Pedagogical Tools in Āyurveda

Abstract

Āyurveda is an Indian traditional medical system that deals with health and disease. The Āyurveda classics not only provide information about medicine and surgery, but also contain ample evidence on methods and tools to gain theoretical and practical knowledge of this science. 

The Caraka Saṁhitā gives us references on ways to conduct debates, seminars, medical conferences, and research methodology. The Suśruta Saṁhitā explains in detail regarding the importance of practical anatomy, dead body preservation, dissection techniques, and gaining clinical exposure through practical experience using medical simulation models.

Using the methods described in the classics, one can either specialise in any clinical field such as Pañcakarma (Purification), Śalya Tantra (Surgery), or Racana Śārīra (Anatomy); or learn Anusandhāna (Research) and become a researcher in the process.

Here, an effort has been made to collect evidence available on specifically medical pedagogical tools from Caraka Saṁhitā and study them to further understand and compare them to modern day tools.

Objective

To do a theoretical study in detail regarding the medical and surgical pedagogical tools mentioned in Ayurveda, compare them to modern day tools.

Methodology

By referring to classical texts of Āyurveda: Caraka Saṁhitā. Taking the guidance of scholars in these fields, studying manuscripts, and also referring to relevant articles.

Results

Upon analysis of literary resources, it is found that there is significant evidence for pedagogical tools specific to Ayurveda in the Caraka Samhita. Some of them can be compared to modern tools like the scientific method of teaching. However, concepts like aaptopadesha pramana, upanayana samskara, relationship between a guru and student are unique to the Vedic system and specifically important in the context of Ayurveda. 

The Scientific Method

(Table 1: Tools that contributed to the advancement of the field of Āyurveda)

1. The first aspect of medical education is selection of a textbook to study:

These are the guidelines given for choosing an ideal medical treatise:

• which is comprehensive, providing all information,
• successful, followed by prominent and wise men (successful practitioners),
• with detailed meanings,
• regarded by authorities,
• useful to all three types of learners (with good, moderate and poor intellect),
• free from the deformity of reiteration,
• descending from the sages (which is written by experienced, intuitive person),
• with well-formed presentation, discussion and conclusion,
• having informative title and firm base, free from weak and difficult words,
• having comprehensive knowledge of the subject,
• with proper sequencing of its contents,
• committed principally to arriving at the essence of thoughts, which reveals clear meanings and concrete conclusion,
• focused on the particular subject without wavering ideas and irrelevant content,
• quickly understandable with separated topics, effectively comprehensible, and having definitions with examples.
• Such treatise with pure knowledge is similar to sun which enlightens the whole subject while warding off the darkness. [3]

A text with a well defined syllabus, authentic source, sequenced content, clear concept explanation, easy to understand analogies, concrete conclusions, and devoid of syntactical errors is desired as it can be used by students of varying intellectual abilities. The Caraka Samhita itself is an example of such an ideal treatise and it is considered as the standard book for many colleges across India. 

2. In the Ayurvedic philosophy, there is a concept of searching for and identifying the ideal preceptor. Assessment of a teacher’s qualifications can be done based on these parameters:

• have clear knowledge of the subject and practical experience,
• be diligent, dexterous, virtuous, with skilled hand,
• well equipped, possessing all the senses in normal condition,
• acquainted with constitutions, well- versed in courses of emergency management and quick actions,
• having his knowledge uncensored,
• free from ego, envy, anger, 
• forbearing,
• paternal to disciples,
• having characteristics of a good teacher and fit for imbue understanding.
• The teacher holding such qualities quickly inculcates physician’s qualities in his disciple as the seasonal cloud furnishes good crop in a suitable land. [4]

By analysing the characteristics of the teacher,one can choose to become a disciple. Once the decision is made after thorough analysis, the student must remain devoted to the teacher.

3. Establishment of the teacher-student relationship:

The student desirous of learning from such an ideal preceptor, should sincerely follow him like worshipping fire, god, king, father and guardian. Subsequently after satisfactorily gaining knowledge of the whole medical treatise, the student should always continually attempt to improve further depth of knowledge, understand the (hidden) precise meanings, gain more scientific knowledge, express it impressively with comprehension of ideas and power of speaking. [5]

This clearly demonstrates the role of a preceptor in shaping and influencing the student and the role of student in absorbing values and knowledge of the preceptor. This concept of guru shishya sambandha is a beautiful relationship on a spiritual and worldly level. The guru guides the student in the path of knowledge with the goal of attaining liberation. He also educates the student on essential life skills and professional skill necessary for success in the world.

