By Frances Bulathsinghala/The Sunday Observer
Colombo, November 1: Here is an interview with Ayurvedic doctor, S.M.S. Samarakoon, senior lecturer and Head of the Deshiya Chikitsa Unit (Indigenous Medicine) at the Institute of Indigenous Medicine (IIM) of the University of Colombo, the affiliate academic body for Ayurveda and Indigenous Medicine in Sri Lanka. Dr. Samarakoon holds over 25 years of experience as a medical officer, lecturer and researcher in the field of Ayurveda and Deshiya Chikitsa of Sri Lanka, and is qualified from Sri Lankan and Indian universities. The detailed interview with Dr. Samarakoon is in the backdrop of Sri Lanka battling the second phase of the Covid-19 pandemic.
How do you observe the practical differences between Ayurveda and (Deshiya Chikitsa) Sinhala Wedakama that pre-dates Ayurveda?
Ayurveda is a complete medical system rooted in India and is a medical science as well as a way of life. Ayurveda gives top priority to the prevention of disease. In its preventive perspective, Ayurveda advices Satvavritta (How best to go about daily routines) for maintaining health, Sadvritta (moral conduct for maintaining mental and spiritual health), Dina charya (daily routines to maintain health) etc., In addition, Ayurveda advices what should be eaten and how, in order to be healthy.
In the curative aspect, Ayurveda has taught perfect treatment protocols (Chikitsa Sutra) along with proper dietary management (Pathya-Apathya) for every disease, with similar emphasis on health promotion. Positive health can be achieved through Rasayana (rejuvenation) and Vajikarana (aphrodisiacs) drugs and procedures. Rasayana is the process by which optimal nutrition of the essential body tissues (Saptadhatu) can be achieved.
Rasayana drugs promote good health, long life, memory, intellectual capacity, disease free life, youthfulness, good complexion, voice and optimal functioning of the sense organs. Some Rasayana drugs improve longevity termed, “Prana-kamyarasayana, intellectual capacity termed “Medha-kamyarasayana” and beauty and youthfulness termed, Sree-Kamyarasayana.
Vajikarana drugs enhance sexual potency of men. Infertility of men and women, subfertility of women, and sexual impotency can be cured by using Vajikarana drugs.
Deshiya Chikitsa or Indigenous medicine is the system of medicine inherent to the Sri Lankan community. The majority of physicians are Sinhalese, therefore it is named “Sinhala wedakama”.
It is also called ‘Helawedakama.” Sinhala Wedakama is a cultural heritage of Sri Lanka, and King Ravana was a renowned physician. This medical system is well mixed with the Sinhala culture, Sinhala language and Buddhism.
During the pre-historic period indigenous medicine was in a hegemonic position in the country. The first full-fledged hospital of the world was built during King Pandukabhaya’s period in the pre-historic era. It is said to be the world’s first systematic hospital, the ruins of which are still found in Mihintale.
By the time of the Kingdom of Kotte, the influence of indigenous medicine gradually declined and was divided into narrow branches such as, Kadumbindumwedakama, Sarpavishawedakama, Unmadawedakama, Gedi-Wana-Pilikawedakama, Sarvangawedakama and more.
As we are close to India, the indigenous medicine of Sri Lanka may have been mixed with Ayurveda medicine.
But, Sri Lankan indigenous medicine is not part of Indian Ayurveda. It has its own identity. Indian Ayurveda is inspired by Hinduism, while Sri Lankan indigenous medicine flourished with Buddhism.
Where similarities are concerned, like Ayurveda, indigenous physicians of Sri Lanka treat patients based on the “Tridosha Theory” considering the patient as a whole.
The unique feature of indigenous medicine of Lanka is that it’s not available in any Ayurveda textbook or Ayurveda pharmacopeia. Rathakalka (paste), Buddharajakalka (paste), Yasodharakalka (paste), Navarathnakalka (paste), Seetharamavati (pills), Mattuphaguliya (pills), Chandra kalka (paste), Yashtikalka (paste), Suranviduraguliya (pills), Jeevanadaguliya (pills), Siddhartha oil and Neelyadi oil are a few.
In these medicines, a single drug with different “anupana” (vehicles) is used for different diseases. For example, the Navarathnakalka, a medicated paste can be prescribed for vomiting with lime juice, for loss of appetite with fresh ginger juice, for fever with dried ginger and coriander boiled water, etc. All these medicines are prescribed with different Anupana for different illnesses. Ayurveda and Deshiya Chikitsa are complimentary and supplementary to each other forming the “Sri Lankan Ayurveda”.
