Traditionel sydindisk lægekunst i området omkring Tranquebar

Kenneth G. Zysk, Ph.d, Dr. Phil, Institut for tværkulturelle og regionale studier, afdeling for Asien studier, Københavns universitet

• Projektet er finansieret af Bikubenfonden og har plads på Galathea3 ekspeditionen.

Dette projekt vil fokusere på den Indiske Siddha – lægevidenskabs historie og udvikling i Tamil Nadu og dens forhold til Ayurveda – lægevidenskaben.

Før muslimerne kom i det 10 århundrede e. kr., eksisterede der to fremherskende former for lægekunst i Indien: Ayuveda i Nordindien samt det centrale Indien og dele af Kerala i syd, og Siddha som hovedsageligt er fra Tamil Nadu. Begge har lange historier og bliver stadig praktiseret i deres respektive Indiske regioner.

Meget er skrevet omkring historien, udviklingen og praktiseringen af Ayurveda både på sanskrit og på hindi. Meget lidt vides derimod om Siddha fordi dens skrevne historie er begrænset og fordi viden om Siddah er blevet mundtligt overleveret fra lærer til student.

Ayurveda bruger balancen fra tre basale kropsvæsker til at diagnosticere: luft, galde og slim. Balancen bliver genoprettet og vedligeholdt ved en kombination af urter, mineraler, livsstil og til tider kirurgi. Siddha bruger derimod andre former for årsagslære, inklusiv puls- diagnosticering med flere. Kuren skabes primært af et system af medicinsk alkymi. Begge systemer hviler på en fundamental forståelse af forholdet imellem mennesker og deres miljø.

Tranquebar i Tamil Nadu er perfekt til undersøgelser i den Sydindiske tradition af Siddha.

Der findes allerede optegnelser, der detaljeret beretter om mødet mellem Siddha og dens praktiserende og de danske læger, som var tilknyttet Tranquebar. Ved at bruge denne information som udgangspunkt i disse informationer, vil et detaljeret studium af  medicinens historie og praksis, samt den indflydelse den havde på både den vestlige medicin og på Ayurveda, blive gennemført.

Dette projekt vil arbejde tæt sammen med andre af initiativets projekter og vil involvere forskere og meddelere fra Indien, som vil sikre dataenes nøjagtighed og forskernes høje standart.

Traditional South Indian Medicine Surrounding Tranquebar

Kenneth G. Zysk, Ph.D, Dr. Phil, Institute for Cross-Cultural and Regional Studies,  Department of Asian Studies, University of Copenhagen

The Project is Financed by Bikuben Foundation and i is Part of the Galathea3 expedition.

This project focuses on the history and development of Siddha medicine in Tamil Nadu and its relationship to Ayurveda

Before the coming of the Muslims in the tenth century A.D., two predominant forms of medicine existed in India: Ayurveda in the north, central, and parts of Kerala in the south, and Siddha principally in Tamilnadu. Both have long histories and are still practised in their respective regions of India. Much has been written about the history, development, and practice of Ayurveda in Sanskrit and Hindi. Comparatively less is known about Siddha because its literary history is meagre, and knowledge of Siddha has been passed down via oral tradition from teacher to student. 

Ayurveda uses the unbalance of three basic bodily humours: wind, bile, and phlegm to diagnose disease. Balance is restored and maintained by means of a combination of herbs, minerals, life-style, and sometimes surgery. Siddha medicine, on the other hand, uses other forms of aetiology, including, among others, pulse-diagnosis, to diagnose illness. Cure is brought about primarily by a system of medical alchemy. Both systems rely on a fundamental understanding of the relationship between human-beings and their environment.

Tranquebar in Tamil Nadu is ideally situated for research into the South Indian traditions of Siddha medicine. Records already exist, which detail the encounters between Siddha medicine and Danish doctors attached to Tranquebar. Using this information as the point of departure, a comprehensive study of the history and practice of Siddha medicine and its influence on and by both western medicine and Ayurveda will be undertaken.

This project will work closely with other projects of the Tranquebar Initiative. In addition, the project will involve researchers and informants from India to assure the accuracy of the data and the high standard of the research.

Kenneth G. Zysk, Ph.D, Dr. phil.

Institut for tværkulturelle og regionale studier

Afdeling for Asien studier,

leifsgade 33, 5,

2300 København S,

E-Mail: zysk@hum.ku.dk

Lektor i Indiologi, afdeling for Asien studier, ved institut for tværkulturelle og regionale studier ved Københavns universitet.

