Contemporary relevance of Indian Medical Heritage
 By Sri Darshan Shankar,
Director, Foundation for Revitalization of Local Health Traditions (FRLHT), Bangalore
Text of Speech delivered on August 1, 2004

The Nature of Indigenous Knowledge and its social relevance, a personal journey:

As an urbanite, I had studied the natural sciences in school, college and university. However, these were all of Western origin: I was not exposed to any other form of knowledge. I did not know that other useful knowledge systems –– indigenous ones –– existed in an organised form in our society or that they were still functional and used regularly by a vast number of people. 

Insights into Tribal Medicine:

Later, while working as a social activist, I lived in the Karjat tribal block for 12 years. There, for the first time, I encountered medicinal plants and forests. I could not fail to notice, often with amazement, that the local Thakur, Mahadev Koli, and the Katkari tribals used many local plants and animals for health care. The methods of treatment I saw first-hand were incredible and impressed me deeply. Lactating mothers used Ipomoea mauritania (vidari kand) to enhance breast milk. The leaf of the common plant Calotropis gigantea (arka patra) was used to reduce a testicle swollen to twice its size (presumably hydrocele): the treatment worked in four days! The latex of the same plant applied on the skin could draw out a thorn from deep within. The fruits of Terminalia bellirica (bibhitaka) were used to treat dry cough. The roots and bark of Holarrhena pubescens (kutaja) could cure dysentery. Helicteres isora (muradasinge in Marathi) could stop diarrhoea. The ‘touch-me-not’ plant (Mimosa pudica or lajjavanti) was used to stop uterine bleeding, and the juice of durva grass (Cynodon dactylon) could dissolve gall bladder stones. 

I discovered that the tribals of this area knew the uses of over 400 plants, animals, birds and reptiles. The people who had access to and used this kind of knowledge were ordinary householders as well as more specialised village healers. Often, households knew of home remedies for managing more than 30 common health conditions. Every village had a birth attendant (called sueen) and at least one other socially recognised healer whom the villagers called vaidu (healer). There were vaidus who specialised in treating snakebites, others specialised in treating broken bones, and there were those who treated veterinary problems. None of the vaidus depended on healing for their livelihood. They had other occupations and healing was only a social service. 

Once, when a colleague of mine was suffering from a severe bout of jaundice, I consulted a vaidu. He promised to get me a remedy the next day. In fact he did not show up for two days. He then cheerfully explained that he had to go deep into the neighbouring forests to locate the herbs he needed. He had spent two whole days looking for the plant, which was used by my colleague with dramatic results. The healer, however, did not ask to be compensated for the trouble he had taken. It was left to us to express our satisfaction in whatever way we could afford. In the tribal culture, no patient expects ‘free service’ and they show their gratitude by giving the healer some grain, a hen, or a bottle of the local brew; but all this is not demanded as a precondition for the service.  

Limitations of Western Science in Validation:

I asked university-based phytochemists and pharmacologists their opinion of these practices and if they could scientifically verify these remedies. They had no clinical data on the applications of these materials. In few cases, the chemistry of a plant was known and the biological activity of an active compound had been studied on rabbits or mice. This information was not sufficient to validate tribal practices. The tribals did not just use active compounds –– they used flowers, fruits, bark, root, latex and gum, either in combination or in their entirety. Chemists and pharmacologists unfortunately did not know anything of the biological activity of the entire plant, only of certain chemicals derived from it. The scientists I approached worked in reputed institutions. However, they could not help. They needed huge funds and several years of research to carry out systematic studies. Hence in my pursuit of validation for local health practices, I was led to the traditional physicians of Ayurveda (the word itself means ‘Science of Life’). 

The capacity of Indigenous Medical Science:

The Ayurvedic physicians I met impressed me. They knew the materials the tribals had used and had books on indigenous pharmacology (Dravya Guna Sastra) in which the materials had been studied using 10 to 15 different parameters. They could therefore confirm the validity of tribal treatments. At times, they could suggest modifications to the local practice, or even substitute plants in cases where the original plant was not available. These doctors knew the systemic effect of plants, their metabolic effects at different stages of ingestion, and their action on body tissues, organs, etc. They also knew the side effects and contraindications as well as how to cancel them by adding other natural substances to balance, synergise or improve their assimilation.  

