Paths Straight and Crooked to Indian Medical Knowledge

[Full title: Review Article / Paths Straight and Crooked to Indian Medical Knowledge / By Rahul Peter Das]

The contents of this book consist mostly of papers first presented at a conference on 'Permanence and Change in Asian Medical Systems', part of the 1985 meeting of the American Anthropological Association in Washington. Some of the contributions were subsequently published in journals and books and are presented here in a revised form, while other contributions have been printed for the first time. In their introduction, the editors write that 'these essays have been selected to focus on a particular set of interests: the sources and modalities of medical knowledge' (pp.13 f.). The collection is divided into three parts: 'Chinese Medicine, Cosmopolitan Medicine, and Other Traditions in East Asia', 'Ayurveda, Cosmopolitan Medicine, and Other Traditions in South Asia', and 'Islamic Humoral Traditions'.¹ Because of its being beyond the abilities of this reviewer to comment on the other two parts, and also because of the particular focus of this journal, this review will be confined to the second part, on medicine in South Asia. The first essay in this section, Margaret Trawick's 'Death and Nurturance in Indian Systems of Healing' (pp. 129-159), gives rise to rather mixed feelings. Its title is a misnomer, and a further example of a disturbing tendency found in many modern studies, particularly, but not only, of North American scholars with sociological, anthropological or A Review of: Paths to Asian Medical Knowledge. Edited by Charles Leslie and Allan Young. University of California Press: Berkeley/Los Angeles/Oxford 1992. (Comparative Studies of Health Systems and Medical Care [32].) ISBN 0-520-07317-7 (hardcover) and 0-520-07318-5 (paperback). x;296 pp. 1 The terms 'cosmopolitan medicine' and 'biomedicine', used synonymously in this work, describe what is variously known as 'Western', 'scientific' and 'modern' medicine, labels which are today considered unsatisfactory by many. Note also Leslie's remark on p.6 that 'perhaps "cosmopolitan medicine" can be retained as a synonym of biomedicine when an author wants the connotation that the ideology and institutional forms of biomedicine are part of the capitalist world-system.'

(even R.P. Das, Paths Straight and Crooked...o 197 ethnological leanings, of an attempt to inflate the evidence of their research: data collected from a circumscribed, often rather small, area is uncritically taken to be representative of a much larger area, as is evident from various titles of studies on 'India' or 'South Asia' which actually give us data from only certain parts of this, very often from only a few villages and sometimes even from one single village. In this case too, the data collected by Trawick comes only from some parts of Tamil Nadu, and cannot serve as evidence for what the title of the study promises. Actually, what Trawick here presents us with is a study of the interaction and at times antagonism of four different systems, of relevance to what we tend to call 'medicine', in the area under study, with particular regard to how they cope with illness and death. The uncritical projection of data from this circumscribed sphere onto one larger has led to some methodical errors. Trawick seems to be unaware of the fact that 'Ayurveda' is no registered trade mark and as such can be used by different groups or individuals in very different senses. Thus what she presents here as 'Ayurveda', with no further qualification, is clearly not what the classical Indologist dealing with the Vrddhatrayi deals with; though both systems are obviously linked, they are not the same, and thus the one cannot simply - and naively - be taken uncritically to explain the other. This is already clear from the very first page of Trawick's essay, where she says, seemingly without even being aware of the discrepancy to the "classical" texts of the Vrddhatrayi, that Ayurveda 'is said to have been originally given to humanity by Siva' (p.129). True, here she refers to 'modern Ayurveda', but even that does not make things better, for what she clearly means is not pan-Indian modern Ayurveda (whatever this vague entity may actually be), but a specific local variety, clearly influenced, as the mention of Siva shows, by South Indian Saivism and/or concepts of a pan-Indian nature from the realm of what is generally labelled 'Tantrism'.³ Similarly, she also makes no allowance for the efforts of modern practitioners consciously to seek links with the "classical" tradiSeemingly consulted by Trawick in the form of translations which are known not always to be reliable. 3 This is not to deny that some Ayurvedic texts, especially of a late date, show influence of what is called Tantrism (cf. e.g. note 6 on p.231 below), but such texts are not the rule.