Hovedområder: Sanskrit, mellem-indisk sprog og litteratur, det pre-moderne Indiens historie.

Hovedforskning: Indisk medicin og medicinsk historie, den Indiske fysiogonomiks historie, kiromanti, Indisk intellektuel historie gennem dens overlevende litterære kulturarv.

First report from India

By Kenneth Zysk

I arrived in India early morning on 13 January 2007. The air was a balmy 25º, but not heavy with humidity, as this is considered to be the cool and dry season in the southern state of Tamilnadu. The drive to the former French colony of Pondicherry took two-and- half hours until I reached the front gate of the colonial style French Institute of Indian Studies on Rue Saint Louis. The French Institute will be hosting me for the period of my research on the traditional Indian medicine surrounding Tranquebar. The room provided me in the guest-house is Spartan, but is equipped with warm water, a working air conditioner, and most importantly, a DSL line to connect to the internet.

After a brief rest, later that morning I was introduced to the head of team working on Siddha medicine in southern India, Dr. Brigitte Sebastia, with whom I had am immediate rapport. Dr. Sebastia is a middle-aged lady, who left her position as a chemist in a biological laboratory in France to return to school for doctorial studies, and has been doing post-doctorial work at the Institute for the past several years. She is accompanied by her husband Christian, who is retired. As a team, she, doing the field work, and he, doing the photography, the two Sabastias have managed to produce a rich storehouse of documentation on Siddha medicine and medical practice in Tamilnadu in the form of interviews, films, and photographs, which they have kindly put at my disposal.

Two days after my arrival in Pondicherry, I travelled to Kerala on the west coast of southern India, where I presented a paper at the “International Seminar on the Textual Tradition of Ayurveda” in the small village of Kalady, famous for the birthplace of the famous Indian philosopher, Sankaracarya. We were hosted by the Shree Sankaracarya University of Sanskrit and were house in the Guest House of the monastery of the Hindu temple devoted to Sankaracarya, deemed to be “the holiest place in the world”.

While attending the seminar, which lasted a full five days, I was able to meet and speak with a remarkable group of healers who belong to the caste of Nambudiri Brahmins and are skilled in the treatment of snake bites and poisons. They belong to the tradition of Vishavaidya or “Poison-doctors,” which has a textual tradition in Sanskrit attached to it. Although the texts of the tradition are very recent, dating from about the 17^th century A.D., the epistemological basis of the system is purely Ayurveda and the medicines include alchemical preparations similar to those found in Siddha medicine. This remarkable fact indicates that Vishavaidya, in Kerala, like Siddha medicine in Tamilnadu, was first an indigenous form of healing, transmitted from one generation of healers to the other by word of mouth, until the received the theoretical frame work of the three bodily humours or doshas, wind, bile, and phlegm, from the by then Brahminical system of Ayurveda. From about the 17^th century, both Siddha medicine and Vishavaidya developed as practical tradition of healing with ongoing texts in Sanskrit, Malayalam, and Tamil in South India.

“Health tourism” in Kerala

By Kenneth Zysk

Another important medically important discovery that came from my visit to Kerala was the explosive growth of what people call “health tourism” that has taken place over the past five to seven years.

 When I first came to Kerala in 1991, I could count the number of resorts offering a form of Ayurvedic rejuvenation therapy on one hand. In 2007, the numbers of increased exponentially. Each one is trying to out do the other to attract cliental from the west, primary Europe. They have been quite successful, especially people from Germany and Austria, where a long tradition of spas and healing baths has existed for centuries. They are lured by glossy brochures, well-produced CDs, and a sales pitch that claims that Ayurveda is the “world’s oldest system of healing and revitalising the body.”

When these health-seeking Europeans arrive at the Ayurveda health resorts, they find the accommodations quite to their liking, but the professional care is something else. Being accustomed to a very high level of professional treatment, they find to their great dismay that the level of care and treatment given by the Ayurvedic practitioners and health-care workers is quite inadequate, so that many of the European visitors return home worse that when they started. This serves as a word of caution to those who might be tempted to visit an Ayurvedic spa in India. Investigate the level of professional care before signing up for a session.

The phenomenon of “health tourism” has not yet found its way to Tamilnadu and the Siddha tradition, but many predict that it is just around the corner.