Could you comment on the different reactions on the body through Sri Lankan/Ayurvedic methods, parallel to Allopathic drugs?
The majority of medicines used in Ayurvedic and indigenous medicine are natural and mainly plant-based. They are free from side effects and adverse effects. Their safety and efficacy are time-tested.
In Deshiya Chikitsa, the raw materials are collected by the physician himself, the drugs prepared by him or under his strict guidance, and are recommended by him, including the follow up.
Therefore, safety and efficacy are ensured. In Ayurveda too, except for a few herbo-mineral drugs all other drugs are herbal based.
Drugs act on the body through pharmacodynamic properties, such as Rasa (taste), Guna (properties), Vipaka (potency), Veerya (Specific potency) and Prabhava (un-explainable drug action). Modern allopathic drugs are chemicals. Therefore, when we use herbal drugs and Allopathic drugs simultaneously, the interactions reported are almost zero.
For example, when a patient suffering from several diseases such as, high blood pressure, diabetes mellitus, high cholesterol levels, etc. gets paralyzed due to a stroke, he is treated at an Ayurveda hospital and administered with Ayurvedic/indigenous medicine drugs, while initially continuing the Allopathic drugs. However, as the patient acquires relief, the Allopathic drugs can be gradually withdrawn.
Many Ayurveda drugs used for communicable diseases have anti-microbial and immune-modulatory effects. Such medicines have been used from early times when epidemics broke out.
These drugs can be used even for rapidly spreading epidemics. Coriander (Coriandrumsativum), Venivelgeta (Cosciniumfenestratum), Pathpadagam (Hedyotis corymbosa), Ginger (Zingiberofficinale), Turmeric (Curcuma longa), Tippili (Piper longum ), Neem (Azadirachtaindica), galangal (Alpiniagalanga) etc are some medicinal plants that have immune potentiating effects.
Could you speak of our Indigenous medicine (Wedakam) practitioners who were and are known to be carrying a medical heritage that is one of the oldest in the world?
I believe the true indigenous physician is a reservoir of traditional medical knowledge. Traditional knowledge is derived from generation to generation that forms part of the heritage of Indigenous people who are the guardians of indigenous knowledge. I have worked with our traditional doctors for long years.
They have well organised and evidence-based knowledge on medicinal plants, make their own medicines and are skillful in clinical practice. But, according to my experience, indigenous medical genealogies (Wedaparampara) have gradually declined subsequent to the Sri Jayewardenepura Kotte period.
I have identified a large number of genuine indigenous medical genealogies throughout the country, but today, only a few have survived. At the same time, the few existing Wedaparamparas are not training any new physicians.
Could you comment on the value of indigenous medicine and its specialists for the country?
Indigenous physicians have traditional knowledge which is time tested and scientific. That is why these knowledge systems are valued by global organisations such as the World Health Organization (WHO). These physicians have gained indigenous medical knowledge through a series of observations and by ‘trial and error’ over many centuries.
In any occupation, quacks may be seen and they use allopathic drugs. Similarly, in the Ayurveda and indigenous medical field too some fake doctors may be found.
But, well trained and registered indigenous physicians treat their patients silently. They have earned the recognition of the community because their treatments are socially accepted, safe and efficacious. We should encourage indigenous physicians to practice sustainably to preserve their inherent medical knowledge.
At present how many indigenous medical practitioners are there in Sri Lanka?
By 2018, there were 14,700 traditionally trained medical practitioners in Sri Lanka. Apart from the registered indigenous medical practitioners, there is a large number of non-registered practitioners whose practice is a rustic form of medicine.
Physicians are registered in the Ayurveda Medical Council (AMC) under different categories namely, Sarvanga (general; for common body ailments), Sarpavisha (snake bite treatment), Kadumbindum (for fractures and other orthopaedic casualties), Gedi-Wana-Pilika (for abscess and tumors), Davum-pilissum (for burns), Vidum-pilissum (therapeutic piercing and heat treatment), Akshiroga (for eye diseases), and Manasaroga (traditional psychiatric treatment).
There are other special branches such as Indigenous Veterinary medicine, treatment for Rabies, spiritual healing practices, treatment for childhood nutritional diseases and indigenous midwifery. These branches are not recognised for registration by the AMC.
In your view how could these physicians be strategically used through a national policy in the battle against the second phase of Covid-19?
