Śaiva medical interventions in medieval South Asia

It is 1261 CE. We are near the terminus of the Śaiva Age, a monicker coined by Alexis Sanderson to describe the efflorescence of Śaiva Hinduism throughout South and Southeast Asia in the medieval period, especially between the late 500s and 1300 CE.Footnote ¹ On a stone pillar next to a now-ruined temple in coastal Andhra Pradesh, near the modern-day capital Amaravati, an engraver chiselled an inscription. Primarily in Sanskrit but also containing technical details in Tĕlugu, this inscription conveys the orders of the Kākatīya king Gaṇapatideva, his daughter and successor Rudramadevī, and the Śaivasaiddhāntika pontiff Viśveśvaraśiva.Footnote ² Viśveśvaraśiva was as close to a pope as one could encounter in medieval South Asia, at least in terms of political influence. Hailing from Bengal, Viśveśvaraśiva was the head of the Golagīmaṭha, which was located in present-day Gurgi, Madhya Pradesh.Footnote ³ He counted among his disciples the Coḻa, Mālava, Kalacuri, and Kākatīya rulers.Footnote ⁴ Signalling his influence, queen Rudramadevī granted Viśveśvaraśiva a large land endowment near the bank of the Krishna River. This was done in accordance with the wishes of her father, a disciple of Viśveśvaraśiva. The details of this grant are meticulously noted in the Malkapuram inscription. We learn from these details that, in addition to establishing a localised subsidiary monastery of the Golagīmaṭha, Viśveśvaraśiva made some philanthropic, public-facing decisions in the lands that he received.

What is the pontiff of a monastery doing allocating land to build a birthing hall (prasūtiśālā) and a general hospital (ārogyaśālā)? Indeed, it is plausible that Viśveśvaraśiva also utilised an island in the Krishna River that was granted alongside the villages in question to grow medicinal herbs.Footnote ⁶ Was Viśveśvaraśiva, then, uniquely pioneering a novel socio-religious intervention in the field of medicine? More broadly, Viśveśvaraśiva’s intervention raises important questions about the premodern intersection of medicine and religion, of science and theology. In the context of South Asia, we are compelled to ask whether healing the unwell body and administering medicine to a patient can be normative religious duties. Likewise, can building public hospitals for the sick be the greatest of all dharmas? How could or did normative prescriptions linking healing, patronage of hospitals, and donation of medicines to religiosity translate in practice? Why did medieval Śaiva communities engage in medical philanthropy?

Recent scholarship in the history of early medicine has contended with comparable questions, particularly in the European context. Sally Brasher’s monograph Hospitals and Charity, for instance, notes the establishment of some hospitals in medieval northern Italy by Catholic bishops.Footnote ⁷ She also remarks on the practice of votaries providing Catholic monasteries with the resources needed for constructing hospitals.Footnote ⁸ Brasher contends that as the purpose of hospitals in medieval Catholic Italy ‘was as religious … as medical or hospitable’, a hospital was ‘almost always’ linked with a church or constructed near one.Footnote ⁹ Existing scholarship in English studying the medical activities of votaries in premodern Asia has tended to centre on Buddhist contexts.Footnote ¹⁰ As it concerns South Asia, the case of the Mauryan emperor Aśoka (r. 272–232 BCE) putatively building hospitals on account of his Buddhist faith is oft evoked, although Dominik Wujastyk has emphatically argued that ‘there is absolutely no evidence for these Aśokan hospitals, in Aśoka’s inscriptions or elsewhere’.Footnote ¹¹ Far more concrete, the case of the twelfth-century Khmer Buddhist king Jayavarman VII building hospitals (or ‘houses of health’) has been freshly discussed by Francesco Bianchini.Footnote ¹² In contrast to scholarship on Buddhist medical activity, the medieval entanglements between Śaiva religiosity and medicinal programming have been rather understudied, although Andrea Acri, Francesco Bianchini, and Jiří Jákl have recently published an article documenting premodern Śaiva texts in Java like the Dharmapātañjala and Vṛhaspatitattva that discuss healing and even offer tangible prescriptions.Footnote ¹³ By asking the questions that I have foregrounded, then, I hope to shed some light on medieval Śaiva entanglements with medicine. In this venture, the record of Viśveśvaraśiva’s project proffers clues, but it is far from being the only epigraphic voice that speaks on Śaiva medical philanthropy. A peripatetic, clockwise tour of medieval South Asia will demonstrate so.

More than a hundred years before the Malkapuram inscription was engraved to document the Golagīmaṭha’s medical activities, a Tamiḻ epigraph was issued in 1120 CE in Tirupugalur, Tamil Nadu, in a local Śiva temple. The proceedings conveyed in this record concern the remission of taxes (iṟaiyiliyāka) on land intended to support a hospital (ātulacālai) that was established by Manattuṟkiniyān in a presumably Śaiva monastery on the northern bank of the great Muṭikŏṇṭacoḻa River to treat the sick and forlorn.Footnote ¹⁴ The treasury of the Tirupugalur Śiva temple was party to this philanthropic decision.Footnote ¹⁵ Comparably, as per an 1131 CE record found in the nearby Tirukkoṭīkāvuṭaiyār temple in Tirukodikaval, Śaiva temple authorities established an endowment for a physician named Catturu Māṉiyaṉ Āḷappiṟantāṉ and ‘his group’ to ensure the delivery of medical services.Footnote ¹⁶ According to the epigraph, this was done with the blessing of Caṇḍeśa, a Śaiva guardian perennially associated with Śaivasiddhānta and invoked in Coḻa records as an arbitrator in matters concerning Śaiva temple property and transactions.Footnote ¹⁷

We now travel to the Koḍiyamaṭha. Located in the Kannaḍa-speaking heartland of Karnataka, the Koḍiyamaṭha was a Kālamukha Śaiva monastery with an extremely expansive curricular system. In an 1162 CE record describing the Koḍiyamaṭha’s programming, we are told that this monastery was additionally ‘a place where many helpless sick people are harboured and treated—a place of assurance of safety for all living creatures’.Footnote ¹⁸ This was no empty exaggeration, especially as it concerns the medical services. At least two inscriptions, one from 1159 CE and another one from 1193 CE, describe the contemporaneous leader of the monastery, Vāmaśaktideva II, as being committed to the gifting of food, cows, lands, shelter, and—topically—medicine.Footnote ¹⁹ A different Kālamukha preceptor of Karnataka named Candrabhūṣaṇa is similarly described in an 1192 CE inscription as pleasing a countless number of people ‘not only with food but with gold, medicines, water, cloth, etc’.Footnote ²⁰ Another inscription issued in around 1165 CE describes the town of Balligave, the predominantly Śaiva locality where the Koḍiyamaṭha was located, as possessing three medical dispensaries that were explicitly intended to serve dharma.Footnote ²¹