Fortune-telling in Pondicherry

By Kenneth Zysk

Today, Friday the 26^th of January is Republic Day in India and a holiday for the Indian workers. Women are dressed in their finest sarees and are accompanied by their husbands and family to spend a leisurely day by the seashore, where the air is cool and fresh. One vendor of every type mingles with the crowd, selling ice cream, snacks, and whistles for the kids. There is even a fortune-teller, who has taken the opportunity of a large gathering of people to make a little extra by reading peoples’ palms and telling them about their future for a mere sum of 20 rupees, which is less than 3 kr. The atmosphere is festive and the people are happy to be out with their families on a splendid afternoon in Pondicherry.

The fortune-telling woman belongs to the Lambadi caste in Pondicherry and practises a form of divination that has a long tradition in India, known as physiognomy or Samudrikashastra in Sanskrit. Dating from before the 6^th century A.D., fortune-telling by means of the examining the marks on the human body was used for two specific purposes:

1. to determine the right of succession of kings and noblemen, which is akin to the process involved in succession of Dalai Lamas in Tibet, and

2. to determine a suitable match in arranged marriages.

The process involved the examination of human body from the toes to the top of the head and included the reading of the lines on palms and soles, as well as on the forehead and neck. In all cases of palmistry, the woman’s left hand and the man’s right hand are used, as in the photo. This form of physiognomy seems to have been most prevalent in western India, but is encountered all over India. It may well have had it origins among the nomadic Romany of Gujarat and Rajasthan, where the knowledge was passed on from generation to generation by word of mouth.

Physiognomy came to Europe via the Romany or Gypsies in the Middle Ages and was taken up by the medical profession as means of diagnosis and prognosis. It surfaced again in the late 19th and early 20^th centuries in the form of Phrenology. In India, it never found a place in the traditional forms of medicine, Ayurveda, Siddha, and Unani.

Kenneth Zysk

11 April 2007

Akattiya and the origins of Siddha medicine in Tamilnadu

By Kenneth Zysk

Research into Citta (Skt. Siddha) medicine in Tamilnadu has revealed certain problems which must be overcome in order to properly understand this medical system and its history. The central problem lies with the reliability of the secondary sources, which are written primarily by Tamil Citta doctors. Very little scholarship on the subject has been carried out by western students and scholars of India and Indian medicine.

Due to the increased awareness of Tamil’s uniqueness over the past decades, a strong nationalist movement has grown up in Tamilnadu. Tamilians consider their cultural and linguistic heritage to be older and more important than the Indo-Aryans to the north; some even claim their ancestors were the first civilised humans on the planet. The fire of this controversy has recently been kindled by a debate centring on the still-to-be-deciphered script of the so-called Indus Valley Civilisation. This ancient urban culture, which extended along the Indus River and it tributaries in what is now Pakistan, resembled the great civilisations of ancient Egypt and Mesopotamia in size, development and age. One side of the debate maintains that the script represents a language probably of Dravidian origin, while the other side claims that it does not represent a language at all. Tamilians, whose language is Dravidian, are anxiously following the debate, for if the former side prevails, it would confirm their antiquity on the Indian subcontinent. The lens through which Tamilians look at their own history will always distort the image in favour of Tamil superiority and antiquity.

The mythical figure of Akattiya is known in Tamilnadu as the founder of both the Tamil language and Citta medicine. Through Akattiya Tamil language and medicine have become the two pillars supporting the edifice of Tamil identity. For most Tamilians, Citta medicine has been a part of Tamil culture and civilisation from beginning of time. The historical records, however, reveal a different story.

Based on linguistic evidence from surviving Tamil texts, best estimates place the origin of the system medicine now known as Citta at no earlier than the 16^th century C.E. Most of these texts, written on palm leaves, are no older than 250 years, since the climatic conditions and prevalence of insects hasten the deterioration of the delicate palm leaves. Moreover, the content of these texts indicate that Citta medicine borrowed ideas and techniques from both Ayurveda in the form of a humour-based aetiology and the Arabic-based Unani medicine in the form of diagnosis by examination of the patient’s pulse and urine. Although the origin of Citta’s alchemical medicine remains a mystery, its technique of Varma-massage, entailing a type of acupressure at select points on the body, and its method of bone-setting represent probably two of the most indigenous parts of the medical system. More on the characteristics of Citta follow in further letters from India.

