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Saturday, April 14, 2012

Drifting from Heritage

As we rejoice celebrating the World Siddha Day this year, beneath the celebration lies an under current of uncertainty. We as a community seem to be losing confidence in our own system of medicine due to various reasons.

The foremost of this being the thought that heritage or traditional knowledge is irrelevant in the current scenario. But the science of system biology today rooted in genomics clearly appreciates the concept of Vata, Pita and Kapha prakriti which are correlated with genotypes as they are the innate constitutional characters present at birth itself. The drug selection for an individual in our system is always ‘tailor made’. This exactly is what current day science calls as pharmacogenomics. The selection is based not just on the ‘Prakriti’ but also is based on the influence of the environmental factors – ‘Kala Vanmai’, ‘Thega Vanmai’ which the current science terms as phonemics.

The extension of this concept is the area of ‘Noi Nidhanam’ or the diagnostic methods unique to our system of medicine. Unfortunately we seem to go in for the glamour of new generation medical gadgets, the availability of which is very limited and invariably increases the cost of diagnosis and treatment. Let me share my experience. The venue was ‘Pragati Maidan’ New Delhi and the occasion was International Arogya Fair. In the free medical consultation wing, consultants from different AYUSH systems were sitting in different chambers. There was a long queue in front of the Siddha consultation chamber. I was a little surprised why particularly Siddha attracted so many. A simple answer came from an allopath, who was a curious visitor ‘We have heard that Siddha physicians are experts in pulse diagnosis, I checked with others, they confirmed indeed you were checking pulse for everyone, so I came’.  I realized how our routine examination of pulse could fascinate others while it is so helpful for us to decide the primary line of treatment based on the ‘dosham’ affected. Our diagnostic tools are purely dependant on the skill and expertise of the physician, which is possible to develop by constant practice. Applying this is possible even in remote locations. Traditional Chinese Medicine not only still thrives in that nation but also globally because they totally trust their basic concepts very strongly.

There is a wide variety of plant drugs suggested in our classical texts for the same clinical condition and one of the major criticisms is that in two different regions, healers recommend different plants and there is no uniformity in treatment. This in reality is strength and not weakness. They always learnt from their gurus about identifying and using locally available biological resources and the stress was always on single drug selection. We need to incorporate in training the local health traditions and also about the local biological resources.

Our traditional wisdom has taught us to explore simple plant based remedies before opting for the inorganic. But today there is an avoidable over dependence on inorganic medicines. It is like wielding a sledge hammer to swat a fly. Further many inorganic preparations are prohibitive in cost, have a long processing time and the personnel trained scant.

Tradition has always taught us to make our own medicines and that is the reason why our medical curriculum includes training in pharmaceutics both at Graduate and Post-graduate level. But again due to various limitations we have drifted away from this practice and not only in Govt. hospitals and teaching institutes but even in private practice most of us depend on industrial products. The number of industries in siddha being too less and also being small in size, industries are not in a position to truly adopt GMP or do adequate research in ‘Process Technology’. During our field studies on local health traditions, we have come across healers who have developed indigenously simple but effective processing equipment and technology.

Today with internet there is a general tendency to browse beyond limits for information but in depth study of our classical texts, healthy discussion and interpretations, commentaries of our classical texts either published or palm manuscripts is becoming very rare. To quote one example, it is a general perception and often we hear that contraindications are never mentioned for Siddha medicines. But in reality our Gunapadam clearly mentions contraindication even for a simple, most frequently and widely used drug like ‘Kadukkaai’ and which variety to be used, and also when.  Critical analysis and commentaries needs to be made based on in depth studies in each area which would make our understanding of concepts much better. Even the fallacies of our current day drug ‘Rasagandhi mezhugu’ and ‘Onan sudar thailam’ are due to not seriously studying the original text ‘Pulipaani Vaithyam’. In ‘Rasagandhi mezhugu’ , the drug powders to which eggs are added should be pounded with equal weight of palm jiggery.But somehow, many of our manufacturing units don’t take into account the weight of the eggs and lament that the product gets fungal attack. That is due to lower amount of Palm jiggery. According to the original text it is ‘Odukkan sudar thailam’ derived from the tortoise and not the chameleon.  The indications mentioned for the same will help us to correct the fallacy. To considerable extend we have neglected our Classical texts. Are we greater than the writers to reject their knowledge accrued over centauries?

