The traditional system on medicine in Sri Lanka.

The word Ayurveda has derived from AYU and VEDA. AYU means life VEDA means Science or knowledge. That means the science of life. Charaka defines "That science is designated as Ayurveda where advantageous and disadvantageous as well as happy and unhappy states of life along with what is good and bad for life, its measurement and the life itself are described " (Charaka Sutra 1 - 4) Ayurveda embrace all living things, animate and inanimate. It is divided into three main branches Viz. Nara Ayurveda dealing with human life, Satva Ayurveda the science dealing with animal life and its diseases,Vriksha Ayurveda the science dealing with plant life its growth and diseases. When one goes deep into the science of Ayurveda, it is clear that this is not only a system of medicine but a way of living for complete positive health and spiritual attainments. Ayurveda believes that the highest wealth one get is health. Righteous life, (Dharma), Wealth (Artha), fulfillment of desires (Kama) and attainment of salvation (Moksha), all these four factors depends on a healthy life. Swasthya (Health) is defined as (a) Dosha Dhatu samya (well balanced metabolism) plus (b) Prasanna Atma, Indriya, Manah (a happy state of the being, the senses and the mind) sense here mean the five organs of perception Gana Indriya (smell, taste, sight, touch, and hearing) coupled with the organs of action Karma Indriya namely mouth, hands and feet, organs of excretion and reproduction.

The origin of ayurveda dates back to the Vedic era. Some historians say that ayurveda is a part of Atharva Veda. In Athavaveda too there are hyms which mention medicine for various diseases. Medicines like Accorus calamus, Phylanthantus embolic are mentioned. The systematized form of ayurveda dates back to the Rishi conference which was held in the place called Chityarata in the foot hills of Mount Himalaya. The great book on ayurveda Characa Samhita gives a detail description of the Rishi conference Rishis are great learned people like the great scientists of today. But with a deference. They are enlightened and refined persons who are absolutely free from the predominance of Rajas and Tama by virtue of the power of penance and knowledge and who are always in possession of an uninterrupted knowledge pertaining to past, present and future and known as authorities (Aptaos). They are also known as gentleman (Sista) and enlightened (Vibudha) persons and their words are considered free beyond any doubt. When diseases were more prevalent these learned scientist called all the scientists of India and neighboring countries like Sri Lanka and of Greater India. A list of the names of scientists who attended the conference is also given in Charaka Samhita. At this conference all the scattered knowledge was collected and 8 schools of thoughts were originated. The main are the school of internal medicine, school of surgery and school of pediatrics. Agniveshas book on internal medicine became the authoritative text. Today it is known as Characa samhita. Susruta's book on surgery became the authoritative text of that subject. Kashyapa's book on paediatrics became the standard book of the subject. There were books written on other subjects like toxicology, ENT diseases etc; but they are lost and are unable to find to in this day. Nevertheless certain portions of some of these books are found.

Similar books were written on veterinary science. The voluminous book on diseases of elephants and there training is called Palakaypa samhita. The book on diseases of horses is called Shalihotra Samhita and it contains 12000, verses 12000 is also the number of verses in Charaka Samhita. The similarity does not end with number of verses, just as Ayurveda is divided into 8 sections this science has also been divided in to 8 sections This Shalihotra Samhita has been translated into Persian, Arabic, Tibetan and English. The Persian translation dating as early as 1387 AD. The section describing the diseases of cattle is called Gava Ayurveda. Senaakayurveda is the science of birds and training of hawks. The book written on plants, their diseases, propagation etc; is called the Upavana vinoda. Thus this is the first historical record, perhaps in the whole world of systematizing the medical knowledge. Knowledge that had come down, till then, as a living tradition traced either from a divine origin or from the findings of the deep thought meditation of sages or from the instinct, experiment and experience of generations of humanity. The 8 branches of Ayurveda are as follows

Kayachikitsa – Internal medicine.

Salya tantra – surgery.

Salakya tantra – E.N.T. diseases.

Kumara tantra – pediatrics coupled with midwifery.

Agada tantara – toxicology.

Buta vidya – psychology and spiritual healing.

Rasayana tantra – geriatrics

Vajikarana – aphrodisiac medicine coupled with eugenics.