The Principles of Disease and Diagnosis in Citta Medicine

By Kenneth Zysk

When residents of Tranquebar succumbed to illness or injury in the eighteenth century, they first sought help from one of the settlement’s colonial surgeons or doctors. However, if their affliction was not abated by the medicine available to them, they might well have looked for relief from an indigenous healer, who would have practised Citta medicine. The patient would have been treated in a different manner from that to which he or she was accustomed.

In all likelihood, the Citta doctor would have examined specific aspects of the patient to determine which humour or humours were vitiated or disturbed. According to Citta, as well as Ayurveda, the five elements that make up all matter combine to form the three humours in the body: wind and ether become wind, fire becomes bile, and earth and water become phlegm. Wind is responsible for nervous actions, movement, activity, sensations, etc, and resides in the five bodily winds; bile takes care of metabolism, digestion, assimilation, warmth, etc, and sits in the digestive track; and phlegm helps to give the body stability and resides in the chest, throat, head, and joints. Although wind predominates in youth and phlegm in old age, which is the exact opposite of Ayurveda, each individual is born with a particular configuration of the three, which is called the person’s innate or natural distribution of the three humours. A similar form of humoural medicine, derived from Greco-Roman medicine, would have been known but not practised by the Tranquebar doctors.

The Citta doctor would first determine the patient’s natural distribution from which he could determine which of the humours were affected. He would usually use examination of the pulse as the principle means to evaluate both the natural and the disturbed humoural condition. Afterwards, he might use a series of other tests to pin-point the exact problem. This procedure involves an examination of the patient’s tongue, complexion, voice, eyes, skin, stool, and urine in order to notice any abnormal colour, texture, and tone.

The predominant mode of diagnosis, however, involves examination of the pulse, which is felt on the female’s left and the male’s right hand by the doctor’s opposite hand, a couple of centimetres below the wrist-joint using the index, middle, and ring fingers of the hand. Pressure is applied by one finger after the other beginning with the index finger. Each finger represents a particular humour which in normal conditions has a movement representative of certain animals. The index finger feels the windy humour, which should have the movement of a swan, cock, or peacock; the middle finger feels the bilious humour, which should have the movement of a tortoise or a leach; and the ring finger feels the phlegmatic humour, which should have the movement of a frog or a snake. Any deviation from these basic movements indicates which humour or humours are disturbed. If all humours are affected the pulse is usually rapid with a good deal more volume.

As a backup, the Citta doctor would use the method of urine examination, which derives from the Arabic and Persian medical system of Unani. In addition to examining urine for its colour, smell, and texture, Citta medicine has developed a unique technique for determining the vitiated humour by reading the distribution of a drop of gingili (sesame) oil added to the urine.  A longitudinal dispersal indicates the windy humour; dispersal in the form of a ring points to the bilious humour; and lack of dispersal indicates the phlegmatic humour.

After having undergone one, several, or all of these diagnostic procedures, the Tranquebar resident would have been given the results in terms of the vitiation of the humours, and would be prescribed a particular form of therapy. In the next report, we shall discuss the Citta cures by which the resident might have been treated.

The Principles of Treatment in Citta Medicine

By Kenneth Zysk

Now that the Tranquebar patient has been properly diagnosed according to the system of the three humours, treatment can begin. Since Citta medicine maintains the basic principle that cure involves not only the removal of disease but also the prolongation of life, the treatment would have unfolded in a series of steps over a long period of time.

First the patient would have been prepared to receive the medicine by means of purifying the body with purgation and enemas using various herbs appropriate to the patient and cleansing the patient’s skin by applying a medicated body-paste containing, among other herbs, turmeric. The purification of the body could have taken up to a week or more depending on the illness. After having been cleansed, the patient was ready to receive the medicine especially prepared for the case by the Citta doctor. Although herbal preparations were often used, the treatment would in all likelihood have involved a combination of plant-based medicines and alchemical drugs which included mercury along with other metals or minerals. Because of the strength of such drugs, the patient would have been given the medicine in small doses over an extended period of time, and might have eventually been taught some basic yogic breathing exercises to help keep the body strong and extend the patient’s life-time.

Central to Citta medicine is the making and use of alchemical medicines. It is precisely the metal- and mineral-based drugs that encouraged the Danish surgeon TLF Folly, who was stationed in Tranquebar in the latter part of the 18^th century, to carry out research into Citta alchemy. The use of mercury in the treatment of syphilis was known in Europe from the time of Paracelsus in the 16^th century; and Folly was interested to learn the alchemical formulas of Citta medicine in order to treat the Tranquebar soldiers who had been afflicted with syphilis.

