The Ayurvedic physician as scientist

.SOC.SC;. Med. Vol. 21. SO. II, pp. 1031-1050. Pnnted m Great Britain

1987

THE AYURVEDIC

0277-9536!87 53.00 + 0.00 Pergamon Journals Ltd

PHYSICIAN

AS SCIENTIST

MARGARET TRAWICK Hobart and William Smith Colleges, Geneva, NY 14456, U.S.A. Abstract-This paper is written in response to an article by Robin Horton in which Horton argues that ‘traditional’ systems of thought are relatively less open to external challenges than is modem scientific thought. Traditional systems of thought are (by definition) past-oriented; they consider truth to have been handed down from past sources and they are consensual rather than competitive in their attitude towards knowledge, Horton claims. Modem scientific thought is future-oriented; it is based upon an ideal of progress, and progress is attained through competition among rival theories or paradigms. According to Horton, the relatively greater openness of modem scientific epistemology accounts for the superior quality of the knowledge that modem science has acquired. In this paper it is argued that past-orientation is consistent with intellectual struggle and open competition among rival theories, as well as with openness to challenges from nature. Overall progressorientation is not a necessary correlate of these approaches to the acquisition of knowledge. The first part of the paper described the thought and practice of a South Indian Ayurvedic physician. Although this physician employed a mode of gathering knowledge which was based upon a belief that full truth could be found only in the past, he recognized the provisionaiity of the knowledge he had acquired, and he struggled to adjust his own body of medical theory to the battery of counter-theories which constantly challenged it. He did not ignore external challenges, nor was he unconscious of their effect upon his

thought. The second part of the paper illustrates this physician’s process of theory-development through analysis of the texts of two interviews that took place between the physician and patients who visited him.

Key w&s-Indian

medicine, Ayurveda, epistemology, rationality

I. ISTRODUCTION During the twentieth century, much crossfertilization has occurred between culture theory and the philosophy of science, and ideas expressed in one discipline have often mirrored ideas expressed in the other. Among the ideas shared by both disciplines are the idea of a teleological development of science (or culture) in the direction of greater mastery over (or adaptation to) nature [I]; the idea of the non-absolute character of the truth value of scientific paradigms or of cultural representations of reality [2]; the troublesomeness and creative potential, in both cultural and scientific representations of the world, of anomalous observations from nature [3]. It is not my intention here to explore these shared ideas or to argue for or against the validity of any of them, but just to point out that they exist. In this paper, I would like to take as my starting point one of the predications that has been made of both science and culture, namely, that creative, productive scientific or cultural thought takes place on the boundary of a paradigm, at the frontier on which that paradigm loses its authority [4]. One implication of this idea, whether mildly or strongly stated, is that people who somehow stand on the border can be expected to be more creative than others, to be more objective than others, to have clearer vision. The idea of seeing alternatives, of questioning, of making a conscious decision, is key in judgements concerning the vitality of both science and culture. If we look a little behind this predication conceming boundaries, we find that it conceals some ambigu-

ities. Questions concerning how objectivity can be recognized, in what creativity consists, where the boundaries of a paradigm lie, once asked, are not at all easy to answer. Is objectivity (with its implication of clear vision) to be defined as non-subjectivity or as inter-subjectivity or as something else altogether? Is creativity the capacity to change what exists or the capacity to see beyond the given? Does the creative boundary of modem world civilization lie on the frontier of the future, on the cutting edge of scientific research, or does it lie on the periphery of centralized authority, among the fissures of the decaying empires of the past? This paper is motivated primarily by the third question posed above: where do the creative boundaries lie? It is written in response to a very thoughtprovoking recent essay by Robin Horton, for whom scientific creativity is to be found on the forefront of modem western civilization, among people who face the future. My paper will suggest that one can equally well find the kind of scientific creativity Horton talks about in a highly fragmented world, among peQpie who face the past. In an earlier essay comparing African traditional thought with western scientific thought [SJ, Horton argued that, whereas these two modes of thought have much in common, they diverge in that ‘traditional’ thought is relatively ‘closed,’ i.e. unresponsive to external challenges, whereas ‘scientific’ thought is ‘open’ to such challenges. In light of much criticism of this essay, Horton has revised his thinking [6] and concedes that a traditionalist world-view, sustained by orally transmitted knowledge, can and does allow 1031

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for the incorporation of new ideas, albeit in a delayed fashion, and w-ithout its adherents recognizing that this is going on. Hence he withdraws his attribution of non-openness to traditional African thought. His revised argument is that western ‘scientific’ thought, in its better manifestations, evinces a ‘faith in progress’ and consciously expands its knowledge in a climate of open competition among rival theoretical schools. African ‘traditional’ thought, on the other hand, is based upon a faith in the past, and as a corollary of this past-orientation, has a consensual rather than a competitive attitude toward knowledge. In developing his representation of modern science, Horton acknowledges indebtedness not so much to the work of scientists themselves as to the work of most especially. philosophers of metascientists, science such as Popper, Kuhn, Lakatos, and Feyerabend [7]. Although these analysts of western natural science disagree on many points, there are at least two points of fundamental agreement among them. One, which Horton stresses, is an essentially agonistic view of how science is and should be conducted-struggle strengthens science. all of them would say. Only the definition of who the antagonists are has changed from an original view of man (or ‘theory’) struggling with nature (or ‘fact’), to a more recent image of different theories competing with each other. .4 second, and related, point of agreement between modern philosophers of science is a high positive valuation of a certain kind of honesty on the part of the scientist-an honesty which recognizes, in general, the provisionality and impermanence of any form of knowledge, and in particular, the vulnerability of the scientist’s own position. In combination with this humble honesty, a kind of valiance is advocated-“boldness of conjecture” (Popper), “defense” of a “sacred” and “hard core” of theory in the face of “challenges” (Lakatos), “revolution” against established and well defended systems (Kuhn), “anarchy” (Feyerabendtin short, a willingness to stick one’s neck out. even against the most daunting odds. Implicitly, Horton denies that a self-questioning attitude, together with the courage that such an attitude en&s is consistent with a traditional orientation. The belief that all true knowledge has been handed down from the past encourages complacency, he suggests. Hence, he continues to maintain that ‘traditionalist’ or past-oriented thought is relatively less open, and to the extent that it is open, it is much less self-consciously so, than is ‘progressive’ or future-oriented thought. For this reason, traditional systems of thought end up with relatively less total knowledge than scientific systems. African traditional thought is similar, Horton says, to European thought of the middle ages. In this paper-using Indian rather than African understandings--I dispute Horton’s claim that pastorientation is not consistent with self-questioning, competition among rival schools of thought, and development of theory in response to such competition My argument is that l$ as Horton holds, conscious response to challenging paradigms is what differentiates scientific from non-scientific thought. rhen the Ayurvedic epistemology to be described in this paper IS certainly scientific. It is not my aim to

evaluate Horton’s definition of science. or to confront the question of what science reallv is. What I am concerned with is the attribution, in essays such as Horton’s of intrinsic inferiority to non-western. allegedly non-scientific ways of thinking. They, nonwesterners, have less total knowledge, it is held, because their ways of knowing are not as good, If I can show that, by Horton’s own standards, a nonwestern system of thought is perhaps even in some ways superior to some western scientific ones, then I may have reason to hope that he will abandon his attempts to justify attitudes of cultural superiority on the part of Europeans and Americans. Underlying the issue of scientific versus nonscientific thought is the still larger issue of the relative clarity of vision of people at the center versus people at the periphery of the world political system [S]. Who are the people better able to understand what is going on around them, those who broach no challenge to their authority or to the ideology supporting it. or those whose authority and ideology are constantly challenged from outside and from above? This is also not an easy question to answer, but it is one that should be raised in the context of a comparative study of the epistemologies of different cultures, and especially now that science has come to be seen, not merely as a struggle between man and nature. but also as a struggle between rival ideologies. PURE SCIESCE AND THE PRhCTICE OF >lEDICINE

II.

In the remainder of this paper, I will be discussing the work of Mahadeva Iyer, a Tamil practitioner of the Sanskrit-based Indian medical system Ayurveda, to show the way in which, through his practice. he developed his body of theories concerning the nature of life processes. I recognize that there are problems with discussing medical practitioners, w-hether they practice traditional or modern forms of medicine. as though they were pure theoreticians or penseurs saucages. For the central aim of a medical system such as the kind practiced by MI or the kind practiced by our own doctors is not to know. but to heal. to achieve a certain practical, tangible goal. If this goal is to be achieved in the absence of understanding of how it was achieved, so be it. In principle, the growth of knowledge is important to medical people only insofar as it contributes to the central goal of healing patients to their own satisfaction. However, not all healers and doctors are strict operationahsts: many of them are motivated to become healers by a deep intellectual curiosity, which inspires their work and which causes them to develop theories and hypotheses which constantly change in response to their clinical work, and vet are not developed in strict practical service of this work, but rather are developed, we might say, for their own sake. Some western doctors are theoreticians of this type. So also was MI. MI often said that the most important and interesting aspect of medicine was not choice of treatment, but diagnosis. At the time that I knew him, by far the preponderance of his mental energy, as it was manifest in his abundant and (to me as an anthropologist tremendously valuable) words, was devoted to this

The Ayurvedic physician as scientist later process. As far as I was able to observe, it was largely through conversations with patients and their families that he developed his particular variant of Ayurvedic theory. In what follows, I will examine some aspects of the development of MI’s ideas, as they evolved in his conversations with me and with others. I will make special reference to three characteristics of MI’s thought which indicate that the contrast drawn by Horton between scientific and traditional epistemologies is not entirely valid. The first of these characteristics was MI’s recognition of the contingency of his own thought system, his willingness to recognize that what he believed to be true might turn out not to be. But whereas recognition of such contingency is associated in the west with progress and with ends (“There’s always room for improvement”) for MI it was associated instead with an orientation towards origins and with a sense of loss (“Our knowledge is incomplete compared with what used to be known”). According to the philosophy to which MI subscribed, only at the very origin of the universe was knowledge whole, just as the universe itself was in perfect harmony only before the beginning of time. Time commenced and change began to occur when the primeval substance became fragmented and the primeval consciousness obscured. In general things went downhill as time went on, and part of this downhill process was that knowledge became fragmented. Ayruveda was handed down from the gods to the human sages, and from the sages to more ordinary people, but in the process of transmission, it became more and more incomplete. Although this doctrine concerning the fragmentary nature of present knowledge was part of traditional Ayurvedic teaching, MI generalized it to include not only his own personal knowledge, but Ayurveda itself. For him Ayurveda itself, the system as a whole, was incomplete, and in need of supplementation from other sources. Understanding, for MI, was something that had to be retrieved, with difficulty, through all the senses, from the world in which it had been scattered. Openness to all sources of knowledge was necessary for the construction of a reasonably whole representation of any present situation, its causes and its meanings. Hence, although IMI could not be said to be progress-oriented, his approach to the acquisition of knowlege was by no means closed [9]. The second characteristic of IMI’s theory development which will be examined here is the particular means he had of handling challenging theories. Here I would like to mention that India provides a good testing ground for Feyerabend’s notion that the proliferation of theories is good for science-for in India, theories are indeed prolific. Nevertheless, even Feyerabend’s ‘anarchistic’ model of theoryinteraction is based (like those of Popper, Kuhn, and Lakatos) on a idea that competition involves, if not attrition of the ‘losers’, at least the keeping of separate theories separate. This rule of thumb follows upon the perceived necessity of maintaining a theory free of obvious internal contradiction. There is another way of dealing with challenges from the outside, however, and this is to openly accept paradox into your own system, or better yet, seek it out. What you end up with is a theory that loses its ‘logical’

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consistency, but gains in openness, dynamism, and flexibility. This is the route that MI followed [lo]. The third characteristic of MI’s theory development that made it interesting scientifically was the nature of the challenges that he chose to face. In an ‘ocean of anomalies’, says Lakatos [I 11, you necessarily have to be selective as regards which anomalies-which challenging theories or facts-you are going to deal with. For MI, the patients who came to him were the most serious external challenges to his medical system. Each patient who came to him brought a set of presenting symptoms, often anomalous ones, together with some kind of theory, partially or fully articulated, as to what was going on inside of him or her. Thus each patient, as a person, was a kind of raw data with which the physician had to contend and to which he had somehow to reconcile his own theories. At the same time, each patient also represented a rival theory, a different explanatory system for the illness which MI sought to diagnose. The patient embodied both challenging theory and challenging data, and of course, the patient’s theory about his or her disease affected both the manifestation of the disease and the course that the disease took. MI’s success both as a healer and as a theoretician depended upon his ability to respond convincingly to such ideational-mingled-with-material challenges. III. NOTES ON MAHADEVA IYER’S PRACTICE

