Homo sapiens originated in Africa about 300,000 years ago and arrived in India in waves beginning about 65,000 years ago. Early populations were hunter-gatherers and did not adopt a sedentary way of life until about 7,000 years BCE, when they began to domesticate plants and animals. As their civilization expanded, villages grew into towns and crafts became more specialized, and by 3300 the Indus Valley civilization emerged in regions that today comprise Pakistan, northwest India, and Afghanistan.

The main known cities of the Indus Valley Civilization were Harappa and Mohenjo‑Daro, but others have also been discovered. Excavations suggest that the inhabitants of these cities had good urban planning, clean living spaces, bathing facilities, and separate cooking and waste areas, as well as wells and covered drainage channels along major streets. They knew how to treat fractures, undertake trepanation and dental procedures, and use medicinal plants such as neem, turmeric, and ginger.

The period starting around 5000 BCE saw the birth of Ayurveda, a holistic healthcare system well-covered in this journal, as were the later contributions of the great physicians Charaka and Sushruta.^1-6 Ayurveda emphasizes the care of the body and mind through adequate nutrition and lifestyle changes. It focuses on removing toxins and impurities, often by using herbs and plants, recommending oils and common spices, diet, meditation, yoga, and massage therapy. Many of these principles have survived to the present day as a complementary healing system.^1-6

The Indo-Aryans entered Northern India around 1800 BCE. They were Sanskrit-speaking pastoral people who moved from around the Caspian Sea and southern Ukrainian steppes to the Indus Valley and Ganges Plain. Their language and indeed they themselves merged with the local population, marking the onset of the Vedic Period.

The Vedic civilization (c. 1500–500 BCE) followed the decline of the Indus Valley civilization. Its sacred texts (the Vedas) are the foundation of Hindu philosophy and practice. They consist of four Sanskrit texts, the Rigveda, Yajurveda, Samaveda, and Atharvaveda, written over several centuries and transmitted orally. The oldest Veda, the Rigveda, was likely compiled between 1500 and 1200 BCE. The latest Veda, the Atharvaveda, includes many references to diseases, healing practices and herbal remedies, rituals, and incantations. As the Vedic civilization matured, it faced two major religious challenges: Buddhism and Jainism. Gautama Buddha (c. 563–483 BCE) and Mahavira (c. 599–527 BCE), the founder of Jainism, both questioned the authority of the Vedas and of the caste system.

By 600 BCE, numerous kingdoms and republics, known as Mahajanapadas (great realms) emerged across the Gangetic plain and beyond. Sixteen major Mahajanapadas are traditionally recognized as competing for dominance through diplomacy, marriage alliances, and warfare. They include the Magadha, Kosala, Vatsa, and Avanti. Gradually, the kingdom of Magadha, located in Northeast India (Bihar), emerged as the most powerful. It expanded its territory under its Hariyanka (c. 544–413 BCE) and Nanda (c. 345–321 BCE) dynasties and developed administrative innovations crucial for future empire-building.

Around 322 BCE, Chandragupta Maurya of the Magadha state overthrew the last Nanda ruler and established a dynasty that united most of the Indian subcontinent. He consolidated control over the Ganges plain and conquered territories in northwestern India following the retreat and defeat of Alexander the Great’s successor, Seleucus Nicator. The Mauryan empire expanded and represented a sophisticated system of governance. It was divided into several provinces governed by royal princes or appointees, and its capital, Pataliputra (modern Patna), became one of the largest cities in the ancient world.

Chandragupta’s son, Bindusara (297–273 BCE), extended Mauryan control. By the time of his death, practically all of India had come under Mauryan suzerainty. His son, Ashoka the Great, further enlarged the empire, as well as promoted Buddhist principles, social welfare, and monumental architecture. He established hospitals, planted gardens to cultivate medicinal herbs, and dug wells to provide clean water. Trade routes were expanded to provide access to new plants and healing substances. Ashoka ruled for 37 years and died in 232 BCE. After 185 BCE, the Mauryan Empire disintegrated.

The Shunga Empire (185 BCE to 75 BCE) took over the Magadha and came to control most of northern India. It successfully fought and resisted the Greeks in the Shunga–Greek War, but in 73 BCE the last Shunga ruler was assassinated by Vasudeva Kanva, who established the short-lived Kanva dynasty. This was replaced in 68 CE by the Kushan Empire, which reached its zenith in c. 126 CE and ruled over most of the northern Indian subcontinent, Afghanistan, and parts of Central Asia.