Turning now to Nepal, an early seventh-century Sanskrit inscription from around the Kathmandu Valley explicitly records a land grant for an ārogyaśālā (hospital).Footnote ²² This grant was issued in 604 CE with the ‘authorisation’ of the Licchavi king Śivadeva I, although in reality the endowment was made by Aṃśuvarman. He was a chief feudatory (mahāsāmanta) who acted as the de facto ruler for much of Śivadeva I’s reign and later as a king in his own right.Footnote ²³ Aṃśuvarman was a Śaiva who not only publicly professed his devotion to Śiva but also, as Nina Mirnig demonstrates, kicked off the trend of Nepalese ruling classes associating themselves with Paśupati, the form of Śiva enshrined in Nepal’s well-known Paśupatinātha temple.Footnote ²⁴ In the concerned Lele inscription, Aṃśuvarman also gave land to Viśveśvara (i.e. Śiva), various ritual officiants and occupational groups, and public halls (śālās). It is noteworthy that a hospital finds itself among the entities that this Śaiva statesman decided to patronise. At 200 units, he actually gave far more land to the hospital than any other space or entity mentioned in the epigraph. In his patronage of medicine, Aṃśuvarman was not alone in seventh-century Nepal. A Sanskrit epigraph on a pedestal of a śivaliṅga (an aniconic representation of Śiva) established in the Kathmandu Valley documents an endowment given by a Brāhmaṇa woman named Suvarṇagominī. According to this 635 CE record, Suvarṇagominī remitted the revenues of a particular area of land to Dakṣiṇatiluḍaka, a Pāśupata Śaiva teacher who—in turn—was entrusted to give the funds to the Śṛṅkhalika Pāśupatas so that they could provide medicines for the sick (śṛṅkhalikapāśupatānāṃ glānabhaiṣajyārthaṃ dattaṃ).Footnote ²⁵ The Pāśupatas of the Kathmandu Valley, then, ‘were not only concerned with religious ceremonies, but also took care of public service’, including medical services that were supported by endowments.Footnote ²⁶

We have evidence from Pāla Bengal that conveys that Pāśupata entanglements with medical activity were not limited to the Kathmandu Valley. In the ninth century, the Pāla king Nārāyaṇapāla bestowed a village endowment for religious ends. Now, Nārāyaṇapāla seems to have been rather open with his spiritual choices. The Bhagalpur copper plate concerning the aforementioned endowment begins with the praise of Buddha (daśabala), and Nārāyaṇapāla himself is addressed with the title paramasaugata (devout Buddhist). Reading this very record, however, we find the influence of the Śaiva zeitgeist on Nārāyaṇapāla, particularly in the following lines that speak of the endowment’s primary beneficiaries: Pāśupata Śaivas.

While it is possible that Nārāyaṇapāla came under the influence of Śaivism at some level, it is at least evident that he patronised it. After all, he granted here the village of Makutikā and its accompanying natural resources to the Pāśupatas. As the translated excerpt conveys, a portion of this endowment was explicitly allocated for medicines to heal the sick, and the language of the plate suggests that this would have included not just the monastic community but—just as importantly—others whom the Pāśupata Śaivas favoured and wanted to help. Could some of the bedding, seats, and necessities have also been used by sick patients receiving care, particularly if they were formally affiliated with the Pāśupata monastic community? We cannot rule it out.

This is not the only Pāla record that conveys the institutionalisation of medical care in Śaiva environs. There is an inscription from early eleventh-century Bengal that documents a predominantly Śaiva ‘program of royal temple building and image installation’ that was effectuated during the reign of the Pāla king Nayapāla, who was a disciple of the Śaiva preceptor Sarvaśiva.Footnote ²⁹ In addition to mentions of royally sanctioned Śaiva monasteries, the epigraph in question conveys that a hospital was constructed to heal sick people (ārogyaśālām ārogyahetau rogavatāṃ nṛṇām) and likewise a home was built for the resident doctor (tathā vaidyaka āvāsaṃ), all located near the precincts of a particular temple.Footnote ³⁰ We thus have another instance of a hospital and a doctor’s residence being constructed in a primarily Śaiva context with the patronage and/or sanction of a king who was a devout Śaiva himself.

We find similar trends in neighbouring Odisha, particularly in epigraphs associated with the Bhauma-Kara Dynasty that reigned between the eighth and tenth centuries. The Hindol plate, for instance, reveals that king Śubhākaradeva of this dynasty granted a village endowment in the ninth century at the behest of a certain tribal chief named Pulindarāja. The Śaiva orientation of this grant is established by the fact that a portion of it is dedicated to funding ritual services for Vaidyanātha (lord of medicine), a form of Śiva worshipped in a temple that Pulindarāja built. Another portion, interestingly, was allocated for providing medicines to treat the sick (glānabhaiṣajyārthaṃ) among Śaiva preceptors and ascetics (śaivācāryatapasvināṃ).Footnote ³¹ The Baud grant issued by a reigning Bhauma-Kara queen named Tribhuvanamahādevī is comparable to the Hindol plate. A village endowment for a Śiva temple near the contemporary Bengal–Odisha border, this grant was initiated by the ‘devout Vaiṣṇava’ (paramavaiṣṇavī) queen at the request of a noble woman named Śaśilekhā who built the patronised temple. Using the very medical wording that the Hindol plate does, the Baud grant conveys that a part of the endowment was to be set aside for medicines to heal the ill (glānabhaiṣajyārthaṃ) among Śaiva ascetics, particularly those who were undertaking the ‘great vow’ (mahāvratadhāriṇāṃ tapasvināṃ).Footnote ³²

In light of this evidence from various parts of South Asia, it is clear that Viśveśvaraśiva was not exceptional in dedicating religiously coded resources for medical purposes in Andhra. His act was not wholly unprecedented even in the Krishna River valley where he established the hospital. Just decades before in 1213–1214 CE in nearby Chebrolu, a Śaiva named Jāya issued an inscription detailing his Śaiva-Kaumāra temple renovation project, which included the re-establishment of a looted śivaliṅga.Footnote ³³ The elephant forces commander of the Kākatīyas during Gaṇapatideva’s reign, Jāya also gave an accompanying land grant to a physician, who was incorporated into the Chebrolu temple economy, along with artisans, artists, and priests.Footnote ³⁴

One cannot examine the epigraphic evidence at hand without questioning why references to hospitals and medicine emerge more than occasionally in Śaiva Hindu institutional contexts throughout premodern South Asia. Indeed, there is evidence that additionally suggests that some Śaiva pilgrimage sites too were important centres of healing in medieval India. We can first turn to the late fourteenth-century and early fifteenth-century Tĕlugu Śaiva poet Śrīnātha’s Bhīmeśvarapurāṇamu (The old tale of Bhīmeśvara), a poetic sthalapurāṇa (temple legend) of the Bhīmeśvara temple in Daksharamam, Andhra. In this work, he describes Daksharamam as a sacred shrine (kṣetrambu) where one could attain material or supernatural perfection (siddhi) through the study of therapeutic pills (ghuṭikā), alchemy (rasāyana), and medicinal roots (mūlikā); there possibly was, then, a healing facility or apothecary maintained by the Daksharamam temple.Footnote ³⁵ Indeed, it is quite noteworthy that three epigraphs, two from the mid 1150s and one from 1430, document endowments made by physicians to the Bhīmeśvara temple for ritual purposes.Footnote ³⁶ It could be that Daksharamam’s association with various siddhis, as hinted by the Bhīmeśvarapurāṇamu, may have also made its Śaiva temple an attractive institution to patronise for physicians.