I met Mahadeva Iyer in March of 1975 and stayed in his infirmary for a total of about eight months between that time and August 1976. He was then over 80 years old. The place where he lived and worked was a village in Kanyakumari District of Tamil Nadu, a few miles north of Nagarcoil. The region was known as Nancalnadu, ‘rice country’, because of the abundance of the paddy land there. The eastern and western Ghats closed in around it. Most of MI’s materia medica were gathered from the forest and scrub of these high hills. In the village MI had a pharmacy where his medicines were manufactured, and he owned about 20 acres of good naddv land and a dozen milk cows. His Paraiyar laborers-worked the fields, and during off-seasons collected medicinal oiants for him from the hills and fields and helped to process the drugs made from these plants. He had learned Ayurveda from his mother’s brother, who had lived in Travancore. He said that his father had been a Vedic scholar. Age had essentially immobilized MI, and when I was there, he rarely left his house. He had evidently been very physically active in his youth, and he hated being old. Now his sons managed the agricultural estate and the pharmacy; and a sister’s sons, who had been trained in Integrated Medicine a the Ayurvedic college in Trivandrum, saw most of the patients who came to the pharmacy. MI himself saw only about half a dozen patients a day-hence the leisurely interviews given below. He died in 1980 after a prolonged illness. When I visited him shortly before his death, he did not recognize who I was, but smiled and blessed me anyway. ‘

Although Mahadeva Iyer had studied texts of ailopathic medicine, he did not prescribe or dispense such medicine. All the prescriptions that he wrote were for medicines that had been manufactured in his own pharmacy. He did sometimes suggest that a patient try vitamin B 12 (which the patient could buy at an allopathic pharmacy in town), but I never heard him recommend any other allopathic medicine by name to a patient. Members of his own family used allopatic medicines for certain sicknesses. MI’s sevenyear-old grandson suffered recurrent fevers which his father (MI’s son) told me only abated when the child was given a course of a certain antibiotic. The same grandson’s asthma was treated with antihistamines. MI did not object to these treatments, although there were some allopathic treatments that he did strongly disapprove of. Among these were treatments that competed with his own specializations. For instance, he felt that polio vaccine was unnecessary, because a child who had been paralyzed by polio could be cured by Ayurvedic treatment if the paralysis was not too long-standing (I disagreed with him on this point, of course, as on many others, but did not feel it was my place to argue with him). The anti-paralytic treatment was a daily oil massage that was administered at the clinic by one of MI’s servants. Patients requiring continuing treatment stayed with their caretakers in a small infirmary that MI had built about a half mile down the road from his own house. The infirmary consisted of four rooms, each with its own attached kitchen and bath. While I was working with MI, I stayed with my family in one of these rooms. When I first asked MI if he had any specializations, he told me no, patients came to him with all kinds of complaints, and he treated them all to the best of his ability. When I asked his nephew, who saw the majority of patients who came to the clinic, the same question, he gave me a similar answer. However, when I asked if there were certain kinds of diseases that appeared at the clinic more often than others, the nephew told me yes, ccita diseases. I asked why this was, and he said there were two reasons. One was that cGra diseases predominated in that region. The other was that MI’s medicines were more effective for r&a diseases than other people’s medicines were. This fit with a Tamil proverb that I had heard, “Wherever a disease is found, there its cure will be found also.” Poliomyelitis @i!!ai ccita n6y) is a vata disease, as are other diseases causing tremors or paralysis, such as cerebral palsy, St Vitus’ dance, and paralysis due to poisoning. Other, less serious vata diseases are arthritis, rheumatism, and aches and pains in bones and muscles. The latter were the most common complaints brought to MI’s pharmacy. Lower back pain (Kukrukku di) was the most common of all. Old people are particularly susceptible to cara diseases according to Ayurvedic theory, and since MI’s medicines were most successful with diseases like rheumatism, the aged patients that came to him were at least as numerous as the children. I cannot report the details of the economic operation of the pharmacy, as I was not privy to the record books, but can at least pass on my impressions and general observations. It was evident that the pharmacy was not a big money-maker in any direct sense, although, inasmuch as it was the source of

MI’s fame and prestiee. it may have mdirectlv brought him some ma&al rewards. The sources of MI’s wealth were his cattle and his paddy land, and his son’s law practice in town. Patients who visited MI brought him no gifts. and neither MI nor his nephew charged for consultations. Xledicines manufactured at the pharmacy were not, at the time of my visit, marketed elsewhere. However most of the patients who came to the pharmacy received prescriptions of some kind. and there was a charge for the medicine prescribed. For the poorer patients, prescriptions were kept simple: a single. inexpensive medicine would be given them. For patients who appeared better off, prescriptions would be more elaborate, generally involving several medicines. I would interpret this differentiation in the elaboration of prescriptions more as a communicative act than as an economic strategy. The relative simplicity or complexity of a prescription indicated. among other things, recognition of a particular patient’s status. MI’s conversation with a patient, w-hether terse or extended, followed the same social contours. There were no strict divisions made between the various domains of MI’s life: the pharmacy, the farm, the family, the rituals of Brahmanism. MI’s lawyer son. for instance, who had no formal medical training, often took over the clinic when the nephew was unavailable. diagnosing illnesses, prescribing and dispensing medicines. In the eyes of some patients, the fact that he was the son of the doctor made him, also, the doctor: it was a kind of hereditary post. The medicines manufactured in the pharmacy were all, like the diet of the family, purely vegetarian, containing no meat, fish, or eggs, but with a large milk component (and in fact, MI often said that nothing should be used as medicine which cannot also be used as food). The same cattle whose milk fed the family also provided milk for inclusion in medicines, and their male calves became draft animals that worked in the fields. The same servants worked in all domains, contributed knowledge of medicinal plants (which they alone now gathered from the hills) and knowledge of animal medicine (what to feed a recently castrated bull, what to feed a cow that has just calved), as well as their physical labor to the operation of the pharmacy. MI seemed to be aware of the Paralyar servants’ indispensibility in a way that his nephew was not. The nephew dealt with the servants harshly. MI treated them with affection and they competed for his favor. In his absence they spoke of him with the greatest respect and awe, calling him srimi (a term reserved for gods, Brahmans, and holy men), though they were Bible-reading Christians and his religion was, according to their belief, the religion of darkness. Were the servants dissimulating because they saw me as an ally of MI? I think not, for their expressed feelings contrasted dramatically with those of Paraiyar laborers in another district where I stayed. who lost no chance to communicate to me in private their intense hatred of their landlord, in whose house I was living and with whose family I had strong and visible bonds of affection. Were MI’s secants charitable in their statements about him because they were Christians? Perhaps. Yet in general they were in the habit of mocking the high and mighty. Perhaps we could take

The Ayurvedic physician as scientist the statements of the servants about their relations with MI at face value. The big difference between MI and other landowners, said the servants, was that MI gave them work in all seasons, in effect he adopted them as individuals, and kept them on permanently, rather than just employing them sporadically. Since their work in the agricultural off-seasons was work for the pharmacy, and since much of this work involved specialized knowledge that could only be accumulated over years through continual contact both with the doctor and with the woods and fields, their integration into this local pharmaceutical operation appears to have been vital both to the pharmacy’s success and to their own relative well-being. The pharmacy building, where MI’s nephew presided and where medicines were manufactured, was a large brick building situated on the main road, right next to the bus stop. It was an important road, and 20 or more buses stopped by the pharmacy every day. There were no overt rules or policies concerning which patients saw MI and which patients saw his nephew, but there were, of course, the unwritten constraints of caste, status, wealth, and of personal ties and preferences, as well as the constraints of time, of each doctor’s way of practicing, and of each doctor’s relative strengths and weaknesses. Patients with simple complaints generally visited only the pharmacy, where they could quickly receive the medicine that they had come for. People knew that MI was old and deaf, and some preferred to be treated by the nephew for this reason. The nephew wore modem dress, had a business-like air about him and a degree on the walls behind him, as well as a stethoscope and a blood-pressure machine which he used regularly. Certainly some visitors, especially younger ones, were more impressed by these credentials than by MI’s relatively unassuming persona. Paraiyars and other people classified as Harijans were traditionally not allowed access to the center of the village where MI lived, and for this reason they also chose to be treated in the pharmacy, rather than risk the punishment that might fall upon them if they entered the village. The patients who ended up seeing MI himself were not only the rich and important ones, however. They were also the ones who had come from far away especially to see him, the ones whose illness was especially complex, the ones whose illness had a strong personal dimension. These included occasional cases of spirit possession, cases of unmarried pregnancy, of cancer, of grief-induced illness. There were also many people who simply preferred MI’s more traditional approach to the more modem approach of his nephew. They would stop in the pharmacy to ask if MI was at home, and receiving a positive answer, would make their way to his house. IV. MEHADEVA IYER’S WAY OF SEEKING KNOWLEDGE

My aim in this paper is not to show that MI was a culturally or historically singular figure. On the contrary, it would be nice if I could claim that, as Indian medical practitioners go, he was completely ‘typical’-but this would be wrong also. I can say, however, that the three aspects of his theory develooment which I have chosen to examine here-the .

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emphasis on origins, the paradoxical style, and the immediate responsiveness to physical and ideational context, the treatment of physical and ideational as not separate but merged in his patients-are all characteristics of Indian communicative patterns that have been noticed by other observers, especially western-trained Indian ethnographers [12]. MI had a deep-seated concern with discovering the origins of things. The sources of this concern in the psyche of the man would be difficult to trace. Nevertheless, it seems very clearly to have gone beyond, and to have pre-dated by many years, his interest in the practice of medicine per se. In his rambling conversations with patients and others, the one theme he returned to again and again was that “none of us are true vegetarians, for we all originate in the womb of a female, and drink her blood for ten months before we are born.” Often his thoughts turned to the question of how a soul (uyir) gets into a womb where conception has occurred, and how the body of the person develops there. This preoccupation w+th beginnings led MI to develop elaborate theories of the origins of language, of writing, and of Indian society. From his father he acquired a strong interest in the Vedas, in the society which gave rise to the Vedas, and in the question of where the Indo-European nomads migrated from. At the same time. he was captivated by the tribal societies still living in the mountainous areas near his home. These people he thought of as dtimanitarkd, ‘original people’, or at least aboriginal Indians. He also attributed great importance to the source of rivers, of medicinal substances, and finally, of diseases. It has long been recognized in Indian medicine that effective healing is dependent upon knowledge of the sources of disease. Further, it is recognized that the sources of disease are neither obvious nor given in tradition. They must be sought. Hence a famous Tamil medical dictum says, “Seek the disease, seek the origin of the disease, seek the way to its cure, and act fittingly” (Nby n&i nby mutal midi atu taqikkum rGy n&ji Gyppac Gyyal-Tirrukkural). Parenthetically, we might note that this verse twice repeats the root criy, whose commonest and most concrete meaning is ‘mouth’: first in tayikkum c6y, “way (route, means, opportunity, opening) to cure”; second, in ciiyppac cbal, “act fittingly (successfully, so that thmgs fit, so that success may be grasped).” Without becoming embroiled in etymological disputes, we may say that the poet was obviously exploiting the deep and ramifying meanings of the term cGy in Tamil. This verse is frequently cited by physicians and others, and sometimes is misquoted as Gy otiy n&ii. . . ., “Seek the mouth of the disease. . ” It fits with MI’s interest in origins, and with his own theory that “the mouth is the origin of all diseases” (a statement which he often made when discussing the importance of tooth-brushing). In practice, the search for the ori_eins of disease led MI to undertake independent study and research on the subject, and to take special interest in patients with diseases whose origin was particularly hard to determine. The disease which intrigued him most was cancer. Over the course of many years he constructed a fascinating, if to western minds bizarre, theory of the origins of cancer, linking this disease to properties