Next to assume power was the Gupta Dynasty (c. 320 to 550 CE), traditionally founded by Sri Gupta and creating India’s Golden Age as Chandragupta I transformed a modest kingdom in the Ganges basin into one of ancient India’s most celebrated empires. His son Samudragupta expanded the empire, conquering territories across northern India while establishing tributary relationships with southern kingdoms. Court poets praised his prowess, not only in warfare but also in music and poetry. There were major advances in mathematics (such as the concept of zero), astronomy, literature, art, and medicine. It was also the time of the great physicians Charaka and Sushruta^5,6 and of the great universities of Nalanda and Takashimaya becoming centers of medical learning. Royal courts employed physicians who were given access to royal libraries, experimented with rare herbs from distant lands, and used metals and minerals to promote health and longevity. The reign of Chandragupta II, Samudragupta’s son, marked the empire’s zenith in the late fourth and early fifth centuries.

After the Gupta’s decline, several dynasties followed one another. In Southern India, the Pallava dynasty (c. 275–897 CE) was celebrated for its architecture, sculpture, and Sanskrit–Tamil literary culture, as well as a sophisticated medical world shaped by Ayurveda, Siddha traditions, Buddhist medical knowledge, and state-supported welfare practices. Temples were not only religious centers but dispensaries for medicines and shelters for the sick and poor. Also ruling primarily in the Deccan region, from c. 753–982, was the Rashtrakuta dynasty. Its most documented achievements were in architecture, literature, and administration.

The Chola Empire, another powerful South Indian Tamil dynasty, dominated southern India from the 9th to the 13th centuries CE. Known for its extensive maritime trade and impressive temple architecture, it had a strong military and efficient administration, reaching its peak under its rulers Rajaraja I and II. The Cholas established hospitals that were often attached to temples and acted as centers of both spiritual and physical healing. Chola medical institutions influenced later South Indian kingdoms. Their integration of state support, temple patronage, and traditional medicine became a model for medieval Tamil healthcare.

In the north, the Delhi Sultanate (1206–1526) was established in 1206 under the rule of Qutb‑ud‑Din Aibak, a former general of Muhammad Ghori who had repeatedly invaded India. He became the first Sultan after Ghori’s death and founded the Mamluk Sultanate. This major Muslim empire based in Delhi ruled vast parts of the Indian subcontinent for over 300 years. It comprised five successive dynasties—Mamluk, Khalji, Tughlaq, Sayyid, and Lodi—and is remembered for hospitals (Dar‑ul‑Shifa), medical education, and public health measures. The last ruler of the Lodi dynasty was defeated in 1526 by Babur, the definitive conqueror of India.

The Mughal Empire (1526–1857) introduced new influences as its emperors enabled comparative studies and stimulated the exchange of knowledge. Under its emperors Babur, Humayun, Akbar, Jahangir, Shah Jahan, and Aurangzeb, the various medical traditions converged, creating a sophisticated healthcare system. The Mughals brought with them the Unani system of medicine, rooted in the teachings of the ancient Greek physicians. They founded hospitals, comprehensive medical libraries, and pharmacopeias that incorporated elements from diverse medical traditions. The imperial court maintained elaborate dispensaries and botanical gardens to support them. They established a network for importing drugs, compiled pharmacological encyclopedias, and trained students in a master-apprentice system. Surgery was practiced for cataracts, bladder stones, battlefield injuries, rhinoplasty, and reconstructive procedures. They organized relief during epidemics, maintained sanitation in major cities, and furthered the introduction of new drugs like cinchona for malaria and inoculation against smallpox.

The medical knowledge developed under these emperors spread beyond India’s borders. Buddhist monks carried medical texts to Tibet, China, and Southeast Asia. Arab scholars translated Sanskrit medical works, which eventually reached medieval Europe. Surgical techniques described by Sushruta influenced later European surgery when British colonial physicians encountered these texts and disseminated some throughout the world.

Further reading in Hektoen International

1. Dunea G. Ayurveda, The ancient Indian medicine. Spring 2025.
2. Banerjee AK. A brief history of Ayurveda. Fall 2020.
3. Mehta K. The history of Indian medicine and its impact on modern practice. Spring 2023.
4. Kalla K. History of medicine in ancient India. Fall 2021.
5. Saroshe S. Sushruta: The ancient Indian surgeon. Winter 2016.
6. Turner M. Sushruta, the father of rhinoplasty. Summer 2024.