Just as the modern medicine is based on physics, Chemistry, Botany, and Zoology. Ayurveda is based on Indian or Hindu Philosophy. The theory of macrocosm and microcosm. That is the man is an epitome of the greater universe. It believes that the matter is composed of five elements (Panchamaha buta).They are Prithvi (earth or hardness), AP (water or liquid), Theja (fire or energy), Vayu (gases state of matter) and Akasha (ethereal state of matter). It is said that matter to exist there should be Kala (time) and Dik (space). With the addition of Manas (mind) and Atma (soul), the matter becomes animate. These9 components are called the Nithyadravyas or eternal elements.It is very difficult to give exact English equivalents to there highly technical Sanskrit terms. In the universe there are the sun, moon and wind, in the same manner in all living things there are the motion, the liquid component, and the heat or energy component. They are called Vatha, Kapha and Pittha respectively. The human body is composed of Pancha maha butas ie the five basic elements. In the human body they are explained in terms of Dosha, Dhatu, and Mala. Life is the union of body, sense organs, mind and soul.The dosha are vata, pitta, kapha. The 7 Dhatus are Rasa (chyle or nutrient fluid), Rakta (blood), Mansa (muscle tissue), and Medas (fats), Asthi (bone, connective tissue), Asthi majja (bone marrow) and Shukra (reproductiveelements or the vital substance). The three main Malas or excretions are purisha (faces) mutra (urine) and sweda (sweat). The doshas when exist in dynamic equilibrium help to maintain the human body in a healthy condition. Then they are called Dhatus. Any disturbance in this equilibrium causes malfunction and results in disease. In that event they are called Doshas. Thus Vata, Pitta, Kapha, are alternatively called Dhatu or Dosha depending on the effect they have on the functioning of the body. The root Va is derived from va-gati gandaya ie which has motion. Vata – This initiates and promotes biological activity responsible for all the movements of the body. It is of five types.

Prana vata – controls the functions of salivation, eructation, sneezing, respiration, etc.more or less it comprises the functions of the respiratory system.

Udana vata - having phonation as the main function.

Samana vata – regulating the gastric secretion, retaining food in the stomach or intestine for the required time and helping its absorption..

Vyana vayu – control pulsation of heart and circulation of blood.

Apana vayu - controlling the function of elimination of semen, urine faces, feouts etc.

Pitta responsible for generation of heat and all the actions of digestion and metabolism. It is derived from the root Tapa Santhapa which means heat or energy.

There are 5 types of Pittas:

Paachaka pitta – responsible for digestion and metabolism of food.

Ranjaka pitta – resides in liver and converts rasa (chyle) into rakta (blood).

Brajaka pitta – resides in the skin and provides pigments to the skin.

Sadaka pitta – resides in the brain and responsible for the intelligence and ego.

Alochaka pitta - resides in the retina of the eye and gives vision.

Kapha (Sleshma) – The main function of kapha is to give nutrition to the body tissues and achieves. It is derived from the root slish – Alingana meaning adhering.

It is also of 5 types:

Kledaka kapha – moistening the food injested in the mouth.

Avalumbaka kapha – provides nutrition to the heart.

Bodhaka kapha – resides in the tongue and percive the taste.

Slesaka kapha – lubricating the joints for there proper functioning.

Tarpaka kapha – giving nutrition to the mental faculties.

Just as the body is governed by the three doshas, the mind is also governed by three attributes (guna) mental doshas. They are called Sathva’ Rajas and Thamas. Sathva is responsible for righteous and kind thoughts and feelings. Rajas is for arrogance, desire, love and passion. Thmas is for sleep, stupour, ignorance. All food, behavior, thoughts and medicine will increase, decrease or neutralize the mental and physicaldoshas.

Dravya or matter has five properties. They are Rasa (Taste), Guna (quality), Virya (potency ie cold or hear), Vipaka (the substance that formes after digestion and metabolism) and Prabha (the specific power of a substance). According to Ayurvedic physiology the body is formed with billions of cells and these cells are constantly changing and therefore every moment the man is changing, because of numerous cells there are numerous channels. These channels are called Srothas means path ways which many things can flow. Through these channels nutritious substances, chemicals and wast products flow. If the flow is deranged then there is stagnation and this will give rise to hypo or hyper function of that part of the body or organ and give rise to pathological conditions. Derangment can cause stagnation, (sanga) overflowing (ati pravrti), flowing in the wrong direction (vimarga gamana) or dilatation of the channels(Sira granti).