Learning methodologies

तत्रोपायाननुव्याख्यास्यामः- अध्ययनम्, अध्यापनम्, तद्विद्यसम्भाषा चेत्युपायाः ||६||

tatropāyānanuvyākhyāsyāmaḥ- adhyayanam, adhyāpanam, tadvidyasambhāṣā cetyupāyāḥ ||6||

The three tools to attain knowledge are studying, teaching, and discussion.

• Methods of learning (Adhyayanam)

One who desires to study with a calm mind and at a proper time, should get up early in the morning. After passing the natural urges and cleaning the body (as per daily schedule), should do the spiritual rituals like sprinkling water, worshipping gods, sages, cow, brahmana, preceptors, elders, accomplished persons and the teacher. Then sitting comfortably on even and clean ground should present the aphorisms in order as learnt from the teacher with a clear voice attentively repeating it over and over. At the same time, he should think about the meaning and principle to get rid of his own defects and to know others’ defects. In this way, he should proceed the study without squandering time in midday, afternoon, and night. This is the method of study.

This indicates the dedication and perseverance which is expected out of a student. The health of the student is also addressed. Sitting on the ground promotes good blood circulation, chanting out loud is a part of all Vedic (oral) traditions and the vibrations that come out of chanting cleanse the body energies. The spiritual health of the student is also taken into account as rituals are advised. It is mentioned to wake up early and pass stools as a part of external purification of the body. These are all methods of inculcating discipline and single mindedness on the subject. Self contemplation and self assessment is also encouraged while thinking about the meaning of the verses and applying the same to oneself and then to others.

• Methods of teaching (Adhyāpanam)

1. Characteristic guidelines to examine the ideal disciple:

• should be very calm, with superior qualities,
• Should not not involved in mean acts,
• Should have straight eyes, mouth and nasal edge (without any defect in eyes, nose and mouth);
• Should have a thin, red and clear tongue; with no abnormality in teeth and lips, not talking with nasal utterance,
• having forbearance, without vanity, intelligent, endowed with logical reasoning and memory,
• broad minded,
• born in a family of physicians or aware with the conduct and behaviour of physicians
• desirous of gaining scientific knowledge
• without any physical deformity or disability of senses,
• humble, keeping the knowledge safely, un-haughty,
• having capacity to comprehend essence of the ideas,
• without anger and addictions,
• endowed with modesty, purity, good conduct, affection, dexterity and sincerity, interested in study,
• dedicated to comprehension of ideas and practical knowledge without any distraction,
• having no greed or idleness, empathetic to all creatures,
• following all the instructions of the teacher and being attached to his teacher. [8]

The physical fitness and mental fitness are analysed before admitting a student into medical school. Emphasis is given to the facial features and sense organs, especially because of two reasons:

• A defective tongue and nose causes improper utterance of the text causing mispronunciation and further misunderstanding of key statements.
• Also, the sensory organs are tools in clinical examination. They come under pratyaksha pramana (direct perception). With inabilities in vision one cannot judge the patient (eg: ill look, yellow discoloration, etc.). With hearing impairments, the student cannot judge the voice of the patient. With abnormal tactile sensation, the student cannot examine the pulse of the patient.

The mind of the student plays an important role in understanding his inherent tendencies. One who is greedy, will rob the wealth and life of the patient. One who has addictions cannot cater enough time towards studies. 

Family background of the student: If the student is from a family of physicians, he has a better chance to broaden his knowledge with the experience of family members. This shows that in those days, joint families laid down a more secure and stable career path for the future generation by growing their family occupation. 

A close bonding between the student and preceptor ensures a smooth classroom environment and a compassionate space for illumination of knowledge.

2. Occasion of commencement of studies

These actions are the means by which one must enter the study of medicine. The elaborate procedure of initiating the student into the subject is called Upanayana Samskara. It is one of the major transformative events in a human’s life as an attempt to reach the ultimate goal, Moksha. It sets the student into a physical, mental and spiritual state conducive to the Jnana marga (pursuit of knowledge). This reiterates the seriousness of the medical study and profession. The astrological and environmental factors are also kept in mind along with other general vedic rituals to ensure the success of the procedure. 

