Nordstrom Ayurveda

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  • 8/12/2019 Nordstrom Ayurveda


    Sot. Sci. Med. Vol. 28, No. 9, pp. 963-970, 1989 027 9536j89 53.00 + 0.00Printed in Great Britain. All rights r~~rvcd Copyright ,r 1989 Pergamon Press plc

    AYURVEDA A MULTILECTIC INTERPRETATIONCAROLYN R. NORDSTROMPeace and Conflict Studies, University of California, Berkeley, CA 94720, U.S.A.

    Abstract-Ayurveda, in practice, comprises far more than a medical tradition in Sri Lanka. It provides,in addition to a manuscript for health care, a popular knowledge paradigm by which the populationaddresses social, epistemological and ontological issues in their lives. The concept of health expands toinclude the many existential levels that are basic to a definition of the self and the many arenas of lifein which it is made evident. The concept of multilectic process is introduced in this paper to explain thisdynamic that characterizes popular Ayurveda, a dynamic that Sri Lankans specify as consisting of afundamental complex interplay of mutually interrelated factors that are capable of referencing multiplemeanings and life contingencies neither contradictory, dichotomous, nor unidirectional in nature. Becauseof the extent to which Ayurveda is embedded in the everyday lives and fundamental conceptualframeworks of the Sri Lankans, it is likely to remain an integrating knowledge system and a powerfulexplanatory paradigm in their general lives as well as for their health care dilemmas.ey worcis-Ayurveda, health epistemology, Sri Lanka, multilectic

    INTRODUCTION: THE ARGUMENTWhen I arrived in Sri Lanka to study the countryscomplex plural medical system, I expected peopleto tell me about Ayurveda, the predominantempirical indigenous medical tradition in South Asia.More often, they used Ayurveda to tell me aboutthemselves.Statements such as the following were commonlyheard in conversations among Sri Lankans: Thepolitical system is like the body, and the parties arelike humors: if they are maintained in a balance, thesystem is healthy. But if one gains ascendancy overthe others and begins to dominate, the balance is lostand abuses can follow-the system can become un-healthy. In another vein, people say: He is a semaperson (sema is the humor or water of phlegm)-youknow, he is overweight, congested, sweats a lot, butusually maintains a cheerful expression. In a thirdexample; one day, after a particularly severe droughtseason that had resulted in critical water shortagesand epidemics, the first rain fell heralding the start ofthe monsoon season. An older woman in the houseI lived in looked out onto the rain, smiled and saidBalanna, sanipai (Look, it is health).

    The argument will he developed in this paper thatthe traditional medical concepts used to explainillness and health are not restricted to the level of thebiological or the realm of the medical during episodesof disease among the Sri Lankans. Bather, theseconcepts exist in a complicated interrelationship withbroader social issues facing individuals. The interplaybetween these various levels of human interactionprovides knowledge and conceptual frameworks thatare used to address epistemological and ontologicalconcerns as well.Because of this complexity of health ideology,health care operates on several levels for the SriLankans. On one level are the infrastructural ele-ments of the health care system: the institutions,practitioners, clinical formats, and medical traditions

    and doctrines that patients navigate in an attempt togain and maintain well-being. Equally important, butexisting on another phenomenological level, is thepopular body of knowledge maintained within thegeneral society that orients the average person tocritical issues of illness and well-being and to thebroader systems defining health in the country.Specifically, the article addresses the idea thatbecause the Sri Lankan concept of self is defined ascomprising an extensive number of interactive levelsthat include social, environmental, and cosmologicalrelationships as well as more personal and biologicalones, the dynamics of health and illness, and themedical traditions that define and treat these states,are more complex and multifaceted than a simpleperusal of the medical institutions themselves. Asthese relationships are interactive by nature, thevarious traditions of health care addressing differentarenas of illness etiology must be integrated as wellinto a comprehensive framework.What is of interest in this paper is the popular bodyof knowledge based on the tenets of Ayurveda andSinhala beheth (Sinhala medicine), but not confinedto the textual tenets of these traditions. Not only doesthis body of knowledge explain the health issuesfacing the Sri Lankans, it provides metaphors [l] thatare used to explain the many aspects of life thatimpinge on notions of personhood and its expressionin the daily world. This popular body of knowledge,understood by practitioners and lay alike, is not onlya knowledge system that elucidates illness and healthcare processes as experienced by the patient duringillness episodes and the ongoing maintenance ofhealth, but is also a meaning system that orients thegeneral population towards questions of a morecomprehensive epistemological nature, regardless ofthe medical tradition specifically utilized or the rela-tive proximity of an illness.I will use the term multilectic to emphasize thefluid and dynamic relationships which exist amongconceptual categories in Sri Lankan orientations