The health sector in the country should consider the doctors and other manpower in the Ayurveda sector, especially in the Government Ayurveda hospitals and the indigenous physicians.
There are several qualified Ayurveda doctors posted at Government Ayurveda hospitals. In addition, many Ayurveda community medical officers are being posted in the community. They are ready to assist the health sector to combat the Covid-19 pandemic.
The phenomenon currently seen in Sri Lanka is that only a few of the Covid-19 patients suffer from serious symptoms and many patients may be asymptomatic and not serious. As we know, there is no particular drug effective against the Coronavirus yet.
However, given our rich medical heritage, we have faith in our medical system that we can overcome the Covid-19 pandemic. It will be prudent at a national level, to give an opportunity to Ayurveda doctors to treat patients at the Ayurveda hospital.
The unacceptable fact in this context is recommending traditional medicines at quarantine centres and for PCR positive cases in the hospitals by Allopathic doctors. Likewise, if Ayurveda doctors use allopathic drugs, it is unethical and unauthentic. Similarly, if Allopathic doctors recommend Ayurveda or herbal drugs to patients, that is also unethical and unauthentic.
These two systems should be integrated when necessary, for a collaborative effort and administered by the respective specialists in the two different medicinal branches, without imposing hegemonic powers. Whether it is Ayurveda or Allopathy it is for the benefit of mankind, not for maintaining one’s autonomy.
Ayurveda doctors and indigenous physicians must be incorporated in health care delivery. They have vast traditional knowledge and effective medicines for many diseases. They have effective traditional preventive measures which can be used even in situations like the current Covid-19 pandemic. Experts who decide the health policy of the country should take into account this situation seriously and carefully.
The State pays millions of rupees for Government Ayurveda doctors and other staff in the Ayurveda sector. Hence, the Government should make use of them for the good of the country, when the country needs them most. Traditional and Ayurvedic physicians can be trained to update them in treating evolving new diseases like the Coronavirus.
Could you comment on the link between medicine in general and the natural world – plants, minerals, animals and even the elements such as wind/fire?
Ayurveda and indigenous medicine are natural forms of medicines. Ayurveda teaches to live in harmony with nature. Everything in the universe whether living or non-living, is made up of five basic elements (Panchabhuta). The human body too consists of these five bhutas. Any change in the environment directly affects the human body. Wind, Sun, and Moon govern the entire universe. Wind is responsible for every movement of the universe. The Sun gives heat and dries up the environment.
The Moon gives moisture and cools the environment. When they are in a balanced state, the environment is in harmony. Similarly, Vata, Pitta, and Kapha govern the living body. Vata, Pitta and Kapha represent the Wind, Sun and Moon. When these three major environmental factors are imbalanced, the body’s Vata, Pitta and Kapha too become imbalanced.
In this manner, the environment provides causes for diseases, and we need medicine to overcome the body’s humoral imbalances.
The medicines are from the environment; in the form of plant, animal and mineral substances. Until humankind understands the nature of health and illness, they have to suffer emerging diseases.
Can Allopathy cure, diabetes mellitus? No. Can Allopathy cure cancer? No. It may control it but cannot cure it as a certainty. We must question why these diseases occur. They are due to misconduct and mis-consuming of drug, food and behaviour. Chemical and artificial drugs have no remedy for such diseases. The Allopathy system is now gradually realising this universal truth.
Many traditional medicine practitioners lament that Sri Lanka has lost a large percentage of its endemic and non-endemic herbs, and even common herbs such as turmeric that were grown in every household has today become scarce. Could you recommend how we could conserve and promote our medicinal herb cultivation?
We should be ashamed that we don’t have even turmeric and ginger in this country if they are not imported. Sri Lanka has a rich bio-diversity. Robert Knox, in his book, ‘A Historical Relation of the Island Ceylon’ says, “the pharmacy of indigenous physicians is the forest”. We had almost every medicinal plant in the country.
Why did we not pursue a national priority in cultivating these plants? Turmeric, ginger and all medicinal plants that are fast becoming extinct can be cultivated here as before. Why do we import them? We should motivate the people and the farmers to cultivate them. Indigenous physicians should be encouraged to use self-prepared medicine by cultivating their own medicinal plants. When we cultivate essential medicinal plants in the country, we save money and contribute to the national economy.
There is currently a major tension in the country with what is described as the second phase of the Covid-19 pandemic. In this context, could you explain the Ayurvedic/Deshiya Chikitsa recognised stages of disease build up in the body?