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of the pre-natal environment. MI thought of cancer as a condition. rather than as an agent or a substance. Nevertheless, it was a configuration which seemed almost to take on a life, and an instinct for selfpreservation, of its own, eluding the would-be healer by taking numerous forms throughout the body, being suppressed here only to turn up again there. It was, literally, a disorder-a failure of particular unclean (rtiippu) substances to perform their proper tasks in the body, almost a rebellion of these substances. which started in one remote comer of the body, on the margins of some organ (such as the tip of the uterus or the edge of the tongue of the end of the liver) and then spread. It could start also as X-arappcin. a skin disease of children which was considered to be contracted at birth as a consequence of the improper sexual behavior of the parents. It seems evident that in his development of this theory of cancer, MI was following a model derived at least in part from his perception of the social processes going on in the world around him. He was, after ail. a landowning, Brahman, living in a time when lower caste agncultural laborers were demanding land ownership, legal protection. and liberation from the constraints imposed upon them by dint of their birth. As far as MI was concerned, if social distinctions were levelled. if people in ‘unclean’ castes living on the margins of the village rebelled and occupied places that they were not meant to occupy, the entire society would suffer. We can read MI’s theory of cancer as based in part at least on a social metaphor. This in itself does not make his theory wrong (cf. Gould’s discussion of Darwin [13]). The important points here are: (I) that he sought the natural causes of disease, attempting to trace them to their origin (hence his interest in birth) and (2) that he perceived causality in a systemic, rather than an atomistic, way: disease, for him, was a matter of improper relations among substances in the body, and not a matter of the mere presence of something intrinsically evil or harmful. Had his principle concern been with appearances (as opposed to underlying realities), with static categories (as opposed to dynamic relations), or with standardization (as opposed to diversification and ramification from a single source), he might not have been so suited to his task. Knowledge, however, lay in the past in more than one way for individuals like MI. According to the view of the Ayurvedic texts which he followed, unity of knowledge, like unity of being, lay only in the origin of things, with God. Whatever present knowledge any one of us may have, like the present substance that each of us possesses, is only a fragment of the whole. Other fragments lie all around us. We can only approach the unity of the past by uniting some of these fragments. The greater the number of our sources of knowledge (and being), the closer to perfection will be the image that we acquire. In Caraka Samhita and Surruta Samhita, important early Ayurvedic texts which MI knew well, the universe in its original state is said to be undifferentiated, homogeneous, and at peace, but in its experienced state it is differentiated and in flux. The achievement of wholeness is a matter of bringing all the differentiated components of the world to-

gether again, in the proper way. So bodily life is seen as the conjunction of all the fragments of this differentiated world (Caraka Chap. IV, Vol. 1, pp. 1617). Food must consist of all the five elements (Susruta, Chap I) and the substance of living consciousness, o&s or ‘light’, is a distillate of all substances, being collected from many places “as honey is collected by bees from various fruits or flowers” (Caraka Chap. I. Vol. VII, p. 75). The heart, which is the place of consciousness, is the point of convergence of many channels, which bring it substance, sensations, and knowledge from the world (Susruta, Chap. II, p. 210). If any of the channels is blockedi.e. if communication with the world comes from less than the maximum number of sources-then sickness will ensue. At death, all the channels become closed. MI avidly studied not only Sanskrit texts-though Sanskrit was. according to MI’s own belief, the perfected language of the gods-but also Malayalam, Tamil, and English ones. Siddha, Ayurveda, allopathy and folk medicine were all sources that he needed. One patient praised him. saying, “In his talk, everything is there.” We might derogate MI’s approach as eclecticism. but I am trying to say that it had a serious philosophical basis. The Ayurvedic texts advocated the drawing of the materials of life and knowledge from as many sources as possible. Only in this way could something like the original unity be reached. MI put the principles of these texts to work precisely by treating them as, in themselves, incomplete. Time was real for MI, and comprehension was gained through seeking chains of causality. But all such chains tended toward convergence in the past. Thus, seemingly unconnected phenomena that one apprehended in the present could be seen to converge upon a single source, if one traced them far enough back. His diagnostic method, as we will see in his interviews with his patients, consisted largely of such tracing. The humility of such an approach lay, not in the sense that the truth would belong to future generations, but in a realization that everything has been known before-you can’t say anything really new. There cannot be invention, there can only be ‘discoveries’ (Tamil kan&&fippu). Within a world age, as within a human age, time was a downhill process, a disintegration, and one knew oneself to be near the end. Seemingly disunited aspects of present experience were united through a tracing of their origins into the past to a common source. They were also united in the experiential present itself, through paradox. MI’s ease in the midst of discrepant paradigms and his ability to embrace paradox surely was fostered by the culturally plural environment in which he lived. There was first, the Brahmanical tradition of his own caste community, with its emphasis upon purity, hierarchy, ritual order, the ancestors, the continuity of the patriline. Then there was the culture of the Tamils of the plains, immersed in the economy and imagery of rice agriculture, the personalities of myriad local deities, the music of the Tamil tongue. There were the hunters and horticulturalists of the hills. There were the British administrators, merchants, technicians, and missionaries. There was the powerful and mysterious world of the women in the house.

The Ayurvedic

physician

There was the cosmic violence of the ancient Sanskrit texts. These various cultures not only co-existed, but competed fiercely with each other in both the ideological and the political domains. There was also considerable effort at proselytization in all directions. Advocates of the perfection of Sanskrit debated with Tamil scholars as to which texts in which language were more expressive of the true religion (this debate has been carried into some American universities). The Siddha and Ayurveda medical schools vied with each other for students, for prestige, and for claims to systematicity of theory and effectiveness of treatment [14]. Both had to confront western medicine in this competition [15], and trance-healers also entered the fray [16]. In all of these cases, persuasion of patients that one’s own system worked better than others was an important aspect of success in healing. Cross-cutting these disputes were competitions among different communities over caste and religious values. These communal competitions (between. e.g. Brahmans and high non-Brahmans, Harijans and middle castes, worshippers of the mother and worshippers of Siva, and the men and women of a single household or caste) involved deep ideological differences, many of which were fought out in the law courts. In the case of medicine and religion, these differences were founded, as I have indicated above, upon language differences. Hence we can speak in these cases, not only of discrepancy of detail, but of genuine paradigm conflict. The practice of Ayurveda in the basin of Nancalnadu in the early to mid-twentieth century tended to bring to the forefront discrepancies among the various cultures, communities, and ideologies that contended (or co-evolved) there. MI’s people, for instance, were vegetarian and were concerned with maintaining social and substantial separations of all kinds, yet his profession demanded close interaction with every variety of human being, and physical immersion in a wide commingled range of substances and life processes. The original Ayurvedic texts, written, as they were, for court physicians and army surgeons, also demonstrated clearly to any reader the fact that Sanskrit, the language of the Brahmans and of the gods, had not always given voice to the ideals that modern Brahmans now .subscribed to. MI’s collection of medicinal plants required forays deep into the surrounding hills, but the sedentary society in which he lived feared the wild unknown and discouraged exploration of it. Tigers and elephants still were said to roam there, and the forest spirits, too, were cruel. Meanwhile, the total lack of accord between Ayurvedic and western medical texts, and the contempt in which the western physicians held native medicine, expressed in the domain of healing the wider conflict between British and Hindu ways of life. Stories that were told about the British in this area emphasized their arrogance and especially their disregard of the local deities. The religious conflict was deeply felt. MI often displayed his intellectual delight in paradox, whatever the origins of this delight may have been. For instance, once, after reading a Sanskrit text commanding a widow to immolate herself on her husband’s funeral pyre, he looked up and said,

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“Sometimes one must bathe after reading the Vedas.” What he meant was that this passage of the scripture was SO foul that he would have to purify himself after reading it. But according to Brahmanical do-ma. the Vedas are the very essence of purity. To say that you should bathe after reading the Vedas was like saying that you needed a cross to ward off the Holy Spirit. It was an intensely paradoxical statement. It was funny. It was meant to be funny. And it knotted warring paradigms together, for the conflicts between auspiciousness and purity, saktic feminism and Brahmanic sexual hierarchy, the past as inscribed and the present as lived, were all bound up in this one terse comment. Yet MI was not a religious iconoclast. He made it clear, in his many discourses in praise of the Sanskrit tradition, that the Vedas were for him God’s truth. The appeal of paradox to MI enabled him to study and appreciate both Ayurveda and cosmopolitan medicine. He analysed and criticized each according to the standards of the other, discovering points of agreement between them, and developing tentative syntheses which took him well beyond the established theories of either system. In treating patients. therefore, he had a wide range of explanatory models of health, disease, and healing and a wide range of therapies to choose from. He avoided dependence upon a small set of rigid categories into which to force individual cases, and he treated patients with creativity and with sensitivity to their particular experiences of illness. The challenge of whole cultures conflicting was followed for MI by the challenge of single ‘facts,’ of day-to-day experience in its inchoately codified. semidigested form, and by the challenge of returning his theory to the world. For someone who was practicing medicine and developing a theory at the same time, through the practice of medicine, the two challenges had to be met as one. Patients were facts to himconcrete, physical, unique realities-but he also knew that, before they had come to him, they had already woven their experiences into meaningful designstheories of their own-which they presented to him, together with the physical ‘raw’ data of their bodies, as a puzzle to solve. Often, patients would visit MI accompanied by family or friends, and then these companions would form part of MI’s audience. At least as frequently, however, a patient would appear on MI’s veranda alone. Whether the patient appeared alone or in company, IMI’s interviews with people were characteristically one-on-one. If there were a number of people present, MI made no visible efforts to involve them all in the conversation simultaneously. If several people in a group had come with complaints, he would speak with each of them serially. In each case, his communicative efforts were concentrated almost exclusively upon the patient. Only when the patient was very young or disturbed or for some other reason unable to speak for herself did he address most of his remarks to her caretaker. Even then, he would at a certain point turn away from the caretaker and try to engage the patient herself in conversation. Thus patients were, for MI, not only embodiments of data and holders of theories, they were also the most important component of the listening (or not

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MARGARET TUWICK

listening) world. They were the ones who had to be convinced of the truth of what he was saying, for they were the ones who would carry (or not carry) his thoughts with them into their own recreations of the culture, and they were the ones who would follow, or not follow, his advice, be healed or not be healed. MI did not, perhaps he could not, rely on the sheer force of his authority to get people to follow his advice. Always in his discussions with those who visited him for treatment, he gave reuSOn.r for his diagnoses and the therapies he prescribed, couched not in a language of distance or indifference, but in a language of commitment and persuasion. His mode of discourse-the words he used, the tone of voice, the body language-differed with each audience, was adapted to each one. MI fused people in the same way that he fused theories. He would seek a point of commonality between himself and each person he spoke with. Often the point of commonality was a common origin; still more often, it was an irony. His conversations with aged patients would tend to center upon the experience of aging, especially the process of ‘hardening’, which to MI meant a weakening and loss of steadiness and integration. His conversations with women would often turn upon his belief in the feminine as the most powerful force in the universe. and the tragedy of this power being turned against women. With meat-eaters. he would always bring up his belief that all people originate as drinkers of their mother’s blood and no one is a true vegetarian. With farmers, he would extol1 agriculture, and call himself a farmer. Then, having praised the producers of food as the mainstays of humanity, he would say, as a large landowner, “but if all the land is distributed equally, we will all be equally impoverished.” With artisans, he would discuss the principles that medicine and art share; when a sculptor came to visit him, he asked the sculptor to make for him a sivalingam out of the poisonous/medicinal mineral cinnabar (Jatilingam). With young men he would recall his own youth and dwell upon the sexual paradoxes facing the young: “A boy who has led a pure life cannot even bring himself to look at a girl he has been taken to ‘see’ as a marriage partner. When asked if he likes her, he will just close his eyes, nod his head, and say ‘Yes, yes.“‘. In the presence of babies, he said he felt joy realizing that soon he himself, having left this life and begun a new one, would be a baby, too. Some western readers may judge MI’s habit of seeking a point of commonality with each patient to be sycophantish, even hypocritical. To them MI’s personalism may seem like no more than bedside manner, and it may be repulsive to those western intellectuals who value a detached, universalistic approach over an involved, relational one, I would ask such readers to set aside their prejudices, however, so that they can recognize that, for MI, the seeking of a common personal bond was not merely a sentimental sugar-coating for therapy, but was essential to the process of diagnosis as well as to the choice of treatment. I got a sense of how it felt to have such a doctor when, at a certain point during my stay in MI’s village, I began to fall prey to frequent mmor infections and underwent a rapid weight loss. All of this