It would also be remiss of me not to mention Srisailam, another prominent example of a Śaiva pilgrimage site that had therapeutic appeal in premodernity. Located in the dense forests of the Nallamala Hills and hosting the temple of Mallikārjuna (Śiva), Srisailam boasted an abundance of herbal, animal, and mineral resources in its immediate vicinity.Footnote ³⁷ This is attested from the Navanāthacaritramu (The exploits of the nine lords), a Tĕlugu hagiography that was written by Gaurana, a poet contemporaneous with Śrīnātha and, thus, active in the late fourteenth and early fifteenth centuries.Footnote ³⁸ A work patronised by a Śaiva pontiff of Srisailam’s Bhikṣāvṛttimaṭha named Muktiśānta, the Navanāthacaritramu explicitly describes Srisailam as a place with many divine medicines (divyauṣadhamula) and pits of mercury (siddharasakūpamulanu).Footnote ³⁹ Similarly, the Śaiva alchemical treatise Rasaratnākara (The jewel mine of mercury) that was composed sometime between the thirteenth and fifteenth centuries proclaims, ‘The body’s powers come forth quickly by means of trees, soil, bulbs, and waters in the Holy Mountain (Śrīśaila).’Footnote ⁴⁰ Finally, Arion Roçu notes that some Tĕlugu village records (kaifiyats) not only mention the rich fauna of Srisailam but ‘also note the activities of the herbalists of the Śrīśailam region, whose medicinal plants are used both in the preparation of drugs and in alchemical operations’.Footnote ⁴¹ Roçu further points out that, at the time he was writing, there were still ascetics (sādhus) who prepared remedies from both plants and minerals, some of which were apparently used to successfully treat a worker who was injured during the construction of the Srisailam Dam.Footnote ⁴² Srisailam, then, has attained quite a reputation, certainly in medieval India, for being a Śaiva site with substantial curative and alchemical potential.Footnote ⁴³

The medieval entanglements of Śaivism with the field of early medicine and the maintenance of medical facilities was, I suggest, thorough enough that it even influenced how the renowned twelfth-century chronicler Kalhaṇa wrote about the legendary aspects of Kashmir’s past in his Rājataraṅgiṇī (The wave of kings).Footnote ⁴⁴ Of particular relevance here is the account of king Raṇāditya’s reign. Described as a māheśvara (i.e. Śaiva), Raṇāditya—Kalhaṇa writes—built a monastery for Pāśupata Śaivas and also had ‘a faultless hospital (ārogyaśālā) for treating the sick’ built.Footnote ⁴⁵ While the historicity of this king and the details of his reign are highly questionable, it is at least noteworthy that Kalhaṇa thought the notion of a Śaiva king building both a Śaiva monastery and ārogyaśālā was ‘unproblematic’, to use Dominik Wujastyk’s designation in the context of Kalhaṇa evaluating the possibility of royal medical endowments.Footnote ⁴⁶

Reading such materials, then, I recall Jason Schwartz’s reference to medieval Hindu ‘acts of mass charity directed especially at the most humble and afflicted within society at large, without any concern for the maintenance of ritual purity’.Footnote ⁴⁷ In particular, Schwartz explicitly notes that medieval Śaiva and Śākta institutions tended to run a ‘concrete and sustained program of providing for the social welfare down through the generations’, including medical services.Footnote ⁴⁸ His reference for this claim, and something that I will now turn to, is the Śivadharmaśāstra. Indeed, I will argue in the remainder of this article that precolonial Śaiva interventions in and engagements with the world of early Indian medicine were intimately informed by the Śivadharma corpus, particularly the notion of the ārogyadāna (gift of health) that was positioned in Śivadharma texts as a highly meritorious religious act conducive to soteriological ends.Footnote ⁴⁹ In making this argument, I also recognise that Śaiva medical philanthropy did not emerge in a vacuum and was building on existing religious customs and political norms, particularly the patronage of medical facilities by rulers, that were first theorised well before the composition of the Śivadharma texts. Yet, avoiding ‘the fetish of single cause’, I contend that one cannot fully contextualise nor understand Śaiva medical philanthropy in premodernity by focusing just on donors’ adherence to established political norms while failing to reckon with the informative influence of the Śivadharma.Footnote ⁵⁰ Here I briefly recall Marc Bloch’s thoughtful words: ‘History seeks for causal wave-trains and is not afraid, since life shows them to be so, to find them multiple.’Footnote ⁵¹ Finally, through philological and intertextual analysis, I will also uncover in this article the uptake of the Śivadharma’s elevation of the ārogyadāna in non-Śaiva Hindu discursive spaces. This will speak to how overlapped medical intervention and theology became in normative pan-Hindu conversations concerning philanthropy in medieval South Asia.

The gift of health as dharma in the Śivadharma

To begin understanding the theoretical discourse that informed Śaiva interventions in medicine, I have suggested that one ought to consider the Śivadharma corpus. This may, at first, seem odd. Indeed, to quote Meredith McGuire, religion and healing are often seen in modernity as ‘two separate spheres, with little mutual influence’.Footnote ⁵² This is partly attributable to the secularisation of medicine, particularly, but far from exclusively, in the West. The secularisation of medicine has even led to some social scientists like Jan Domaradzki to speak of biomedicine as a ‘secular religion’.Footnote ⁵³ It is worth recalling, then, that early Indian medicine more than occasionally staked its legitimacy partially in the language of religion. Both the Carakasaṃhitā (Caraka’s compendium) and Suśrutasaṃhitā (Suśruta’s compendium), foundational texts of Āyurveda, claim affiliation and allegiance to the Veda, despite not being ‘obvious precursor[s]’ to medical notions in the Veda itself.Footnote ⁵⁴ Meanwhile, as Eric Gurevitch elucidates, the medieval Jaina intellectual Ugrāditya sought to argue in his Hitāhitādhyāya (Study on what is beneficial and what is detrimental) that originally ‘the principles of medicine had been propounded in a pure form in a text titled the Prāṇāvāya by the Jina who was omniscient’.Footnote ⁵⁵ Given such intersections of the religious and medical, it is important to recognise that some ‘religious’ texts, as opposed to just ‘medical’ ones, could offer guidance on medical interventions and set normative expectations for their audiences in premodern South Asia. The Śivadharma corpus did just that.