 Activities to be performed by the student:

When such a disciple with desire of study and feeling of commitment approaches the teacher, then teacher should address the student as- “when the sun is in the northerly course and during the full moon phase, on propitious day the benevolent lord moon having conjunction with one of the pushya, hasta, shravana and ashvayuja constellations in kalyanekarana and maitramuhurta come with shaved head, after fasting, bathing, and wearing ochre-coloured clothes and sacred thread and with fragrance sacred fire wood, fire, ghee, means of besmearing (cow-dung etc.), water jars, garland, rope, lamp, vessels of gold, silver, jewels, pearls, corals, silken cloth and sticks for edge of the sacrificial ground, holy grass, fried paddy, mustard seeds, barley grains, white-flowers, with or without strung, eatables increasing memory power and paste of fragrant wood.” [9] The student should follow instructions of preceptor. [10]

Knowing that the student has come, the preceptor should make a rectangular platform measuring four cubits and sloping eastward or northward, in an even and pure place. This ought to be spread with cow-dung, covered with sacred grass and bound on borders with paridhi. Further it ought to be equipped with the said articles, for example sandal, water jar, silken garment, gold, golden vessel, silver, jewel, pearl and coral and beautified with eatables increasing memory power, aromas, white flowers, fried paddy, mustard and barley grains. Then attending to the fire with the fuel-sticks made of palash, ingudi, udumbara, madhuka while in pure condition and facing eastward, as recommended under the method of study, he should offer oblations of honey and ghee to the fire reciting benedictory mantras first invoking Brahma, Agni, Dhanwantari, Prajapati, Ashvinis, Indra and various sages, the authors of the aphorism and ending with svaaha three times each.[11]

The disciple should follow him. After offering oblations he should go round the fire keeping it to the right side, then brahmanas should recite svasti. At the end, he should pay regards to the physicians in the society. [12]

3. Code of conduct for medical student and professional

This is considered the pedagogical oath for Ayurvedic students and students in general. It highlights the rules and regulations regarding diet, regimen, behaviour, and mental makeup. The strict rules are a direct reflection of Chanakya’s parenting principle:

लालयेत् पञ्च वर्षाणि दश वर्षाणि ताडयेत् / प्राप्ते तु षोडशे वर्षे पुत्रं मित्रवदाचरेत् ||

lālayet pañca varṣāṇi daśa varṣāṇi tāḍayet / prāpte tu ṣoḍaśe varṣe putraṃ mitravadācaret ||

(One should pamper his son till five years. Thereafter one should be strict and administer punishment for the next ten years, but once the son reaches the age of sixteen one should act as a friend towards him.)

In the perspective of child psychology, a major portion of the brain is still developing so decision making, critical thinking, and handling emotions are areas that are difficult for the child to manage all alone. The teacher plays an important role in mentoring the child in the best path for his future.

Now the teacher should instruct the student in presence of sacred fire, brahmanas and physicians,

• You shall follow abstinence, keep beard and moustaches,
• speak truth only,
• shall not eat meat,
• follow pure and intellectual functions,
• do things without jealousy and weapons,
• You should always follow my (teacher’s) instructions except in case they lead to king’s wrath, end of life, great unrighteousness and other such calamity.
• You should always entrust me, see me as head, be submissive to me and follow the course which is liked by and advantageous to me. You should live with me behaving as a son, servant and suppliant.
• You should live with modesty, alertness, a focused mind, humbleness and constant vigilance about work, without seeing defects in other’s qualities, and not leave without my permission.
• When permitted to move out, you should first make an effort as far as possible to furnish things told by the teacher.
• When you join the medical profession and wish success in work (treating patients), in purposes of life (purushartha like dharma, artha, kama and moksha), fame and heaven after death then you should always pray for the welfare of cow, brahmana and all the living creatures.
• You should try to provide health to the patients and all creatures by all means.
• You should not hate the patients even if the poor patient is not able to pay your fees.
• You should not think bad about other women and anybody else’s property even in your imagination.
• Your dress and accessories should be modest.
• You should not be addicted to alcohol, indulged in sins and accompanied by sinners;
• You should be soft spoken, talking flawless, righteous, blissful, thankful, truthful, useful and measured statements keeping in mind place and season or time. with good remembrance, striving constantly for knowledge, progress and excellence of equipment (medicines etc.).
• You should not treat the persons disliked by the king (thieves etc.) or disliking the king (rebellions), disliked by good persons or disliking them and all those who are excessively diseased, wicked; having troublesome conduct, behaviour and management, have never counteracted their censors and one nearing death;
• You should not treat the women in absence of their husbands or guardians, you should not accept meat provided by the women without permission of their husband or guardian.
• At the time of entering into the patient’s house you should take along a known individual whose entrance is allowed; should be well-dressed, with head lowered, having good memory, with stability, thinking deliberately and moving as needs be; having entered there, you should never engage your speech, mind and sense organs any place except the patient, his well-being and other entities of the patient’s body respectively. The matters of the patient’s house should never be revealed outside, in spite of the fact that you know the diminution in life-span of the patient, you should not specify where it is liable to cause harm to the patient or others. Even though you have learned enough you should not boast too much for your knowledge because mostly people become anxious about excessive boasting even if it comes from an authority. [13]

