Special issue with the Sunday Magazine
From the publishers of THE HINDU

Indian health traditions: October 08, 2000

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Panel discussion

Dr. P.L.T. Girija, Ayurvedic physician, Sanjeevini Ayurveda Yoga Centre, Chennai
Dr. Uma Krishnaswamy, surgeon, Apollo Hospital, Chennai
Dr. Hari John, international Health Consultant, Chennai
Dr. T. Tirunarayan, Siddha physician Sheela Rani Chunkath, I.A.S., Commissioner of Maternal and Child Health, Government of Tamil Nadu
Mr. A. V. Balasubramanian, Centre for Indian Knowledge Systems, Chennai
Ms. R. Krithika, The Hindu Dr. Harish Narain Das, Sociologist, University of Delhi.

A. V. Balasubramanian: The unique feature of traditional medicine in India is that it flourishes at multiple levels. On the one hand you have practitioners of Ayurveda, Unani and Siddha systems who are institutionally qualified and trained in colleges. On the other hand, there is the folk stream or Lok Parampara which is rich and diverse. This includes home remedies, dos and don'ts in day-to-day life, adaptations to the seasons, Pathyam and Apathyam - knowledge of foods and properties of foods to be preferred and avoided in various conditions, tribal or folk health practitioners, families specialising in the treatment of various diseases such as asthma, jaundice, etc. and above all specialists to take care of conditions such as bone injury and treatment for poison. There are also practices like yoga or martial arts traditions such as Kalari and Silambam which have a preventive or promotive role.

The knowledge of use of natural products such as plants amongst our people is truly phenomenal. The All India Coordinated Research Project on Ethno-biology of the Department of Environment reveals that the tribal communities alone have a knowledge of the use of over 9,000 species of plants of which the single major use category is traditional medicine for which over 7,500 species are used.

According to Mythology, Lord Dhanwantri, an incarnation of Vishnu, is the God of Indian medicine - Ayurveda. He emerged from the milky ocean as it was churned by the Devas and asuras. He possesses a leech in the right hand and a golden pot containing Amrit in the other.

However, traditional health practices are on the decline owing to modernisation and changes in lifestyle. Another important contributory factor appears to be the indifference of the modern medical practitioners and our health policy makers to these traditions. By and large they are of the view that most of these traditional practices are at best, harmless and at worst, superstitious and retrograde, unless they can be examined and proved by modern research methodology. Thus we seem to be sitting upon a gold mine of traditional practices being unable to build upon it for the betterment of our peoples' health. How can we build upon our peoples' health traditions?

Dr. Girija: There has always been this ambivalence vis-a-vis traditional medicine. On the one hand it is seen as being unscientific and on the other, the constant demand from most quarters is that it needs to be validated. I think this business of validating our traditional medicine should be met head on. While many of our herbs have found their way into the modern medical pharmacopoeia, the dominant trend constantly questions us and looks to the West for solutions. The question is whether Ayurveda needs validating, and if so how? Here it must be pointed out that in India, from ancient times the issue of validating knowledge and experiences had been dealt with very meticulously. This question is nothing new to our tradition. It has been with us all the time. If we turn to the Nyaya Sastra, the rules for what constitutes valid knowledge are quite clearly laid down.

It says that there are three sources of valid knowledge :

1) Pratyaksha or direct observation or experience. Any theory that contradicts direct observation and experience is not considered valid knowledge.

2) Shabda or Agama, which is the accumulated wisdom of our entire tradition found in texts.

3) Anumana or inference, which is a source of valid knowledge when it does not contradict direct observation, experience and textual reference.

The science of Ayurveda is based upon the above methodology applied in the context of maintaining human health. It is based on rational and scientific principles and is sceptical of any knowledge that is not acquired in pursuance of scientific method and rational means. Ayurvedic texts go to the extent of stating that any success achieved without following the correct method is sheer accidental success and it is to be discouraged. Based on this method, Ayurveda has put together an enormous body of observational data under a theoretical framework and developed methodologies and categories which hold good for all three times: past, present and future. It has developed its own concepts on health and ill health, which find support in their theoretical formulations. And these have been validated by practice over thousands of years. Now, when a demand is placed on us that Ayurvedic drugs and therapeutics be tested and validated it sounds outlandish. It is doubly so because validation means validating traditional medicine in terms of the currently reigning paradigms which may be based on say the current theories of molecular biology and biochemistry and they prove their practical efficacy by various statistical and other field trials. But the problem is that these theories of molecular biology and biochemistry are totally unstable and constantly changing. I can give an example from my practice.

Women come to us with menstrual complaints - they have been diagnosed as suffering from hormonal imbalance and hormones are administered. Here the cause of the disease is reduced to a single bio-chemical factor in the body. Similarly, the administration of steroid drugs with all its side effects may temporarily give some results but it unleashes a whole chain of other reactions in human body, which they are unable to address. Hence the basis and validity of the approach itself has to be questioned and if there is a problem of validation of drugs, it is here. Thus drugs and therapeutics developed on a single bio-chemical factor ignoring a host of other factors have validly given rise to the talk of holistic health.

If our modern medical practitioners had tried to understand the Ayurvedic drugs and therapeutic practices like Vamanam (emesis), Virechanam (purgation), Vasti (enema), Nasya (errhines) etc., and studied their actions in the human body even according to their science they would have made some original and useful contribution to their own field of medicine. Instead they constantly look to the West for guidance and solutions. While India sits over a huge body of knowledge in medical science and ought to have been on frontiers of medical science, its policy makers and others are only interested in exporting its herbs and making a quick buck.

Dr. Hari John: Having worked with villagers there are three questions that need to be addressed.