To offer some context, the Śivadharma corpus consists of several anonymously authored Sanskrit texts that discuss the ideal conduct, rituals, and activities that lay devotees of Śiva—across social divisions—should engage in or aspire to. To be sure, it is a ‘prescriptive rather than descriptive’ corpus.Footnote ⁵⁶ Yet its influence on the actual performance of Śaiva religiosity is tangible. Indeed, from its origination somewhere in northern India, the Śivadharma corpus became particularly popular all over South and Southeast Asia. The most important and influential texts in the Śivadharma corpus were the Śivadharmaśāstra (Manual on Śiva’s dharma) and Śivadharmottara (Coda to Śiva’s dharma), which were composed sometime around the sixth and seventh centuries—respectively—with the former being the earliest text of the Śivadharma.Footnote ⁵⁷ These texts were the only ones in the Śivadharma corpus that circulated outside of Nepal.Footnote ⁵⁸ The Śivadharmaśāstra was, for instance, deeply informative for Śaiva communities in the Deccan, including the Kālamukhas and their Vīraśaiva (i.e. Liṅgāyata/Vīramāheśvara) successors, in matters of ritual praxis and anti-caste sociality.Footnote ⁵⁹ The Śivadharmottara was similarly influential throughout South Asia; it was even translated in early modernity into Tĕlugu by a Śaiva aristocrat named Kāmineni Mallārĕḍḍi and into Tamiḻ by the Śaivasaiddhāntika theologian Maṟaiñāṉacampantar. Although we have yet to see evidence of other Śivadharma texts being circulated outside of Nepal, three more are topical to discuss in this article: Umāmaheśvarasaṃvāda (Dialogue between Umā and Maheśvara), Dharmaputrikā (Daughter of dharma), and Lalitavistara (Expanding on the play).Footnote ⁶⁰

I particularly name these three texts because all of them discuss health and medicine at some length. With a terminus ante quem in the tenth century, the Umāmaheśvarasaṃvāda, for example, features a conversation on medicines, curative spells, and alchemists in verses 12.1–31.Footnote ⁶¹ Meanwhile, the Lalitavistara—which is not incorporated in the conventional Śivadharma corpus but is fascinatingly included in one Nepalese variant contained in a 1036 CE manuscript—and the Umāmaheśvarasaṃvāda parallel each other often.Footnote ⁶² Thus, in the fifteenth chapter of the Lalitavistara, we similarly find goddess Umā inquiring about the purpose of medicines and herbs and about alchemy. To her, Śiva replies that physicians who use the appropriate therapies to extend the lives of their patients please the gods, and he also praises the meritorious usage of alchemical practices that putatively prolong lifespans.Footnote ⁶³ Turning to the Dharmaputrikā, it is a somewhat Śaiva-coded yoga text composed by the middle of the eleventh century. The tenth chapter of this text expounds upon the classical Āyurvedic paradigm of the three humours theorised in the Carakasaṃhitā and Suśrutasaṃhitā and proffers treatment regimens, including breathing exercises and mental meditations, for certain medical conditions that hinder the practice of yoga.Footnote ⁶⁴ The lacklustre circulation of these three Śivadharma texts outside of Nepal meant that the medical contents of these texts could not have been all that informative to the larger Śaiva community in premodern Asia. Yet, because the well-circulated Śivadharmaśāstra and Śivadharmottara both discuss healing and medical philanthropy, the Śivadharma corpus did have a major transregional impact on Śaiva (and broader Hindu) engagements with medicine.

What exactly, then, do these two texts say about healing and medical philanthropy? In the critical edition of the Śivadharmaśāstra’s eleventh chapter, which is entitled śivāśramādhyāya (chapter on Śiva’s stations), we find two verses that concern the soteriological merit derived from healing the impoverished sick and unwell patients, especially with medicines.

In addition to these two verses, there is one recension of the Śivadharmaśāstra, known via a Pondicherry manuscript, which contains two more verses on healing in the eleventh chapter. These accretions to the Śivadharmaśāstra may have circulated only in southern India.

Complementing these verses, the second chapter in the Śivadharmottara offers selections that specifically concern the construction of hospitals, staffing, medical equipment, and social accessibility.Footnote ⁶⁷ It is interesting that these verses are at the end of a section concerned with the gifting of knowledge (vidyādāna), as if to inherently link the gifting of health to the gifting of wisdom. One cannot write, study, or copy manuscripts, after all, if they are feeling unwell.

Complementing this discourse, other verses in the Śivadharmottara echo similar sentiments. One verse, for example, specifically extols the practice of donating medicine: ‘Being free of disease, those who donate medicines to the sick will attain happiness.’Footnote ⁶⁹ Another specifically lists medicine (bheṣaja) as one item that should be donated to at least five learned Śaivas ascetics for five years (śivajñānaratātmanām pañcānāṃ pañcavarṣāṇi), an act that would bestow the same benefit as gifting knowledge.Footnote ⁷⁰ In addition to these ‘carrots’, the Śivadharmottara also offers a ‘stick’ to incentivise Śaivas to aid the sick, among others.

The content of the Śivadharmottara concerned with medical philanthropy was reproduced in various later Śaiva texts, including the Haracaritacintāmaṇi (Śiva’s exploits: a wishing-stone).Footnote ⁷² The Haracaritacintāmaṇi was composed by Rājānaka Jayadratha, a Śaiva teacher from Kashmir who was active in the late twelfth and early thirteenth centuries. Not quite a kāvya (belletrist poem) or a purāṇic scripture but a mix of both genres, the Haracaritacintāmaṇi tells more than 30 stories of Śiva’s deeds in Sanskrit.Footnote ⁷³ While writing this text, Jayadratha also quotes significant selections from the Śivadharmottara’s discourse on health. Specifically, he reproduces, almost verbatim, Śivadharmottara 2.182 and parts of Śivadharmottara 2.180, 2.186, 2.188–189, and 2.192–193 in verses 30.55–59 of the Haracaritacintāmaṇi.Footnote ⁷⁴ More broadly, the scholarship of Anil Kumar Acharya has shown the influence of both the Śivadharmottara and Śivadharmaśāstra on Śaiva Sanskrit texts of various genres produced in premodern Odisha, which—as noted above—was a region that witnessed the establishment of medical endowments in Śaiva environs. He makes note of the Ekāmrapurāṇa, a temple legend of the Ekāmrakṣetra in Bhubaneswar written sometime between the thirteenth and fifteenth centuries. This text explicitly refers to the Śivadharmottara in the context of yogic practice.Footnote ⁷⁵ We thus know for certain that premodern Śaiva intellectuals were not only reading the Śivadharmottara but actively citing and reproducing parts of it, including its exhortations on health, in their own works in Sanskrit.

In terms of Sanskritic receptions, the innovative development and circulation of Śaiva tantras focused on healing also come to mind. For example, the Gāruḍatantras expound upon both herbal formulations and mantras that are intended to treat poisoning from snakebites.Footnote ⁷⁶ The circa ninth-century Netratantra belonging to the Mantramārga branch of Śaivism and accessible to both ascetics and householders ‘sets out to grant success in the world of men, to confer benefits, to bring an end to sickness, to destroy untimely death, and to bring about peace and nourishment’.Footnote ⁷⁷ While medicinal healing is not the focus of the Netratantra, which centres on the use of mantras and maṇḍalas, the officiant of mantras (mantrin) in at least one Netratantra rite aimed at warding off death is supposed to utter mantras to protect herbal medicine, which he must then give to his sick client.Footnote ⁷⁸ I think the burgeoning of such Śaiva tantras that are meant to proffer curative services during the very same period that the Śivadharmaśāstra and Śivadharmottara, with their discussions on healing, were circulating is not a mere coincidence.Footnote ⁷⁹

