| Abstract|| |
Emperor Ashoka is widely regarded as one of the greatest rulers of India. This paper mainly deals with his medical condition as recorded in the Buddhist texts of Sri Lanka as well as in the Buddhist texts of North India and Nepal. These sources mention his skin disorder which is described as very rough and unpleasant to touch. He is also known to have episodes of loss of consciousness at various times in his life. One of the earliest representations of Ashoka, about 100 years after his death at one of the gates of Sanchi Stupa, shows Ashoka fainting when visiting the Bodhi tree and being held by his queens. In this sculpture, Emperor Ashoka is shown as a man of short height, large head and a paunchy abdomen. In this paper, it is speculated that Emperor Ashoka was probably suffering from von Recklinghausen disease (Neurofibromatosis Type 1), which could explain his skin condition, episodes of loss of consciousness (probably epilepsy) and other bodily deformities.
Keywords: Emperor Ashoka, fainting episodes, neurofibromatosis, skin disorder, von Recklinghausen disease
|How to cite this article:|
Wig N N, Sharma S. Emperor Ashoka: Did he suffer from von Recklinghausen's diseases?. Indian J Psychiatry 2015;57:95-7
| Introduction|| |
The purpose of this paper is to consider the skin disorder and other illnesses of Emperor Ashoka and to suggest a possible medical diagnosis for his condition. Emperor Ashoka is generally regarded as one of the greatest rulers of India who ruled about some 2250 years ago. His empire covered most of the countries except perhaps the Southern tip of India and also extended to what is now Pakistan and Afghanistan. Surprisingly most of what we currently know in the history about this great emperor has been put together relatively recently, during the last 200 years or so after the arrival of East India Company. Governor General Warren Hastings and Sir William Jones, a senior judge in Calcutta's Supreme Court started the Asiatic Society of Bengal in 1784. Sir William Jones was a great scholar, and he is generally recognized as the "Father of Indian Studies." Asiatic Society of Bengal soon became the center where in regular meetings various new discoveries about Indian history, especially of the pre Muslim period were presented and discussed. It also started a research journal, which recorded important findings of various historical sites, pillars, writings on Rocks, coins found in India, Nepal, Sri Lanka, etc., Records of the Asiatic Society of Bengal are a rich source of ancient history of India. It is a fascinating story how step by step various people collected information about Mauryan dynasty kings, Chandragupta, Bindusara, Ashoka and their successors. This is very well described in John Keay's Book "India Discovered" (1981)  and even more comprehensively covered in the recent book "Ashoka - The Search for the India's Lost Emperor" by Charles Allen.  These researches have unfolded a glorious chapter in the early history of our country. One may also mention in passing that even the full life history of Mahatma Buddha was not clearly known at that time, and some early scholars even suggested that he could be an "African" conqueror.
| Sources of Information|| |
Historically the information about Emperor Ashoka has been collected from various sources. Most important source is of course, various writings (Edicts) engraved on Rocks and some stone pillars found in different parts of India and Pakistan at places as far as apart as Bihar, Odisha, Gujarat, Karnataka, North West Frontier Province in Pakistan and even in Afghanistan. Some of the best known Rock Edicts are in Girnar (Junaragh District, Gujarat) and Ashoka pillars now at Ferozeshah Kotla Cricket Ground in Delhi (originally from Western U.P.) and in Allahabad (originally from Kausambhi). In these Edicts, Ashoka usually refers to himself as Devam - Piya (Beloved of the Gods) and King Piyadasi (pleasant to behold).
Apart from these Rock and Pillar Edicts, there are two other main written sources about Ashoka's life, one from Sri Lanka and one from Nepal-both Buddhist texts. The Sri Lankan reference is from the book "Mahavansha" or the Great Dynastic Chronicle, (earlier called Deepavansha - or a chronicle of the Island). This book contains detailed reference of King Ashoka, how he sent his son Mahinda and daughter Sanghamitta to propagate Buddhism in Sri Lanka, how he completely changed after battle of Kalinga and turned to Buddhism etc., The language of this book is Pali - variation of Prakrit, which was the spoken language in Magadh (Bihar) at that time.
The second source is the book Divyavadna, which is Mahayana or Northern Buddhist tradition. It is written in Sanskrit, - which was the language of elites. One of the 38 stories in this book is "Ashokavadana" or Legend of King Ashoka setout in nearly 10,000 verses.
Both these versions, Northern and Southern Buddhist accounts tell the story of King Ashoka with of course, significant differences as per religious traditions of North (Mahayana) and South (Theravada). Both groups of writings point out how Ashoka was a ruthless ruler before he turned Buddhist. He is known to have killed almost all his hundred or so step brothers who could have been possible claimants to his throne. By his order, terrible tortures were inflicted on prisoners in his jail in Patliputra. Earlier in life he was often referred to as Chanda Ashoka or Ashoka - the Ferocious." However, after becoming Buddhist he became known as "Dharma Ashoka."
Numerous historians have lavished exceptional praise about the later day Ashoka. His rule by "Dharma" or moral force and with "Ahimsa" or nonviolence as depicted in his Edicts is indeed a rare example in world history.  As Wells in his famous book, "The Outline of History" has written "Among the tens of thousands of names of monarchs that crowd the columns of history - the name of Ashoka shines and shines almost alone, a star. From the Volga to Japan his name is still honored." To Ashoka must also go the credit of one of the earliest idea of a "Welfare State" in history when in his Edicts he says that he considers all his subjects as his children and their welfare is his responsibility.
| Medical History of King Ashoka|| |
As stated in the beginning, the main purpose of this article is to consider various medical illnesses of King Ashoka as described in historical records and which, to best of our knowledge have not been medically analyzed or written about before. The bulk of the medical information about Ashoka as mentioned in this article has been obtained from recently published book "Ashoka - the search for India's Lost Emperor" by Charles Allen (2013). 