“Prayogahsamayethvyaadhim yo-anya-manyam udeerayeth Na asau visudha sudhasthu Samayeth yo na kopayeth”

(Ref: Ashtanga Sangraham sutrasthanam chap 21:29th verse).  

Proper treatment is that which pacifies the disease without any untoward effect. On the contrary if a treatment that besides curing the existing disease, gives rise to a new one, then it is termed as improper treatment. 

I was surprised by the depth of their knowledge, which included processes required to convert plants into various dosage forms and strengths. 

I was deeply impressed by the attitude and conduct of an eminent Ayurvedic physician from Pune. He was publicly felicitated for curing a case of leukaemia: the patient, who had been given a few weeks to live, had survived without remission for five years and was still healthy. While speaking at the felicitation, the physician declared:

Ayurveda does not have a term equivalent to ‘cancer’ and there is no mention of a condition called leukaemia. I did not bother to study the case sheets and the diagnosis from the cancer hospital that my patient presented to me for scrutiny because I have not studied biochemistry and therefore do not understand the subject. I examined the patient afresh and diagnosed his condition using Ayurvedic principles. The patient’s status had to be classified under a provisional diagnosis that was not described in the diagnostic literature of Ayurveda  (Ayurvedic science does enable physicians to make provisional diagnoses of new health conditions that have not been previously described). I then designed a treatment to suit my diagnosis. The patient was thus cured.  

He added: 

I do not, however, claim to be able to cure cancer. But I do claim that I have the capacity and willingness to look at any new health condition for, with the help of Ayurvedic science, a physician may be able to diagnose and treat, and perhaps even cure the disease. 

This statement gave me an insight into the dynamic nature of Ayurvedic science. 

Indigenous pharmacy and Clinical skills of traditional physicians:

In the context of pharmaceuticals, I observed that although the manufacturing technology behind indigenous medicine was pre-industrial, the logic behind dosage forms like wines, bhasmas (baked powders) and oils was sophisticated. The number of traditional methods of processing was far more than those available in other medical system. I appreciated the range of the diagnostic acumen of traditional healers –– their reading of the pulse, for instance, appeared incredibly sophisticated. Their acute clinical observations, even for a simple condition like a cough, were impressive: according to them, a dry cough was a wind disorder, a cough with heavy congestion and expectoration was due to an imbalance of water and earth, and a cough with inflammation and sore throat and mild congestion was due to an imbalance of agni or fire. These are all expressions of a scheme of ‘systemic’ diagnosis. In this scheme it is not important to identify a causative agent like a virus or bacteria, which may in fact be present, but to read from the symptoms the specific nature of systemic imbalance that has taken place and to choose for treatment natural products that will restore the balance. Scientists may subsequently discover that this scheme of treatment might also inhibit the growth of bacteria and virus in unexpected ways.  

The social characteristics of Folk Medicine:

As an Indian citizen, my exposure to the rich culture and knowledge of my own people both inspired as well as angered me. I felt inspired by the decentralised nature of folk health knowledge. Rural India already appeared to have the futuristic ideal of ‘health in your own hands’ that social thinkers dream of. Every village household had the knowledge of dozens of common ailments and also of preventive and promotive health care aimed at introducing practices that result in total health rather than only in fighting individual illnesses. Along with this, every village has its own folk healers who have the appropriate skills to manage most primary health problems. 

It is extremely important to note that folk traditions are not only rooted in the community, they are also supported by the community. The size of the folk tradition in any locality, and thus all over India, is so large that it is only the whole community that has the capacity to sustain the tradition. In the 1980s the Health Ministry made the mistake of declaring that they would pay Traditional Birth Attendants (TBAs) for every delivery conducted. It soon found out that state governments could not afford to pay thousands of TBAs. Nor was it easy for them to monitor such a process. So today, the estimated 600, 000-plus TBAs of India continue to be paid by their own communities. 