tion, even though historically these may in actual fact be tenuous.4 On the other hand, Siddha medicine is treated more or less as an isolated phenomenon, though Trawick does, rather obliquely, hint at some doubts she entertains in this regard. She pays no attention to pan-Indian Siddha cults, which even extend well into Central Asia, to the many similarities the Tamil Siddha system seems to show with systems, usually called 'Tantric', in other parts of South Asia, and with Rasasastra and Yoga systems; she also does not take into account the fact that parts of the most basic vocabulary of Tamil Siddha medicine consist of Sanskrit expressions common to Ayurvedic works. In doing so, she seems unconsciously to have aligned herself to accord with the tenets of Tamil political correctness. Similarly, trance-healing through Mariyamman (also Mariyammai), the goddess of smallpox, is quite divorced from the wider background of similar goddesses in many parts of South Asia (one springing to mind at once being Sitala). Here too, as in the case of Siddha medicine, a pure Tamil background seems to be presupposed. However, as I have pointed out elsewhere, we cannot afford to neglect Sanskrit mari- (also mari-) "(wide-spread) killing/death; pestilence", which is also the name of (a) goddess(es) of pestilence and the like, and therefore should examine carefully whether the Tamil name of the goddess is not actually nothing 7 4 On problems such as those detailed here see e.g. Rahul Peter Das, 'On the Nature and Development of "Traditional Indian Medicine", Journal of the European Ayurvedic Society 3.1993, pp.56-71. See also the remarks on p.155,n.38 of Maarten Bode, 'Empirie en dogma in een Ayurvedische praktijk in Kathmandu. Een pleidooi voor verlicht etnocentrisme in de medische antropologie', Medische Antropologie 7.1995, pp.140-157. (Incidentally, Bode concludes on the basis of his data: 'Medisch antropologen moeten, uit angst om van etnocentrisme te worden beticht, niet-westers medisch handelen niet bij voorbaat legitimeren. Verlicht etnocentrisme behoedt niet-westers medisch handelen voor de wurgende omhelzing van het voorbarig begrip.') 5 P.131: 'Basing their arguments on this body of poetry, proponents of Tamil ethnic pride claim Siddha medicine as a distinctly Tamil medical system, set apart from Ayurveda.' 6 A very recommendable recent study on the Tamil Siddhas, by a Tamil scholar who, striving for objectivity, has refused to toe this line (and has hence come into the line of fire of Tamil chauvinists), is R. Venkatraman, A History of the Tamil Siddha Cult. Madurai 1990. 7 Indo-Iranian Journal 27.1984, p.324.

R.P. Das, Paths Straight and Crooked ... 8 199 but the Tamil form of the Sanskrit name, with 'Mother' (amman, ammai) added; indeed, Miron Winslow's Tamil-English dictionary presents us with this analysis unhesitatingly. In his essay in the work under review, Mark Nichter not only draws attention to the belief in Mari(yamman) (I am sticking to the Tamil form of the name) in South India outside the Tamil area, but also refers to her as a 'pan-Indian' deity (pp.235;238). Of course it would be extremely naive to assume that an ultimately Indo-Aryan name, should it indeed be proved to be present here, would automatically entail identicalness of character with North Indian goddesses too, but at the very least it would show points of connection and contact, whether actual or only supposed by those who first used this nomenclature, and should serve to make us be very careful in drawing conclusions and "interpreting" the data. In this context I may also point out that pre-colonial variolation (i.e. inoculation against smallpox) was not, as p.132 seems to assume, something special to the Tamil region. In fact, it was in vogue not only in many other parts of South Asia, but also in other parts of the Orient; the technique was brought to Europe from Istanbul at the beginning of the eighteenth century. Since we cannot simply assume that in all those other areas variolation was associated with a smallpox goddess, and that, even in cases of association with a smallpox goddess, the notions pertaining to this were all the same, the speculations of Trawick that 'this practice was related to a religious ideology permitting the goddessmediated mingling of bodily fluids of people of different communities' (p.132), i.e. is in keeping with the 'defiance of caste and sexual hierarchies' (p.131) she associates with Mariyamman, is another example of a sweeping and in this case quite clearly misleading far-reaching consequences based on very meagre data. One could point out various other inaccuracies or unreflected statements throughout the essay, for instance on the nature of 'religion', or - - 9 statement with 8 All Trawick has to say on the name is, instead (p.154): 'Thus the name Mariamman, according to the medium, means "the changed mother." 9 Inoculation is not the same as vaccination. On vaccination in India see especially Dominik Wujastyk, "A Pious Fraud": The Indian claims for pre-Jennerian smallpox vaccination', Studies on Indian Medical History. Papers presented at the International Workshop on the Study of Indian Medicine held at the Wellcome Institute for the History of Medicine 2-4 September 1985. Edited by G. Jan Meulenbeld and Dominik Wujastyk. Groningen 1987 (Groningen Oriental Studies 2), pp.131-167.