Here it’s worth noting that the Niśvāsatattvasaṃhitā (Compendium on the sighing principle), the oldest extant Mantramārga Śaiva tantra, features two verses on healing in its Niśvāsamukha (Face of the sighing) book, which was added to the core text by the end of the seventh century.Footnote ⁸⁰ Part of a chapter explicating the dharma of lay Śaivas, one of these verses declares that a donor attains good health by giving medical remedies to the sick or items like ginger (viśvabheṣaja, lit. ‘universal medication’). The second verse in question promises a long life to anyone who restores the health of a patient.Footnote ⁸¹ It is interesting that the Niśvāsamukha shows parallels with the Śivadharmaśāstra in some verses concerned with philanthropy. This possibly means that the latter informed the former’s discussion of medical philanthropy.Footnote ⁸² In this vein, Nirajan Kafle suggests that Mantramārga Śaiva tantras did not develop in a vacuum and were likely influenced by lay Śaivism.Footnote ⁸³ To be sure, I do not think that curative Śaiva tantras developed as a direct result of the Śivadharma corpus’s discussion of medical interventions and assistance.Footnote ⁸⁴ However, I do contend that we can situate their composition—and certainly their circulation—in the context of a broader medical or curative awareness that was part and parcel of grassroots Śaiva religiosity in premodernity. Fostered in part by the Śivadharma, this awareness would have been concomitant with the increasingly public trajectory of Mantramārga Śaiva traditions, a phenomenon that Dominic Goodall has identified in the Śaiva Saiddhāntika uptake of public festivities that originally lacked soteriological significance for them.Footnote ⁸⁵ Ritual accommodations were also made by Śaiva Saiddhāntikas to address the growing diversity of their votaries, many of whom could not perform time-consuming rituals.Footnote ⁸⁶ The circulation of Śaiva curative tantras like the Gāruḍatantras and Netratantra that promised cures for various commonplace ailments was likely too informed by and conducive to the expansion of Mantramārga Śaivism among lay populations.Footnote ⁸⁷

Setting aside Sanskritic receptions of the Śivadharma, the Śivadharmottara was recreated by Śaivas in the vernacular. As an example, one can look to Maṟaiñāṉacampantar. Also known by the name Nigamajñāna I, Maṟaiñāṉacampantar was a prolific sixteenth-century Saiddhāntika theologian residing in Chidambaram, Tamil Nadu. He had an affiliation with the local Kukai monastery.Footnote ⁸⁸ T. Ganesan has rightly described Maṟaiñāṉacampantar and his disciple Nigamajñāna II as ‘good representatives’ of Śaiva ‘textual renewal’.Footnote ⁸⁹ They enriched the textual corpus of Śaivasiddhānta, a vast South and Southeast Asian Śaiva tradition that did not originate in Tamil Nadu as popularly believed, by composing doctrinal texts not only in Sanskrit but more importantly in Tamiḻ that weave in content from the śaivāgamas and pan-Śaiva texts, including the Śivadharmottara.Footnote ⁹⁰ It would thus not be an exaggeration to say that, in an environment where the Śrivaiṣṇava and Mādhva Vaiṣṇava traditions were patronised heavily by the Vijayanagara empire and expanding their reaches across the imperium, these two teachers contributed to intellectually stabilising some ideas of Śaivism and Śaivasiddhānta in Tamil Nadu, which remains the unchallenged bastion of this tradition in the contemporary era.Footnote ⁹¹

For his part, Maṟaiñāṉacampantar contributed a Tamiḻ version of the Śivadharmottara called the Civatarumottaram. This is not, to be clear, a literal translation of the Śivadharmottara. While the organisation and structure of the texts are similar, Maṟaiñāṉacampantar incorporates new expressions inspired by the Tirumuṟai corpus (e.g. Māṇikkavācakar’s Tiruvācakam) and adds his own devotional verses at the end of the fifth chapter.Footnote ⁹² He even sprinkles in quotations from the Tirukkuṟaḷ (The holy word).Footnote ⁹³ It is safe to say, then, that the Civatarumottaram ‘oscillates between condensing and expanding upon the original Sanskrit text’.Footnote ⁹⁴ Yet the text does not fail to mention the importance of aiding those who are socially peripheralised in one way or another and individuals with medical conditions. Indeed, in a verse in the Civatarumottaram’s second chapter, Maṟaiñāṉacampantar highlights the significance of aiding people who have a leg disability (paṅkukālar), children (pālar), individuals whose bodies are afflicted with disease (uṭal viravu noyar), people who have blindness in the eye (viḻiyiḻ antār), and the elderly (viruttar).Footnote ⁹⁵ Maṟaiñāṉacampantar says this should be done after giving things, beginning with valuables, to the preceptor (kuravaṉṟaṉakku niti mutaluṅ kŏṭuttu). He also includes ascetic scholars of the Vedas who are dripping virtue without deficiency (kuṉṟāk kuṇam ŏḻukkam viratamuṭaiya vetiyarkkum) and devotees of Śiva (paramaṉ aṭiyār avar tamakkum) as ideal beneficiaries. The specific mentions of the sick and those with medical conditions like blindness in the concerned list that Maṟaiñāṉacampantar puts together in the Civatarumottaram can be said to be broader reflections of the Śivadharmottara’s emphasis on helping these groups of people as an act of dharma. Indeed, it is absolutely not a coincidence that the featured verse of the Civatarumottaram closely parallels Śivadharmottara 2.36.

For another vernacular reception of the Śivadharmottara, one can look to Kāmineni Mallārĕḍḍi’s late sixteenth-century Śivadharmottaramu, an understudied Tĕlugu text in the academy.Footnote ⁹⁶ Hailing from a peasant-martial caste lineage, Mallārĕḍḍi was an accomplished poet, scholar of Tĕlugu and Sanskrit, and an aristocrat in the Quṭb Shāhī-ruled Golkŏṇḍa Sultanate. His family seems to have been affiliated with Vīraśaivism. I deduce this from the fact that Mallārĕḍḍi’s preceptor was an ārādhya, a term that became associated with caste Brahmins subscribing to a form of Vīraśaivism.Footnote ⁹⁷ It is clear, at least, that Mallārĕḍḍi was a Śaiva-leaning poet and a devotee of the Śiva enshrined in the Siddharāmeśvara temple in Bhiknoor, Telangana.

Coming to his Śivadharmottaramu, Mallārĕḍḍi was quite faithful—as per my comparative analysis of the Tĕlugu contents—to the contents of the Sanskrit Śivadharmottara when recreating it. He also adhered to several classical Tĕlugu poetic conventions, like the detailed description of his lineage in the prologue, that make his text a uniquely Tĕlugu production in style. In terms of his faithfulness, which should not be confused with literality, to the Śivadharmottara, the following verses show how closely Mallārĕḍḍi echoes the content of the original Sanskrit text in the Śivadharmottaramu’s discussion of medical philanthropy.

The ideal hospital that the Śivadharmottara and its vernacular receptions like the Śivadharmottaramu describe in rather terse terms may be comparable to the exemplary hospital described in some detail in the Carakasaṃhitā, a description that is deeply concerned with the materiality of the facility—namely medical equipment, medicines, and food—and qualified staffing.Footnote ⁹⁹ We know from the Tirumukkudal temple inscription, which documents the patronage provided by the eleventh-century Coḻa king Vīrarājendra to a hospital, that medicines utilised at the Tirumukkudal hospital in Tamil Nadu were almost all discussed in the Carakasaṃhitā.Footnote ¹⁰⁰ We thus see the influence of the Carakasaṃhitā in regulating the medical facilities in at least some religious environs, and it is not fantastical to assume that this would be applicable to some premodern Śaiva hospitals as well. This is particularly the case because a Tamiḻ inscription issued in 1121 CE suggests that a monastery in Thiruvavaduthurai affiliated with a local Śiva temple taught medical texts like the Carakasaṃhitā and Vāgbhaṭa’s treatises to students, whose meals were taken care of via land that was subject to tax remission in the concerned inscription.Footnote ¹⁰¹ It is thus apparent that Āyurvedic knowledge was being circulated in a number of Śaiva institutions. At any rate, as I have sought to contend, there is much textual evidence to suggest that the Śivadharma’s prescriptions concerning medical philanthropy and other forms of giving did tangibly inform how medieval and possibly early modern Śaiva communities went about establishing medical facilities, donating medicines, and giving endowments to physicians.