As we know, community-based, oral health traditions are embedded in the lifestyle, diet and health practices of thousands of local communities all over India.  

“Ucito yasya yo desa tajjam tasyausadhamhitam

Desenyatrapi vasato tattulya guna karma ca”

(AS, Su, 23/34)

The drugs which is grown in the in the same region in which a person resides is ideal for that person. Those drugs that possess properties similar to the drugs of native land are good for a person even though living elsewhere.


Like music and agriculture, health care also flourishes as a folk tradition. It is estimated that there are around 1.4 million folk healers as well as millions of rural (and to a much lesser extent, urban) households who possess immense knowledge of home remedies. They are also well informed about local foods, their availability and nutritional value. The health traditions of all these healers are based on local resources. According to an All India Ethno-biological Survey carried out by the Ministry of Environment and Forests, Government of India, over the period 1985-1995, around 8,000 species of wild plants were listed as being used in health care by rural and tribal communities. These account for almost 50 per cent of the known flowering plants of India (17,5000 species). Apart from plants, local animals, metals and minerals are also used.  

The most fascinating features of local health traditions are their wireless (non-institutional) transmission and the fact that they are self-sustaining. They exist in millions of homes and thousands of villages, town and cities, without the aid of any institution or external source of funding. They are transmitted through family or community traditions via a person-to-person process. Folk gurus (teachers) guide their sisyas (students) in cultural and ethical codes, which   evolve, adapt and alter in time. They embody the knowledge of the human mind, physiology and anatomy as well as of food and nutrition. This knowledge extends even to the pharmacological properties of plants, animals, metal and minerals. Though community health practitioners have no legal status, they enjoy much social legitimacy in their localities.  

It must be noted that folk healers do not generally undertake medical service as a full-time vocation, nor are they dependent on their health services for a livelihood. The typical healer may be a farmer, a barber, a shopkeeper, a blacksmith or even a wandering monk. And while the medical services they provide are not free of charge, they are offered in an ethical and non-commercial spirit. So though the community (patient) pays the healer for his/her services following local cultural norms, the income earned is usually incidental and supplementary. This low sustenance cost is one reason why the tradition is so large, widespread and decentralised, and has over million foot-soldiers. If folk healers were to depend on such earnings for their livelihood, their numbers would have been much smaller, as not every village can sustain the livelihood needs of full-time healers. 

The Sophistication of the codified traditions: 

The composition of the Codified Stream:

This consists of medical knowledge systems like Ayurveda, Siddha, Tibetan &  Unani.  The content of the ayurvedic knowledge systems for instance covers eight broad areas:  Kaaya chikitsa (general medicine), Bala chikitsa (paediatrics), Gruha chikitsa (psychiatry), Oordhwanga chikitsa (ENT & Eye), Salya chikitsa (surgery), Damshtra chikitsa (toxicology), Jara chikitsa (rejuvenation) and Vajeekarana chikitsa (virilification). The codified stream has sophisticated theoretical foundations. It has special understanding of physiology; pathogenesis; pharmacology and pharmaceuticals, which is different from western biomedicine.

The size & carriers:

There are currently 6,50,000 licensed practitioners of these systems that are recognized and registered by the state governments under the Indian Medicine practitioners Act. 

Ocean of Knowledge:

There is an ocean of knowledge in the codified stream. The extent of knowledge is reflected in the large number of medical manuscripts, and the range of subjects they cover.   The classical medical knowledge has been generated by physicians, scholars and seers. The codified stream has also drawn upon the empirical knowledge of the folk stream. Apart from the knowledge of pharmacy and drugs, there is an extensive knowledge of diagnostic methods, therapeutic techniques, surgery, specialized lines of treatment, physiological concepts, understanding of the body-mind relationship etc.  There are an estimated 25,000 herbal formulations in the traditional formularies of Ayurveda alone.  This figure of 25,000 seems astounding when we take note of the fact that the total repository of modern drugs in the world today is of the order of 4,000 formulations.  