on the philosophical background of "classical" Ayurvedic texts, but it does not seem necessary to go into such detail here, as I hope to have demonstrated sufficiently that its contents have to be taken not only cum grano salis, but with a largish lump of salt. Nevertheless, it offers us some very interesting data and also insights into how the three systems mentioned, as well as Tamil Saiva Bhakti, coexist in the area studied. One wishes that Trawick had given us more of such data, or else largely confined herself to presenting it, without plunging into giving interpretations and drawing conclusions based only on an imperfect realisation of the complex issues involved here. In 'Science, Experimentation, and Clinical Practice in Ayurveda' (pp.160-176), Gananath Obeyesekere examines how a modern Ayurvedic practitioner in Sri Lanka works, how he correlates his actions with the theories he subscribes to and traditions he has learnt, varying, adding and deleting, even against the tradition, according to the exigencies of the individual case, and also striving to find new paths when confronted with situations which his acquired knowledge actually does not envisage. According to Obeyesekere, this shows that not only this Ayurveda, a 'special kind of Ayurvedic practice that, I believe, took root in Sri Lanka among its more sophisticated physicians and the traditions they represented' (p.174), but Ayurveda in general is 'a science of medicine. And, like its Western counterpart, the development of a scientific attitude in Ayurveda presupposes either a demystification of magic, or its methodological isolation from clinical practice' (p.172),¹ evident especially in its acceptance of the principle of 'clinical falsification', in contrast to what he calls ritual curing (p.172)." This has led the editors to ask in their introduction to this part of the book (pp. 127 f.): 'But if this is so, what are we to make of the fact that publishing and studying case histories ... is a central path to knowledge in Chinese medicine, while this is not true for Ayurvedic literature?' 10 Charles Leslie, in his contribution entitled 'Interpretations of Illness: Syncretism in Modern Ayurveda' (pp. 177-208), first gives an overview of the historical development of the syncretism between Ayurveda 10 P.175 also refers to a 'special kind of empiricism that underlies much of Ayurveda'. 11 Interestingly, Ayurvedic practitioners interviewed by Trawick expressed similar opinions (pp.147-149).

R.P. Das, Paths Straight and Crooked... - 201 and 'cosmopolitan' (cf. note 1) medicine, especially of the struggle between advocates of the syncretistic form ('integrationists' in Leslie's terminology) and advocates of a "pure" Ayurveda. The former came especially from Bengal,12 but were also able to influence prominent South Indian practitioners, whereas the latter came especially from western and north-western India an antagonism found, I may add, in the spheres of religion and politics too. The development of a syncretistic tradition and the prominent role practitioners from Bengal played in it has, incidentally, already been duly noted by Arion Rosu¹³ (to whom Leslie unfortunately does not refer). After this historical outline, Leslie gives examples to show how medical syncretism and pluralism work in practice. 13 In 'Gentle Purge: The Flower Power of Ayurveda' (pp.209-223), Francis Zimmermann takes issue with the notion that Ayurveda is somehow a 'nonviolent' form of treatment and as such more 'natural' than what he calls 'modern scientific' medicine. Zimmermann highlights the ideological underpinnings of these notions, both in India and the West, and pays special attention to modern Western ideologies that serve as a vehicle for the propagation of such notions outside South Asia. 14 As the editors put it: 'Zimmermann traces the consequences of commodification as Ayurvedic companies and sanatoria modify theories and practices to exploit a market for alternative forms of health care' (p.128). In this connexion he also draws attention to the role of the 12 This is not surprising, given the intense contact between Indian and European culture in this region, which was until the early part of this century the nerve centre of British India; the development paralleled that in other walks of life. 13 'Le renouveau contemporain de l'Ayurveda', Wiener Zeitschrift fur die Kunde Sudasiens und Archiv fur indische Philosophie 26.1982, pp.59-82. On the "professionalisation" of Ayurveda see also Ronald Kaiser, Die Professionalisierung der ayurvedischen Medizin und deren Rolle im indischen Medizinpluralismus. Bonn 1992 (Kolner Ethnologische Arbeitspapiere 3). 14 'This modern version of Ayurveda appeals to an ideal also shared by environmentalists in which the soft, the gentle, the harmless, the cool, the refreshing, and the natural are qualities rooted in the soil, in the cycle of the seasons (which is praised as manifesting spiritual values that elude an economic calculus), and inscribed in the fabric of life itself, that is, in the vital fluids of humoral physiology. Nonviolence is thus akin to humoralism. Far from being obsolete, the humoral concept of temperamental fluid is revived in our modern partiality for environmentalism and holistic medicine' (p.209).

