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

Indian health traditions: October 08, 2000

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Spots that harm or heal

Goutam Ghosha

IN a world where instant cure is the goal, where drug firms wage a war of attrition for survival, where diagnostics improve each year, where corporate hospitals thrive on helpless patients, traditional medical practice, which strikes at the cause of a disease, survives too.

Goutam Ghosh
Kuppusamy Siddha Hospital, Vellore.

If you had a stiff shoulder, a painful knee or wrist, you would swallow a painkiller. Any worse and you would consult an orthopaedician. You may not even consider the promise of alternative medicine.

Just as fancy degrees mean nothing, not all siddha or ayurvedic practitioners may be competent to handle your case. But there is no system to rank the doctors annually to guide you. Even you can be a "doctor" with a correspondence "degree."

A massage usually helps. If you have a headache, you instinctively massage your temples. Do you know that if you press your earlobes hard for about three seconds, and repeat it every 10-15 seconds, most headches will disappear?

Marmachikitsa (the treatment of vital spots) is an off-shoot of the martial art known in Kerala as kalaripayattu and in southern Tamil Nadu as adimurai. A master knows the human anatomy and the vital spots so thoroughly that he aligns a broken bone or stops a bleeding injury with herbal paste.

Goutam Ghosh Somasundaram, Kuppusamy's son speaking to patients.

Goutam Ghosh

The first reference to the vital spots was by Susruta in Susruta Samhita. There are 108 vital points (marmams in Kerala, varmams in Tamil Nadu) and 12 are so sensitive that they throb the moment you point at them. Penetration of any marmam would injure a person, and a master must quickly reverse the effect that could be fatal. Masters also use this knowledge to align the upset equilibrium between the three humours or tridosa - vata (wind), pitta (bile), kapha (phlegm) - the three elements which, they say, form the essence of life. Massage is meant to increase longevity (ayu) and it depends on who does it.

At CVN Kalari (Ph: 0471-474182, e-mail: sathyacvn@vsnl.com), a stone's throw from the chaotic bus stand near Fort, Thiruvananthapuram, the treatment room is a floor above the kalari, the pit where dozens of youth practice the defence and offence sequences (meyipayattu) following cryptic verbal clues (vayattari) from the gurukkal, C. V. Govindankutty Nair, or his son, Sathyan Narayanan.

Every evening, people, a good number of them women, wait their turn patiently. Sathyan, in his thirties, pours oil on the neck and shoulders of a patient and massages with the heel of his palm. His hand draws ellipses which merge into circles, are elongated into trapeziums, and collapse into straight lines. The pressure applied seems to be measured drops from a burette. After the 10-minute massage, the man pays Rs. 30.

Full body oil massage (uzhichil), though not for patients at CVN Kalari, is routine for students. Despite this lacunae, the quality of massage was impressive.

The martial art tradition thrived for centuries in every village but the names, as Phillip B. Zarrelli writes (When the Body Becomes All Eyes), are of recent origin. The secrecy shrouding the art, the diktats of the texts - "... watch (a student) for 12 years and only then give this knowledge (of vital spots). Do not give it to anyone who is cruel, but only to one who is a Siva yogi" (Agasthya Suthiram) - and the ban by the British almost strangled this art. Now the doors are open to all.

Explaining the differences between the southern and northern styles, Sathyan said marmachikitsa was a neuromuscular and orthopaedic science, and the northern style was less aggressive than the southern adimurai (the art of striking the vital spots). But K.P.P. Menon (History of Kerala) and A. Sreedhara Menon (Social and Cultural History of Kerala) have written about Nair armies trained in the art and that kings had bodyguards sworn to protect the crown till death.

Balachandran Master, whose clinic is at his exquisite kalari in Thiruvananthapuram, insists that, despite the differences, the common thread is commitment. In both the systems, the marmams are identical. Penetration techniques may differ but the treatment to reverse the effects is virtually the same.

Tradition is the way of life at Balachandran's "Kalariyil" (Ph: 0471-325140 or 0471-202686; TC15/854, Shishu Vihar School Road, Near Tagore Theatre, Vazhuthacaud, Thiruvananthapuram). Medicines are patient-specific for which herbs are handpicked and ground to paste before being processed in oil on a woodfire. "We do not compromise on tradition. Every herb used has a scientific name but we identify these by the local names," he said. The process of diagnosis is unusual. Balachandran reads the pulse and lists your problems. No stethoscope, no x-ray plate, no ultrasonogram is needed.

"Prayer is important because any master can only do his best. The rest is up to god. Energy flowing from the master rejuvenates the patient's body," he said.

As for the honorarium, Balachandran said "I never ask for a fee. What I do is my duty to god and my forefathers. If I demand a price, I have to send away patients who cannot pay. I never do that." But even a casual reference to how poorly some patients pay exerts a subtle pressure which extracts an honorarium higher than justified. Given the flow of patients, including foreigners who pay him honorariums higher than what Indians can ever afford, Balachandran thrives.

But success stories are rare.

R. Utthaman Vaidya is respected in his village despite his tiny treatment room where he prepares his medicines and oils. D. Nelson Asan (60), who could neither understand what was being asked nor stand erect, treated his patients at their homes, a sign of pecuniary distress.