It is also absolutely essential to study the composition of the classical medicines in depth and appreciate the beauty of their composition and design. In our over enthusiasm to invent new proprietary medicines we fail to truly understand the reason for incorporating ingredients, the plant part used the level of incorporation of each ingredient. They serve multiple purposes which include enhancing they pharmacological activity of the primary ingredient, improving bioavailability, reducing the undesired effect of the primary drug and optimizing the dose. All these are based on the principles of taste, characteristic feature, potency, after taste and unique pharmacological activity which are determined by the combination of the primordial properties. The drifting from this tradition has led to simple drugs like today’s ‘Nilavagai churnam’ not delivering the desired effect.

Siddha literature clearly indicates the stages or conditions which are curable, curable with greater efforts and which are not curable. Our decision of referral are not always based on these principles but guided by the thoughts of biomedicine. We have started considering
‘If not possible by bio-medicine it is also not possible in Siddha’. The fact is otherwise. There are many conditions including degenerative conditions and certain types of cancers where Siddha medicine is really able to improve the quality of life of the patients if not ensure complete reversal of the disease. We need to concentrate in areas where other system doctors seek refuge.

The Daily and seasonal regimen for well being apart from the specific regimen for a particular disease condition is the prescribed norm of our tradition. Clinical practice has also reinforced this concept. Similarly the role of the adjuvant is also proven by several studies. The Traditional Local Heath Practitioners of Jaundice invariably recommend the herbs be administered with goat’s milk. Scientific evidence indicates that goat’s milk is low in fat and hence readily digestible and provides instant energy and promotes immune response. Varying the Anupanam depending upon prakriti and vikriti needs to be followed for better clinical outcome. Though many of us are aware of the importance of Anupanam, Pathyam and Apathyam asuming that patients will not comply or shy away from Siddha, we fail to insist this in our practice. In reality the sufferer and their attendant will ensure they adhere to if adequately impressed upon by the physician.

The traditional knowledge was preserved and practiced to its full potential by the traditional healers not only far long before the institutionalization but even today. In fact the contribution in the form of documenting clinical experiences as ‘Atma rakshamirtham’ or ‘Sarabendra vaidya muraikal’ or by other healers like Abdhulla Sahib, cannot be ignored. But unfortunately there is ever widening hiatus between institutionally trained and the traditional healers. This is now being slowly bridged. Interactions, knowledge and experience sharing is slowly happening. The graduate doctors of the younger generations openly admire the intellectual property inherited by them from the ancient shastras.

Some of the traditional healer’s posses great skills in Siddha Pharmaceutics particularly of the forms like Kattu and Kazhangu, which are currently becoming a rarity. Expert Traditional healers even now use the ones made six or seven decades ago. It will be prudent on our part to entrust Pharmaceutics to these traditional healers and learn from them.

Staying with tradition does not mean ‘not to understand or present’ our science from the current advanced scientific knowledge. It is absolutely essential for us to give rational interpretations based on current scientific knowledge. Today we have many siddha physicians who have interdisciplinary qualification but confine themselves to teaching due to the prevailing situation. We need to create a conducive research environment for this to happen.

We are conversant with internal medicine but neglect cleansing therapies and external therapies which are integral part of disease management and healthy living. For many herbo-mineral drugs prior administration of purgation as cleansing therapy and post oleation therapy were the order of the day even in the 1960-70. Emphasis needs to be laid on this.

The Social, cultural, scientific and spiritual components of Siddha science are slowly getting separated and jettisoned from medical practice and it is very difficult for our traditional medical science to be accepted by the society without these understandings.

We, the institutionally educated doctors, have attained a basic status by learning the traditional medical science where we can attempt to successfully master atleast one branch of the specialties in its entirety.Let us recognize our identity, be proud of our tradition and stop drifting away from it. Let us stem this drift and go mainstream henceforth.

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