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

Indian health traditions: October 08, 2000

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The relevance of a vibrant tradition

Dr. A. V. Balasubramanian

Director, Centre for Indian Knowledge Systems, Chennai.

The Indian sub-continent abounds as it were in a variety and diversity of health traditions. We have with us what is perhaps the longest unbroken health tradition which has not only a stream of practitioners but also a textual and theoretical backing in terms of the Ayurvedic and Siddha systems of medicine. They have made their presence felt even outside India, in other parts of Asia such as China, Thailand, Cambodia and Indonesia. The Unani system that came in during the Arab period also enjoys great popularity and it has interacted with the Ayurvedic system and has enriched it as well as got enriched by it. However, what is most remarkable about the Indian medical tradition is that it prevails at two different levels, namely, the classical system and the folk system.

By the classical system, we refer to the codified systems such as Ayurveda, Siddha and Unani traditions. They are characterised by institutionally trained practitioners, a body of texts and highly developed theories to support their practices. As against this, we also have a folk tradition (or what may be termed as the Lok Parampara) which is an oral tradition passed on from father to son or mother to daughter (or daughter-in-law) or from guru to sishya in tens and thousands of our villages through the ages.

These folk traditions are rich and diverse and include several practitioners as the following list illustrates.

*Home remedies and cures for common ailments

*Hundreds of thousands of folk and tribal practitioners known as Nattu Vaidhyars who learn through oral traditions and who treat a variety of ailments.

*Knowledge and beliefs regarding foods - Pathyam and Apathyam, i.e. foods to be preferred or avoided during specific diseases or conditions such as pregnancy, by lactating mothers etc.

*Folklore on health (eg. Proverbs relating to health)

*Individuals/ families specialising in the treatment of specific diseases. (e.g.) jaundice, asthma.

*Knowledge of diagnostic procedures

*Knowledge of preventive measures

*Knowledge of Rutucharya or adaptation of food and regimen to suit the seasons.

*Yoga and other physical cultural practices of a preventive nature.

*Special areas such as bone setting, Visha Chikitsa (Treatment for poisons), Panchakarma (Five purificatory procedures) etc.

*Over 600,000 Dais (Traditional Birth Attendants) who perform home deliveries

This constitutes a rich and vibrant tradition offering enormous possibilities. There is a tremendous sweep and depth of knowledge regarding the use of natural resources. The All India Coordinated Research Project on Ethno-biology that was carried out by the Department of Environment of the Government of India, has concluded that the tribal communities alone (who constitute only a small percentage of our population) use over 9,000 species of plants, of which the single largest use category - medicinal plants, accounts for over 7,500 species. Folk practitioners are by no means confined only to the treatment of coughs and colds or simple ailments. For example, it is interesting to note that specialist practitioners such as our traditional bone setters are widely prevalent throughout the country and even at a conservative estimate we have about 70,000 families practising this art. It is estimated that even to day over two-thirds of the fractures are being attended to by these practitioners since modern orthopaedic practitioners and treatment facilities are too few in number and concentrated largely in cities and urban areas.

Speciality areas such as Panchakarma (the five purificatory procedures) have been drawing global attention in recent times since they offer possibilities of lines of treatment for certain degenerative disorders for which modern medicine does not as yet have a satisfactory solution.

An important component of knowledge based on classical medicine is the enormous number of manuscripts on this subject.

It is commonplace to say that traditional medicine is holistic and treats the complete individual and not merely the disease. But how is this achieved? Traditional medicine with its understanding of Prakriti i.e. the constitution of an individual, offers powerful insights and guidelines in this area. The treatment can be varied for different individuals based on their constitution and similarly guidelines for diet and regimen can also be given.

In recent decades there has been increasing interest in the West to attempt to bring back childbirth into the household. The women's movement in the West has formulated a powerful critique of the current practices of obstetrics and gynaecology and an increasing number of women are opting for childbirth at home. However, today the West has by and large wiped out the midwife, during the process of modernisation and hence their starting point is rather weak. As an interesting contrast, we find that in India a vast majority of childbirths are still attended to by dais. These dais not only deliver children but also provide valuable help to take care of the minor ailments of pregnancy and the care of the baby and lactating mother.

Above all, it is interesting to see the extent to which health practices are still prevalent even among the public at large in terms of knowledge and properties of foods, common home remedies and even practices for promotive health care such as taking oil baths.

There is no doubt that such a situation has prevailed over millennia since the classical texts of medicine themselves have often great respect and appreciation of knowledge that prevails at the folk levels. For example the Ayurvedic classic Charaka Samhitha states that "the goatherds, shepherds, cowherds and forest dwellers know the drugs by name and form". Thus there has been a symbiotic relationship between the folk and classical health tradition.

As a nation, we still seem to have little awareness of the fact that there exists a large body of Indian System of Medicine (ISM) professionals and they represent an entire body of scientific knowledge and approach, as distinct from the modern medical profession. While we have about 100 colleges of Ayurveda, 20 colleges of Unani and two colleges of Siddha, the allocation for Indian System of Medicine has never been more than 5 per cent of our total health budget. Also, the folk traditions and practitioners are even more remote to our policy makers - they do not figure anywhere at all and get no support or recognition from the state.

The National Health Policy Document (1983) recognised the problem when it said - "The country has a large stock of health manpower comprising private practitioners in various systems, for example - Ayurveda, Unani, Siddha, Homeopathy, Yoga, Naturopathy, etc. This resource has not so far been adequately utilised. The practitioners of these various systems enjoy high local acceptance and respect and consequently exert considerable influence on health beliefs and practices. It is, therefore, necessary to initiate organised measures to enable each of these various systems of medicine and health care to develop in accordance with its genius".

