Indian Journal of History of Science, 49.3 (2014) 340-347

PROJECT REPORTS

THE TRADITIONAL PRACTICING BY PARAMBARYA VAIDYAS IN AND THEIR UNIQUE ETHICAL OUTLOOK*

Sreekumar Nellickappilly**

1. Introduction parambaryavaidyas have been doing this for centuries and their practices may provide valuable This study tries to understand the history insights for contemporary life as well. of the traditional healing practices of the Parambarya Vaidyas of Kerala, who are members This study relies on the primary data of families who have been practicing medicine as generated using qualitative methods of research, their vocation for generations and have learned which consist of semi-structured interviews. the methods of their profession in the traditional Besides some other experts in the areas of ways. For many of them, it was either a family medicine, folk tradition and Kerala history, about profession or a caste duty. Along with their history, 20 practitioners were interviewed in order to this study examines the ethical principles that are understand their ethical perspective. The responses integrated into the practice of these physicians. were recorded and transcribed and a qualitative Hence the enquiry is partly historical and partly analysis was performed. The secondary data for philosophical and ethical and these two are the the work was generated from the study of some primary objectives of this study. While analyzing important texts in Āyurveda, written documents, the latter, the study tries to draw upon the insights official web sites and historical and philosophical presented in the works of Caraka, Suśruta and works which are relevant to the practice of Vāgbhaa and in their light examines how their parambarya vaidya. The project was carried out practices tackle some of the relevant ethical under the following chapters: problems related to the science of medicine in I. Introduction general like abortion, euthanasia, quality of life II. Parambarya Vaidya Tradition their distinct etc. Such aspects will be historically interesting features and Kerala’s Tradition, Geography considering the multi religious and caste-based and Climate social structure of Kerala. It will also be relevant to examine the questions of public accountability III. The History of the Parambarya Vaidya System of the physicians and their interrelationship with and its development after arrival of Brahmins; the society in general and what does the general Avaidyas and the history of Kerala public expect from them and how do the IV. The Ethical Outlook of the Parambarya physicians respond to such expectations. The Vaidyas

* The project was accomplished under the sponsorship of Indian National Commission for History of Science between the period October 2010 and December 2013. **Professor, Department of Humanities and Social Science, Indian Institute of Technology, - 600036, Email: [email protected] PROJECT REPORT: TRADITIONAL AYURVEDIC PRACTICES OF PARAMBARYA VAIDYAS 341

V. Limitations and Future Scope like the Aavaidyas adapt to the modern VI. Concluding Remarks requirements in this manner, many minor and less well-known families and groups find it difficult 2. Tradition of Parambarya Vaidyas to survive. Some branches of like toxicology (Via vaidyam) have already The Parambarya vaidyas have been become irrelevant in the present world, as modern trained in very different ways than the modern medicine offers quicker and easier remedies to physicians, who are educated in Colleges and snake bites. Again, many of the methods and Institutes and the former also share very different procedures of older generation vaidyas are already ideas and perception about health, disease, lost. The traditional diagnostic methods which diagnosis, healing and medicine. They are comprised of observing the imbalances of the educated directly by their predecessors and even doas—vāta, pitta and kapha of the patients’ body today many of them continue the legacy of and suggesting remedies that would restore the traditional learning and age-old practices and harmony — is hardly adopted by modern day methodologies. In this study the term Parambarya Āyurvedic physicians, as they too have vaidya is employed in a very broad manner. The increasingly began to espouse modern diagnostic term refers not only to the members of traditional methods. This traditional method was once the families of physicians, but also to those who have hallmark of Āyurveda in which physicians would learned such healing practices from the traditional first assess to which category the patient belongs, practitioners following the ancient methods and as in each person one of the doas may dominate. curricula. However, for many of them, medicine He then would assess the imbalance of which doa is a family profession, which they inherit with was responsible for the ailment and would pride. prescribe medicines that would bring back the lost In this strict sense there are only very few equilibrium of the three doas. Such methods, Parambarya vaidyas now alive and in another few according to some traditionalists, constituted the decades the system may sadly become mere very core of Āyurveda and replacing them with history as in modern era their conventions have modern methods has taken away the originality become obsolete and the Parambarya vaidya of Āyurveda. system itself is in the verge of extinction. Many Other systems and practices, which form of the families have given up their traditional part of the Parambarya vaidya tradition more or methods and have either adapted their vocation less subscribe to this idea of Āyurveda, which to satisfy the demands of modern day conceives disease essentially as a loss of requirements—qualifications from modern equilibrium. Most of them consider the goal and Āyurveda medical colleges—or have diversified purpose of healing as consisting in restoring this into other fields. Families of Thaikkattu Mooss, lost equilibrium. Hence they adopt a very Vaidyamadom, Pilamanthol Mooss, comprehensive treatment procedure which Pattarumadom etc., have modernized their integrates the patients’ totality of physical and practices by building institutions like clinics, psychical life with his/her natural and social and even medical colleges. Though the environment, climatic conditions and food habits older members of these families still practice with the consumption of medicine that directly Āyurveda in traditional ways, their younger aims at bringing all of them into a harmonious generations are trained more in the modern lines. whole. Though they do not explicitely articulate, While more established and well-known families most of them suggest such a philosophy of life. 342 INDIAN JOURNAL OF HISTORY OF SCIENCE