happened after my husband. who had accompanied me to India, finally was unable to bear the lowly status of man-attached-to-his-wife, and went home. All of the people around me attributed my illnesses to his departure. I consulted MI for treatment. He clucked his tongue and said. “Previously you looked like a goddess but now you look like a fourteen-yearold girl” (already I started to feel better). He ordered me to return to a carnivorous diet (while in India, I had become a vegetarian) and he prescribed for me a pleasant-tasting medicine with a high alcohol content. He seemed to sense that dislocation, and a feeling that in this cultural environment I could never relax and ‘be myself,’ were contributing to my loss of appetite. If I returned to what he thought were my accustomed dietary habits, he believ.ed I would feel better. Perhaps he assimilated me to other young women he had known-his own first wife, his daughter and daughter-in-law-who. transplanted from their homes, overworked, jolted from old habits, lost their health and, in two of these cases, their lives. The development of treatment on the basis of a common bond between patient and doctor meant that MI could and did connect patients not only or necessarily with himself, but with other patients or loved ones that he had cared for in the past. In other words, his diagnostic categories were built upon his experiences with persons. Textual learning provided a fairly sketchy framework that was fleshed out, joined together, and drawn in detail by experience. Ayurvedic texts, compiled over many centuries and spanning diverse regions and a wide spectrum of social and natural conditions, provided an array of divergent theories, alternative treatments, constellations of symptoms, categories of disease, types of patient, types of typologies, etc, from which the individual physician had to pick and choose the information most suitable to his environment and experience. In the core texts, debate occurred over the meaning of the most basic terms, and vying theories of such things as embryological development were placed unapologetically side-by-side. Further, over the centuries and in the transplantation of texts from region to region, knowledge of the referents of many plant names and disease names in the core texts had been lost. Hence the Ayurvedic physician, in order to act effectively, had to be able to think for himself, and had to be able to turn to his own experience for answers to the many questions that the texts left open. So MI in his discussions with patients tended to hark back to discussions he had had with other patients in the recent past. A lesson that he learned from one patient he would apply to his treatment of another, sometimes in the same day. He was quick to see similarities among people. He also made a point of locating the patient in his conceptual map of the region. The town that the patient came from, the patient’s occupation, the patient’s kin. how the patient had come to hear about MI, all of these facts were determined so that the exact nature of the linkage between patient and doctor could be ascertained. In this way, MI wove a great web of patients, friends, and acquaintances. He knew intimately the region in which he lived and the people in it. He in turn was widely known.

The .\yurvedic physician as scientist According to Tamil understanding, a physician of any kind cannot be successful unless he or she possesses a certain kind of power called kairrisi, ‘harmony of the hand.’ If a physician has this property then any medicine that he or she dispenses with his or her own hand to the patient, so that the hands of physician and patient touch, will have some healing effect. even if the medicine by itself has a potency. This quality of immanence, of being personally, physically involved in the treatment process, is the quality that above all others made MI a successful physician, and an open-minded theoretician. Like the musician who loves music, like the saint who loves God, like the herpetologist who loves snakes, MI had a passion for the subject of his science. But his was a felicitous passion because, unlike other passions which often draw their victims away from human society and make of them rather lonely, uncommunicative people, his passion was that very human society which was both the object of his study and the mind to receive his message. Hew was an intensely sociable soul, and so it happened that the man and the doctor in him were merged almost completely. v.

PATIENT INTERVIEWS

The following two patient-interviews were the second and third of about 50 interviews that I taperecorded during my stay at MI’s village. I chose these two interviews to present in this paper because they were next in line; the first interview has already been discussed in a previous paper. In translating these interviews from Tamil, I have tried to stick as close to the sense of the original as possible. If some of the passages sound strange in English, this is because of my wanting to maintain in the translation some significant characteristic of the original dialogue, such as the first patient’s general avoidance of the first person singular. Sometimes the patient or doctor uses English terms or phrases. These are indicated by quotation marks. My own interpolations are in brackets. Although the texts of the interviews are rather long, I have avoided editing them so that others may study them and draw their own conclusions from them. MI spent most of his waking hours reclining on a chaise-longue on the enclosed front veranda of his large house. This was where he met the patients who visited him. No degrees on the wall, no paraphernalia, no shelves of bottles and jars, no physical sign at all of the medical profession was present in this room or anywhere else in the house. As one entered the small veranda, one saw only a bench, a chair, family portraits hanging below the eaves, an open door giving a view through the living room, dining room and kitchen and out again to the light of the back courtyard. Next to the door, looking out towards the street, lay MI. He wore a wrinkled white cotton shirt and waistcloth, the topknot of very old-fashioned Brahmans, stripes of ash on his arms and forehead, marking him a worshipper of Siva. His feet were bare and swollen, his mouth stained red with betel, which he chewed constantly. His eyes shone. Sometimes his wife or daughter-in-law would

come to the door next to where he lay to bring him betel or to bring coffee to a visitor. But most often

1039

he lay alone, gazing onto the empty street, lost m his own thoughts. When a visitor came he would brighten up. Most of his visitors were patients and most were strangers, but they offered chances for friendly conversation and story-telling which were perhaps more important to MI at this time in his life than matters of profession or protocol. For MI as a physician and theoretician with a strong Sanskritic orientation. words were the most important things, the most important source of knowledge and the most important tools of action. Perhaps for this reason, he did not perform extensive physical examinations upon his patients. At most, he might pull down one of the patient’s lower eyelids and look at it, briefly feel the patient’s pulse, or, with a child, ask her to stick out her tongue. He generally did not comment upon why he did these examinations or what they told him, and my impression was that when he did carry out such stereotyped doctorly actions they were essentially pro forma. In the pharmacy, the urine of some patients would be tested chemically for sugar. MI’s nephew also used a stethoscope and measured patients’ blood pressure. Often patients would report to him the results of laboratory tests performed by allopathic institutions, and MI would prescribe medicines on the basis of these reports. But MI’s own examinations of patients were almost entirely verbal. The two interviews that follow are examples of such verbal examinations. I offer them here not as pieces of case histories, but as examples of how MI performed his examination and developed his diagnosis, given a patient whom he had never seen before, and whom he would never see again. Although the words spoken by the patient and the doctor constitute only one aspect of what took place between them during the encounter, I believe they reveal more clearly than anything else what might be transcribed onto paper, how MI learned from a patient, and what he did with what he learned. First interciew

The patient arrived late in the morning, having reached MI’s village by bus. She was a slightly heavy-set woman who appeared to be around 50 years old. There were dark circles under her eyes. She was dressed in a silk sari and had on a substantial amount of gold jewelry. In southern India, this is a woman’s way of letting others know that she is well situated socially. The red dot of kumkum on her forehead said that her husband was alive. Although she arrived alone, as did many patients, male and female, she brought not only her own ailment but the ailments of other family members with her, i.e. she had come not only on her own behalf but on behalf of several members of her family who needed medical treatment. In this way they were spared the trouble and expense of a journey to see the doctor, but could still benefit from his medicine and advice. As the patient stepped onto the veranda and took her seat on the bench, MI greeted her cheerfully and asked her why she had come. P. Well, frequently there is defecation [oe!i$e @rafu]. Whether eating takes place or not. there is defecation. And rather often there is blood, too. Often it goes a little at a

time. Once a month it is mucousy. Oiten there is this trouble. As soon as the thought comes. it happens. Whate\er is eaten is not digested. D. How long has it been’! P. It has been seven or eight years D. What other medical system [uairri~am] have you used for

this? P. We have done everything. From time to time, pills were bought and eaten. Ailopathy has been tried. Sothing got better. D. Where are you from? P. Trichinopoly. Trichinopoly-Purvitam. Sow [our home is] Pavanacam. D. Is there belly pain at defecation? Is there fever from time to time? P. There is indeed belly pain. There is no fever or anything. Only in the belly there is an aching [nomunomunnu]. As soon as the thought comes, the problem comes. Like an allergy. D. Are there hemorrhoids and all [m&z/ciim] in your town? P. That is not much trouble. When there is defecation it gets stuck, as though maybe there are hemorrhoids [miilum] inside, or something. There’s no trouble because of that. It doesn’t hurt at all. It goes just a very little bit at a time. D. Is there bleeding in your teeth? P. There is none of that. D. Does sleep come well at night? P. Sometimes I sleep. Sometimes sleep won’t come. D. Do the hands and feet become numb? P. They become numb. There is back pain, calf pain, tiredness. D. What is your age? P. Fifty-seven. D. Has menstruation stopped? P. There is none of that. It stopped at forty or forty-two. D. At the time that menstruation stopped was there any sickness? P. Then there was this same kind of trouble. Only now for six years it is rather increased. Six or seven years ago our daughter at the age of twenty-five died in childbirth. From that time there has been a great fear. When the thought comes, defecation occurs. l3ere is a noise and much gas. It goes a little at a time. Whatever is eaten, even if only coffee is consumed, it doesn’t stop. D. Is there blockages of the ears? P. No. D. Do bugs fly in the eyes? P. They fly. D. Does the head spin? P. There is not much spinning or anything. D. Is there chest pain? P. There is chest pain. D. At night when you defecate and wash your hands and feet, is there shivering? P. Now and then, occasionally. D. Is there heaviness of the stomach after you’ve finished a meal? P. There is nothing iike that. Maybe a little bit. For the rest, there is nothing. Only this defecation. D. What is your food for one day, starting in the morning until evening. P. In the morning we drink a coffee. At ten o’clock a meal--korumbu [vegetable stew], rucam [spiced tomato or tomarind soup] and all. p] don’t like it all that much. [IJ like buttermilk rice. I eat it with a few pickles. D. What food at night? P. I eat something light at night. We eat just rice. Chappati. Otherwise I will just be without wanting anything. D. Do you drink milk? P. [I] don’t drink milk or anything. D. Have you taksn any native medicine for this? P. [I] haven’t taken any native medicine. Once, at some time or another, [I] took it. D. Do you ever have injections if you want them?

P. No. D. Have you had your feces tested before by a doctor’? P. It has been rested. There was nothing in it. D. This is a kind of “piles complaint.” There is a kind of germ called “amoeba.” Because of it, this blood-diarrhea, mucous-diarrhea, frequent diarrhea, a!! of that happens. Hunger-there will not be a regular hunger. Sometimes it will be as though burning. Other times, it will be as though little. Buttermilk preparations are good for this. Milk is not good. You must not eat bananas. If you eat a!! that, it will become worse. Eat with buttermilk. Even if you eat idli[rice cake made from fermented batter], put buttermilk on it. Don’t add too much spice or dried peppers or chili powder. When you bathe, you must bathe in warm water. You must not bathe in cold water. If you do, shivering will come. Your feet and all will become numb. Your body will grow cold. So bathe in warm water. I will give you just a little bit of oil. For the first two days, rub it on when you bathe. That bowel [will become] we!!, that diarrhea, the constipation and all having stopped.. This is the creation [iikkam] of a disease called gruhani. “This is the inflamation of the pylorus.” You know the digestive tire [juduriigni]? This is the product of a disorder in that. Until it gets better. the food ydu must eat-in the morning, a coffee with cow’s milk. At ten o’clock, you must eat buttermilk-vegetables with more buttermilk added. Many vegetable “complications”. legumes. you must not eat too much of all that. Eat lemon rice if you want to-that is not a fault. In the afternoon at three o’clock one cup of coffee. You must eat only “light food.” In the evening you must eat on!) buttermilk rice. You must not eat anything else. You may take rice gruel (Kutici) and add a lot of buttermilk and drink it-that is not a fault. Otherwise you can eat rice gruel with ghee. P. IMay [I] add salt? D. You may add a little salt. You must not add a lot of hot spice. You must also not eat dishes with a lot of tamarind squeezed in. P. rhere is] a pirtu problem [pittu, bile or fire, is one of the three &shus or sources of activity and disease in the body, according to Indian medicine]. It is making noise. There is a rumbling of the stomach: D. Has there ever been a disorder of childbirth? P. When the fifth daughter was born, a shaking fit fiunniy&i&m] came. It was very “dangerous.” Only then was there a little difficulty. D. How old is that fifth girl now? P. She is thirty years old now. D. The fifth daughter is very important. Where is she? P. Indrittur. If you want her to come here, too, she too has an allergy. Ever since she has existed she has been saying, ‘.It hurts here, it hurts there.” D. Your name? [writing prescription] P. R. Vijayam. D. “Inflammation of the alimentary canal.” From the mouth to the bowel, all of it is wounded. Nothing spicy can be added. Even if I said to, you would not be able to add it. Drink the medicine. For five or six days when you take it. the feces and all having become well. the bowel and all having become clean, the germs’ afflictions and a!! having changed, a state of health will be obtained. If you add warm buttermilk, and put in 5mam [a medicinal plant], and add heated buttermilk and eat it, it will be good. I have prescribed a measure of medicine. You must eat only that measure. The Ekiyum [candied medicine for licking]. one half tablespoon only you must eat. Having eaten that. to drink you must drink only heated water. “Boiled and cooled water” only you must drink. “Even protected water you don’t take. Boil it, coo! and then take.” You must not drink un”boil”ed water. To bathe, you must bathe only in heated water. Whatever oil you normally rub on when you bathe, you rub on that oil and bathe. Using coconut oil when you bathe is good.