Covid-19 is a virus belonging to the Coronavirus group which cause clinical features on mainly the respiratory system. Many patients may be asymptomatic.
The majority will get clinical features such as, mild fever, sore throat, cough etc. Only few patients reach the severe stage of the above features, such as high fever and respiratory distress. People who have already chronic diseases of the respiratory tract and other vulnerable people are more at risk of getting the disease. Immune compromised people are vulnerable.
In Ayurveda there are a group of diseases called “Jvara” (fever). Jvara is sub-divided into many, based on doshic predominance; Vatajajavara, Pittajajvara and Kaphajajvara. The symptoms of Covid-19 bear more resemblance to Vata-kaphajvara. On the other hand, there are other varieties of fever such as, VishamaJvara and SannipatajaJvara. Based on the clinical features, we have to identify the doshic predominance when we plan treatment. We all have natural resistance in the body against diseases.
The natural resistance is nothing but the immunity of the body which is called “Bala (strength). If your natural resistance is very strong and can overcome the virulence of the Coronavirus, you will not be a victim to the disease. If your resistance is good, you might have mild symptoms even if the virulence of the virus is high. If your immunity is low, you will get severe symptoms. To withstand against Covid-19, you have to enhance your “Bala” or immunity by adopting a natural way of living with natural food and a calm mental status.
Can any virus that enters the body naturally leave the body if immunity has been successfully built (such as by taking authentic Sri Lankan traditional diet and some of the products that the Ministry of Indigenous Medicine has produced?
Yes, of course. Consume natural food; natural traditional Sri Lankan food free from unwanted and excess nutritional substances, and free from toxins. Eat more leafy vegetables, drink more water, get physical exercise, live a stress-free life, have a sound sleep daily and live happily. With the support of the above, the defence system of the body will boost, and you will be protected from any kind of foreign invasive disease.
Could you comment on the importance of a happy, content and non-stressful, non-fearful mental state for the fast recovery of any disease in the early stage of incubation in the body?
Yes, in general mental clarity is an important part of health. Ayurveda has placed much importance on the mental condition in defining health. All of the body’s physiological functions are governed by “Tridosha”, and mental state is governed by “Triguna”. Triguna is composed of Satva, Raja and Thamaguna.
Thamaguna should be improved to potentiate mental state. If you have a strong mental state, you will not be a victim of disease easily. Therefore, mental clarity or happiness speeds the recovery of disease. This is applicable to any epidemic too. During the lockdown period people need to be productively engaged. Living in dread of the pandemic and spreading panic would not do any good. Be wise and take all the health precautions but keep your mind calm.
Could you give your suggestions/comments on the handling of the second Covid-19 phase?
The second phase of Covid-19 seems more serious than the first. It is said the virulence of the virus is higher. More patients are being reported. In this stage, people should behave responsibly and follow safety measures strictly.
Very importantly, the health sector can give an opportunity to the Ayurvedic sector to look after Covid-19 patients. I personally know that almost all people in Sri Lanka follow at least some of the Ayurvedic advice to prevent themselves from diseases, especially in this pandemic context. There is a huge demand for Ayurvedic drugs these days. I see long queues at Ayurveda drug stores every day.
China seems to be the only country which had controlled the community spread of the virus so far. China is known for the use of the integrated method where traditional Chinese medicine is used with highly advanced Allopathic medicine. Your comments?
China has overcome this situation through the use of its well-integrated national medical system built upon traditional knowledge and appropriate advanced technology. Western medicine was introduced to China at the beginning of the 19th century. Then, there was a conflict between Chinese indigenous medicine and western medicine but soon a compromise was reached.
However, the Chinese indigenous medicine was not given its due place and acceptance until the People’s Republic of China was established in 1949. Subsequently, China has developed an advanced integrated health care system that prevails at present. Many other countries such as Vietnam and Malaysia today practice the integrated system of Chinese medicine. That is how the countries develop their own health policy.
In Sri Lanka we don’t have a national health policy in the sense of real nationalistic nature. Ayurveda and indigenous medicine of the country have been neglected. WHO has given due recognition to traditional medicine especially in primary health care. Health policy makers should take action to give proper recognition to traditional medicines for the benefit of the people.
Could you speak about the practice of steaming in the Deshiya Chikitsa system that can be used for the prevention of early influenza like stages in the body?
Using fumigation and steaming has been done since thousands of years by Ayurveda and indigenous physicians in the country. Those treatment methods are not new to them. There are a large number of time-tested recipes used for fumigation and steaming for diseases such as Covid-19.