Evidence for this dynamic can also be garnered from the paradigmatic Malkapuram inscription. The epigraph, for instance, does not exclude any particular caste (jāti) or class (varṇa) from accessing the hospital and the birthing hall. This is very important to recognise. When the inscription seeks to designate spaces for specific groups of people, as it does with the choultry that is reserved exclusively for the Brāhmaṇa class, it does so. By and large, then, the social programming of Viśveśvaraśiva’s institution in coastal Andhra was catholic. He, of course, helped fellow Śaivas, including Śaiva ascetics who had come for aid (upeyuṣāṃ śaivatapodhanānāṃ), the Kālamukhas (kālānanas), students of Śaiva scriptures (śivaśāsanānām vidyārtthināṃ), and undertakers of the Pāśupata vow (pāśupatavratānām) by providing food, clothes, and other items (annavastrādisamarpaṇāya).Footnote ¹⁰² However, the inscription also describes how Viśveśvaraśiva arranged for the perpetual feeding of people ranging from ‘unobjectionable Brāhmaṇas to suffering outcastes’, without making any reference to their sectarian or religious affiliation.Footnote ¹⁰³ It is no coincidence that this form of food distribution—without any consideration of caste, class, or social status—is explicitly encouraged by the Śivadharmaśāstra as part of its universalised charity.Footnote ¹⁰⁴ Resultingly, epigraphs in the medieval Deccan concerning Śaiva monastic leaders, especially Kālamukha pontiffs, routinely mention their support of food distributions intended to primarily help the poor or disabled people.Footnote ¹⁰⁵

In light of this evidence speaking to the fairly inclusive bent of medieval Śaiva social interventions, it can be said with great confidence that the hospital established by Viśveśvaraśiva in Andhra served a diverse public. This is in line with the vision of the Śivadharmottara, which posits that attending upon all classes of sick people offers a soteriological benefit that is not gained by even performing great rituals. It would also concord with the foundational texts of Āyurveda in that, while they do mention that certain types of people should not be treated by physicians, they do not proscribe an individual from receiving treatment from a physician trained in Āyurveda on the grounds of their caste or class.Footnote ¹⁰⁶ In fact, the Suśrutasaṃhitā and Kaśyapasaṃhitā (Kaśyapa’s compendium) normatively sanction the practice of Āyurveda by all classes of people.Footnote ¹⁰⁷ Moreover, reflecting the concerns of both the Śivadharmottara and the Carakasaṃhitā, Viśveśvaraśiva ensured that his hospital was staffed with two trained doctors and scribes (vaidyakāyasthau dvau vicakṣaṇau). He also facilitated the presence of goldsmiths, coppersmiths, stoneworkers, and potters (suvarṇatāmrapāṣāṇavaṃśāya sukumbhakārakāḥ).Footnote ¹⁰⁸ It would seem tantalisingly possible that these craftsmen would have been involved in making the pots, plates, utensils, and other tools that the hospital (and monastery) would have utilised and which are indeed prescribed by the Carakasaṃhitā for hospitals.

Additionally, it is paramount to mention that the Carakasaṃhitā discusses the concept of a birthing house (sūtikāgāram), which should be accompanied by not just stocks of various medicinal herbs, salts, and oils but also—as Martha Selby notes—a retinue of women with expertise in birthing.Footnote ¹⁰⁹ While we cannot know to what degree the Carakasaṃhitā actually informed the functioning of Viśveśvaraśiva’s birthing hall, especially because it was intended to be a permanent public facility and not a temporary domestic arrangement, the possibility that a staff of women had an institutionalised or somewhat formal medical role in Viśveśvaraśiva’s new community as midwives in the birthing hall cannot be ruled out. In this period, it is hard to imagine how such a facility could have functioned without a staff of trained women. At any rate, Viśveśvaraśiva’s intervention in the world of medicine—as with other medieval Śaiva engagements with this field—was likely informed by the Śivadharma corpus. This corpus highlights the importance of medical philanthropy and encouraged Śaivas of all backgrounds to build hospitals staffed with good doctors and instruments, tend to the sick, and donate medicines to patients irrespective of their social identities. These were part and parcel of the prescriptive ethics theorised for all Śaivas in the Śivadharmaśāstra, including charity, non-harm, and compassion.Footnote ¹¹⁰ Putting these lofty ethics into practice, Viśveśvaraśiva explicitly dictated that the monastic proprietor (adhikārin) who would manage the Golagīmaṭha’s subsidiary monastery that he had established should be compassionate to all beings (sarvāṇi bhūtāny anukampamānaḥ).Footnote ¹¹¹

All this being said, it’s important to recognise that Śaivas were not the only or first Indian community to outfit religious institutions with medical facilities. In other words, what they were doing and encouraging others to do was not wholly unprecedented. There is evidence that some Buddhist monasteries had clinics or places for administering medicine to sick monks or nuns and possibly also the general population.Footnote ¹¹² However, while recognising this and Buddhist contributions to the circulation and preservation of medical knowledge, Bianchini postulates that the practice of medical healing by Buddhist monastic communities for the broader public in southern Asia was ‘sporadic’.Footnote ¹¹³ Bianchini writes that what public engagement did occur often did so ‘against monastic regulations’.Footnote ¹¹⁴ The Brahmajālasutta of the Buddhist Pāli canon, for example, denigrates various medical practices—including surgery and the administering of medicines—as unfit sources of livelihood, at least for ascetics and Brāhmaṇas that receive donations of food from lay Buddhists and certainly for the Buddha himself.Footnote ¹¹⁵

Turning to other religious communities, Jainas in medieval Karnataka often attached medical facilities to their religious institutions, which not only built on Jaina theological exhortations to donate medicine—along with food, knowledge, and shelter—but also helped link Jainism with the larger publics of the Deccan.Footnote ¹¹⁶ Some Vaiṣṇava temples in southern India also had affiliated hospitals. This includes the famous Srirangam temple of Raṅganātha, which received an endowment in 1257 CE from the Hoysaḷa general Śiṅgaṇṇa Daṇḍanāyaka to support the temple’s clinic, remunerations of the physician Garuḍavāhanabhaṭṭa and the clinic’s staff, and preparation of medicines.Footnote ¹¹⁷ On that note, the practice of individuals endowing medical amenities in religious environs began before the Śaiva Age. As an example, a perhaps Buddhist woman named Viṣṇudattā gave an endowment in the third century CE to cover the medicinal expenses of Buddhist monks living in a monastery on Mount Triraśmi.Footnote ¹¹⁸ Moreover, the patronage of physicians was listed as a royal prerogative in the Arthaśāstra (Manual on statecraft), a Sanskrit treatise that was both composed and then redacted sometime between the first and third centuries CE.Footnote ¹¹⁹ The Śivadharma corpus, ergo, did not spur individual or royal patronage of medicine. Śaivas were participants in a long-standing pan-religious and political phenomenon concerned with medical philanthropy initiated by Indic religious institutions, devout patrons, political players, and/or lay followers of dharma.