The indigenous scientific method (way of knowing of Ayurveda):

To gain an understanding of the sophisticated knowledge system underlying the indigenous  health systems, such as Ayurveda, it is necessary to be familiar with its epistemological traditions.  The Ayurvedic worldview is based on the Sankhya school in which the manifest world (vyakt) emerges from the unmanifest world (avyakt).  One flows into the other.  Observer and observed are one, just as subject and object are one. The way to understand nature is, therefore, to become one with it. This is achieved by the five senses and the mind.  Sight, hearing, touch, taste and smell make it possible to decipher the world around while the mind moves both inwards and outwards. A mind free of prejudice is both perfectly objective and subjective. This is perfect oneness with nature and is termed as the mental state of Brahma from which Ayurvedic Shastra was pro-pounded. 

“Dvividhameva khalusarvam sat ca asat ca.

Tasya Caturvidhaa pariksa – Aptopadesa,

pratyaksa, anumana, yuktisceti” (CS, Su, 11/17).  

All can be divided into two – existent and nonexistent. Their examination is four fold – authoritative statement, direct perception, inference and logical reasoning.

In the western tradition, the scientific temper is limited to the use of analytical disciplines. But in Ayurveda it means freeing the mind of the six prejudices of kam (lust), krodh (anger), lobh (greed),  madh (intoxication), moh (delusion) and matsar (jealousy).  The western tradition restricts itself to the concepts of matter,  time and space.  But Ayurveda is based on the recognition of fundamental padarthas or existential principles such as dravya (existential principles of 9 types), guna (qualities of 41 types), karma (action of 5 types), samanya (generality), vishesha (distinctiveness) and samvya (inseparability). 

Dravya encompasses nine categories of being from atma (soul) to prithvi (earth), which means it covers a range from subtle to gross, from consciousness to solid earth.  They are simultaneously different and linked, one devolving into the other. Consciousness devolves into the mind, because the mind's qualities like innumerability (sankhya), magnitude (parimana), uniqueness (prthaktva), conjunction (samyoga), disjunction (vibhaga), nearness (paratva), remoteness (aparatva), impression (samskara) causal relations (yukti) and repetitive expression (abhyasa), create the notions of time and space or the mental plane. The mind further devolves into the five states of matter: akasha (space like), vayu (wind like), agni (fire like), ap (water like) and prithvi (solid earth like).   

“Samanyam ca visesam ca gunan dravyani

Karma ca samavayam ca tatjnatva tantroktam

vidhimasthitah” (CS, Su, 1/28).  

Generality, specificity, inherent qualities, existential principles and effects are essential to know both separately and in totality in order to understand a phenomenon in a logical and systematic way. 

An understanding of the world is not limited to the five senses, which only convey reality in its grossest manifestation.  Complete awareness only comes from a level of perception at which the observer both reaches out and looks within, thereby establishing a subjective flow, which connects the observer and the observed. 

The western tradition in theoretical sciences is founded in the logic of Aristotle and the deductive and axiomatic method of theory construction as evidenced in Euclid's elements, which have been further refined in the course of work in logic and mathematics during the last hundred years. The Ayurvedic Shastras (sciences), by contrast, are based on the Indian school of logic called the Nyaya-Vaisesika Darsanas.  Western logic deals with a study of 'propositions', especially their 'logical form' as abstracted from their 'content' or 'matter'. It deals with 'general conditions of valid inference'.  Whereas one of the main characteristics of the Indian 'formal' logic is that it  refuses to totally detach form from content. It takes great care to exclude terms that have no referential content, from logical discourse. 

The difficulty in making arbitrary comparisons between Indian and Western epistemologies can be illustrated when one attempts to compare their internal parameters. For example, there is no conceptual correlation available between the three basic physiologic parameters of Ayurveda:  kaph, vat and pith and western physiologic parameters like hormones, blood pressure, lipid levels and blood. Quantitative parameters in Ayurveda are also not given the same importance as they are in western traditions. Although measurement and quantification are used, they differ in form from western systems of knowledge.  Most measurements in the traditional medical science are made using units 'normalised' to an individual. That is, while assessing a person's height or the length of his or her limbs, the measurement is expressed in units of anguli, the dimension of a finger of the individual concerned rather than in an arbitrary standard external to the individual, such as the international meter. Such normalized units exist not only for measurement of length but also for volume and time. Qualitative parameters and natural language have been given far more importance and support the rigour and accuracy of Indian tradition. 