Nevertheless such statements have remained mere sentiments or sporadic pronouncements and have not been reflected in any action plan. This is hardly surprising, since the problem is deep-rooted and hence does not admit of any solution that can be brought about by mere cosmetic changes. It calls for a deeper examination of our entire approach to healthcare and an understanding of the historical forces that have governed its development in the last two centuries, since the advent of British rule. The problem itself is one which we share with several other non-Western societies, particularly those which have a history of European domination.

There also exists a need to initiate a serious dialogue between the practitioners of ISMs and modern medical professionals in many areas. The intense Westward orientation of the modern medical profession has been a serious problem - making such a dialogue quite difficult. Aside from the fact that the nation will indeed gain much by such an interaction, it will also help us to arrive at a clearer understanding regarding some areas where the two sciences differ.

A number of steps need to be taken to strengthen local health traditions and ISMs and make them play a meaningful role in today's healthcare systems.

Strengthening the resource base

The Local Health Traditions are heavily dependent upon the local flora which serve as the important resource base. With increasing deforestation, the loss of local control over forest land and the commercial exploitation of forests the resource base stands seriously threatened. Steps need to be taken to ensure that forest resources are protected and made available for local use. Of course, resources imply not only flora and fauna but more importantly the human resources, and also the knowledge base in terms of texts and manuscripts.

Resource material

What has been known, said and written about the ISMs has perhaps merely scratched the surface of the vast potential that is lying dormant in this area. For example, it is estimated that there are 10-30 million manuscripts in Sanskrit alone. There is no definite information on the number of these manuscripts that pertain to medicine - but it is bound to be quite a large number from various indications. The Tamil University at Thanjavur has made a catalogue of all Tamil manuscripts in public libraries and collections. About 8,000 of the 24,000 manuscripts listed pertain broadly to Science and Technology. Among them, over 4,000 texts relate to medical sciences. Most of these have not been printed. This would give an idea about the number of manuscripts relating to medicine which one may find in our libraries in Sanskrit and other Indian languages. In addition there are innumerable manuscripts with individuals and families of Vaidyars. There is need to undertake a systematic effort to compile information on these matters and launch a programme for editing and publishing the same.

The millions of our countrymen and women who are now involved in providing local healthcare despite severe constraints must be encouraged to participate actively in the nation's programme of health care. What is called for is a massive effort for revitalisation of the local health traditions. Revitalisation should mean an exercise by which we can examine our practices to

- confirm what is sound
- add to what is incomplete and
- discourage what is distorted.

In this exercise our codified medical systems - Ayurveda, Siddha and Unani would have a major role. While such efforts have been initiated in the voluntary sector much more active involvement from official agencies is also called for.

A new outlook

Even more important than any of the above inputs is a new outlook towards indigenous systems of medicine (or for that matter towards all indigenous systems of knowledge). With the development of modern science and technology and the onset of worldwide colonialism, all non-Western cultures were dismissed as devoid of any systematic and viable science and technology. Yet while modern science and technology has limited its blessings to a small minority, the vast majority of our people still survive with the material and intellectual sustenance from our own indigenous traditions. What is needed is a thorough reevaluation of indigenous traditions of sciences and technologies as part of our present day search for alternatives. This should have to be free of the prejudices and preconceptions of the Western ethnocentric outlook that has till now clouded our vision. This reevaluation, we hope, would lead to the development of an alternative science and technology - based on more humane values, that would lead to a better, self reliant and non-exploitative system.

UTILISATION PATTERN OF WILD PLANTS BY TRIBALS IN INDIA 1. Total (9500) 2. Medicinal (7500) 3. Edible use (3900) 4. Other material & cultural requirements (700) 5. Fibre and cordage (525) 6. Fodder (400) 7. Pesticides, piscicides, etc. (300) 8. Gum, resin & dye (300) 9. Incense and perfumes (100) In terms of the use of plant materials for traditional medicine, it is estimated that local communities used over 7,500 species of plants.

Small pox inoculation in Bengal One of the practices about which very little is known even today is the traditional Indian method of inoculation against small pox. This seems to have been widespread in large parts of northern and southern India before the 18th century. While there are various references that have been made to this practice, one of the most detailed descriptions is the one given by J. Holwell, FRS. He described the practice as he observed it in Bengal in 1767. "Inoculation is performed by a particular tribe of Brahmins who are decided annually for this service from the different colleges over various provinces. They travel in small groups (of 3 or 4) from place to place so as to reach various places some weeks before the usual onset of the disease. In Bengal, the inoculators normally arrive in February (or sometimes as late as March) before the onset of summer. The residents of each locality know the usual time when they arrive and observe a strict regimen for a month in advance. This consists of abstaining for a month from fish, milk and ghee. "When they begin to inoculate they pass from house to house and inoculate only those who have observed the regimen. Usually they inoculate outside of the arm midway between the wrist and elbow for the males and between the elbow and the shoulder for the females. Before the inoculation, the inoculator takes a piece of cloth in his hand and rubs the part to be inoculated for eight to ten minutes. He then makes a small prick with a small instrument till a drop of blood appears. After that he opens a linen double cloth and takes from there a small piece of cotton charged with various matter which he moistens with a few drops of Ganges water and applies it to the wound with a bandage. This remains in place for about six hours. The prohibition of fish, milk, and ghee extends for one month from the day of inoculation." Dr. Holwell goes on to say that "When the before recited treatment is strictly followed, it comes to a miracle to hear that one in a million fails of receiving the infection or of one that miscarries under it."