3. History of the Parambarya other rulers of the North. Along with the arrival Vaidya Institution of the Brahmins—the Nampoothiries—earlier in the 4th century AD and later in a major way during While this study attempted recording the the 8th and 9th centuries, Āyurveda was introduced historical lineage of the different families from in Kerala more formally and systematically where the memories of the members interviewed, it was it would have further flourished with active and found that most of them have only a vague idea of creative interactions with the existing systems and their historical past. They often relate their past to practices of medicine, which included Siddha and myths. Hence the time which led to the emergence various other tribal forms. The temples and of Parambarya Vaidya tradition in Kerala can be Buddha shrines upheld the legacy of these healing traced only on the basis of textual analysis. systems, as the various offerings from these However, the account of these family practitioners worshipping places had therapeutic impacts on the and their sense of understanding of their history devotees who consumed them. Even today some are also important, as they have very strong temples in Kerala have such medicinal offerings. bearing upon their ethical outlook. Several such The Vazhuthananga nivedyam in the historical, cultural and religious factors have Koodalmanikkam temple in Irinjalakkuda, the influenced the ethical outlook of these indigenous ghee offering of Sabarimala, the Palpayasam of practitioners. The interviews conducted enlighten Guruvayoor are examples. us about many of them. While we attempt to trace the history of The parambarya vaidya institution had the Kerala parambarya vaidya institution, we emerged in Kerala owing to certain peculiar and come across certain stumbling blocks. There are unique historical and cultural factors, apart from certain ambiguities regarding the history of ancient the geographical and climatic peculiarities of the Kerala itself. However there are some literary land. Swami Nirmalananda, one of the Āyurvedic evidences that suggest the prevalence of Siddha physicians who have been interviewed as part of medicine in the region long before the arrival of this study, emphasizes the climatic aspects that Sanskrit-based Āyurveda system to the state. With make Kerala’s biodiversity unique1. The history the arrival of the Nampoothiries and the of the tradition was traced by examining the establishment of their settlements, the State had history of Kerala, primarily with the help of the been transformed into a new socio-political and works of the historians of ancient Kerala. This economic order and it was during this time examination reveals some important and medicine was institutionalized for the first time. interesting factors, which help us to understand The Namboothiries have divided the State into not only the emergence and evolution of the eighteen villages (thalis), and one Vaidya family tradition, but also the factors that are responsible was appointed as chief physician in each of these for the uniqueness of the Paramparya Vaidya villages2. These Brahmin families were made tradition. responsible for addressing the problems related to physical and mental health of the people in their The Vedic tradition from where Āyurveda respective villages. had emerged has a direct influence. The Buddhists in and the business communities who had Another important historical factor is the to make extensive travel across different states influence exerted by the texts Aāga Samgraha spread the science of medicine and patronized it. and Aāga Hdaya, both composed by Vāgbhaa, One important route through which Āyurveda who had very clear Buddhist lineage. Considering arrived Kerala is through these traders and the the opposition between the Vedic tradition upheld Buddhist missionaries appointed by Aśoka and by the Kerala Namboothiries and the non-Vedic PROJECT REPORT: TRADITIONAL AYURVEDIC PRACTICES OF PARAMBARYA VAIDYAS 343

