Chapter 22 - Pharmacy

Pharmacy and Pharmaceutics form a very important and substantial part of medicine. As the proverb goes, the proof of the pudding is in the eating and the efficacy of the medical science depends in a large measure on the nature of the medications administered. The richness of the medical advancement therefore has to be judged largely by the richness in the variety as well as the quality of the pharmacopia and pharmacy.

1. Vedic period:

Veda is spoken of as having six limbs, viz, phonetics, grammar, etymology, astrology, canons of ritual and prosody.

[...]

Out of these, or the canons of ritual is defined as (kramaṃ karma prayogāṇāṃ kalpa tatra pracakṣate [?]) i.e., the order of rituals is spoken of as Kalpa.

Ayurveda was considered to be on a par with the Vedas, and as in the Vedas we get a section on Kalpa in Ayurveda too, Kalpa meaning the canons of pharmaceutics.

In Vedic period we find that single herbs are prescribed. They also prescribed minerals and animal substances, but the prescriptions were not compound. This is the pre-historic period. At that time simple prescriptions were the order of the day throughout the world. It is probable that magic and black art were practised to some extent in the Misra Desha (Egypt) which is called the Syama, Shyava or the black country. It is likely that the word Syama might be the origin of the words kimia, alchemy and chemistry. The secret prescription for the preservation of mummies is an instance to prove their advanced knowledge in chemical pharmacy We are getting more and more enlightenment on Mohenjo-daro and from the findings that have come to light we learn that Shilajit (mineral pitch) and other drugs have been found there even after thousands of years of oblivion. This definitely shows that this special branch of knowledge had developed in India also.

The art of preserving dead bodies was not unknown in ancient India. In Ramayana, Ayodhya-kanda, we find that the corpse of king Dasaratha was preserved in medicated oil. In Visnu Purana we find that the corpse of Nimi was preserved by being embalmed with fragrant oils and resins.

In Kashi-khanda, there is the description of the corpse of a Brahman’s mother being preserved in the following manner. The corpse was washed and then embalmed in (yakṣakadarma), i.e. specially medicated balm and enveloped severally with Netra-vastra (flowered muslin), silk cotton, coloured cloth and Nepalese blanketing. The corpse was conveyed in a copper coffin from Rameshvara to Kashi,

2.The golden period of Ayurveda, 600 B. C to 600 A.D.:

Pharmacy had reached the scientific stage at this period, as is evinced by the master-classics of Caraka and Sushruta. They evolved the all-comprehensive concept Caraka declares—

[Carakasaṃhitā Sūtrasthāna 2?.12]

“There is no substance in the world which is not medicine”.

They knew the uses of practically all the known substances, as is proved by the enumeration in the following verses

[(Carakasaṃhitā Sūtrasthāna 1.68-72]

“Again they are classified differently in three groups—animal, vegetable and mineral”.

Honey, milk, bile, fat, marrow, blood, flesh, excrement, urine, skin, semen, bone-sinews, horns, nails, hooves, hair, down, and inspissated bile—these are the substances used in medicine from the animal world.

Gold, ores, the fine metals, sand, lime, red and yellow arsenic, gems, red ochre and antimony are the mineral products used in medicine

The vegetable group is divided into four classes (the direct fruiters, creepers, flowery fruiters and herbs) Root, bark, pith, exudation, stalk, juice, sprouts, alkalies, milk, fruit, flower, ash, oils, thorns, leaves, buds, bulbs, and off-shoots are the plant products used in medicine.”

In addition to these classifications, clear instructions were given regarding the kind of country, season and clime of culling of herbs, selections of herbs and the methods of storage.

Regarding country, we have deatailed descriptions in:

[Carakasaṃhitā Kalpasthāna 1.8]

“Place or clime is of three kinds Jangala (arid) Land, wetland and ordinary land. Then follows a description of three kinds of land”.

Regarding the season and time of culling the herbs we have:

[Carakasaṃhitā Kalpasthāna 1.10]

“Of them such drugs should be culled as were put forth in their proper season and have attained their fulness of growth, taste, potency and smell.....” etc.