Transcendental Meditation movement of Maharishi Mahesh Yogi, which has recently been scrutinised extremely critically in this journal. 15 This image of 'nonviolence' is according to Zimmermann projected especially through the abandonment of the important traditional practice of often quite violent evacuation (such evacuation being an important pillar of "classical" Ayurveda), and by changing the accompanying theory: 'Only recently, under the influence of Western anatomical thinking, the Hindu fluid conception of the human person which pervades Ayurveda gave way to a Western concept of physical therapy in which the solid parts of the body play the title role' (p.212). The case Zimmermann presents seems convincing. Subsequently, however, he adds what is basically an appendix: 'Operative Medicine in the Indo-European Triad' (pp.218 ff.). His main thesis here is developed first by a reference to 'the ideal synthesis', exemplified in the Latin work of Celsus, who draws attention to similar Greek notions, 'of medical knowledge, in which dietetics, pharmaceutics, and surgery represented three therapeutical methods for one and the same art. This is no news to medical historians in the West. What has remained unnoticed, however, is that the very same division appears in Ayurvedic Sanskrit texts. The trifunctional division of medicine is common to both Greece and India' (p.218). Ultimately, this division is traced back to Indo-European times. Zimmermann adduces Carakasamhita, Vimanasthana 7,14 f. and Astangasangraha, Sutrasthana 12,3 f.16 as evidence for his claim on Ayurvedic Sanskrit texts made above. However, not only are these passages problematic, but their relation to the postulated trifunctional division too is debatable. The Astangasangraha passage at first seems clear enough: therapeutics (ausadha-) is of three kinds. But the actual nomenclature in the subsequent list is problematic, for, though the first member, namely extraction (apakarsana-), and the last member, namely avoidance of the causes (nidanatyaga-), are clear, the second member of the list is not. Zimmermann has prakrtivighata-, which he translates as 15 Dieter von Schmadel, 'Ayurveda - FortQuo vadis? Maharishi Ayur-Veda schritt oder Sackgasse?', Journal of the European Ayurvedic Society 3.1993, pp.229-249. 16 In the edition he used. The edition used by me (of the Sutrasthana by Govardhanasharma Chhanganee, Varanasi 71991 <The Kashi Sanskrit Series 157>) has the text on p.138.

