda very precisely. For this excellent work on the history of Ayurveda, this book is a must-read for the Ayurvedic fraternity.
Conflict of interest
None.
Footnotes
Peer review under responsibility of Transdisciplinary University, Bangalore.