The Ayurvedic

physician

P. [I] don’t use any oil at all when I bathe. Since that girl died I don’t use oil when I bathe. Since father’s piflu became excessive, he cannot eat well. D. What is his age? P. His age is seventy. For him, too, and for one of my sons, there is this defecation. It happens as soon as they eat. Please give some of this medicine for him, too. This is just like a diarrhea. Must he too fast? D. His meals should be the same. The fast is not for the medicine. The fast is for the disease. “Diet is restricted for the disease and not for the medicine.” Father’s name? P. S. Raja Rao. D. What is his affliction? P. Pirra. One day in the month he gets pitta. He brings it up from his mouth. He can’t eat. If he goes to the hospital and gets tonic or something and takes it, it calms down. Then it comes back again. It comes like this once every two or three months. A person called Rangappa Rao came here, you know? His legs were all swollen. Only with you he got better. Heart disease. Very frightened he came. He stayed at the house of the people across the street. He was there for a month. D. You must make still another visit here. The reason is that, because of the disease connected with your bowel, just from the bowel everything is produced. Because the bowel is an excellent organ. It will become happy with this medicine. But it must be “complete”ly “eradicate”d. All of its afflictions must abate. “Piles, digestive trouble, gas formation. liver disorder,” all must be healed. If you take [the medicine] still one more time. it will be healed. This is an affliction connected with grahani. The “pylorus” and all is “involved.” Only buttermilk is an excellent food for this. You must not drink a lot of very sour buttermilk. Having eaten properly, come. P. May p] eat legumes? D. Legumes, bananas, oily substances, these three will not agree [iikiitu, “will not become”]. Carrot, tomatoes, cabbage and all you may add. P. May I add fried spices [tiiliccu]? D. You may add fried spices. Coconut oil you must use. Coconut oil is a preparation that is like a good tonic. It is very good for the bowel. P. May I eat whatever I want that is made with coconut oil? D. When you use oily foods. they may not be digested. Other afflications will arise. P. Must I not add coconut at all? D. You may add coconut. You may grind coconut and make puliceri [a tamarind dish] and eat it. P. Should I use salt in measure? D. Nothing like that. You may use it as usual. Salt is necessary to the body. For some diseases it is forbidden. It is not like that for you. You can eat a little salt. Old Tamarind you may use. Tamarind is a medicine. In olden times tamarind would be kept and it by itself when it was ready would be like a medicine, a healing. They would prepare and keep the tamarind that was needed for that. It would be something to be prepared in the house. When disease and illness came it would be used as a medicine. It does not harm. And some people would heat it and use it. You can use lemon also. Often it vexes and troubles just the belly-the harm called grahani. Between the bowel and the stomach there is something called grahani. That grahani itself is what digests all the food. The many substances that are in it, it changes into the form of the food that we eat. Having changed them, it takes those things that it needs and the remainder goes as feces. Halfway in the digesting, because it is injured, all of it softens and will be going out as feces. Blood too will go. Except that it is like piles it doesn’t cause any trouble. It is wounded and so it hurts. Because it hurts, blood will go, pus will go, the phlegm in it will become knotted and go. All of that will go and become con-

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tinuously tormenting. You must not eat many ripe peppers. P. Bananas are forbidden? D. In Tamil medicine he has said-to keep disease from coming and to keep disease from growing worse [here he quotes a phrase Siddha medical text], VZrai i@mpin‘coriyu kani uru!tal cey,Gn [But for the baby banana fruit we will not give bananas]. We will not eat bananas. If there is a disease and you eat them. the disease will get worse. Otherwise, if there is a chance for any other disease to come, it will come immediately. So the person who is healthy may eat fruit and milk. And to the body which has a place for disease, if disease comes and they eat this banana. it will grow worse. But you know the baby banana? That is very good. That will do no harm to the body. The substances in the fruit--“starch, sweet” substances-none of them will be in that. This is a song sung by Siddhars. This is a rule which is part of Siddha medicine. It is in other systems of medicine also. In some systems of medicine, they have said that one must eat only fruit. If you eat fruit and if you eat goat’s milk disease in the bowel will go away. Are the feet and all numb? For exactly that reason you must not eat bananas. The feet must always be warm. One must cover one’s feet. The head must always be “cool.” The mind [purti] must always cool. The mind must always be level [ri&m~ku]. The feet must always be warm. If the feet become cold it is very bad for the body. ‘-It is an indication of some serious disorder. nervous.” It is the “direction” of “aged people.” For “young people,” they may sleep even in the street. P. [Enjoying the talk] We will set out a long time from now. We will set out in two years. D. For you the “unit” of counting is years, isn’t it? If you eat an enzyme for digestive power it will respond. “Enzyme is a living or non-living and a catalytic agent and decomposes all the food and the chyle is formed and the food absorbed.” So much work goes on in the bowel. It is a “complicated machinery.” But only if it does its work is everybody healthy. The eyes, the ears, the nose, all of these will do their work well. Therefore, for no harm [kshinmn] to come to the body, you must make your food orderly. You must not prepare too much food. And you must not fast. P. Can I take betel leaf and areca nut? D. You must take a lot of betel leaf. The body needs “calcium.” A great wise person [Eini] has discovered this. The first salt that is in lime [cunniimpu] is “calcium hydroxide, hydrated calcium.” That is just what we put on the betel leaf before we eat it. Betel leaf is a “cure” for the “heart.” Areca nut is a “tonic” for the body. Some persons eat only areca nut. P. Don’t they say that if you eat too much areca nut anemia will come? D. If you eat anything too much it will only be harmful. It is good to eat within a “limit.” As soon as you eat you should take a piece of areca nut. You should not take five or six. With a good mango, if you eat more than one mango it will be harmful. The work of the tongue is to see the “tase.” There is a tongue inside. If harm comes to it there will be vomiting, or it will go by way of the gut [cuyiftiil]. For our digestive Ere Ijuduriigni], the tongue is like a “gatekeeper.” It will examine the “taste,” and say, ‘This is good, you must eat a lot of it;’ or, ‘This is bitter. eat just a little.’ The tongue out of habit will eat much just for the taste. The stomach will not tolerate it. Therefore we must eat having made the necessary order. We say rice is enough for the body. We have weighed it and seen. Women know it. If we will eat only two ladles of rice they will put only that much. “They have calculated the amount you are able to consume for a single meal.” It will be in an order. Just by looking, “they are able to decide the quantity according to the quality of food. Man eats a quantity of food of which one third is for the body and two thirds is for the doctor to deal with. AraniiG [therefore] you should not give room

for the doctor to deal with your food. You use only food for your body.” If you give only the food which is necessary to ;he body: it is- enough. You must eat according to necessitv. in “liauid” and in solid Iknddil. They have said it in ‘$hilosopiy.” There is one’called “philosophy of human beings.” In that [quoting a Sanskrit sloka]:’ aham vaisnavo bhuthva praninam dhehama srudha pranapana samayuktho bajamyannam chathur Vishnu Hey Arjuna! The four kinds of food I eat. Then I in the form of fire within the stomach, dwelling in the first location of creatures. make it ready and give fatness to the body, he says. Therefore, even if we eat the food. it is as though God [bhugm~n] eats it. “It is godly fare that is inside the abdomen.” Because calcium is a very important thing, and because betel leaf is a good thing, they give them at weddings. “It is a license for the young couple to chew even before great men. They are authorized to chew.” If you take betel leaf, it gives digestive power to the body. A major part is “calcium.” Without the essence of lime [cunniimpu cartu], health will not come into being. I don’t know how they discovered it. But somebody has discovered it. It has been for a long time. Even to God, an offering may be just a betel leaf. For women who have given birth, it they take betel leaf, no other medicine is needed. For each country, for each body, there is already a medical system in effect [na&@]. Giving milk is for women an excellent habit. It should not be stopped. It will create health for women. It will create health for children also. Letting down her heart [manam ipfiki] she gives milk. does she not? What the child drinks is that power itself. Only with women, God has placed the portion called power [Sakfi]. He did not place it with men. He [man] has not a single power. At a young age, one must be under the tutelage of the mother. In middle age, one must be under the protection [pariimarippu] of the “wife.” In old age, no one at all will care for you. They can’t. Both of them will grow old. Because you are in the mother’s belly for ten months and grow must by drinking her blood, the power of the mother is important. You know “heart disease?” I have “treated” “heart disease.” A sixteen-year-old girl child had heart disease. She stayed in “bed” for two years, and the “doctor” said, her “heart” is very bad, how will you give her medicine he asked. It will be very “dangerous,” he said. None of that will work [akuru]. Because this is a girl child, I give medicine. She survived. She went to “Benares University” and wrote the “examination” and “pass”ed, and got married. She must not get married, that was everybody’s opinion [uppirZ~um]. I said, she can get married. Now there are two or three children. The reason I am saying this is that it is the Sukli given by God. Not from medicine or “tonic. *’ .‘It is not human nature or tonic. It is an inherent power in them.” If this “heart disease” had come to males, I could not create “success.” Even all of God’s “reincarnations” were born from the bellies of women. Vasudevasudhan was in the belly of Devaniyam for ten months before he was born. In the same way Ramachandra Murthi, Nabi, Jesus Christ and moreover all the demons had to serve this jail term. You cannot deny the Gita. All the work can be @ven to women. “Fifty per cent of the jobs must be given to women.” If you gave all the “economic matters” to them there would be no danger in that. “Wife must be given equal power in the administration.” Great, great souls and wise people and lights of the house, women give milk to children. P. Until what age can one give it? D. Ten months-that is, however many days it is in the belly. for that many days you may give it. There is blood which is prepared for that purpose. It will stop by itself [quotes a sloka]: sthanyam rajascha narinam kale bharathi gachathy

The menstrual flow and mother’s milk-in whatever time is necessary for them to be prepared, having been prepared in that time. in H hatever time they must be stopped. in that time they will stop. This does not happen because of our power. The work of the Creator [sirushri] is important. They say that you may raise a child giving it just bottle milk. One may give substitutes and appeasements [cumiiriinariku!]. But you cannot change the way it is [nilui nirur!u muqfiyiiru].A child that has grown up drinking only bottle milk will not have good power.