The first medical condition which is very striking is Ashoka's skin disorder. It is described as "rough and unpleasant to touch."  Charles Allen in his book "Ashoka" writes that it made him so unattractive that his father Bindusara wanted nothing to do with him and sent him away from Patliputra. There are further references to his skin condition in Northern Buddhist. "Legend of King Ashoka." First there is the story that in earlier life Ashoka as a child met Gautama Buddha who asked for alms (Bhiksha). Ashoka playfully put some dust or dirt in his begging bowl. As a punishment for this act (Karma) in the next life when he became a king, he had skin that had the texture like pebbles or dust which he gave to Lord Buddha. Then there is reference in Legend of Ashoka, how the earlier wrathful or Chanda Ashoka ordered burning alive all his queens when he learnt that they disliked caressing his skin! There is also a reference to a court diviner (Raj Jyothshi) declaring that Ashoka's body bears certain "inauspicious" marks for which he tried to remove by performing some meritorious deeds.
The second very clear medical condition, which is described, are the episodes of fainting or unconsciousness at various time in his life. There are several such episodes described in Sri Lanka's Great Dynastic Chronicle. For example, when on pilgrimage to various Buddhist places, at Kushinagra, Ashoka is so much overcome with emotions that he fainted and had to be revived by attendants. Similar episode happened when he visited the Bodhi tree at Bodhgaya, where, he again fainted. This scene is depicted in one of the gates of Sanchi Stupa where Ashoka is shown fainting and being held by his queens (Photograph in Charles Allen's book page 344). 
The third reference to his health condition is toward the end of his life when Ashoka is seriously ill and "an impure substance was oozing from his pores." The queen Tishyarakshita ordered a search to find a man with similar illness. A large worm was found in the belly of that man. After trying various remedies, the queen succeeded in killing the worm by onion juice. The onion was generally considered as unclean vegetable in religious belief, but the queen gave onion treatment to king Ashoka and he was cured by that. It is also worth noting how the images of Ashoka have undergone changes in Indian sculpture.  As Charlies Allen points out in his book, the sculpture at gates of Sanchi Stupa are probably some of the earliest images, made <100 years of Ashoka's death. In these sculpture images at Sanchi gates, Ashoka is shown probably as the really was: "A stumpy, fat-faced and fragile king with a tendency to faint under stress." Two centuries later at Amravati, he is now shown as a handsome, tall, Chakravarti Monarch, embodiment of Buddhist Dharma on earth.  His ugliness and frailties are all forgotten now.
| Medical Interpretation of Ashoka's Illness|| |
Hence, we have the following available information about king Ashoka's health:
- He had a gross skin condition in which his skin was like crude dust or dirt. It was unpleasant to look at and unpleasant to touch
- He had many episodes of loss of consciousness
- As shown in sculpture at South Gateway of Sanchi Stupa, Ashoka was a short statured man, Paunchy, with a grossly pumpkin-like face" (Allen 2013, P 375) 
- His father Bindusara is also known to have "spots" on his skin as indicated by his name.
| Final Medical Assessment|| |
It is of course, very risky to make a modern diagnosis of medical conditions of somebody who live more than 2000 years ago. All we have is the descriptions given in some Buddhist texts related to Ashoka's life.
In our opinion, putting all the facts together, it seems likely that King Ashoka suffered from what we now call, Neurofibromatosis Type 1 (von Recklinghausen's disease)  The well-known Harrison's Principles of Internal Medicine describes von Recklinghausen's disease as "characterized by cutaneous (skin) neurofibromas and pigmented lesions of skin called "Café-au lait spots." Neurofibromas are benign peripheral nerve tumors. They are present as multiple, palpable, rubbery, tumors in the skin. They are generally asymptomatic but at time many have in addition hydrocephalus (large head), scoliosis, short stature, hypertension, epilepsy and mental retardation.
The description seems to fit in well with King Ashoka's skin condition and the fainting fits may have been due to epilepsy. One can also speculate about his short height probably due to scoliosis and his large head could be a sign of hydrocephalus. He certainly did not have mental retardation; on the other hand, he was exceptionally intelligent.
We are conscious of the speculative nature of our medical interpretation, but his skin condition, and fainting episodes strongly point to this possibility. His short stature and large face further support this hypothesis. The name of Ashoka's father - Bindusara (spotted one) also suggests the possibility of a hereditary character of the skin disorder, which is known in von Recklinghausen disease.
| Acknowledgments|| |
We are grateful to Professor B. K. Sharma, former Professor of Medicine and Director, Postgraduate Institute, Chandigarh for his help and encouragement in writing of this paper.
| References|| |
John K. India Discovered. England: Windward An imprint of W.H. Smith and Sons; 1981.
Allen C. Ashoka - The search for India's Lost Emperor. London: Abacus, An imprint of Little, Brown Book Group; 2013.
Wells HG. The Outline of History. Popular Edition. London: Cassel and Company Ltd.; 1930. p. 402.
Sagar SM, Israel MA. Neurofibromatosis type I, (von Recklinghausen diseases). In: Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, et al
., editors. Harrison's Principles of Internal Medicine. 17 th
ed. McGraw Hill, Medical, New York. 2008. p. 2607.
Dr. N N Wig
279, Sector 6, Panchkula - 134 109, Haryana
Source of Support: None, Conflict of Interest: None