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    964 CAROLYN R. NOR STROMtoward Ayurveda. These conceptual categories derivetheir dynamic quality from their openness, recep-tivity, and mutually influential interrelationships, andfrom their ability to encompass multiple meanings atthe same time. In contrast to the idea of a dialecticin which opposition and contradictory processes,or what Hegel [2] might term determinate negation,are central to perception, Sri Lankans perceivenoncontradictory relationships among categorieswhich Westerners might view as discreet (Martin,personal communication). A primary example ofthis developed in this paper is the Sri Lankan con-ceptualization of the self and its interaction withfundamental attitudes toward health, and morespecifically, in the notion of state as it is usedto discuss simultaneously a persons physiologicalcondition, their existential and phenomenologicalrealities in life, and their relations as a collectionof people bounded by social-level ideas of stateor nationhood. This kind of conceptual fluidityreinforces the centrality and power of the notion ofhealth in Sri Lankan culture which concomitantlystrengthens the viability of traditional medicalepistemological frameworks rooted in Ayurveda.


    Data for this paper was collected during 2 years ofstudy in Sri Lanka in 1982-83, and in subsequentfield visits each of several months duration in 1985,1986 and 1988. Research was conducted in an area inthe southern part of the island, and included bothurban and rural settings. In an attempt to understandthe full dynamic of the Sri Lankan health care system,extensive interviews were conducted with peoplerepresenting all aspects of the health care system:with cosmopolitan, Ayurvedic and indigenous prac-titioners, and with both patients and people from thegeneral populace not currently suffering an illness.Attention was given to addressing as broad a repre-sentation of the population as possible, and inter-views crossed a full range of caste, class, occupation,age, and gender divisions. The area I worked in ispredominately Sinhalese, but my work includedTamils and Muslims living in the area as well. AsSiddha and Unani medicines are not well representedin the south, few health care distinctions along theselines were evident among groups, and thus unlessthe materials collected reflect a distinctly SinhalaBuddhist orientation, the term Sri Lankan, ratherthan Sinhalese, is used to denote commonlyheld general assumptions shared throughout thecommunity.The Ayurveda medical tradition of Sri Lanka isbroadly similar to that operating in India with twoexceptions. Over the centuries, the medical practicesand conceptualizations in Sri Lanka have adapted tothe specific health care problems and lifestyles of theisland, and, for the Sinhalese, reflect an intersectionwith basic Buddhist philosophies.In order to understand the full dynamic ofAyurveda and its influence on the lives as well asthe health of the Sri Lankans, it is important tounderstand the concept of self these people hold, theway in which this intersects with the demands createdto maintain this self in health, and the mechanisms

    Ayurveda affords toward this end. The broad-basedsocial dynamic rooted in popular Ayurveda thatemerges in this paper reflects the fundamental viewsheld by practitioners, patients, and the general popu-lation alike: it is an integral part of the basic socialknowledge by which people articulate themselvesvis ci vis their world and their health in general. Thefollowing sections are a condensation of the SriLankans own words. I have stated elsewhere [3] thatthe sophisticated knowledge the average Sri Lankanholds concerning health care and ideology, and theease with which they can articulate this is in large partresponsible for the very high indices of health enjoyedby the Sri Lankan people (41.As my interest in this paper lies primarily with thepopular knowledge and meaning systems operating inSri Lanka, and not with the more formal textualtraditions defining medical care, I have chosen notto delve into lengthy explanations of the formalphilosophies defining medical traditions that arebasically relegated only to educated practitioners.For more in-depth works on these topics, thereader can refer to Obeyesekere [5,6]; Nordstrom [7];Wijeratne [8]; and Wanninayaka (91 on Ayurveda;Amarasingham [IO]; Waxler [1 I]; Yalman [12]; andObeyesekere [131on health care processes; and Carter[14]; Gombrich (15, 161; De Silva [17]; Ratnapala [IS];and Wickramasinghe [19] on Buddhism; and Daniel[20] on Tamil knowledge systems.


    The Sinhaleses conception of self is multifacetedand, in essence, multi-existential. Made up of fivebasic universal elements (water, fire, air, earth, andspace), people are no more than a collection ofchemical elements, and no less than an essentialpart of the universe. Because of this, they affect, andare affected by, processes taking place in their worldand the universe they exist in. This is an orientationthat infuses Buddhist philosophy alongsidecompatible Ayurvedic concepts into general culturaltraditions basic to the Sinhalese. People thus conceiveof themselves as being comprised, and as existing,simultaneously on these dynamically different butfundamentally complimentary phenomenologicalplanes. They are, in essence, equally detined by thesevarying realities, and being so defined, they likewisedefine the world and the universe they comprise.They equally determine, and are determined by, theuniverse they populate.The Sinhalese state they do not draw sharpmind/body, individual/social, or personicosmos dis-tinctions in their assessments of personhood. Allthese levels coalesce to define a person. People aremade up of biological, mental, and emotional pro-cesses. They interact in life through a series of socialrole associations, and are a fundamental part ofthe society and the environment (both physical andsocial) they live in. They are shaped by religious andphilosophical epistemology, and are an inherentpart of a larger metaphysical and cosmological world.In popular conception, the Sinhalese tend to seeall of these domains, from biological to social andcosmological, as processes which run according to the

