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

Indian health traditions: October 08, 2000

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Monumental heritage

Dr. Abdul Hafeel, Suma T.S.

The authors are with the Foundation for Revitalisation of Local Health Traditions, Bangalore.

What are local health traditions? They date back to the cave man who started consuming raw vegetables and fruits when he had to satisfy his hunger and also imitate the action of the animals, which consumed plants for any health disorder.

V. Muthuraman/Wilderfile

Traditional bonesetters to care for broken bones, vaidyas treating snake bites (Visha Vaidya), dais (traditional midwives) who conduct hundreds of child births -- who are these skilled people constantly serving the community? Our traditional lifestyle is oriented towards using herbal medicine. When you showed symptoms of fever and cold, did your grandmother not give you hot pepper rasam? What are these practices that have become a part of our culture and evolved through many years of experience in the inhabited ecosystems? These diverse health practices are non-codified and are better known as local health traditions. Most of them are locality and community specific. This is further bifurcated into household level health traditions and natuvaidya traditions.

The household health tradition comprises home remedies: health related customs, seasonal regime, rituals, ceremonies, food and regimen. It not only utilises the spices and condiments from the kitchen but also a wide range of plants and its products available in the locality. Some areas of Kerala and Tamil Nadu have reported over 2000 plants and other resources used for health care at the household level. Keezharnelli, tulsi, adhatoda, neem, curry leaves, coconut, drumstick, aloe vera, hibiscus, castor plant are familiar names in primary health care in South Indian households.

Specific foods are also prescribed for specific seasons. Patients with jaundice or with skin conditions are not given chicken or eggs. Those suffering from body rash and skin ailments are not supposed to eat brinjal, dry and salted fish, as these can aggravate the problem. In Kerala inchikkari, a side dish combination of ginger and other spices is a good appetiser and helps in digestion. The karkkadakka kanji of Palakkadu in Kerala, is a porridge prepared out of the nava dhanyas (nine pulses and cereals) and is prescribed as a seasonal diet for old people. This is consumed in the monsoon (Karkkidaga means rainy month) to alleviate rheumatic disorders, which tend to increase in the season. A porridge is prepared out of idinjil (Commiphora caudata) bark and red rice (kutthari) in Palakkadu called marunthukanji. This is also a popular preventive measure to combat the rainy season for the aged for similar health problems. The raagi kanji is considered a good coolant and commonly consumed during the summer in Karnataka and similarly raab (porridge of jowar) is consumed in Gujarat.

A bitter decoction of maddale (Alstonia scholaris) prevents malarial fever in Dakshina Kannada during the monsoon. A sweet dish is prepared out of madh toppu (Justice) herb, which is found growing luxuriantly in Coorg. This herb is believed to have 18 medicinal properties. This is harvested on the 18th day of Karkata masa (July 15 to August 15). The Coorgis also consume karkata kozhi (chicken) on this day. The reason is that during the monsoon the chicken accumulates excessive fat content to fight the cold weather and if eaten will add to the body fat.

The kani tribes of Kerala use Trichopus zeylanica as an energy booster to perform strenuous jobs. Certain customs are also followed as part of these traditions which have a preventive and promotive impact on health management. These also vary in communities and localities. The periodical cleaning of the surroundings and house, filling the house and environment with doopas (smoke) and many such hygienic measures are also an integral part of these traditions.

Healing touch

Another parallel stream of carriers of local health tradition who render service to the communities are the folk healers or the natuvaidyas, nattivaidyas or vaidus. These healers cater to a wide range of conditions covering promotive, preventive and curative aspects of health. They handle simple ailments like the cold as well as emergencies like snakebites, traditional ophthalmology, gynaecology, paediatrics and many individual organ related conditions and specific diseases.

The folk healers can take care of poisonous bites, bone setting, delivery, vet care and many other specific organ related health conditions. They have a holistic understanding about diseases, backed with specialised diagnostic techniques and disease management. They have vast knowledge about the wide and narrow spectrum use of a resource used for specific conditions.

A study conducted across Southern India recently by the Foundation for Revitalisation of Local Health Traditions, Bangalore found there were five main categories of healing hands - the general physicians, traditional bone setter (TBS), veterinary (paashu or mriga vaidya), traditional birth attendants or dais (TBA) and visha vaidya who treat poisonous bites.

Traditional birth attendants

Traditional birth attendants are the largest group of practitioners who take care of ante natal and post natal care and also attend to deliveries. This group comprises a large number of women nativaidyas. In Tamil Nadu, the tradition still exists. WHO, having understood the lack of the additional human power for attending to deliveries in rural areas of India, have trained these dais for conducting asceptic deliveries. Lambadis of Karnataka, Parayar, Vannan of Kerala are a few among these communities.