In this verge detailed descriptions are given as to how and when the herbs should be culled.

Minute instructions regarding the selection of drugs are given in:

[Carakasaṃhitā Cikitsāsthāna 1.38-40]

“The best of habitats for medicinal plants is the Himalayas, the most majestic of mountains. It is the fruits grown in the Himalayas that are therefore to be properly culled every season, rich with juice and potency, mellowed by the sun, wind, shade and water, unnibbled at by bird or beast, unspoiled and unmarked with cuts or diseases. We shall now describe the modes of administration and the excellent effects of these fruits”

Very valuable instructions are given in Caraka Kalpa-sthana 1.11 regarding storage of herbs

It says that the herbs should be stored in houses with doors opening to the east or the north, and that the rooms should be windless, proof against fire, water, moisture, smoke, dust, mice and quadruped.

In order to ascertain the action of the drugs on the human body, the great sages evolved the five determinants viz., taste (rasa) quality potency (vīrya), post-digestive effect (vipāka) and specific action (prabhāva).

This system enabled them to study completely all the drugs necessary for therapeutics. These drugs were chiefly administered through the natural channel of the mouth and hence the arrangement of Rasa or tastes came into prominence, the sense of taste playing an important part in oral administration of drugs. This arrangement and metaphysic of taste in six categories is a speciality of Ayurveda and it has been so arranged as to fit well arithmetically to the Tridosa theory. The properties and actions of inedible drugs were experienced by senses other than that of taste and so a comprehensive scheme of twenty or more kinds of properties was evolved which could be tested by other sense-organs Some drugs acted more powerfully than usually expected and so (vīrya) or potency of drug became one of the determining factors. Another peculiarity of Ayurveda is its theory that the drugs while entering the body submit themselves to the process of digestion. As a background of this theory, the concept of Ayurveda that diet and drugs fall in the same category is worthy of attention. The Upanisads consider food also as medicine (anna bheṣajam). The difference between diet and drugs is not fundamental, taste is predominant in diet (rasaviśeṣa) while potency is predominant in drugs (vīryaviśeṣa) and it is but a natural corollary that just as diet gets digested in the system, so drug also is digested in the system. It is on this sound fundamental theory that Ayurveda forbids the administration of another drug before the first drug is digested. Thus comes (vipāka) or post-digestive effect, the form that a drug is turned into after being digested and its action on the body, these form the subject matter of (vipākajñāna). Last but not the least comes the specific action (prabhāva) of a drug. Even in this modern scientific age not to talk of the so-called empirical age of knowledge, no scientific explanation can be given for the specific properties of certain drugs, because they are beyond the ken of the present stage of science. When the knowledge of specific action attains perfection, there will be no need of research but so long as there is room for research, we must admit that the knowledge is incomplete.

These five-fold deliberations on drugs cover the whole field in a comprehensive way. As Ayurveda has conceived diet and drug as one, the properties and the actions of the substances that comprise our diet have been subjected to the same process of study and exposition as those of the drugs. This is really a speciality and peculiarity of Ayurveda

The Varieties of Preparations

Caraka in the first chapter of Kalpa-sthana declares thus regarding the varieties of preparations:

[Carakasaṃhitā Kalpasthāna 1.1-6]

“Taking into consideration that drugs differ with respect to land, season, source, flavour, taste, potency, post-digestive effect and specification and also that men differ with respect to their body, morbid tendency, constitution, age, vitality, gastric fire, proclivities, homologation and stage of disease, we shall here describe six hundred purgative preparations that are pleasant in their variety of smell, colour, taste and touch of drugs, although the extent of the possible preparations from these drugs is innumerable”.

The various processes known to modern pharmacy are nearly all represented in the aphoristic list given by Caraka.

[Carakasaṃhitā Kalpasthāna 1.2]

“Preparation is the process performed to modify the natural properties of substances. That process again is that which modifies radically the properties of substances. This modification is brought about by dilution, application of heat, clarification, emulsification, storing, maturing, flavouring, impregnation, preservation and the material of receptacle.”