However, as the popularity of Śaivism in medieval South and Southeast Asia may arguably intimate, premodern Śaivas were remarkably successful in theorising on their own terms and practically instituting—through the leveraging of their endowed resources and political capital—inclusive social programming as an important aspect of both lay and institutional religiosity. Indeed, Śivadharmottara 2.181 echoes the language of Carakasaṃhitā 1.15–16 when placing health as fundamental to all other pursuits of life.Footnote ¹²⁰ Practically, we see how Śaiva authorities like Viśveśvaraśiva and Vāmaśaktideva II took this message seriously. Some Śaiva monasteries and temples supported social programmes that included medical services aimed at not just the monastics or ascetics but also the ordinary public. A number of medieval South Asian rulers of both Śaiva and non-Śaiva persuasion supported medical programming in Śaiva contexts. They were, no doubt, participants in the Indic political custom of doling out state patronage for medical facilities and physicians. However, a ruler ‘who prevents the injury of living beings in his country’ was also promised prosperity for their kingdom, personal wealth, and honour in Śiva’s heaven for themselves and their family by the Śivadharmaśāstra.Footnote ¹²¹ Additionally, composed well before the sixteenth century, a medieval Śaiva pratiṣṭhātantra (installation manual) called the Dīptāgama prescribes for a ‘site of medicine’ (bheṣajasthāna) to be built in a kingdom’s capital.Footnote ¹²² Such guidance too may have motivated and informed state patrons of Śaiva medical activities, especially Śaiva rulers. Aside from institutional programming, Śaiva therapeutic services were further bolstered by their pioneering development of curative tantras that combined herbal treatment regimens and the use of mantra formulae intended to treat common maladies in premodern (and modern) Asia, such as poisoning from snakebites. These therapeutic ventures were likely informed by lay Śaiva concerns that were partly primed by the Śivadharma. Additionally, as I will show now through the usage of philology, Śaivas were greatly responsible for raising the normative importance of medical philanthropy in Hindu discursive contexts, including in Smārta circles that were normatively committed to the conservative Brahmanical dharmaśāstras.

Medical philanthropy as dharma beyond the Śivadharma

To briefly contextualise this discussion, it is important to first point out the commonplace reproduction of Śivadharma materials in non-Śaiva Hindu literature and scripture, broadly construed. The most thorough study of this phenomenon has been undertaken by Florinda De Simini. In her methodical monograph Of Gods and Books, De Simini shows how discussions of the vidyādāna (gifting of knowledge) in the Śivadharmottara were reproduced in many verses of the Devīpurāṇa, ‘with almost all parallels being very literal’.Footnote ¹²³ This eighth- or ninth-century purāṇa (scripture) tends to just replace Śaiva references with mentions of the goddess while keeping the other content of the Śivadharmottara on the vidyādāna as is.Footnote ¹²⁴ The Devīpurāṇa also reproduced and adapted selections from the Śivadharmottara’s section on the conversion of monarchs.Footnote ¹²⁵ When non-Śaiva Brahmin writers of dharmanibandhas, which are normative digests on dharma, like Bhaṭṭa Lakṣmīdhara and Hemādri were mining texts for quotations in the medieval period, they did not directly cite the Śivadharma corpus heavily, especially the Śivadharmottara.Footnote ¹²⁶ This was the case even when the Śivadharmottara discussed a topic in question at great length. I would argue that one can attribute this hesitancy to at least two factors, namely sectarian considerations and conservative Smārta Brahmanical discomfort with the fairly universalised philanthropic vision of the Śivadharma corpus and its notion of dharma.Footnote ¹²⁷ However, because the Devīpurāṇa was often quoted by these writers, the Śivadharmottara was able to influence even non-Śaiva (esp. Smārta) textual productions indirectly, including on sections concerned with the gifting of knowledge.Footnote ¹²⁸

I argue that a similar phenomenon of indirect influence can be deduced with regard to engagements with the ārogyadāna in late medieval, non-Śaiva discursive contexts. For evidence, I turn to Bhaṭṭa Lakṣmīdhara, the pioneering twelfth-century author of the Kṛtyakalpataru (Wish-granting tree of acts) who effectively popularised the nibandha (digest) genre and influenced later writers of digests. He utilised citations attributed to the Nandipurāṇa when discussing and extolling the giving of health as an act of dharma. Such is also the case for the slightly later Ballāla Sena, a Sena Dynasty ruler of Bengal who composed the Dānasāgara (Ocean of giving) in 1168 CE.Footnote ¹²⁹ Additionally, the Smārta Brahmin polymath and Seuna Yādava minister Hemādri also quotes the Nandipurāṇa in his discussion of medical philanthropy in the Caturvargacintāmaṇi (Wishing-stone for the four aims). Now, the Nandipurāṇa is not extant; at least, no known manuscripts exist or have surfaced. However, based on its title’s reference to one of Śiva’s attendants (gaṇas) and verses attributed to it that have been quoted in other texts, it is evident that the Nandipurāṇa was a Śaiva-coded scripture of some sort, palatable to non-Śaiva sensibilities but suggestive of its affinity for Śiva.Footnote ¹³⁰ This Nandipurāṇa, I would like to posit based on the available evidence, was probably informed by the Śivadharma corpus.

The claim I have just put forth stems not only or even primarily from the Śaiva leanings of the Nandipurāṇa. Rather, as De Simini has noted, the Nandipurāṇa has striking parallels with the Śivadharmottara on sections concerned with the gifting of knowledge, even if its ‘parallels are rather loose as far as the literal text’ goes.Footnote ¹³¹ An analysis of two verses of the Nandipurāṇa quoted by Lakṣmīdhara, Ballāla Sena, and Hemādri in their respective sections on the ārogyadāna will indeed show that the Śivadharmottara—in all probability—informed the author(s) of the Nandipurāṇa, as the former text has been dated to an earlier period than the latter.Footnote ¹³² The two verses in question from the Nandipurāṇa are featured below, and they are quoted without much variation in the Kṛtyakalpataru, Dānasāgara, and Caturvargacintāmaṇi.

The contents of these two verses on the ārogyadāna parallel, literally to some degree and thematically in a wholesale manner, the contents of verses 2.180–183 of the Śivadharmottara. The literal correspondences are bolded in the accompanying footnote. Moreover, additional verses that the digest writers quote from the Nandipurāṇa on the benefits obtained by a medical philanthropist parallel the Śivadharmaśāstra and Śivadharmottara in promising heavenly rewards, although the Nandipurāṇa’s relevant heaven is devoid of any distinctly Śaiva connotations. See, for instance, the following two selections, the first from the Śivadharmottara (ŚD) and the other attributed to the Nandipurāṇa (NP) by Hemādri et al.