Krishnankutty Asan's ground-level kalari at the idyllic Mudavanmukal village next to the Kiliyar river was in poor state. To prove his prowess he asked one of his students to get ready for a massage. It was meaningless as unless one needed a massage, energy need not be wasted. Krishnankutty had suffered two cerebral strokes, and despite a wiry body, his lips trembled - a sign of fatigue.

The success of marmachikitsa depends on two factors. First, the patient's faith in the system, god and the master. Second, the master.

Even though massage parlours exist everywhere, you should not risk visiting one unless you are sure. After massages in many "famous" centres at Kovalam beach, Kerala, Cheryl Bentley wrote "It hurt!" ("Warrior Healer", Yoga Journal, March-April 1998) till Balachandran massaged her body.

Unlike the patient-specific oils and medicines, Devaki Health Care Centre, Thiruvananthapuram is run commercially. C. P. N. Nair, managing director, Sri Dhanwantari Matam, said that even though the ingredients were traditional, he could not follow every diktat (particularly the wood fire which is slow; he used gas stoves instead) because demand outstripped supply. Massages were given by physiotherapists at his clinic.

In Vellore, Somasundaram treats more than 250 a day at the Kuppusamy Siddha Medical Centre. In-patients paid Rs. 15 for each concrete-slab bed in the 72-bed asbestos-topped room. "What I charge just covers the cost. Actually I do social service," he claimed.

One freelance journalist, who suffered from polio as a child and paralysed neck down, was cured by Kuppusamy, Somasundaram's father. Dr. Ramdas, of Tamil Nadu Agricultural University, had spent thousands on allopathic medicines to treat his trigeminal neuralgia, and finally turned to Somasundaram. Dr. Ramdas claimed he was 30 per cent better after 10 days.

The family prepares a single oil and every patient ingests the drop of the same honey-camphor-herb mixture on a leaf (that almost scorched my tongue and the tang remained for hours) and another thimbleful of a secret concoction.

How does the same medicine work for all nerve diseases? How does massage work where orthopaedic surgery can promise nothing? How does your pulse give clues to your external body (sthula-sarira) problems? It defies a reductio ad absurdum approach to arrive at an answer. Obviously more than faith works. It is a tradition that we don't flinch to dump. Because advertisements cast a blinding spell on us.

A rub that soothes IN the dimly lit room, filled with sweet smoke from incense sticks and the soft sputtering of a brass lamp wick, sits the table, hewn from a single piece of wood. The top, wiped clean, is smooth and slippery. As I wait, clad in a loincloth, the dancing shadows on the wall infuse a heady mixture of the unknown and hope. The pictures of divinity fail to quell the queer kneading within. The four-inch wide calico loincloth is tucked into the string tied round the waist. Women also wear a wider strip of calico on their upper torso. "Indian women are more inhibited but soon they realise they are in safe hands. The body massage is done by a woman I have trained, but I touch the vital points to set the flow of energy right," said P. S. Balachandran Nair, the kalaripayattu master. Herbal oil boils on a portable gas stove. The fume smells familiar - "a concoction of 40 to 60 herbs, and several base oils depending on the patient," says Balachandran. A disciple gets the items for the prayer that precedes each session. Balachandran dedicates his efforts to god with a short prayer - "Om Agasthyay namah. Om Guruveh namah. Om Sivay namah". Tradition demands total submission to and complete faith in God. He brings a set of lit incense sticks close to my chest and prays softly. "I pray to your soul to allow me to touch and to help me find the faults in your body," the master explains later. I lie down, on my stomach, my chin cushioned on a towel. A disciple begins the warm-up massage at my feet, rubbing the soles gently at first and vigorously later. His fingers glide between my toes in figures-of-eight. The master then pours a stream of hot medicated oil down my spine. "Relax", the masseur says. The gentle firmness of his words reassure and I submit to the sensation. The massage begins at the waist and flows upwards, touching every point on my back. The anticlockwise motion with pressure around the marmams (the nerve centres) soon envelops my body in a cocoon of calm. His hands, which move slowly at first and then at a furious speed, increase the pressure at certain points and reduces it within a fraction of a second on the vital points, show his immense command of his fingers and palm. With the herbal oil acting as a lubricant, the hands glide. The expert's touch is needed on the marmams, as penetration of some vital spots can kill. Criss-crossing from the left shoulder, down to the waist and thence to the right leg, back to the waist, up the back to the right shoulder, and down again to the left leg, slowing, massaging with the heel of his palm, and then speeding up to a blistering speed requires a superhuman effort. Despite the 90-minute, vigorous massage that covered almost every square inch of my body the master has the energy to sing slokas. During the procedure, he leaves the table for only a few minutes. There is just a faint sign of panting as the master explains what he did. "But for your left shoulder and left knee, you are in good shape," he says. And I instinctively look back to see if I could trace my worn-out skin that was peeled on the table.

Is this possible? P. S. Balachandran Nair was describing the vital spots when I reached for my camera to capture him contemplating, but through the lens I saw his eyes narrow to slits. I clicked but the camera did not fire. "You have violated our discussion's sanctity. It will not work." Goutam Ghosh P. S. Balachandran Nair with his disciples. "You must be kidding!" I said, laughing aloud, but irked by the coincidence of the camera failing when I needed it most. "It will work only when I want it to," he asserted. I checked every setting but it still did not work. Much later he said with a grin, "Now try," and the flash popped. The camera has worked on difficult terrains. It was hard to believe that Balachandran had willed the camera to fail, but a nagging doubt remains.