This shows that the art of pharmacy had reached a very high level in those days. The ten arts described by Sukracarya comprise practically all the processes known to modern pharmacy.

A full fledged culinary art could only be possible in India, and the works on (sūdaśāstra) and (pākaśāstra—science of cooking) bear testimony to our statement. Even today, India would perhaps stand first in the world so far as the art of cooking is concerned.

The manufacture of sugar was a sort of monopoly in India. When the soldiers of Alexander saw sugar for the first time, they called it sweet chalk. Sugar began to be exported to the West in greater quantities after the twelfth century of the Christian era, but even then it was imported by those countries as a medicine and was available in the market at a very high price.

Thirdly the use of spices native to the tropical zone is a distinguishing feature of India Cloves, cinnamon, cardamom, ginger, saffron etc. were more responsible for foreign invasions of India than any political or cultural motives of invasion. Italy, Arabia. Portugal, Holland and England fought wars, devised strategies and organized plunders to capture this trade of spices

Fourthly the sense of smell in the oriental is more sensitive than that of the occidental and this has played no small part in the pharmaceutics of our country. Nature as well as human characteristics vary in different countries. The Himalayas produce more of sweetsmelling flora while the Alps abound in flora charming only to look at

Fifthly a Vaidya always used to be the presiding officer of the royal kitchen.

These forces combined to evolve medicated food which was medicine and food in one. Besides, the practice of administering some medicine to princes and the aristocrats varying in accordance with their tastes and pursuits of pleasure, gained favour. The abundance of sugar resulted in devising of varied preparations of wine

India was well conversant with the utility of salt Caraka enumerates 15 kinds of salt, such as:

1. Saindhava,
2. Sauvarcala,
3. Kala,
4. Vida,
5. Pakya,
6. Anupa,
7. Kupya,
8. Valuka,
9. Ela,
10. Maulaka,
11. Samudra,
12. Romaka,
13. Audbhida,
14. Aushara,
15. Pateyaka,
16. Pamshuja.

They prepared various kinds of alkalies and alkaline salts from vegetable, animal and mineral products.

The preparations of medicated Ghrita (ghṛta) were common in India in those days and even today it is a special feature of the Indian pharmacy. In addition to these special factors, the vastness of the country, the variety of seasons, the progressive period of civilization, and the increase of pleasure pursuits etc, gave a great impetus to the progress of pharmacy

The Field of Pharmacology

[Carakasaṃhitā Vimānasthāna 8.87]

“And of that material this is the test: that it is of such and such nature, of such quality, of such efficacy, is born of such a season, gathered in such a manner, preserved in such a way, medicated thus, and in such dosage, administered in such and such a disease, to such a person, either eliminates or allays such and such a humor. And if there be any other administered medication in similar manner, should it also be examined.”

Caraka classifies medicine into two kinds:

[Carakasaṃhitā Cikitsāsthāna 1.4]

“Now medicine is of two kinds: one kind is promotive of vigour in the healthy, the other destructive of disease in the ailing”.

Thus the drugs are of two kinds; one that goes for positive health and the other belongs to the curative group.

The group of drugs for positive health are sub-divided into two kinds:

[...]

“One is (vṛṣya) or the virilific and the other is (rasāyana) or the vitalizer.”

On going through the description of these two processes, we are surprised to know how high the ideals and the practical life of men of those days were

While explaining the word Rasayana (Rasāyana), Atreya describes the properties of a Rasayana drug

[Carakasaṃhitā Cikitsāsthāna 1.7-8]

“Long life, heightened memory and intelligence, freedom from disease, youth, excellence of lustre, complexion and of voice optimum strength of body and senses, utterances that always get fulfilled, the reverence of people, body-glow, all these does a man obtain by the use of vitalizes. The vitalizers are so called because they help to replenish the vital fluids of health.”