At this point. another patient arrived at the door of the veranda. MI, noticing him, stopped speaking to the first patient and invited the second one in. The first patient thanked MI and left, taking with her the list of medicines that MI had written down for her. Presumably she purchased these medicines at the pharmacy before she left. I did not follow her out as I wanted to be present at the interview with the next patient. The first patient lived in a place that would have been over a day’s journey by bus from MI’s village. I did not see her again. Second

interr’ielr

Two main categories of patient came to visit MI. The first category consisted of relatively well-to-do people from distant towns in Tamil Nadu who learned of MI through friends or relations of theirs whom he had treated. The woman in the interview above belonged to this category. The second category consisted of people from villages in Nanjalnadu, most of them poor farmers, who knew of MI because of his longstanding local reputation. Although their homes were no more than IO or I5 miles from MI’s village, buses to the mountain villages were scarce and the routes devious, and feet were slow, so that a visit to MI might still mean a day’s journey for them. The patient interviewed here was an agricultural laborer who had previously lived in the region, and was known to MI, but had moved away. As MI told me later, he had worked during his youth on a tea plantation in Ceylon, and then had returned to Tamil Nadu, where he continued to work as a laborer. He was a lean and leathery old man, barefoot, dressed in a worn white veshtie, shirtless. Despite MI’s judgement that he had a “disease of the backbone,” the patient carried himself straight, and had no apparent trouble walking. Characteristically, MI treated old people with affection and respect. The bond he felt with them is evident from this interview. Also evident is his regard for physical labor and his absence of contempt for non-vegetarians. Neither of these attitudes appeared to me typical of South Indian Brahmans, although my experience with the Brahman community is limited. I think his approval of meat and muscle was the consequence of a number of influences. He had read the works of Vivekananda, who advocated bodybuilding programs. The Sanskrit Ayurvedic texts (Susruta and Caraka), which MI knew well, list all kinds of animal parts and products as useful foods and medicines. Finally, most of MI’s clientele were non-vegetarian, and proud of it, as for instance the fishing industry magnates from Tuttikkudi whose patronage had contributed greatly to the growth of MI’s partice in its early days. Also evident in this interview is MI’s particular

The Ayurvedic

physician

attitude toward Siddha medicine. which I saw as one of _erudging admiration, fascination commingled with mistrust. MI often called himself a Siddhayurvedic doctor. He considered the two systems to be distinct, but said that he practiced both of them. Much of his knowledge came from Malayali palm-leaf texts, which were more concerned with particular treatments for particular ailments than with developing a systematic theroy, and which mingled what we would call the magical with the natural. At least as important as the content of the Malayali texts, was the attitude that people of the Tamil plains, such as MI himself, had toward people of the Kerala mountains. Kerala was and is the home of several very developed Ayurvedic traditions. The most prestieious of these traditions is maintained by a lineage ot’ Nambudiri Brahmans. Nambudiris are (in their own estimation) the highest ranking of South Indian Brahmans, jealously guarding both their caste purity and their professional knowledge. People in MI’s family spoke of them with awe and some resentment. But Kerala is also the home of the most powerful sorcerers, as many Tamils told me. In fact each Kerala village has its sorceress (~~llicapad). To say that a Malayali woman seduced a man is tantamount to saying that he was the victim of a love charm. In Nanjalnadu, so close to the mountains of Kerala (moluyii!i literally means people of the mountains), the legends of Siddhars merged with the legends of mountain sorcerers. Siddhars dwelt hidden in the mountain forests, got their herbs there, performed their magic there. The ancient mystique of the Siddhars was lodged in the legends of their alchemy, their Faustian (I use the word advisedly) quest for power, their flirtations with evil [17]. They had potions which could turn copper to gold, and potions for immortality. MI was particularly interested in one potion which they had, which he had tried, and failed, to reproduce. It was called muppu, it contained three salts (or three flowers), and it was made from the fluid of parturition. It was the immortal elixir. MI said that a Siddhar he had met in the mountains had told him about it. The patient’s mention of ‘skull water,’ and of medicine which had taken away his eyesight, led MI in this interview to think of Siddhars, their strange sexuality, and their powers. For some Siddhars carry skulls as begging bowls; and for Indians, the light in the eyes is a form of sexual power, which in turn is what gives the body its vitality. MI joined thoughts of skulls, of eyesight, and of Siddhars with thoughts of the loss of vitality in the patient’s aging body. After the patient was seated, he was silent for a moment, and then spoke. P. The hands tremble a lot. D. The hands shake. When you push your hands down, do they shake? P. Only the right hand and leg do it excessively. D. The left side is not so much? Do water and feces pass all right with you? P. This all passes. Sometimes there is a little binding. I take a purgative. D. On the front side is it expanded or decreased? P. Decreased.

as scientist

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D. This disease you have-there is the center bone [haddelumpu]. you know? They call this “spinal chord disease.” In the backbone [mu!!untqt~il], there is a fault. For this you must drink medicine that is for riira [“wind.” the first of the three action-creating principles in the body-]. In the body, your nerves have all gotten a hard property [kadinartucam]. “Hardening of the nerves.‘* This has grown excessive. Therefore, this is a kind of division of pukkaciitam [ciira of the side]. This is a disease that time can bring. and time can heal. You are able to carry very heavy loads. But you can’t pick up a needle in your hand. The hand will not be still. Your nerves of touch do not work well. The eyes, the ears, the nose. the tongue-are these all okay? P. There is a burden on the skull [muyjaipiirumj. That is to say, skull-water [kap&nir]. Previously, water came in the eyes, and I used an oil when I bathed, and the eyes lost their sight. In youth. D. Did you take ciinmeruku [a kind of wax for the scalp]? P. No. D. In Ceylon what medicine did you take? P. This skull-pounding, for the skull-water, some Brahman [avvar] gave a good Sandhangthi tailam [an oil for external application]. D. Then about how old were you? P. About twenty-five. D. Then, it was at that time, that you bathed using this oil? P. And the eyes went blind. Then I went to a Sinhala vaidyar and made it better. Then again I got another tailam from the vaidyar and used it while bathing. It came into the other eye and ‘dak’ it came down [i.e. the water went out through the eye]. Whatever tailam I rub on. the water will come down. Ordinarily I use only sesame oil. D. Now have you gotten medicine from us and used it? P. I haven’t gotten medicine for this. D. What town are you living in? P. Alantalai, in Trichendur. D. Now you have just come for medicine? P. Yes. D. Previously she [the patient’s wife] had had asthma. Is that all okay? P. Yes. D. We also have asthma attacks [referring to his _grandson]. If you drink medicine for asthma, if you stop it suddenly, it will turn into t&z. If you take medicine for ciiru, it will turn into “blood pressure.” There is dirt [tuSippu] in the body-it is just this that will turn it from one thing into another. The head, the “heart”-it will affect these. If it goes into the head, all of the powers of touch wiIl go bad. “Motion”-feces, water all must go normally. For this I will give a railam. Together with that I will give a medicine that is excellent for the inside. If you take those medicines that are good for the inside, there is that hardness, that is, “hardening of the nerves, or hardening of the arteries, muscles,” and all, you know. That will all become soft and return to its usual habits. First you must eat that medicine for a few days in succession. This is a disease that arose during youth. It has very much grasped and adhered to the body. To keep it from turning from one disease into another, the disease that arose in the beginning is not cured.. Now how old are you Have you passed sixty? P. Seventy. D. The time of old age is.. If the time of old age has come, you must keep the fast that I tell you. Take the medicine for two days and return. Do you eat meat? P. No. I eat fish and chicken meat. D. You must not eat chicken meat. All the medicines that are for ciira, keeping them within the age of a chicken [?I, you must take them four or five times. It will not be very

104-I

?&RGARET TRAWICK

much. It will be just one ounce. You must eat half an ounce of that. If you add a half ounce of “brandy” and eat it for three days. it will respond immediately. It will be a little bitter. That medicine joined with the substance of food, the substance will quickly have an “e!%cr.” .?raroikka.v [a kind of bean], cabbage, carrots, pu<ik;?.v [a gourd]. all of these vegetables you may eat. You must not use ruraramparuppu [yellow split peas]. You must not go to places that are too crowded. You may go to the temple. P. Every day, morning and evening, I go to the temple. I don’t go anywhere else. D. Only the body doesn’t go, but the mind goes to a thousand places. There was a person called Sankaracaryar. He lived only to the age of thirty-two. He became a sannyasi at the age of seven. He wrote philosophy: Vrudhasthava! Chindhasakthaha. In old age. we think of the deeds we did in youth. However th; body is, we must mediate upon God and keep the mind bound in one place. No old people can do this. they say. [Recites a Tamil Siddhar poem]: Kantuka matak kariyai vacamHy nadatta!Hm karadi ven puli vZyaiyum kaddalam oru cinka mutukin me! ko]]a!gm kad cevi eduttHddalIm vFroruvan kZnHma! u!akattu!Lva!Hm vinnavarai tvelko]]a!Zm kanal meI irrukkalgm jalam mE! nadakkalam cintaiyai adakkiyz cummI irukkum tiram aritu catt?iki en cittam kudikonda] paripurananantame. [I can tame the horse, tame the rutting elephant, I can bind the mouths of the bear and the burning tiger, I can ride the lion, lift the snake, whose eyes are ears, and make it dance, wander unseen in the world, enslave sky-dwellers, live on fire, walk on water, but the skill that keeps thought bound and still is out of reach-you essence who possess my will, you deepest, fullest bliss.] You may come riding on a lion, you may bind an elephant and get it to work for you. You may walk so that no one sees you. That is the work of the Siddhars. He will be right with us, and we won’t even know it. We know that Siddhars have much “power.” We have read about it. but it has also actually happened in one place. Only after that happening did I become convinced. He brought his power [cirli] into a secret place. He had studied with some sannyasi. He would come every night into the bedroom of the house of a very rich man. The rich man couldn’t see him. He would come there and sit down. They would put milk there every night. He would drink only that milk and go. This happened. One day what his wife did was-one day she went to the temple and returned. She came and. without eating, went to bed. Because she lay down with a portion of the prasZd [food blessed by the god] from the lamp of that temple, her body could not be seen. She could see that something was moving about. Then suddenly there was a Nambudiri, a big man. Then she asked a question: “I want to see you,” she said. Thus a person walked around without being seen. You can’t discover him. Tomorrow, you have to bring ten or twenty policeman. They must have nuns. The activitv of a Siddhar is like that. He will come at night as soon as it is eight o’clock. You must leave the door open. The door will not be bolted. He will come inside. When he comes-1 have a medicinal herb for that-using its oil I light a lamp and go. If he comes into the light of that lamp, within one or two hours-there is

that oil. you know?-as soon as it is lit that smoke fills the whole place up. The door and al! must be shut. As soon as the smoke touches him he u-ill be able to be seen. As soon as he becomes visible you must make a noise. The police wi!! come. In the same way. as soon as this Siddhar made a noise. the police came and caught him. My tape recorder stopped at around this point, The noise of its shutting off reminded MI of its presence and shortly after that he concluded his remarks of Siddhars. I don’t know how long he would have continued othenvise. My notes say that MI and the patient chatted for a few more minutes about some recent event (the nature of it unclear to me) and then the patient left.

\I. DISCUSSION

OF INTERVIEWS

Recall that this paper is written in response to Horton’s claim that traditional thought is fundamentally different from modern scientific thought in two connected ways. Traditional thought, Horton says, is past-oriented and therefore relatively closed to deliberate consideration of conflicting paradigms, whereas scientific thought is future-oriented and based upon openness to and competition among rival theories. In this paper I have tried to show that past-orientation does not necessarily entail a closed attitude toward paradigms which contradict one’s own. that thinkers who espouse a past-oriented philosophy are still quite capable of dealing openly with paradigm-conflict. In support of my argument I have made three claims for the science of Ayurveda as it is practiced by Mahadeva Iyer, and I will now discuss each of these claims in turn with respect to the two interviews translated above. The first claim is that the idea of causality is central to Ayurvedic theory and practice, and that this concern with causality is intrinsic to Ayurveda’ pastorientation. To find the cause of a disease, one must seek its origins. which are hidden in the past. In Ayurvedic theory, everything converges upon a point in the past, and the apparently diverse phenomena of the present stem from this past unity, now hidden from view. The person who seeks true knowledge faces the past, and traces present reality to its past causes. I have suggested in Ref. [9] that the Ayurvedic vision of truth is not totally different from the vision of truth inspiring modern physics, which also seeks the unity underlying all the apparent diversity of the universe, and which also (in some of its variants anyway) postulates that the universe was condensed into a single point at the beginning of time. One difference between the physicist and the Ayurvedic physician is that the physicist has faith that human knowledge draws closer to truth as time goes on; the physicist believes that there is progress. But the Ayurvedic physician believes that human knowledge, like the world itself, becomes increasingly fragmented over time. A second difference is that for the physicist, theories about the nature of the universe, as they are inscribed in physics texts, are a reality of quite a different order from data given by the universe itself, whereas for the Ayurvedic physician, knowledge of the universe, as it is encoded and inscribed in Sanskrit

