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Ayurveda: A system that has stood the test of time

15 Jul 2021

By Janik Sittampalam  When you fall sick, what do you do first? Most Sri Lankans would either drink a Samahan or take a Panadol, or maybe both. If you have a chronic illness, like arthritis or diabetes, most people would go to the hospital, but also seek out Ayurvedic ointments or tonics.  Such is the state of Ayurvedic and Western medicine in Sri Lanka: they are separate, but for most people, both systems have their uses. However, in the medical establishment, Ayurveda is given a slightly lesser status than Western medicine. While Ayurveda accepts the efficacy of Western treatments, Western medicine prohibits the use of other systems.  According to Dr. S.N. Arseculeratne, Emeritus Professor at the University of Peradeniya, “the alternative use of traditional medicine and Western medicine does not indicate a synthesis of the two systems.” In The Social Scientist journal, he describes it as a “cultural duality”, where “traditional medicine may prove useful where Western medicine fails, or that people in traditional societies choose traditional medicine for cultural reasons.”  But how did these parallel medical systems emerge in the first place?  The Ayurvedic system is based on the theory of three humours (tridatu) which correspond to elements of the universe that make up the human body: air appears as wind, fire as bile and water as phlegm. Imbalances among these humours cause various diseases and the treatment often requires an infusion of hot or cold substances. The methods of diagnosis and treatment were listed in ancient texts, and historically monks were the most important sources of Ayurvedic knowledge.  Margaret Jones, in her book Health Policy in Britain’s Model Colony noted that European doctors initially tolerated traditional systems, and recognised their knowledge of local drugs and herbs. Howerever, as the 19th Century progressed, and more scientific medical practices emerged in Europe, indigenous doctors were increasingly seen as “deceitful magicians or superstitious quacks”.   In the 1870s, the modern medical infrastructure of Sri Lanka began to take shape under Governor Sir William Gregory and the head of the Civil Medical Department, William Kynsey. At the start of Kynsey’s tenure in 1875, there were only 21 civil hospitals, located only in large towns with a significant European population.  By the end of the 19th Century, there were 33 civil hospitals, 15 new district hospitals and a large network of rural dispensaries organised into a system of medical districts. The Ceylon Medical College was established in 1880 to train doctors and medical personnel for the expanding infrastructure, and the Ceylon Medical Association was inaugurated in 1887 to serve as a platform for the profession. This new system was instrumental in treating and controlling the outbreaks of diseases like: cholera, smallpox, malaria, parangi (yaws), beri-beri (thiamine deficiency) and the bubonic plague.  By 1920, most of the Medical Department was staffed by Sri Lankans, with only senior positions held by Europeans. However, these developments were still incomplete because of limited financial resources and the presence of indigenous medicine.  Even the colonial government recognised that it was impossible to remove local systems because most people subscribed to them and an intrusive medical policy would cause unrest. Ayurveda survived as the medicine of the majority, especially for general ailments. Every village had at least one Vederala (Ayurveda doctor), and an official report in 1927 estimated that “75% of cases of illness were treated by Ayurvedic practitioners”.  In addition to being entrenched in cultural practices, the preservation of Ayurveda became one of the objectives of the nationalist revival movement, according to sociologist Rathnayake M. Abeyrathne. In his article for Social Affairs, he described the primary goal of the Ceylon Reform Society, an organisation founded by Ananda Coomaraswamy which sought to preserve the artistic and cultural heritage of Sri Lanka.  The Society began to focus on indigenous medicine after Donald Obeysekere, a member of the Ceylon Legislative Council became president. They collected donations and established the Oriental Medical Sciences Fund, which sponsored the training of Ayurvedic doctors and pushed for legislation to recognise indegenous medicine. Since it was linked with the culture of the past, the move to revive Ayurveda was part of the rising national consciousness in the pre-independence era.  In 1909, a proposed Opium Ordinance sparked a debate about the registration of Vederalas. The prohibition of opium would affect them as it was an ingredient in some remedies. A solution proposed was to register Vederalas and give them an allotment of opium.  Despite opposition from the Colonial Office, a commission was set up by the governor to look into the question of registration. The commission concluded that it was possible to distinguish a genuine Vederala, who had received training and instruction, from “ignorant pretenders”, further stating that “a system that has stood the test of time in spite of neglect must have something good in it, otherwise 70% of the population will not resort to it in time of illness”.  By the late 1920s there was a nationwide call for state protection of age-old medical practices and a respect for traditional values by practitioners of Western medicine. In 1926, a committee chaired by K. A. Balasingham was formed to assess whether it was feasible for the government to assist financially or otherwise in the training of future practitioners.  A Majority Report was signed by all the non-doctors in the committee, proposing a Board of Indigenous Medicine to be set up. This would be responsible for training and licensing Ayurveda practitioners. It argued that most general ailments were treated by Ayurveda, while people still accepted Western medicine for diseases like malaria.  The professional members of the Committee disagreed with this view and signed a Minority Report. It rejected the practices of Ayurveda, stating that “their pathology [was] unsound, their diagnostic methods out of date, and their surgery and midwifery [were] crude and dangerous.” The Governor and Colonial Secretary rejected the Minority Report, stating that “there was no justification for asserting that the path of discovery lies only on Western lines”. Although the Colonial Office in London sympathised with the Minority Report, they conceded to the Majority Report for political stability. In 1927, a Board of Indigenous Medicine and The Ayurvedic Medical Congress was established.  Following Independence, the legitimacy of indigenous medicine in Sri Lanka was further strengthened by the Ayurvedic Act of 1961. This created a series of institutional bodies to cement the practice such as the Ayurvedic Medical Council, the Ayurvedic Formulary Committee, an Ayurvedic Drugs Corporation, Ayurvedic Research Institute and Hospitals, an Ayurvedic Development Fund.  Interestingly, the desire to develop indigenous medicine as a separate practice from Western medicine, resulted in it being regulated and formalised into modern institutions very similar to those of Western medicine.  However the two systems remain separate.  “The Sri Lanka Medical Council prohibits practitioners of allopathic (Western) medicine from recommending any other medical system,” stated Dr. Upul Dissanayake, a physician at the National Hospital and member of the SLMC (Sri Lanka Medical Association.) “However, doctors cannot stop patients from inquiring into such treatments, and sometimes doctors may recommend them, as local, traditional remedies are often very popular among patients.”  Ayurvedic practitioners allow and recognise werstern medical benefits, and are generally more tolerant of Western treatments, yet they maintain a strong tenacity to their traditions and cultures to emphasise their distinction from practitioners of Western medicine.  “[With] the fundamental differences of traditional medicine and western medicine, any true synthesis between the two systems perhaps remains unattainable in Sri Lanka,” said Dr. Arseculeratne. “In the immediate future, their contemporary existence in parallel reflects a duality, rather than a synthesis of the systems.”  Yet this duality does not indicate an equal status of the systems. Ayurvedic practitioners will allow Western treatments, but this attitude is not reciprocated. Despite the formalisation and regulation of indigenous medicine along western lines, it remains a subordinate system in practice.  (The writer is a journalist, researcher and short story author and can be found on Twitter as https://twitter.com/1_Janik)  This op-ed is supported by HistoricalDialogue.lk. The views expressed in this piece are the author’s own and not the institutional views of historicaldialogue.lk. We encourage pieces that look critically at Sri Lanka’s recent past in creative and reflective ways. If you would like to contribute to HistoricalDialogue’s growing archive of Op-Eds please email info@historicaldialogue.lk


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