What a noble conception of health! The virilifics were used for the purpose of producing progeny of the highest calibre. Progeny was considered to be the preserver of the traditions of ideals and aspirations of men. The use of virilifics was recommended solely for this purpose. Moreover, they gave positive health, immunity against inroads of diseases and retarded aging

These two superb concepts of Ayurveda were held in such a high esteem that these obtained recognition as two special branches of the octopartite Ayurveda.

Atreya has classified the drugs into fifty classes according to their properties and each class contains ten drugs (Caraka Sūtra IV, 8) and this is the simplest, easiest and most systematic classification

Among the four requisites for curing a disease, drugs occupy a place second only to the physician

[Carakasaṃhitā Sūtrasthāna 9.3]

“The physician, the drugs, the attendant and the patient constitute the four basic factors of treatment”.

Caraka enumerates the necessary qualifications of a good drug as under:—

[Carakasaṃhitā Sūtrasthāna 9.7].

“Abundance, applicability, usability in multifarious inodes and richness of quality—these four are said to be the tetrad of desiderata in drugs”.

Drug action is fully described in Caraka. For instance in Caraka Samhita Vimana-sthana, chapter 1.16 we find concise but full description of long pepper (pippalī).

“Long pepper, pungent though in taste, is sweet in postdigestion, heavy, neither overmuch unctuous nor overmuch hot, is deliquescent and esteemed as medicine. It is at once productive of beneficial and baneful effects. If administered in the proper time and measure, its action is at once beneficial. But if continued for over a long period, it results in morbid cumulative effect, as due to its heavy and deliquescent qualities it arouses Kapha. It aggravates Pitta on account of its hot property and is not able to allay Vata because of its meagreness of unctuous and hot qualities. Nevertheless it makes a good vehicle. In view of these considerations long pepper should not be used in excess”. (Vimāna 1.16).

Similar descriptions of salts and alkali are given. We find detailed actions and properties of various kinds of milk in Caraka Sutra-sthana chapter 1.105-113. A lengthy but apt description of actions of wines (madya) is given in Caraka Cikitsasthana chapter 24, verses 29 to 73.

Speaking about the preparations as regards their properties and actions, Caraka says:

[Carakasaṃhitā Siddhisthāna 4.15-16]

“That should be known as the proper medication which requires to be taken in small dose which is quick in action and is curative of even an excessive degree of morbidity, which is easy to take, which is light in digestion, palatable, pleasing, curative of the particular disease, not harmful even if complications arise, not very depressant and is possessed of the most agreeable smell, color and taste.”

The prescriptions of drugs were arranged in such a way as to contain the above qualities. The processes for these preparations were explained and rules for nomenclature of these preparations also were framed in order to bring about a certain uniformity. Rules were also framed regarding the use of drugs containing just the opposite properties in these preparations, if it was found necessary to add such a drug for the sake of taste, appearance or smell.

[Carakasaṃhitā Kalpasthāna 12.43-46]

“It has been laid down that a compound preparation is named after the basic drug which forms its principal active ingredient.

In the prescription of a compound where the emetic nut etc., form the basic or principal drug, wines etc., occupy the secondary role as constituents, vehicles or excipients. They followed the main drug in the prescription, even as the attendants follow the king.

Even the antagonism of this potency does not vitally impair the main effects of the principal drugs, while admixture of drugs of similar potency intensifies its action.

As laid down, the use of articles that are of antagonistic potency to the disease is allowed for the purpose of imparting to the medication pleasant colour, taste, touch and odour suitable; to the conditions of a disease”

In the modern method of writing a prescription the letter ‘R’, a symbol for ‘recipe’, is always found at the beginning; This sign or symbol is called superscription. As a matter of fact the symbol ‘R’ is the symbol of the planet ‘Jupiter’. Ayurveda enjoins on the patient to chant some sacred hymn while taking the medicine.

The sacred hymn as given in Caraka, Kalpa-sthana I, 14 is as under:

[...]

It is better to use symbols rationally than blindly. The chanting of a hymn would seem ridiculous to us is this modern age, but we must probe behind the apparently absurd practice and try to find out the concept on which such a chant is based. This can be understood only if we study the other ideologies of the period.