R.P. Das, Paths Straight and Crooked... 203 'dissolution of the basic factor' (p.219). The edition used by me, however, reads prakrtividhana- 'measures according to the nature [of the individual at the time]', and in the given context this too makes eminent sense. But a variant has prakrtivighate (in the place of prakrtividhanam); since m and superscribed e, dh and gh, and n and t can be confused in several Indian scripts, it is difficult to reach a conclusion regarding the correct reading here. True, the Carakasamhita passage has prakrtivighata-, and the edition of this text I used does not give any variants, but I would hesitate to determine on this ground alone the reading of the Astangasangraha passage without further close examination of the readings of both texts. Nevertheless, it is clear that both passages are related in their terminology and basically in their explanation of this, though the latter passage brings in subdivisions of each of the members of the list which the former passage does not know. But that is where the similarities end, for, whereas the Astangasangraha passage remarks on therapeutics in general, the Carakasamhita passage expressly applies its division only to the therapy of internal parasites. What is even more important is that the Astangasangraha passage gives us the division cited as an alternative for another three-fold division of therapeutics, namely the well-known division of ausadha- into daivavyapasraya-, yuktivyapasraya- and sattvavajaya-.17 But the passage corresponding to this in the Carakasamhita, Sutrasthana 11,54 f. (i.e., in quite different a part of the text), knows nothing of the alternative division the Astangasangraha mentions; what we find there instead is, beside daivavyapasraya- etc., the following alternative division 18 (11,55): 'In the case of excitement of the morbific elements of the body, [the authorities] generally desire, as one knows, a threefold therapy having recourse to the body alone: internal purification, external purification and the application of instruments. With regard to that, internal purification is that therapy which, entering within the body, removes the illnesses arisen 17 Regarding these terms, I would like to draw attention to the debate I had with Eckard Wolz-Gottwald on the pages of this journal: Journal of the European Ayurvedic Society 2.1992, pp.158-187, and 3.1993, pp.305-318. 18 The commentator Cakrapanidatta: samprati prakarantarenopayuktam bhesajatraividhyam aha.

due to food. Again, that which, having recourse externally to the touch (i.e. organ of touch, the skin?), removes illnesses through inunction, sudation, poultices, affusions, massages etc., is external purification. And again, the application of instruments is cutting up/removing, cleaving/breaking, piercing, splitting, lancing, extirpation, scarification, stitching, probing, caustics and leeches.'19 It is most interesting to see that parts of this passage are to be found in the Astangasangraha passage cited by Zimmermann too. On the basis of this evidence, I cannot but gain the impression that what we have in the latter passage is an attempt at creating a new theory claiming general validity by combining different statements found in older texts and in other contexts. Now this is a review, and hence I cannot examine the matter in detail here, but can only state a first impression. Nevertheless, this alone should make us be wary of simply taking the passages cited as evidence of a tripartite division going back to Indo-European times. Moreover, the tripartite division Emile Benveniste and, following him, others postulated for Indo-European times is treatment with words, plants and the knife, a classification found in Iranian and in Greek and recently drawn attention to again by Ronald Eric Emmerick.20 Zimmermann simply links the division which he claims to be characteristic of Indian medicine to this division by saying that their evident disagreement is due to a sort of secularisation of the Indian system; in doing so he is very obviously also trying to link the tripartition of Celsus to both the Indo-European and the Indian division. This is done apodictically, and hence is methodically most unsound. I shall not complicate matters by trying to remark on the accuracy of Benveniste's theory on the tripartite division of medicine in IndoEuropean; Zimmermann simply accepts it, and so did I in an earlier 19 sariradosaprakope khalu sariram evasritya prayasas trividham ausadham icchanty antahparimarjanam bahihparimarjanam sastrapranidhanam ceti. tatrantahparimarjanam yad antah sariram anupravisyausadham aharajatavyadhin pramarsti. yat punar bahih spar- sam asrityabhyangasvedapradehaparisekonmardanadyair amayan pramarsti tad bahihparimarjanam. sastrapranidhanam punas chedanabhedanavyadhanadaranalekhanotpatanapracchanasivanaisanaksarajalaukasas ceti. 20 Pp.74 f. of 'Indo-Iranian Concepts of Disease and Cure', Journal of the European Ayurvedic Society 3.1993, pp.72-93.