Like the traditions in Europe, the Middle East and China, the esoteric science of alchemy in Tamilnadu involves the transmutation of base metals, such a copper, into gold. Hence it remains very much a secret art passed on from teacher to student. Citta medicine, however, is not for making gold. Rather, its main concern lies in the sustaining of life, so it developed a special form of medical alchemy.

Alchemy in Citta Medicine

By Kenneth Zysk

The elaborate process of preparing alchemical medicines requires special esoteric knowledge. The alchemist has to know which plant products to use and which metals fit together as an alkaline and an acid to produce a medicine that in the end will be stronger than the sum of its parts. 

Before any metal or mineral can be used as a medicine, it first has to be purified and detoxified by an elaborate process. First, powerful herbs are used to “kill” the innate toxicity of the inorganic substance. The next step involves the combination of the metal with its appropriate acid or alkaline. The metal or mineral is now ready for its final transformation into an ash or “bhasman” by incineration in special furnaces made of cow-dung cakes. As a final step, a special, secret salt, called muppu, is added. The salt is particular to Citta medicine and serves as Citta’s equivalent of the “philosopher’s stone.” It gives the medicine its special strength. The calcinated metal or mineral is now suitable to be used as an internal medicinal, which would have been given to the patient through a palatable medium such as honey.  Mercury, the central element in Citta’s medical alchemy is considered to be alkaline, so it is combined with the acidic sulphur in the same way that goddess Shakti is mated with god Shiva.

The esoteric substance muppu is clouded in mystery. Literally, it means the “three salts,” i.e., pooneeru, kallupu, and vediyuppu, which correspond respectively to the sun, moon, and fire. Although their exact identification is an issue of much discussion, a reliable source explains that pooneeru is a certain kind of limestone composed of globules that are found underneath Fuller’s Earth. It is collected only on a full-moon night in April, when it is said to bubble out from the limestone, and is then purified with a special herb. Kallupu is hard salt or stone salt, i.e., rock salt, which is dug up from mines under the earth, or is obtained from saline deposits under the sea, or it can be gathered from the froth of sea water, which carries the undersea salt. It is considered to be useful in consolidating mercury and other metals. Finally, Vediyuppu is potassium nitrate, which is cleaned seven times and purified with alum.

If the illness was severe, the Tranquebar patient would have been expected to undergo treatment for a considerably long period, months, even years, until the cure was complete and the bodily humours restored to their appropriate seats. The follow-up therapy would have then involved the maintenance of the healthy body and mind by the periodic use of alchemical medicines and the practice of yogic breathing exercises.

Citta Surgery: Varman-therapy

By Kenneth Zysk

If the Tranquebar-patient would have suffered from an injury to body or limb, conventional forms of surgery would not have been performed by the Citta practitioner. The Citta treatment for such injuries would have likely involved an indigenous form of bone-setting particular to the southern part of Tamilnadu or a type of acupressure, called varman-therapy, which developed in close association with the martial arts in the modern state of Kerala, where warriors where taught the varman or vulnerable points on the body in order to disable their enemies.

The number of important varmam (Skt. marman)-points is said to be 108 (some say 107) out of a total of 400. Indigenous healers developed techniques of applying pressure to these points in order to aide patients suffering from debilitations of the body and limbs, remove pain, and cure a variety of other ailments. Already in the early Ayurvedic treatises 108 marman-points are mentioned. It is therefore likely the identification of the different varmam/marman-points derived from the tradition of Ayurveda, but the techniques for massaging these points to promote healing developed among the indigenous tribes of Kerala and Tamilnadu.

It is a common practice for indigenous healers from one region to travel to other regions in order to learn new techniques of healing, so that over the course of time, indigenous forms of healing were incorporated with parts of other medical systems to become what is today called Citta medicine. Citta/Siddha medicine as it practised today in Tamilnadu represents a blending of Ayurveda, Unani, and indigenous forms of healing.

This series of reports has provided but a glimpse of the rich tradition of Citta medicine which was available to the residents of 18^th century Tranquebar. To date, we don’t know how many, or indeed, if any Danes would have chosen to utilise this form of Indian medicine. Perhaps we will never know. The records show that at least one Danish doctor, Dr Folly, was impressed enough with Citta’s alchemy to undertake research into it. The ongoing research on various aspects of the former Danish colony under the National Museum’s “Tranquebar Initiative” will surely reveal more information about Citta medicine around Tranquebar.