Minuteness and singleness are the two qualities of mind Mind cannot work at two places at a time. So one must concentrate on the work on hand otherwise the work cannot be a success. On this reasoning the chanting of a hymn becomes helpful in transferring the attention of the mind busy in other affairs to concentrate on the medicinal dose.

Therefore Atreya says:—

[Carakasaṃhitā Siddhisthāna 6.17]

“If a person after cleansing his mind of its impurities like passion and other inauspicious sentiments and concentrating his mind on the treatment, takes this dose, it brings about the most desirable results.”

The second stage or step in a prescription is the writing of it, it consists of the basis or the chief ingredient, adjuvant and corrigent. The nomenclature of the prescriptions is based on the names of the chief ingredient followed by the word (ādi) or “and others” to suggest the compounding of other ingredients, e.g. (nāgarādī cūrṇa). In English, ‘Co’, the shortened form of ‘compound’, is used for this e.g. ‘Pulvis glycyrrhiza co’. This similarity in the nomenclature of prescriptions both in the East and the West show that science is one but ignorance can lead to manifold differences

In therapeutics, the mere knowledge of the properties and actions of the drugs in the prescription is not the end in itself. Therapeutics is an art or more properly it is an artistic science.

Caraka says:

[Carakasaṃhitā Sūtrasthāna 2.16]

“The art of prescription depends upon the knowledge of dosage and time, and on this art, in return, depends success; hence the skilful physician stands ever superior to those possessing merely a theoretical knowledge of drugs”

He further adds:

[Carakasaṃhitā Cikitsāsthāna 30.320]

“Though treating with the right prescriptions yet if the physician be ignorant of the knowledge of place etc, he cannot achieve success in treatment. There exist many differences in the nature of men as regards age, vitality, constitution etc.”.

The preparations should be made in accordance with the doses. We generally believe that standardization is the last word in modern medical science, but we must not forget that accuracy in measurement is the first step in scientific progress. “Logical reasons for everything and accuracy” was the motto of the scientific age of India which began about 600 B.C., and it is for this very love for accuracy that the science of logic (nyāya) and Sankhya (sāṃkhya) came to be written. In an age when even the sequence of words in a sentence was strictly regulated and the words could not be used without a definite purpose, the laxity in accuracy of measurement is unthinkable Let alone the accuracy and exact measure of medicinal doses, even food was to be taken in measured quantities. While narrating the principle of hygiene, the first chapter on the subject begins with (“mātrāśī syāy”) i.e., “you shall eat food in measured quantities”. The word (mātrā) is derived from (mīyate anena) i.e., “by which it is measured,” while the Enghsh word ‘dose’ is derived from (dā) to give. The English word simply “gives” while the Sanskrit word “measures”. This proves that accuracy in measuring is emphasized more in the Ayurvedic term.

A few quotations pertaining to this accuracy of measurements from various Ayurvedic treatises will not be out of place here.

[Carakasaṃhitā Sūtrasthāna 5.3]

“You shall eat food in measured quantities.”

[Kāśyapasaṃhitā Cikitsāsthāna 3.101]

“All treatment depends on dosage”.

[Śā. Pra. 1.14]

“There can be no compounding of drugs without taking into view their measure of dosage”

[Carakasaṃhitā Sūtrasthāna 15.10]

“The dosage of medicines is dependent upon individual patient”.

[Carakasaṃhitā Cikitsāsthāna 30.313-314]

“An under-dose of medication cannot cure the disease just as a small quantity of water cannot quench a great fire, and medicine given in over-dose will prove harmful just as excessive, watering harms the crops So, after carefully considering the security of the disease and the strength of the medication, the physician should administer it, neither in too large a dose nor in too small a dose.”

[Carakasaṃhitā Kalpasthāna 12.86]

“The dosage of drugs given in the section is with reference to moderate-bowelled persons and of average age and strength. This should be regarded as the standard for pharmaceutical purposes and larger or smaller doses have to be prepared keeping that standard in view”.