R.P. Das, Paths Straight and Crooked... 205 article. 21 I must however point out that this theory has not gained acceptance in all quarters, or at least not without certain reservations.22 Moreover, attention should also be drawn to the fact that there was also a fourfold classification of therapeutics in India. 23 But these are relatively minor matters compared to what I consider to be a fundamental deficiency, namely Zimmermann's efforts to incorporate his tripartite division of therapeutics within the framework of Georges Dumezil's trifunctional division of Indo-European society without even pausing to consider the worth of Dumezil's theory. For it should be common knowledge that, though this theory is widely accepted (especially in France and North America), it is equally widely not accepted, but seen rather as a Procrustean fabrication whose aim is not so much to explain ancient society as to cope with problems perceived in the modern world through a biased interpretation of ancient times. 24 This is, of course, not the proper forum for a discussion of the merits or demerits of Dumezil's theory; my only intention in mentioning the matter here is to draw attention to the fact that the subject is controversial, and to append a plea that we as scholars should strive to view a subject from all angles, even if that should mean going against our convictions or playing the advocatus diaboli, and try to avoid falling in love with theories that appeal to us - love, as everyone knows, tends to be blind. The last essay in this part is Mark Nichter's 'Of Ticks, Kings, Spirits, and the Promise of Vaccines' (pp.224-253). It describes how 21 See Indo-Iranian Journal 27.1984, pp.235 f. 22 On this see Kenneth G. Zysk, 'Reflections on an Indo-European Healing Tradition', Perspectives on Indo-European Language, Culture and Religion. Studies in Honor of Edgar C. Polome. Volume II. McLean, Virginia 1992 (Journal of Indo-European Studies Monograph 9), pp.321-336. 23 Cf. loc.cit. in note 21, as well as p.310,n.49 of Albrecht Wezler, 'On the Quadruple Division of the Yogasastra, the Caturvyuhatva of the Cikitsasastra and the "Four Noble Truths" of the Buddha (Studies in the Patanjalayogasastravivarana II)', Indologica Taurinensia 12.1984, pp.289-337. 24 In this connexion cf. the scathing criticism of a German author I quoted in Journal of the American Oriental Society 111.1991, p.738,n.4. Attention may also be drawn to Zysk, who, while accepting Dumezil's theory, nevertheless writes: 'Mesmerised by the novelty of Indo-European tripartitism distracting the troubled minds of Paris intellectuals during the early 1940 s, Benveniste perhaps leapt too quickly to conclusions indicative of the tripartite ideology' (op.cit. in note 22, p.327).

25 26 Kyasanur forest disease spread in a Tulu speaking part of Karnataka due to deforestation preparatory to intensive plantation agriculture, and how the villagers attempted to cope with this deadly epidemic through the means not only of modern medical resources, both Ayurvedic and allopathic, but also of more traditional local methods such as the propitiation of spirits and other supernatural agents, as well as through other means. We learn how the spread of disease was explained as the result of multiple causes stemming from different systems of belief and treatment, i.e. how these explanations were syncretistic, in the same way as a large part of the treatment was. We also learn that often the choices leading to the rejection of one sort and the acceptance of another sort of treatment were made quite hard-headedly, though out of motives which modern Westerners might find hard to understand.2 Nichter also lets us know private practitioners' responses to the epidemic, paying special attention to one practitioner who seems to have played it by ear and thus managed to keep his treatment in line with the expectations of his patients and their beliefs, in the process gaining great respect and popularity (pp.243 f.). A side effect of the epidemic has been to promote local self-help groups and community activists who have also taken up environmental issues. 'Ritual activity in the region as a whole has also increased' (p.247); this is partly the result of a rediscovery, in the face of this crisis, of traditional beliefs and actions which social changes had already obliterated to a large extent. In the context of this revival, a misprint in a table of mortality statistics on p.227 could be taken to make rather macabre sense: 'Other cases reported not leading to morality'. 25 The parallels to similar developments in other spheres of South Asian life are too obvious to need comment. 26 Thus on p.241 we learn, for instance: 'In a context where the death rate inside the hospital appeared to be no lower than that outside the hospital, villagers debated the merits of sending the afflicted to the hospital against the demerits of having a family member die at the hospital. An unsatisfied spirit, preyta, caused by a bad death in hospital, is believed to trouble kinsmen. The need to appease such a spirit through expensive rituals would have to be weighed against the family's subsistence needs. Some families, after considering risk, decided against hospitalization. They looked beyond death to the well-being of the spirit and the family. The cultural concept of a good death is little appreciated by biomedical practitioners.' The last line is bound to strike a chord, though for quite different reasons, in many in the industrialised countries dissatisfied with the often inhumane artificial prolongation of life in their hospitals.