Disease is defined as Dukkha samyoga ie contact with dukkha. Dukkha means physical discomfort, pain or suffering as well as mental anguish including the pangs of jealousy, fear, anger, avarice, hate, treachery, passion, love, hate etc,

Diseases are caused due to

Asatma – indriya – artha – samyoga ie. Not using the five sense organs in the correct way i.e. wrong use, exessive use, or not using them at all. Pragnaparadha ie; intellectual blaspheme which means indulging in wrong things knowing very well that it leads to destruction of health. Parinama which means diseases caused by seasonal changes.

Disease is fourfold:

Aganthuka - adventitious.

Sharirika - physical.

Manasika - mental.

Svabhavika - natural.

The agantuka diseases results from external factors, cuts, bites, stings, injuries, accidents etc.; the physical diseases consist of internal ailments nutritional and metabolic imbalance, growths, inflammation and so forth. The manasika (mental) diseases in ayurveda includes the state of anger and wrath, pride and vanity, greed and avaisce, treachery, falsehood, indiscipline and uncurbed desires, hate, fear, cruelty, distress, sorrow, anxiety, unhappiness, laziness, etc; along with insanity epilepsy and so forth. The natural diseases cover birth, natural old age, death, natural hunger, thirst and natural sleep.

For clear diagnosis five points have to be studied intensively.

AHetu - the causative factors.

Purva rupa - the premonitory symptoms..

Rupa - the symptoms.

Samprapthi - the pattern of combination of the vitiated doshas.

Upasaya - whether the disease is responding or not to the medicaments.

The Ayurvedic treatment consist of three factors they are.

Ahara - food.

Vihara - mental and physical behavior.

Aushadha - medicine.

The definition of the Ayurvedic treatment covers the widest possible prophylactic and therapeutic approaches conceived by any system of medicine. It says “A salubrious use of a drug (Aushadha) diet (Anna) and practices (Vihara) prescribed jointly and severally

contrary to the cause of the disease.

contrary to the disease itself or

contrary to both the cause and the disease or

similar to the cause of the disease or

similar to the disease or

similar or both the cause and the disease, constitutes treatment.

The treatment is of two types:

Description:Swasthasya urjakara ie the treatment which promotes and safeguards the existing health. Aphrodisiac and geriatric medicine comes under this.

Description:Arthasya roganuth ie the treatment for the sick. It covers prophylactive and curative medicine. This is done by two methods, they are :

(A) Shodhana the cleaning or eliminating the morbid factors from the body by the five purifecatory procedures. This is done in three phases ie pre operative, operative and post operative stages. Pre operative stage is the oblation and sudation therapy, in this phase the patient is given various oils internally and externally, and various types of sudations. By these processes the morbid factors are loosened and removed or brought to the stomach or the elementary cannal. Operative stage is the removing of the thus loosened morbid doshas by

Vamana – ematics.

Virechana – purgatives.

Nashya – nasal inhalations.

Vasti – enemas.

Rakta mokshana – blood letting and cupping.

The post operative stage is the gradual administration of food from simple gruel to solid food.

(B) Shamana which means palliative treatment - This is done by –

Diet control.

Fasting.

Exposing to the rays of the sun and wind .

Various exercise yoga.

Medicine.

It is said that the best treatment is Nidana Parivarjana ie to eschews from the causative factors. For treatment there should be four components. They are the physician, patient, nurse and the medicine. In Ayurvedic text the qualities of the above four are practical knowledge, kind and not greedy of wealth. The patient should be obedient and have faith in the doctor. Nurse should be kind, clean. The medicine should be of variety and of proven effectiveness.

In Charaka samhita it is stated that the physician should not hesitate to learn even from an enemy and went to the extent of saying that there is nothing in the world which cannot be taken as medicine. It is surprising to note that before 3000 years ago they knew that anemia is caused due to iron deficiency. Night blindness was treated with liver. Marasums was treated with liver and meat. In Susrutha samhita 20 sharp and 101 blunt instruments are described and the surgeon was given the option of modifying or inventing any for skin grafting, cataract operation, operations in the gut, gall bladder, bladder and many other surgical methods.

In the olden days the course of medical education ran through a period of 7 years. Susrutha samhita describes how a medical student should do dissection on dead bodies. Certain points high lightened by Susruta are worth mentioning because every single word mentioned in these stanzas holds true till today.These are direct translations of the Sanskrit text “Patients in whom there is a break in the continuity of tissues should always be protected from dangerous and invisible creatures.”