Buddhist school, this factor is extremely relevant Even the practice of Āyurveda itself cannot claim and interesting from a historical perspective. The absolute purity and is not devoid of influences Namboothiries were the highest Brahmin caste of from other traditions. At the most one may agree Kerala who were engaged in the learning and with Swami Nirmalananda who claims that there teaching of all the knowledge traditions including is nothing in the other systems that may directly Āyurveda, but were primarily practitioners of the contradict the basic assumptions, principles and ancient Vedic religion, which was characterized practices of Āyurveda4. by the strict observance of several customs, social Besides the most ancient insights about the protocols and ritualistic practices. It is believed medicinal value of plants, which the tribals who that Vāgbhaa had come to Kerala from Sind in inhabited the land had, the traders and the the North in the 7th century AD. He was apparently missionaries from the north and later the dejected by the attitude of the Brahmins in the Namboothiries, brought Āyurveda to the state. North who refused to accept his treatises owing These developments happened during the initial to his Buddhist connection. But in Kerala, he was centuries of the first millenia. Thereafter, we find not only welcomed, but also was adored as an a coexistence of Āyurveda with several other Ācarya and it was he who taught and trained some minor and major systems of medicine in Kerala. Namboothiries in Kerala, who later became the Though Siddha, which also has a very strong Aāga vaidyas or the Aāavaidyas. It is believed that he lived in the “illam” (the name for a theoretical basis as a system of medicine, Namboothiri house) of Pulamanthol Mooss, who originated in the South and many from Kerala had was his disciple. The Buddhist influence is evident practiced and contributed to its growth, it never in their practices. Unlike the other orthodox gained the kind of popularity Āyurveda later Brahmins, these vaidyas never practiced gained in the state. This is primarily because, untouchability in the rigid sense in which it was Āyurveda was promoted by the Brahmins, as its observed by other Namboothiries—who fundamental texts were written in Sanskrit, which considered even seeing a lower caste man as they understood well. The learning of Sanskrit was polluting—and did not very strictly performed mandatory for the learning of Āyurveda. On the some of the very important caste duties of their other hand, the tradition of Siddha was based on times. Since they were physicians, they could not Tamil texts and with the emergence of Malayalam avoid coming into contact with blood and other as a language of the land, distinct from Tamil, this body fluids, which was considered impure and tradition gradually lost its hold. polluting by the orthodox tradition. All these Normally, the history of Āyurveda in factors ultimately resulted in downgrading them Kerala was studied under three stages: Pre- in the caste hierarchy, as it was traditionally not a Sanskrit era, Sanskrit era and modern period. The common practice for other Namboothiris to marry social structure of Kerala during the remote past from the family of these physicians3. Hence they has to be examined in order to know about the were forced to have marriage relations among rise of Āyurveda in Kerala. As it has been themselves, which led to the extinction of some mentioned earlier, much before the arrival of of the Aāavaidya families. Some families have Sanskrit, the region had its traditional medical merged with others. knowledge, influenced by the tribal and Siddha The paramparya vaidyas are constituted, practitioners. Later, with the arrival of Sanskrit not only of the Brahmin Aāavaidyas, who and with the beginning of the Namboothiri practice Āyurveda, but also of many other minor settlements, Sanskrit texts-based Āyurveda too and local traditions and systems mentioned above. had developed and spread in Kerala. The influence 344 INDIAN JOURNAL OF HISTORY OF SCIENCE of Buddhism was also visible. Some scholars Kerala’s traditional Āyurveda has its prominence argue that, before the Brahmin settlers arrived due to the state’s geophysical conditions. He says Kerala, there were many Buddhist establishments, “Almost all medicinal plants depicted in Āyurveda including their shrines present in the state. The grew in Kerala’s biodiversity. However, certain culture of Buddhism may not have spread in the practices like kāyākalpa can be traced to the state influencing the lives of people who were indigenous methods of healing from the region. primarily tribals. They would have primarily been Swami Nirmalanda says, “Kerala has earned its catering to the requirements of the north Indian stripes in Pancakarma. The main reason for that traders. Some of these Buddhist worshiping would be its unique climatic condition and centers were later converted to temples of Hindu biodiversity. There is no other place like Kerala Gods and Godesses. The Kodungalloor temple and in the whole world.”6 Sabarimala temple are cited as examples for this. The physicians in Kerala hailed from all As Malayalam is a language born out of strata of society. Along with Brahmin Aavaidyas, the merging of the two languages, Tamil and who were entitled to study Veda, there were Izhava