Both the Nandipurāṇa and Śivadharmottara not only mention the intergenerational benefits that a medical philanthropist stands to reap but also put the soteriological fruit obtained through medical philanthropy in positive comparison with or in relation to the heavenly results gained by performing Vedic sacrifices. It is clear, then, that the Nandipurāṇa echoes the Śivadharmottara in its espousal of medical philanthropy, most probably because its author(s) or redactor(s) were reading the Śivadharmottara on various topics concerned with giving. Thus, the citation of the Nandipurāṇa by non-Śaiva writers of digests seems to have contributed to the Śivadharma’s theorisation of gifting health transferring to the realm of non-Śaiva dharma.

The uptake of the Śivadharmottara in non-Śaiva discussions of medical philanthropy can be seen more clearly in the Caturvargacintāmaṇi. Aside from the verses he attributes to the Nandipurāṇa like his peers, Hemādri cites verbatim several additional verses that obviously originated in the Śivadharmottara section concerned with the ārogyadāna, specifically verses 2.180–194.Footnote ¹³⁶ He, however, does not list the Śivadharmottara as their source but attributes them to the Skandapurāṇa. While we cannot be certain of the reason behind this discrepancy in provenance, Hemādri may legitimately have had in front of him a manuscript of a certain Skandapurāṇa that reproduced these verses from the Śivadharmottara without attribution.Footnote ¹³⁷ It is also possible, although much less likely in my view, that Hemādri mislabelled the Śivadharmottara in this particular instance because the text is framed as a dharma discourse imparted by Skanda to the sage Agastya upon learning said dharma from Śiva. In any case, this extraction in the Caturvargacintāmaṇi is another example of how the Śivadharmottara exported its advocacy of the ārogyadāna, albeit often indirectly and without credit, to the larger Hindu world of dharma literature that transcended strictly Śaiva boundaries. This, in turn, normatively helped further popularise public medical involvement by religious stakeholders as a particularly valuable act of dharma in premodern India. The uptake of the Śivadharma’s discussion of medical aid by premodern Smārta Brahmin intellectuals like Hemādri is particularly notable. This is because of their commitments to ancient Brahmanical dharmaśāstras (i.e. Mānavadharmaśāstra) and dharmasūtras (i.e. Āpastambadharmasūtra). To be sure, these texts, including the Mānavadharmaśāstra (i.e. Manusmṛti) and the Yājñavalkyasmṛti, do contain verses that encourage people to care for the sick.Footnote ¹³⁸ However, they also stigmatise the medical profession and theorise various restrictions constraining social engagements with medical practitioners.Footnote ¹³⁹ This obviously hindered the in-house development of a robust, appealing theorisation of medical philanthropy, such as the one we find in the Śivadharma corpus.

At any rate, it is additionally worth noting that the Śivadharmaśāstra also contributed to the Śivadharma corpus’s export of its medical philanthropic theory. This is the case because the Bhaviṣyapurāṇa has significant reproductions of the Śivadharmaśāstra’s eleventh chapter.Footnote ¹⁴⁰ Much like the Devīpurāṇa’s usage of Śivadharmottara materials, the Bhaviṣyapurāṇa replaces references to Śiva with mentions of Sūrya in its extractions from the original text.Footnote ¹⁴¹ As part of this reproduction, the Bhaviṣyapurāṇa’s redactor lifted verse 11.65 of the Śivadharmaśāstra, which concerns the immense soteriological benefit of treating the impoverished sick.Footnote ¹⁴²

The conceptualisation of the ārogyadāna in the Śivadharma corpus, then, was indubitably borrowed into various strands of purāṇic scriptures—often verbatim and almost exclusively without attribution. These purāṇas, in turn, were quoted by late medieval non-Śaiva theologians and intellectuals in various normative texts on dharma, which contributed to popularising and establishing the gifting of health as a pan-Hindu act of dharma. It can be said, then, that the intellectual gifting of a heightened philanthropic consciousness in medicine was a donation that the Śivadharma corpus gave to the broader Hindu world in the Śaiva Age. Indeed, to treat the sick by financing medical interventions, building hospitals, and donating medicines was an aspect of being or trying to be a pious Śaiva in the worldview of the Śivadharma. This datum is also discernible from reading the vision of the Piṅgalāmata (Piṅgalā’s instruction) for a utopian theocratic settlement.

A hospital and doctor in the city of Śiva

Dated to the eighth or ninth centuries, the medieval Piṅgalāmata is a Śākta–Śaiva pratiṣṭhātantra (installation manual) that was particularly well-circulated in southern India among the Kālamukhas and Śaivasaiddhāntikas. This text contains a section on building an ideal city, which it calls śivapura (the city of Śiva).Footnote ¹⁴³ Śivapuras are headed by cumbakas, a term for Tantric preceptors.Footnote ¹⁴⁴ The Piṅgalāmata envisions these śivapuras possessing treasuries, legal offices, a university, a dance hall, a central temple, dining halls that serve lay devotees and ascetics, spaces for debate and literary or dramatic performance, and a monastery that is at the epicentre of all ritual activity in the city.Footnote ¹⁴⁵ More importantly for this article, a śivapura ought to always have a hospital and a residence for a physician, posits the Piṅgalāmata.Footnote ¹⁴⁶ That is, a utopian theocratic settlement of dharma practitioners is simply incomplete for the Piṅgalāmata if it lacks medical infrastructure to treat and serve the domiciled population. This view has a parallel in the Kāmikāgama, a Śaiva scripture that was redacted at least a few times in the medieval period, including with Śivadharmottara borrowings.Footnote ¹⁴⁷ In delineating its ideally configured town, the Kāmikāgama prescribes for the construction of a physician’s residence either in the middle of the town or outside of it.Footnote ¹⁴⁸ Further, listing them separately from a doctor (vaidya), it also situates a ‘dispenser of medicine’ (bheṣajapradaḥ) and ‘remover of poison’ (viṣāpahaḥ) in the town.Footnote ¹⁴⁹

These visions of the Piṅgalāmata and Kāmikāgama clearly find some thematic compatibility with the Śivadharma corpus on the subject of medical infrastructure. Similarly, one might consider Viśveśvaraśiva’s activities in the endowed Andhra villages or Vāmaśaktideva II’s programming in Balligave to be efforts towards constructing their own śivapuras, which would have been incomplete if there were not hospitals, associated birthing halls, free medicines, and doctors to serve the local population and the monastic community. The importance of medical facilities for medieval Śaiva communities and institutions, then, cannot be stressed enough. The emphasis on the ārogyadāna in the Śivadharma corpus, in particular, almost certainly informed the approach of Śaiva monasteries, temples, and votaries that sought to engage with the medical field in an expression of their religiosity. These Śivadharma texts told them that healing the body was an act of dharma—one of the greatest dharmas, in fact—and many Śaiva stakeholders across South Asia listened. They accordingly obliged by translating theory into practical medical interventions, as medieval epigraphs and textual productions convey. The Śaiva emphasis on gifting health, as I have shown through philology, also informed pan-Hindu conceptions of medical philanthropy in the late medieval period, influencing even the conservative Brahmanical tradition. The Śaiva Age, then, may have come to a political end in the 1300s, but many ideas of this age certainly did not. This includes the most cherished gift of health, without which—as both the Carakasaṃhitā and Śivadharmottara remind us—no other aim of life can be achieved.