The Ayurvedic physician as scientist

texts, is inherent in that universe itself, and has co-evolved with it. However, the physicist and the Ayurvedic physician have in common the view, which they both act upon, that truth is not simply given, either in texts or in phenomenal appearances. Appearances and texts are fragments from the past. Truth and unity both must be sought, in part through the discovery of chains of causation. For the Ayurvedic physician, searching for the truth underlying the symptoms of a disease entails putting together all the fragments of the present-ideas as well as data, even if these seem unrelated or mutually contradictory-in order to reconstruct an image of the original unity from which these fragments have come. In dealing with the fra,gmentary thoughts and feelings presented to him by a particular patient, the Ayurvedic physician need not go back all the way to the beginning of time in order to find where these particular fragments converge and the patient’s disease originated. He will, however, look to the past to find the meaning of the disease-its cause and what is needed for its cure. Consider the first patient interviewed above. Her complaint is chronic diarrhea. The symptoms suggest amebiasis-one of the most common afflictions in India-and this is in fact MI’s initial diagnosis. He might have prescribed an amebicide and left it at that. But things go deeper. The patient makes a point of telling him that she has had this complaint since the death of her young daughter in childbirth. She says several times, “whenever I think about it, it goes,” i.e. she has an attack of diarrhea whenever she thinks about her problem. Two other members of her family also suffer the same illness. The patient says that her disease is “like an allergy. ” “Allergies” are considered to be psychosomatic problems by many South Indians. Asthma is thought to be a prototypical “allergy” of this kindits attacks being brought on by anxiety or stress-and the patient mentions that there is asthma in her family also. Hence two superficially unconnected problems are related to each other by the patient herself: her chronic diarrhea, and her inability to get over the death of her daughter. The patient evidently considers a direct cause-effect relationship to exist between her prolonged mourning and her diarrhea, for she talks about the “fear” [pu,vam] she has experienced since her daughter’s death in connection with her attacks, and South Indians often remark upon the fact that fear can make you have “loose motions.” But then, what about the amebas? Powerful drugs are available in India to treat amebiasis. Also, a healthy body by its own power can generally adapt to their presence in the system. Chronic amebiasis can occur as a consequence of repeated, massive reinfection, or a generally low level of health (especially, poor nutrition) or both. For many people, this combination of circumstances is unavoidable. But this particular sufferer is a well-todo, well educated Brahman woman. She has seen other doctors who have given her medicine and probably also advice concerning diet and hygiene, and she has the resources to follow their advice. She senses that something more than simple physical causes is keeping the disease going, but she cannot quite put the whole picture together, and she cannot

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yet see what MI is about to show her-that the wholeness she seeks is to be found precisely in the origin of her present condition. One source of this patient’s difficulty, which she reveals in passing, is that as a consequence of her mourning she is neglecting physical care of herself. She is indifferent to food, and she has not taken an oil bath since her daughter died. Baths, especially oil baths, are a great pleasure in South India. People who use no oil at all on their bodies are in the worst possible social and psychological shape. A madman; a neglected, semi-feral child; the indentured servant of a heartless landlord-all of these are people who “have no oil to put on their heads.” MI therefore prescribes warm baths, sweet medicine, and a rich cooling oil for the patient to rub on her body. She tentatively asks about betel-chewing (another source of pleasure) and he talks at length about the virtues of chewing betel. He reminds her of its associations with auspiciousness (joy in life), sexuality and love by talking about the fact that a young couple are “licensed to chew” together on their wedding day. In response to the patient’s self-effacement, MI encourages her to chew betel, thus telling her. from his position of authority, that she, too, may be allowed to care for her own pleasure once again. Finally in his monologue on sakti, MI goes back to an even more fundamental source of both suffering and health-the power of motherhood. The patient has this power within her, he implies. It is the cause of her present pain-the death of her daughter in childbirth, and her mourning at the death of this daughter-but it can also give her the strength to recover, as it did with the young girl whose story he tells. It comes out in the interview that the patient has another daughter (a fifth child, aged thirty; MI’s fifth child was a daughter who died at thirty shortly after childbirth). The fifth daughter is “important (muk&yam)” says MI. He may be hinting that the patient should live for this daughter’s sake. Thus we see in this interview how the tracing of a cause-and-effect relationship takes place within a frame of orientation to the past as a unified source. Both the cause and the cure of this patient’s suffering, according to MI’s diagnosis, are to be found in the sakti of motherhood, which is the origin of all things, the lost unity which all creatures seek. In studying MI’s interview of this patient, one is reminded of the methodology of Freudian psychoanalysis, which traces the apparently meaningless pieces of a person’s present symbolic behavior to the rupture of a primordial wholeness. MI’s belief that truth and wholeness lie in the past does not preclude his facing all the contradictory data of the present. Rather, he seems almost compelled to take everything into account, progressively refining and revising his assessment of the situation as new evidence arises. In the second interview, MI proceeds in a similar way. The patient is an old man with a trembling hand. He gives the doctor a seemingly unconnected bit of information-viz., that in his youth he was temporarily blinded by an oil given him by a Ceylonese vaidyar for ‘water on the skull.’ MI responds by discussing the unification of the mind in youth, its tendency to wander during old age. Again there is the assumption of a unity in the past

of the patient, closer to his particular point of origin than the present. and a backward tracing ofcausahty towards this point of unity. The trembling hand is. in the Ayurvedic frame, a riita disorder; in allopathic terminology it is a nervous system disorder.’ In both frames, it is close to a mental disorder. ‘V%ta’ in Sanskrit also means wind, and Ayurvedic descriptions of the action of vata in the body point to its similarity with the actions of wind on earth. It dries things out, it makes things tremble and move. it creates hollows, it fans flames. it is known by touch and affects most the sensation of touch. as fire is known by sight and its associated humor, pitta. affects most the sensation of sight (Susruta Chap. I. pp. 12C~121; Caraka Chap. I. Vol. I, p. 59). In Indian thought. disembodied spirits take the form of wind; they wander restlessly, and may possess people and make them insane. According to the Ayurvedic texts, c&a is the wanderer in the body-it causes problems of motion and sensation. and also. to a greater extent than the other two humors. various forms of insanity. People in old age are most prone to ciira diseases-trembling, numbness, dryness of the skin, general aches and pains. Hence the connection between trembling. the wandering mind. and other afflictions of age becomes clear. They are all traceable to ciita, which is an imperceptible sign of perceptible activities in the body. A more specific possible source of this patient’s illness is his encounter in youth with the bad doctor who gave him the binding medicine. MI guesses that this doctor was a Siddha doctor. In this connection he discusses Siddhars. their power as gurus to influence people in evil directions, their proclivity for wandering, and their ability to blind others to their presence by making themselves invisible. Again, MI has taken all the bits of seemingly unrelated information that the patient has given him and has traced them to a common source. Unity of understanding is sought in the past. The humility of this effort lies in the recognition that he, like his patient, dwells in the fragmented present of old age, the kali yuga of the person. Hence his reconstruction of the chain of causality leading into the past is provisional, and alters in response to what the patient tells him. He does not have a fixed diagnostic category into which he slots his patient, attending to the information which fits this category. and ignoring the rest of the patient’s communications. The second claim that I have made for MI’s system of medicine is that he does not avoid facing paradigm conflict, but focusses squarely upon it. choosing points of high friction between the paradigms he lives with, and elaborating this though around some key paradox that articulates these raw spots. In his patient interviews, three pairs of conflicting paradigms come to the fore: (I) Siddha versus Xyurveda; (2) atheistic western biomedicine versus theistic Indian medical philosophy; (3) classic Brahmanism versus (for lack of a better term) Tamil Saktism. The Siddha-Avurveda conflict comes up clearly in the second interview. Here we are concerned with the disagreement between the Siddha injunction to reverse life processes, and the Ayurvedic injunction to foster them. This disagreement becomes particularly salient to one facing old age, for Tamil Siddha

medicine specializes in rejuvenating medicines and elixirs of quasi-immortality-mineral compounds which are supposed to make the body like gold or like a diamond. keep it from changing. The problem is that these elixirs are reputedly dangerous and unreliable. like the Siddhars themselves. Many (or by some account, all) Siddhars stop short of immortality for the sake of exercising the worldly powers that they have acquired in their yogic efforts towards the former goal. Ayurveda, on the other hand, though its central concern is also the prolongation of life (avus means long life) makes no promises about restoring youth or halting the aging process. On the level of theory. questions concerning what life processes are, Siddha and Ayurveda are fundamentally opposed. Siddha claims that natural life processes are all a process of dying (I am greatly oversimplifying here), but with great effort you can break out into isolated immortality [IQ Ayurveda claims that the good comes with the bad (again. I oversimplify), and is concerned with harmonizing the complex flow merging the inside of the body with the outside. Formulated in one way. the question becomes, what is human power capable of doing? And in the merger of Siddha and Ayurveda, the answer comes back in paradoxical forrr-a human being can transform the world with relative ease, but even with the greatest effort, he cannot keep himself from changing. Or in terms of the poem quoted by MI. I can enslave the gods but I cannot tame my own mind. Or in terms of his direct communication to his patient, you can move great burdens but you can’t keep your own hand steady. Notice that MI does not choose one paradigm and reject the other. The paradox is his final resting point. The conflict between classical Brahmanism and Tamil Saktism rests in part on a discrepancy between a vision of the world as organized around hierarchical principles of purity, and the world as maintained by the messy dynamics of procreation. In texts more oriented toward the former (Manacadharma.sa.wa, Tirumanriram) females are described. at best, as means towards ends, and at worst, as foul creatures honored by shackles. For thinkers more oriented toward the latter (Tiruvalluvar, Sankara. Ramanuja, Bharatiyar, Annadurai), the equation between motherhood and godhead prevails. This kind of polarity is of course not confined to India, but in India it is particularly elaborated. Neither pole can be said to be dominant; the tension between them has prevaded Indian civilization for many centuries. In MI’s world, this tension centers around love and loss, especially the memory of his dead only daughter. Hence his striking reformulation of the famous dictum in Manacadharmasastra that a woman should be under the control of her father when she is young, of her husband when in the middle of life, and of her sons when old. MI says to his patient, a person should be under the protection of his mother when a child, and of his wife in maturity, but when he is old he will have no one at all to look after him. This ironic statement articulates the discontinuity between world the the ideal of dharmasasrra and mother-goddess ideal. It also takes into account an empirical fact that both of these ideals neglect-the short life-expectancy of females in India relative to

The Ayurvedic physician as scientist males, and the very high rate of childbirth-related death there. Hence the paradox-that women have the power to give birth, but are easily overcome in the very process of birthgiving by the power of deathbecomes a pivotal point in MI’s dialogue with this patient. A third pair of discrepant paradigms that are part of MI’s world are the atheistic western biomedical frame and the theistic Indian medical frame. These two types of frame are at the outset incommensurable in the strictest sense: translation of core propositions of one frame into the terms of the other is literally impossible. However, western biomedicine has been in India long enough that it has undergone seachanges in the direction of commensurability with the other systems. I believe that these changes largely take place in the internal and external dialogues of multilingual individuals such as IMI. One of the processes that is involved is the gradual equilibration of particular pairs of terms drawn from the two languages. For South Indian Brahmans who know Sanskrit, there have come to be exact equivalences in the lexicons of the two languages as these speakers use them-Sanskrit ayus and Tamil cZirnSi{,for instance. The same is true in their use of English and Tamil. Code-switching and translation back and forth between the two languages takes place continually in conversations among bilingually educated speakers. In this context, both languages become revised with respect to one another [19]. We can see a similar, but somewhat higher-level, process of equilibration taking place in MI’s struggle to bring into harmony the western and Ayurvedic models of chronic diarrhea. According to Ayurveda, this complaint, called grahuni, is the consequence of a disturbance of the digestive fire, juduriigni, which is situated between the stomach and small intestine and ‘cooks’ the food in the stomach, before passing it on to the small intestine; there is no recognition of antagonistic microorganisms dwelling in the body in the Ayurvedic etiology of this disease. According to western biomedicine as MI employs it here, the kmd of chronic diarrhea presented by the first patient is a consequence of amebic infection; there is no recognition of any kind of fire or cooking process going on as part of digestion. These are two different explanations of the ‘same’ event drawn from two different medical paradigms in two different languages. There are many ways that these two views might be put into relation to one another: one of the two might simply be discarded; one might be seen as the cause of the other (for instance, the amebas might be seen as distributing the fire); some kind of third explanation, drawing upon some aspects of both original explanations and discarding some aspects of both, might be chosen. For MI, the problem of relating the two discrepant explanations appears to be a linguistic one, essentially a matter of translation. MI is not alone, of course, in his work of reconciling paradigms through translation. Ayurvedic texts have been translated into English, and Ayurvedic discourses written in English, and often enough differences between the western and Indian frames have been solved by fiat (some would say glossed over) through translation. For instance, one English version of Caraka Samhita translates the Sanskrit