“The powerfully virulent and harmful organisms, to whom flesh and blood is very dear, invade and patients tissues through the portals of entry of ulcers and wounds.”

“When flies come and drop the invisible organisms on the wound flourish on it and a severely painful swelling appears.

“The surgical instruments should be used only after having been heated in the fire.”

“The surgeon should make efforts so that in compound fracture, infection does not supervene. Because suppuration of muscles, ligaments, vessels and nerves lead to great difficulties in the healing of fractures.” (Susruta).

This is how Susruta describes the sharpness of surgical instruments and how to handle.

“When the blade of the knife has been made so sharp that it can slice the hair into two, the different parts of the instruments have been fixed properly, the adjustments regarding the measurements have been done correctly and it has been held in the proper way, only then should it be used in surgical operations.”

In Ayurveda great emphasis have given to pharmacy. Drug action, poisonous properties, benefits and hazards of long term use, dosage, expiry period of the potency and many other aspects are described.

In the treatment more emphasis is given to the patient than to the diseasesè All living beings are divided into three main psycho-somatic types They are called Prakurti. The main three are Vataprakurti, Pittaprakurti and Kaphaprakurti. These prakurties or psycho-somatic types have unique characteristics and some diseases are prone to occur in some types, for example vatic disorders or diseases of the nervous system can occur more easily on a vataprakurti man. According to Ayurveda even one can not name a disease still, can treat if he could find out the nature of imbalance occurred in the body. This can be known by observation, interrogation and palpation. The unique pattern of the unbalance of dhosa is called the “Melaka vishesa.”

Charaka Samhita has described about 600 items as medicine. This book has been translated to many languages like English, Persian, Arabic, Sinhalese, Japanese and many Indian languages. Susruta Samhita, the book on surrery mentions 1120 disease conditions and 573 items used as medicine. This book is also translated into many languages. Though these books are written over three thousand years ago, still they are in use.

Buddhism has contributed a great deal to the development of Ayurveda. With the spread of Buddhism, the temples became the institutes of higher studies; they were gradually converted to universities. Amongst these universities Taksasila, Kasi, Nalanda have earned fame. The best account of the universities is furnished by the two Chinese pilgrims to India. Yuan Chwang who traveled in India for 16 years ie. 629 to 645 A.D. as a student of Buddhism of which he spent 5 years at Alana University and It Sang spent 10 years i.e. 675 to 685 AD. As a student there. Taxila University was flourishing in the 7th century BC. Historians have said that students from foreign countries like Babylonia, Misra (Egypt), Syria, Arabia, China and Greece have come to learn philosophy and medicine in Indian Universities. These have flourished from 450 AD to 12th century AD.

Descriptions of Chinese travelers who toured India in the 5thcenturies fully corroborate the fact of hospitals being an established institution in India of those days. Fa Hien (405 – 11 AD) describes the charitable dispensaries. He says thus a hospital of Pataliputra (Patna) “The nobles and householders of this country have founded hospitals within the city to which the poor of all countries, the destitute, the cripple and physicians inspect their diseases, and according to their cases order them food and drink and medicine or decoctions, every thing in fact that may contribute to their ease, when cured they depart at their convenience. “ Huen Tsang’s account (610 – 650 AD) that the king Siladitya II was inclined towards Buddhism and in all the high ways of the towns, villages throughout India created hospitals, provided with food and drink and stationed physicians with medicines for travelers and poor persons round about to be given without any stint.

The history of Sri Lanka records a lot of information in how the kings took up the erection and maintenance of hospitals as their chief duty. From the great chronicle of history the Maha vansa we gather that in 4376 BC king Pandukabhaya constructed hospitals. King Duttu Gemunu (161 BC) has built hospitals at 18 different places and maintained them with state coffers. At the same time it is interested to note that the earliest hospital In Europe the Maison Dieu of Paris is said to have been opened in the 7t century. The ancient text on Ayurveda have gone into minute details of how a hospital should be built, how beds should be arranged, about the cloths the patient should wear, how his cleanings should be kept by trimming the hair, cutting the nails etc. It has gone to the extent of describing how the floral arrangement should be in a room of a patient. King Buddhadasa (498 – 426 AD) was an eminent physician himself built hospitals for the sick people and animals. He is also credited with the compilation of Sarathasamgrahaya a compendium of all existing handbooks composed in Sanskrit.