Traditional Bonesetters

The second largest group of the folk practitioners are the traditional bone setters who take care of sprains, dislocations, simple to complex fractures, mal union. Guesstimates suggest that a high rate, about 60 per cent of all bone fractures are managed by this group. These people know the skills of reduction and immobilisation. They also use locally available plant material. The resources thay use are comparatively lesser than the other branches of traditional healing specialities. This includes bamboo for splints, egg, black gram, oil and few plants. Some traditional bonesetters have well-established traditional clinics in urban areas.

Visha vaidyas who treat poisonous bites

The visha vaidyas are the third largest group among folk healers. They are estimated to be 60,000 in number. They treat all kinds of poisonous bites like bite of krait, viper, cobra, scorpion bite, rat bites, dog bites, spider poisons etc. Their diagnostic and treatment techniques are crucial in the management of poisonous bites. Diagnostic and prognostic techniques include naadi (pulse reading), colour of the skin, movements of the eyes, expressions of the patient and even the expressions and gestures of the person who come to call the physician (dhootha lakshana in Tamil and Malayalam). The treatment includes purgation, antidotes and specific plants that have anti-poison effect. Through the available literature survey, it is estimated that there are 427 plant species used in the treatment of poisonous bites in local health traditions.

The service rendered by this field is imense because there is no reference in modern science related to herbal cure for poisonous bites. In the Indian health scenario it is estimated that there are 4000 deaths occurring in India annually due to poisonous bites. This are requires immediate attention for further research so that the service rendered from this tradition could be utilised in a large way.

Mriga vaidya

The mriga vaidyas manage conditions like broken bones of the animals, delivery, neurological problems, gastrointestinal disorders, cold, fever, jaundice etc. The domination of this category is more in the areas of northern Karnataka - Chitradurga district due to extensive livestock farming and agriculture.

The general practitioners

The healers deal with gynaecological conditions, paediatric disorders, eye disorders and also spiritual curing. The kannu vaidyas of Alagaapuram village are not only famous in the Villuppuram district but also in different parts of Tamil Nadu. These traditional kannu vaidyas (eye physicians) treat eye disorders and even perform cataract surgeries.

There is some tradition, which forms the characteristics of a particular community. This in turn is related to their lifestyle, occupations etc. The Irulas of Kerala - snake charmers have good antidotes for snake bites and other poisonous bites. The Navidhars of Tamil Nadu - the barbers take care of skin disorders. The Gollas and Kurubas of Chitradurga - the shepherds community take care of veterinary problem. The Lambadis of Karnataka are nomadic tribes who take care of delivery, ante-natal and post-natal care.

Nature's support

In local health tradition systems, spices, raw drugs, fruits, vegetables and weeds are also used. All parts of the plant have some use. It can be the root, stem, leaf, stamens and pistils. In the neem plant, the root and stem are used for fever, leaves for fever, flower for malaria, oil from seeds to destroy lice. There are also many plants used for the same conditions - keelanelli, manjal karisalangannifor jaundice, tulasi, neem, ginger, shaaitan, pepper, periayanangai for fever.

According to the All India Co-ordinated Project on Ethno-biology about 7500 wild plants are used for medicinal purpose by tribes and 950 are found to be new claims and are worthy of scientific scrutiny. The animals and animal products are also used in this stream of health care, 76 species of animals have proved to be the vital source of tribal medicine. Most of these resources are obtained from the forest, markets, gardens and kitchens.

Tribal communities not only know the usefulness of the resource but also conserve them by suitable management tools. They take care not to pluck the premature plant or do not harvest off season or do not harvest if there is sparse growth of the plant species. The Purali tribes restrict premature tapping of gum and resin from young plants. They avoid tapping more than twenty plants at a time.

The classification to identify plants/animal or others based on their observation of morphology or actions is interesting. Place of occurrence - There is a plant that grows in marshy area called neer (water) brahmi. Scientifically called Bacopa monneri, it is used as a brain tonic. Based on the activity of the resources: Certain plants are named based on their action. Sackarai kolli (Tamil) "killer of sweet" (Gymnema sylvestre) is used to cure diabetes. The brain shaped leaves of Centella asiatica is used as brain tonic. Use of touch-me-not plant (Mimosa pudica) is used to stop uterine bleeding.

There is a personal relationship between the physician and the patient. The system has a holistic approach towards health care. The traditional healers place much importance on values and not many really practise for monetary gain. The teacher is a very strict disciplinarian while transferring knowledge and skills. They have strict code of ethics and criteria to select the disciple. This is based on the socio-cultural background. In some cases they accept kanikkae (a kind of offering) and start teaching the ward after a strict routine of prayers before and during the course of studies.

The loss of local health traditions will be a monumental loss to the world and particularly to rural communities because with the erosion of local health traditions one is losing the time-tested medical knowledge of plants, animals and minerals; It is necessary to act urgently in order to save our health traditions which form an important facet of the Indian medical heritage.