Efficacy of Indian Medical Systems:

The fact that both the folk and codified health culture, have “living” health traditions and practices, used by millions of people & implemented by thousands of physicians and the fact that the Indian Medical Heritage has an unbroken and evolving tradition which is more than two millennia old, is irrefutable evidence of its basic classical efficacy. 

In the recent years there is limited western science supported data generated by very limited research investments in the form of a few hundred “scientific” studies, which have evaluated traditional health practices on the parameters of western biomedicine. Such studies have been conducted in India & abroad mainly on drugs but also on traditional diets & diagnostic and surgical procedures. It is important to understand the reason for this limited data. The limited scientific data is the output of sub-critical financial and human investments in collaborative research. If more substantial data were needed then much larger investments should have been made. The responsibility for mobilizing funds for such collaborative research rests with the western scientific community and policy makers.  

How was the ocean of knowledge generated?

It is important to ask this question and “learn” from the answer. Traditional medical knowledge both in the folk and codified stream was not generated by western knowledge systems. 

They have had their own theoretical foundations, worldview, methods, logic, principles, concepts and categories. This indigenous knowledge system was active and functional till the beginning of the 20th century. This is borne out by the Ayurvedic studies recorded in Nighantus on properties of exotic plants like tea, coffee, green chillies, tomato, potato, pineapple etc. that entered Indian soil from foreign countries only during the last 200 years or so. It is the “suicidal” attitude of Indian elite and policy makers that ignores and in fact discourages “serious research” on the theoretical foundations of indigenous medicine. Ironically serious researches on theoretical foundations of Indian medicine are under way in western universities.  

Summing Up: 

Non-western knowledge systems have so far failed to establish their right to endogenous development. Their epistemology, or ‘the method of knowing’, lies unexplored outside of their traditional worlds. Their universal attributes lie unrecognised. It may be alarming to learn that they are, in fact, being rapidly eroded and face destruction due to the political and economic effects of a globalisation process that has thus far been promoting a monoculture. This destructive process began with colonisation and continues today.  

All cultures have a potential stake in supporting the revitalisation of the world’s many indigenous cultures because world civilisation as a whole stands to gain from a state of ‘flourishing’ cultural diversity. It is necessary to appreciate the historical fact that various knowledge systems have had their genesis and basic evolution in specific cultural spaces in time. Modern science, as we know it today is, in this context, definitely, a product of European culture, with its Greek antecedents. Science, despite its universal attributes, which are also a feature of non-western knowledge systems, is a cultural product. Science, therefore, cannot be viewed, except from a Eurocentric viewpoint, as the only universal way of studying and knowing nature.

In the medical field, particularly in the countries of Asia, Africa and Latin America there are living medical knowledge systems that are indigenous and have been evolving in these societies for generations. These medical cultures have epistemological foundations that are very different from western biomedicine. There is an urgent social reason for promoting these indigenous cultures because, in the context of public health, the ‘modern’ health system, based on western biomedicine, is unable to solve all the health needs of the people. In the Indian context even the outreach of the modern medicine health system is limited and it is only able to offer primary health care services to about 30% of the rural population. Revitalisation of indigenous health cultures based on locally available biological resources and local knowledge has the potential to both improve the quality of the healthcare as well as provide health security to millions. 

The concern for revitalisation of indigenous cultures and their ways of knowing must, not be viewed as a concern for reviving the past. It should rather be seen as a serous attempt to broaden and deepen the scope, quality and content of modern civilisation. Unfortunately, this process has, over the last two centuries, become wedged in a narrow monocultural track and resulted in worldwide cultural uniformity. This cultural uniformity is extremely dangerous for the survival and evolution of civilisations. Uniformity narrows down the alternatives and options available to the peoples of the world and their capacity to cope with the present and the future. It should encourage the understanding that just as bio-diversity is critical for biological evolution, a flourishing cultural diversity holds the key for civilizational evolution.