There is no limit for knowing the science of life i.e. Ayurveda. Therefore, one should dedicate himself to studying Ayurveda continuously and without any carelessness. This is worth-doing and to be followed.

Further one should keep good behaviour with everyone, without pointing out the defect in other’s qualities. Because for the wise the whole world is a teacher, while for the unwise it is the enemy. Consequently, the wise, after due consideration, should follow the advice which is prosperous, promoting fame, life-span, strength and useful to the society even if it comes from an enemy.

After that the teacher should speak this, “You should always worship gods, fire, brahmanas, preceptors, elders, accomplished ones and teachers, thus this fire along with all the perfumes, eatables, gem, grins and aforesaid gods would bless you with prosperity, and if you behave in opposite manner they would curse you.” When the teacher has said something like this, the disciple should say ‘Yes’ indicating his compliance.

If the disciple follows these instructions then he should be taught, otherwise not. The teacher when teaching such a worthy disciple obtains the aforesaid fruits of teaching and enjoins the disciple and himself with other not mentioned beneficial qualities. Thus, the method of teaching is said. [14]

• Method of Discussion (Tadvidyasambhāshā)

Group learning is a big part of Ayurvedic studies. The Charaka Vimana Sthana chapter 8 talks in great detail regarding the aspects of discussion, seminar, symposium, and debate.

• Sambhasha vidhi (panel discussion)
• Vada marga (conduct debate)

To summarise, the 3 learning methodology (i.e: self study, teaching, and group study) highlights the importance of skill based learning and 3 step model: read to understand, understand to teach, and teach to apply. The result of this method is an open pedagogy. The ancient Ayurvedic pedagogical approach, as gleaned from the Charaka Samhita, embodies a holistic and skill-based learning methodology. The texts emphasise self-study, teaching, and group study as essential components, promoting not only knowledge acquisition but also its application and dissemination.

The incorporation of group discussions, debates, and seminars within Ayurvedic education is reminiscent of contemporary open pedagogy. Historical evidence of open pedagogy in Caraka Saṁhitā include rasa sankhya vada, garbhavakranti sharira, etc. This hints at the progressive and collaborative learning environment that ancient Ayurveda fostered.

The whole text itself is a documentation of academic discussions of scientific importance. Agnivesha, the student of Atreya, carefully documents the entire conversations of scholars as he genuinely puts forth his questions. This learning method demonstrated throughout the text, is common to several Vedic texts like the Upanishads. The essence of introducing the concepts of tadvidyasambhasha, debates and discussions as a separate entity in the Charaka Samhita highlights the  importance of introducing allied science for a holistic experience. Nyaya Shastra (logical reasoning) is required to study debate as a learning tool and apply it in the medical context. It also helps us learn the guidelines to identify authentic sources for empirical knowledge.

Conclusion

The results from this textual exploration offer immense potential for incorporating some aspects of Ayurvedic systematic guidelines for teaching and learning methodologies into modern day medical education. Hence, the contribution of this study creates the literary review background and provides scope for further systematic research studies to be undertaken. 

Acknowledgements

1. Dr. Nagaraj Paturi, INDICA IKS
2. Dr. Prasanna Narasimha Rao, Principal & Professor in Shalya Tantra, SDMCAH, Hassan
3. Dr. Nagaraj Kamath, HOD, Department of Kriya Sharira, SDMCAH, Hassan

References:

⁵ Ca. Sū. 25: 40

⁹ Ca. Vi. 8

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