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term hrduyu (etymologically related to English ‘heart’ and said to be the meeting point of all the channels in the body) as ‘brain’. The translator evidently chose this term because in the Ayurvedic texts, hrdqvu is the seat of consciousness (tit). Similarly, MI translates qrahuni as “inflammation of the pylorus,” perhaps drawing upon the work of previous translators. Note, however, that this is not a facile translation, but one carefully chosen for its ambiguity. Although the term ‘inflammation’ does not literally mean that the organ is on fire, the flame is preserved in the word itself. In MI’s discussion of this patient’s complaint, the place of referential focus is an anatomical junction, a halfway point, and, in Ayurvedic thought, a point of transformation. This seems peculiarly appropriate, since the pragmatic or methodological focus of this same interview is the process of translation. The native medical systems regard the anatomical place of transformation, the junction between the stomach and small intestine, to be an ‘internal tongue,’ which, like the tongue in the mouth, ‘tastes’ the food. If the food tastes bad to this internal tongue, the person experiences indigestion. The tongue in the mouth and the tongue in the gut both help keep harmful substances out of the body, and help process and transform beneficial substances so that they can be received further down and absorbed. In western medicine, this point of junction is called the pylorus. MI begins his process of linguistic assimilation by calling gruhuni “inflammation of the pylorus,” thus maintaining the Ayurvedic connection of this disease with fire. Being intersted in the origins of language, he has looked up the etymology of ‘pylorus’ and has found that in Latin it means ‘gatekeeper.’ Now he has discovered a point of commonality, for this definition of the junction accords with the Ayurvedic description of it as well. Again he has sought and found unity in origins. Inasmuch as Greek humoral medicine remains preserved in western biomedicine through Latin vocabulary and its attendant presuppositions (cf. Foucault’s discussion of ‘hysteria’ and ‘melancholia’ [20]), it is useful in MI’s attempts at synthesis, at finding a common ground of presently unrelated perceptions, for there was considerable interchange between Greek and Ayurvedic medical thought at the time that the core Ayurvedic texts were being compiled. The gatekeeper is the fire in the belly, the sacrificial fire which from Vedic times was considered to transmit offerings to the gods, and to be itself a god. Thus we are led to a final image of God in the gut, and to MI’s final synthesizing paradox. Amebas are orgnisms, living beings, in the body, whose growth and destructive activity are encouraged by the consumption of starchy and sweet foods such as bananas, foods which would contribute to the growth of the patient if she were healthy. In gemeral, according to the Ayurvedic system, a patient must observe a partial fast when sick for just this reason-to avoid feeding the disease. Amebas in the body are analogous to the doctor, who fluorishes as a consequence of excess food consumed by the patient (hence “twothirds of the food is for the doctor”). Though his aim should be the well-being of the patient, in fact, MI is saying, the doctor fluorishes at the patient’s expense.

lo4

.MARGARET TRAWICK

The doctor in turn is analogous to God (Bhagavan) who dwells in the body and consumes the food that enters there. Thus the circularity of creation---“1 who am food eat the eater of food”--the realization that everything returns to its source, becomes the paradox which unites the theistic Indian and the atheistic western medical paradigms. Indian medical practitioners are acutely aware of the dichotomy between ‘science’ and ‘religion’ and consider western medicine does represent itself as non-theistic. Although on the level of fundamental premises, western medicine, like western physics, may be based upon a monotheistic world view [21], modern biomedical writers make no explicit reference to God in their explanatory theories, and consider teleological paradigms such as vitalism to be outmoded [Xl. As an overtly athesitic system, modern medicine denies conscious purposefulness in creation and strives to remedy the imperfections of nature. Ayurveda as MI understands it, however, is openly theistic. The theistic paradigm of Ayurveda says that nature was created by God for a specific purpose and you should not oppose it. Hence. “There is already a medical system for every country and for every body,” and, “There is blood in the body prepared for that purpose” (i.e. for the purpose of milkproduction). ‘MI’s ironic synthesis of theism and atheism says, in the end purposefulness is purposeless. God consumes his own creation. Nonetheless, MI addends a caveat. “Creation [srushti] is important.” If we don’t follow its order, e.g. if we don’t nurse our children, we will not thrive. In his final acceptance of theism, as in his general proclivity to find a resting point in paradox and not resolve it, he remains firmly within an Indian mode of thought. My third claim about the development of MI’s thought within his practice of Ayurveda is that it was highly responsive to external challenges: it was not a closed system. In particular, I have said that of all the external challenges that were presented to him, MI was most responsive to the unique set of conditions presented to him by each patient, especially as this set of conditions was represented by the theory that the patient herself had formulated in order to comprehend it. I will not devote much further space to demonstrating this claim, as it has already been illustrated above. We have seen how MI took all the facts presented as significant by a particular patient, together with aspects of his own knowledge, and worked them into a single gestalt. This was done in what struct me as an almost oneiric fashion, but the oneiric mode is not necessarily unscientific. What differentiates this method of patient examination from the more closed one in which all physicians are trained is that MI habitually did not attend to a few ‘relevant’ pieces of information while ignoring the rest. We have also seen how, in his interviews with these two patients, MI centered his diagnosis upon a point of commonality between himself and the patient-in one case, old age, in the other, death of a daughter. Thus a personal openness accompanied his theoretical openness, In lieu of the objectivity of the

western physician, IMI’s method of reaching diagnosis was closer to what could be called intersubjectivity. The point I wish to stress in closing is the way in which, on a micro-level, .LII continuously expanded and refined his comprehension of the human organism, maintaining a constant open dialogue with the data which were his patients. maintaining integration by moving from gestalt to wider gestalt. and through irony and humor, maintaining a valiant humility in the face of truly daunting challenges to his world.

REFERESCES

Although the idea of unilineal cultural evolution is now recognized by most anthropologists to h very problematic, teleological views of culture remsin. and assertions are still often made that contemporary foraging peoples have a way of life very similar IO that of our own distant ancestors, and that these foraging peoples should be studied for that reason. (For a criticism of this approach see Pratt M. L., Fieldwork in common places. In Clifford and Marcus [23]). Marcel Maws developed a theory of the growth of human knowledge which transparently revealed the Judaeo-Christian underpinnings of teleological views of wor!d culture: the collective human spirit evolves toward a kingdom of heaven on earth (Carrithers M.. Collins S. and Lukes S. The Category of the Person. Cambridge University Press, Cambridge, 1985). Modem, more particularistic formulations of cultural evolutionism say that culture is not static but changing, and that change is not random but accumulates in a certain direction, touards greater fit with or dominance over an environment. and toward greater complexity. Recent teleological views of human culture include Marvin Harris’ cultural materialism and E. 0. Wilson’s sociobiology. Science also, by many definitions, changes for the better. It progresses either absolutely, tow-ard closer and closer approximation of the truth, or within a particular paradigm or research program, toward increasingly fine fit between observation and theory. Karl Popper (The Logic of Scienlifc Discorery. Basic Books. New York, 1959) is the best know-n modern writer on the topic of scientific progress. The literature on cultural relativism is massive. For a recent debate on this topic, see Hollis and Lukes [24]. Since Popper, authoritative theories of scientific relativism have become more and more radical. In Conjectures and Refutations (Harper, New- York, 1963). Popper develops his famous formula concerning the falsifiability of theories: a theory cannot be proved to be true, it can only be shown to be false. and the most valuable theories are those that are easily falsifiable. Thomas Kuhn [25] goes a step further by proposing the notion of alternative scientific paradigms. though he also maintains that succeeding paradigms are chosen over preceding ones because of their superior explanatory powers, i.e. in the move from paradigm to paradigm, there is progress. Imre Lakatos 1261 and Paul Feyerabend (Againsr .Merhod. Verso. London, 1975) also hold to the idea that science as a whole can, does, and should improve. But in direct opposition to Kuhn’s idea that the accumulation of anomalies in and of itself leads to the overthrow of an old paradigm. they argue that any theory or paradigm can be found to be immersed in “an ocean of anomalies.” Tine point of a research program, they say, is to choose which anomalies are most likely to be able to be turned into confirming instances of one’s own theoF. Thus, the longer a theory has been around, the more time its proponents will have had to discover ‘observational’

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sity of California Press, Berkeley, Calif., 1986. Srinivas M. N. The Remembered Village. University of California Press, Berkeley, Calif., 1976. Gould S. J. Ever Since Darwin. Norton. New York, 1977. Egnor M. Death and nurturance in Indian systems of healing. Sot. Sci. Med. 17, 935-945, 1983. Leslie C. The ambiguities of medical revivalism in modem India. In Asian Medical Systems. University of California Press, Berkeley, Calif., 1976. Egnor M. The changed mother, or what the smallpox goddess did when there was no more smallpox. Conrrib. Asian Stud. 18, 24-15, 1982. Eliade M. Yoga: Immortality and Freedom. Bollingen Press, New York. 1958. Zvelebil K. Poets ofrhe Powers. Rider Press, London, 1973. Egnor M. [ii]. Egnor M. [14]. The first section of the text which is considered to be the foundation of Tamil Siddha medicine, Tirumantiram, is devoted to illustrating the ephemeral nature of human life, and the blindness of all human being to their own mortality. The central section of this text then maps out the tortuous passage to immortality, which involves withdrawal of the self from all normal life processes. Horton and a number of other thinkers interested in the relation between science and culture argue that cultural relativism entails absolute untranslatability from language to language and the impossibility of communication among cultures. Hence one must assume the existence of a universal logic or a shared core of experience upon which to build bridges. (Hollis and Lukes [24]; Sperber D. On .4nthropological Knowledge, Cambridge University Press, 1982; Wilson B. R. (Ed.) Rafionalify, Blackwell, Oxford). But this argument is wrong, because it takes for granted that languages and cultural worlds are selfcontained and immutable. This is analogous to saying that there can be no communication between human beings because no one can know what is in someone else’s head. Quine calls this the museum theory of meaning. It gets us nowhere. What gets us somewhere is the realization that culture is created in communicative acts. that it is constantly changing, that we, the ‘bearers’ of culture, are also constantly changing, and that each of us is composed of sub-selves that talk to each other in much the same way that they talk to other people’s sub-selves. Translation, like ethnography, is not a replication of one world inside another, but a synthesis, a brand new world, composed of two worlds together, and apprehended by each of them in a different way. If the translation is successful, each of the two contributing worlds will be changed by it. The more two cultures engaged in these joint creative acts, the more they will contribute to each other’s continued growth. See Ulin R. Understanding Culfures. University of Texas Press, Austin, Tex., 1984, for a similar, hermeneutically based answer to the problem of cultural relativity and incommensurability. See Asad T. The concept-of cultural translation in British social anthropology, in Clifford and Marcus [23], for a discussion of the relation between simplistic theories of translation and ethnocentric scientism. Foucault M. Madness and Cicilixtion. Random House, New York, 1967. Foucault M. [20]; Niebuhr H. Radical Monorheism and Wesfern Culfure. Harper & Row, New York, 1970. Gould S. J. The Panda’s Thumb. Norton, New York, 1983. Clifford J. and Marcus G. (Eds) Writing Culture. University of California Press, Berkeley, Calif., 1986. Hollis M. and Lukes S. (Eds) Rationality and Relufiukm. M.I.T. Press, Cambridge, Mass., 1982.

25. Kuhn T. The Strucrure ofSclenrz$c Rerolutions. University of Chicago Press. Chicago. Ill., 1962. 26. Lakatos I. Falsification and the methodology of scientific research programs. In Criricirm and fhe Growth of

Knowledge (Edited by Lakatos I. and blusgrave A.). Cambridge University Press, Cambridge. &lass., 1970. 27. Holton G. Themalic Origins of Scienrifc Thoughr: Kepler 10 Einsrein. Harvard University Press. Cambridge, Mass., 1973.