Sanskrit, the influence of both these strong families who studied Sanskrit works and practiced traditions and several other local systems made the science. Swami Nirmalanda says “All the the indigenous practice of medicine richer and traditional vaidyas, irrespective of the caste they unique. The so-called upper caste people of this belong to, follow the same classical text of region were deeply influenced by Sanskrit and Āyurveda. There are no differences in the methods. imbibed its studies. Many of the upper caste The arrival and spread of Buddhism too had helped households were well versed at least in the basics in spreading Āyurveda in a massive scale.”7 There of Sanskrit. Naturally their interests led to existed a variety of methods and systems of Āyurveda. However, there existed different modes medicine in Kerala. But the most notable and of treatments as some medicinal plants were found systematic were Āyurveda and Siddha. Among the only in this region. practitioners of Āyurveda, the Aavaidyas occupy Another historical factor that had an important place. influenced the growth of the indigenous medical systems in Kerala was its status as the main hub 4. The Ethical insights of the for trade with the west and other parts of the world. Parambarya Vaidyas It always welcomed foreign cultures and religions. Several historical, cultural and religious Systems such as Unani reached Kerala shores factors have influenced the ethical outlook of these before anywhere else. Later the associates learnt indigenous practitioners. The religious caste the science and spread it to the inner circles of the discriminations that existed in the society had an state. By the time the Namboothiries came to impact in the practice of medicine as well. This Kerala, there already existed a hybrid variety of factor might have encouraged the development of medicine system. The social structure was such a diversity of practices and systems, which that the civilization was adept to absorb their nevertheless had interacted with each other. Owing culture and also make significant contribution to to the conceptions of caste and profession based it. Thus Kerala’s Āyurvedic system is a reformed purity (as the Namboothiries were Yajnavadins or result of combining its indigenous system, practitioners of the Vedic rituals which demanded classical yurvedic texts and foreign systems. Ā high levels of purity amounting to their According to Dr. Raghavan5, one of the community’s insulation from others), many practitioners interviewed as part of this study, Namboothiry families were reluctant to take up PROJECT REPORT: TRADITIONAL AYURVEDIC PRACTICES OF PARAMBARYA VAIDYAS 345 medicine as a profession, as the latter demanded the vaidya is to ensure the welfare of the patient, constant interactions with the general public and which consists in restoring the natural state of the also would put the physicians in physical contact patient which enables him /her to pursue his/her with blood and other bodily fluids which were basic objectives of life (Puruśārthas)—this system treated as impure. Future physicians were worked well. discouraged to take it up as a profession by their In the modern day, this paradigm elders as they considered it inferior to their social encounters several challenges, and with modern status. This trend was prominent in pre- medicine and its practices becoming paradigmatic, independence days as well. Brahmins had several issues like ensuring patients’ rights, reservations in treating people belonging to the patients’ autonomy etc., have become prominent. lower caste. In this modern framework, the patient has the right However, since the practice of medicine to know the details of his health problems and the was unavoidable for any society and the members remedial methods used to resolve them, which the of these families who took it as their profession physicians have to provide them. The former has had enjoyed respect and admiration in the society the right to make decisions about the treatment. in general. The rulers of the land also have These are issues, which the traditional encouraged them by granting them high status in practitioners have never encountered. Dr. the society and rewarding their services with Raghavan makes an important observation in this monetary benefits. The vaidyas themselves context. Being equally conversant in the science regarded their vocation as very important and of modern medicine, he says that the right to take divine and took the responsibility of serving the a decision remains with the patient without doubt. common men when they were in need. This He points out that, “….