[Carakasaṃhitā Siddhisthāna 3.6]

“(... should be administered) after a full investigation of the morbid humors, the medications, clime and season, homologation of the patient, his digestive power, psychic conditions, age and vitality”

The Anupana (anupāna) or after-potion concept of Ayurveda is in accord with the theory of humors. The dose of medicine was to be followed by some after-potion prescribed as a corrective to the medication in accordance with the constitutional tendency of the patient or the humoral imbalance of the disease-condition.

Toxicology is one of the chief branches of Ayurveda. We need not reiterate that the knowledge of toxicology in India was far superior to that of other countries. When Alexander invaded India (323 B.C.), he had ordered that whenever any treatment for poisoning was necessary, only an Indian physician should be called. This is but one proof of the superiority of toxicology in India. Vishakanya (viṣakanyā) or poison girls are no fable. They were reared to be used against enemies. It was the practical application of the theory of immunization in the body by gradual and constant administration of poison. India abounded in poisonous animals and vegetation. Kings were always under constant vigilance against poisoning, and so a physician was always in attendance to protect the king against food-poisoning etc. During wars, poisoning was resorted to for killing individuals as well as for mass murders. The knowledge of snake poison was also profound. The snakes were, and still are, plenty in India and hence the knowledge about snakes and toxicology came to be special branches of study. The classification, recognition, description etc, of serpents is astonishing. Snake poison was used as a medicine also Atreya has prescribed it for the incurable condition of Tridosa Udara, mostly a malignant growth.

The science of toxicology was the result of varied experiments. The poisonous drug or poisoned food was tasted by the senses, fire, by mixing them with water and other substances, and also by administering it to beasts and birds. We find that about 25 beasts and birds were thus made use of in such experiments

The list of terms describing actions of drugs surprises us even today We find more than 500 terms used in this connection

Atreya, while fully recognising the physical, pharmaceutical and physiological incompatibilities, goes further and describes the following 18 points which should be considered in deciding the incompatibility or otherwise of a drug.

[Carakasaṃhitā Sūtrasthāna 26.86-87]

“That substance is unwholesome which is incompatible from the point of view of country, season, gastric fire, measure, homologations, Vata and other body humours, preparation, potency, bowel tendency, state of the patient, rules of eating, things to be avoided or observed, cookery combination, palatability, richness of quality and rules of eating.”

Food as well as medicine should not be incompatible with eighteen points

Channels of Administration

A general principle is laid down that medicine should be administered by the channels through which it can reach the seat of disease at the earliest. In the world of today the channels of administering a drug have increased, but they all fall within the above comprehensive precept.

[Carakasaṃhitā Cikitsāsthāna 30.294-295)

“In the disease of stomach, the medicine administered by the mouth, in diseases of the head nasal medications, and in diseases affecting the colon the medications given by the rectum, act most readily. In local diseases arising in the various regions of the body and in acute spreading affections and pimples and similar lesions, local applications suitable to the part afflicted, will prove specially efficacious.”

Time for administering drugs

The time for the administration of drugs should be fixed according to morbidity, constitution and age or season.

Ayurveda gives the following times, ten in number, for administering medicine (Suśrutasaṃhitā Uttaratantra 64.65):—

1. Abhakta—On empty stomach;
2. Prāgbhakta—Pre-prandial;
3. Adhobhakta—Post-prandial;
4. Antarābhakta—In-between the meal;
5. Madhyebhakta—In the middle of the meal;
6. Sabhakta—Mixed with the meal;
7. Sāmudga—Given in the beginning and at the end of the meal;
8. Muhurmuhu—Repeatedly;
9. Grāsa—With each morsel of food;
10. Grāsāntara—In-between morsels.

This is followed by detailed exposition as to why the medicines are to be taken at particular periods.

The brief survey of ‘pharmacy’ as it was in theory and practice in ancient India would suffice to give an idea of the development of the science in its multiple aspects, some of which have not been excelled by modern science. The rich heritage left to us needs but proper research so that we can proudly hold it before the scientific world and declare it as one of our richest contributions to science.