1) Why do we want to build on peoples' health tradition ?

2) Who will benefit from them?

3) Will it go back to the people or the managers ?

Prior to globalisation and commercialisation, knowledge came from the people, primarily, the women. They had the ability to heal both the body and mind. By way of an example, marijuana was known to women and it was under their control. With few exceptions like dattura, most herbal medicines have no side effects. But now the people's health traditions are on the verge of getting lost due to modern medicine's onslaught. If you examine the Hippocratic oath, it deals with the whole person. In the Hippocratic system the body caused the diseases and the body has the ability to heal itself. The practitioner and diet are aids in the process of healing. But from the 19th century, the body is seen as a battlefield between the disease and an external agent. As a reaction to all this, we have turned towards alternative systems of healing. But the question is : is it possible to take peoples' health traditions, refine it and give it back to them?

We know well that the rural poor lack even the most basic of facilities. On top of this, they have to put up with caste oppression everyday. The only thing that they have going for them is cleaner air and environment apart from access to herbal medicine. If we are to take this knowledge, refine it and propagate it, whom will it benefit ? We can be sure that even this resource will be lost to them. More likely, it will benefit the so-called researchers who may get doctorates or international recognition. Also, surely there will be commercialisation of people's knowledge which will benefit the middle classes (look at Ayurvedic Concepts which are being lapped up by the richer classes). This threat has now increased many fold due to globalisation, WTO, IMF, free trade and so on. Remember the patenting of turmeric by an American Company, some thing we have been using for centuries ? Or the patenting of neem? We need to constantly keep in mind as to whom this development of local health traditions is going tobenefit. We need to keep constant vigil so that the poor do not get ripped off again.

Sheela Rani Chunkath: We have started an experiment in Tamil Nadu where Village Health Nurses (VHN) are for the first time being trained in Siddha Vaidhyam and Ayurveda. This is a sea change from the earlier practice where the same people are explicitly told to discourage all forms of local health practices. A VHN in Dharmapuri district, most effectively managed to wipe out the practice of adopting the standing/ squatting posture during delivery. Now, through a 15 day course, these nurses are being re-educated, both to find out what the local health practices are and to endorse them. Earlier our health manuals for training VHNs systematically attempted to wipe out these practices without managing to erect anything sensible and comprehensible in its place. I quite agree with Dr. Girija that 3000 years has been more than enough as a trial period and these local traditions have been refined and validated enough.

Dr. Uma Krishnaswamy: I agree that the important question is validation and I fully agree with Dr. Girija that Ayurveda has its own method of validating knowledge. It is time that traditional practitioners got together and articulated this to the larger public. What we seem to have is a communication gap.

Sheela: Validation of Ayurvedic drugs is no problem. The difficulty lies in the standardisation of drugs. Each manufacturer prepares the same drug in different ways that we are not able to standardise them.

Dr. Tirunarayan: Lifestyles have changed. Pollution is affecting the environment. There are pesticides even in tender coconut water. In the light of this we need to re-examine prescriptions and proscriptions.

Sheela: Validation of drugs needs resources and the resources are forthcoming only from those who want patents and profits.

Uma: Commercialisation is a driving force for validation. I do not need anyone to tell me that an oil bath is good for me.

Sheela: No. On the contrary we all need to be told that an oil bath is good for us. In fact our health workers have been telling our communities that the oil bath is a bad thing or of no particular use.

Uma: I think we must make a distinction between research and textbook medicine. Even in the textbook medicine there is nothing in it which condemns the traditional medicine. The only thing that I can recall is the application of cow dung after the umbilical cord is cut. I'm sure all of you will agree with me that this is a practice that richly deserves to be condemned and has been the cause for infant mortality.

Dr. Tirunarayan: I think we need to make a distinction between principles and practices. Principles are not well understood. It is important that we promote principles and not practices. Today, there is a brand of "oil" in the market which contains 99 per cent liquid paraffin.

Girija: We must be careful before we say whether oil baths are good or bad. While it is certainly true that the application of oil is a part of one's dinacharya (daily routine), and increases longevity, promotes sleep, is good for the eyes and retards aging etc., it is contra-indicated in the cases of Kapha diseases, indigestion and so on. Similarly, while thambulam (betel leaf and nut) is generally good for digestion etc., it is not to be used in individuals suffering from pitta diseases, Raktapitta (blood disorders), giddiness etc. Within such a scheme the notion of a double blind trial etc., seems completely blind to me.

Balu: But if an explanation is given in Ayurvedic terms most patients may be unable to understand what is being said. One reason is that their entire education leaves them unprepared for understanding an explanation wholly in ayurvedic terms. A leading ayurvedic physician told me that he would often be driven to tears when he began delivering his introductory lectures to the first year Ayurvedic students on Pancha Maha Bhutas - the students thought that he was talking of ghosts.

Sheela: It certainly means that if the coming generation are to be able to make sense of health, disease and treatment in traditional terms, we need to introduce them to these concepts in our school curriculum.

Balu:There is a need to initiate action at various levels. We all seem to agree that there is much that is valuable in our health traditions that needs to be strengthened and propagated. These practices can be understood and validated based on the theory and practices of traditional sciences themselves and do not stand in need of a fresh validation based on modern research. Standardisation of drugs or raw-materials is being felt today as a need due to current developments - such a problem may not have existed in earlier times. We need to pay attention to this matter. We need to understand the principles underlying traditional practices - they may need to be modified and adapted to suit the current lifestyle and situation. We must ensure that our interventions primarily benefit the local communities who are carriers of these traditions and not just researchers or intermediaries from outside. Above all we need to educate the younger generation - not merely introduce them to this knowledge but also install in them certain confidence and pride in these traditions.