Āyurveda, however is not apparent conflict between the Brahmanical limited to the curing of diseases. It is actually a traditions had significant impact in the history of Veda. To practice it in its purest form in today’s indigenous medicine and in the history of the state socio-cultural scenario is difficult. Now we find as well. that there is no Ayurveda, instead what we have is 8 The ethical outlook of these practitioners Ayurvaidya.” needs to be understood from this peculiar historical This study explored the ethical perspective and socio-cultural background of the state. They of the Parambarya vaidyas by interviewing them too consider the ethical prescriptions laid out in and from these interviews it identified 115 the classical texts like Caraka and Suśruta responses and from them 6 broad interrelated Samhitās and Vāgbhaa’s Aāgasamgraha and themes were identified, which have bearing upon Aāgahdaya as vital to the practice of medicine. the ethical outlook of the Parambarya Vaidyas. The vaidyas considered service to the people as These themes are; (1) Glorifying Past/ Kerala’s their dharma or duty and in a society, which was Peculiarities (2) Uniqueness of Parambarya not rights-based, but was emphatic on the Vaidya and its Superiority (3) Patient-Physician obligations individuals and communities have Relationship (4) Belief Systems and Profession based on position, knowledge and caste in the (5) Changing Society and the World and their society, the vaidyas’ knowledge and authority Impacts on Parambarya Vaidya System and (6) remained unquestioned. From the perspective of Quality of Medicines, Treatment Methods and modern medicine, this may sound paternalistic and Practice. Keeping these themes in the background, hence problematic. But in a society which stresses two major premises—Ethical Issues and on the obligations of the vaidyas—the dharma of Frameworks and Present Scenario—were found 346 INDIAN JOURNAL OF HISTORY OF SCIENCE to be emerging under which the theoretical bioethics like abortion, euthanasia, rights of the framework is further developed and discussed. patient, decision making, autonomy of the patient, Most of the physicians emphasized the the role of family, the role of the physician etc. importance of an integrated outlook in their very Advocating a conception of morality, which conception and practice of medicine. They assert emphasizes the duty of human beings towards that the responsibility of the physician is more each other, they all consider life as valuable and important than all other factors in the course of even divine, and believe that physician has no right medical practice. What is emphasized is the notion to take it away. None of them will approve of a of dharma; the duty of the physician towards the situation where the Physician is playing an active society and how the actions performed for the sake role in taking away a patient’s life under no of these duties reward its performer as well. Hence circumstances. Some of them are even shocked it is not the individuals’ rights-based paradigm of even hearing the idea of physician-assisted suicide, ethics, but an ethical outlook that stresses the duty as suicide and murder are not philosophically that is relevant here. The Parambarya vaidyas’ interesting topics of these traditional physicians. outlook gives equal importance to the physician and the patient and never treats the patient as the 5. Conclusion center and considers the physician as a service This study attempted to make an overview provider, whose role is to just assist the patient. of what is known as the Parambarya vaidya The physician has to be trusted by the patients institution of Kerala, which is comprised of several and in its absence the treatment will not be major and minor traditions of healing practices. effective. Hence the ethical framework of the The emergence and development of the Parambarya vaidyas considers both as important. Parambarya vaidya system in Kerala is examined This trust and authority, however, are not by analyzing the different stages through which it something, which is established a priori. developed. Here it began from the period before Physicians earn them as a result of their selfless the arrival of the Brahmins. It was found that, after service to the public. the Brahmanical settlements were established in Kerala, medicine was for the first time This aspect has been elaborated above with institutionalized with the emergence of the the idea of dharma and the patient-physician Aavaidya tradition. This stage is the most crucial relationship. Dr. Raghavan articulates the one, as it was during this period a peculiar socio- theoretical presupposition of this idea by affirming economic system had emerged in the state, which that the doctor must see the patient as a replica of existed till the mid 20th century. Malayalam as a himself.9 While being critical of the present day language for communication also evolved during commercialization of Āyurveda and Prambarya this period and this was the golden era of the vaidya, many of the physicians interviewed have Parambarya vaidya tradition. With the arrival of emphasized that the traditional system always the Europeans and the establishment of the British have considered service above money and other rule, the Parambarya vaidya institution started material consideration. Chandran Gurukkal who encountering a crisis. The contemporary scenario is a Kalari Master from , affirms that a is disappointing, as the institution is almost on the good practitioner never sees money as primary but verge of complete extinction. Unless the the ailment and its cure10. government comes up with creative measures, the This study has also interrogated the Parambarya vaidya institution and the rich Parambarya vaidyas with an interest to know their repository of knowledge it possesses may sadly responses to some typical problems facing modern become a mere memory. PROJECT REPORT: TRADITIONAL AYURVEDIC PRACTICES OF PARAMBARYA VAIDYAS 347

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