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    Ayurveda: a multilectic interpretation 965same basic principles. This view tends to focus onconcepts of synergistic, interrelated configurationsand the effects of balance and imbalance, harmonyand trouble. Balance and harmony themselves arecomprised of many elements: of the properties of heatand coolness that affect the health of a system, ofsweetness and bitterness that give it flavor, of orderand disorder that characterize it, and of the positiveand negative alignment of parts that defines its natureat any given point in time.This orientation represents a multilectic approachto issues of an existential nature. Each of thesephenomenological domains is essential to definingbeing, yet makes sense only in its definitionalrelationships to the other domains it is perceivedas being in interaction with. This entails a set ofmutually influential interrelationships that exists ina dynamic such that each of the categories maintainsa coherency of nature, while at the same timebeing fundamentally defined by the nature andcharacteristics of the other related processes and thecomposition of the whole.This is not a directional process, as is usuallyassociated with the dialectic, but one that is necessaryto the maintenance of the integrity of the whoIe as itexists over time and space. The multilectic does notstand in oppostion to the dialectic, nor is it intendedto replace it: it addresses a different order of concep-tual categories and their related phenomenologicalprocesses. While they can be used separately in theoryand analysis, they represent compatible concepts thatcan be used together to highlight the relationships ofphenomenologically divergent processes.While a multicausal orientation is basic to thisapproach, it is not sufficient in explaining it. Theprocess is more complex in that discrete factorscannot ultimately be identified as basic componentsin a process of reduction: to the Sri Lankan, the partcannot accurately be distinguished as isolated fromthe whole, nor the cause separated in explanationfrom the effect. In the multilectic, a universe, and auniverse of knowledge, is being continuously createdand maintained by the various parts and parts-as-wholes simultaneously, and as well by the processesand dynamics of the relationships themselves as theygenerate and define existential domains.Given the fact that all of the aspects of life and selfas defined by the Sri Lankans are perceived asexisting in a dynamic relationship, a disturbance inany of these realms can jeopardize an individualsimmediate well-being. Well-being, then, is not as-sessed solely in terms of an individuals physical andmental health, but as a set of positive relationshipswith the people and processes in the persons world.This includes not only a rounded intellect andbalanced emotional states, but also fulfilling socialrelationships, a clean environment, a stable society,and a proper conliguration of supernatural andcosmological forces.Though the Sinhalese recognize the physicalsuffering of illness, they may trace its origins todisruptions taking place in any of the many levels ofexistence that define the self. In the same way, frictionin any of these realms in and of itself is ultimately asignal of unhealthiness for the people who are a partof it.

    For example, a healthy mental/emotional balanceis as important to physical health as is a strongconstitution, and the two are not separated by the SriLankans

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    966 C ROLYN R. NORIXTROMIssues of environmental cleanliness are closelyrelated to religious principles of purity and whole-someness and are fundamentally tied to notionsof health and illness for Sri Lankans. The Gods donot like dirty environments, and neither do the SriLankans. The public generally recognizes the vectorsof many infectious diseases, and during an outbreakthey may explain the ultimate etiology as a Godswrath, but realize the immediate etiology as patho-genic infection. They will thus direct their energies toisolating patients and monitoring the cleanliness offood, water resources, and sanitary conditions as wellas conducting rituals to appease the God(s).During one survey I conducted in both an urbanand a rural area in the south of Sri Lanka, I askedpeople what request(s) they would present the Min-ister of Health if he came to their homes inquiringabout how to improve health standards in the com-munity. In conducting this research, I was careful tointerview as representative a sample of the population

    as possible, and spent as much time with the morerural, economically poor, and less formally educatedfamilies as I did with the more affluent urban popu-lace and the health care practitioners. One of themore surprising aspects of this study was that virtu-ally everyone I talked with had a fairly well-developed explanatory model that shared the samebasic elements of the body of popular knowledgedescribed here. The sentiments outlined here reflectcommonly held views regardless of peoples gender,economic, occupational, or educational background.In answering the above question, many of the people,after responding that the Minister of Health wouldnever come to their house in the first place, and thatwas one of the proplems, said that if such a thingwere to pass, one of the first requests they wouldmake would be that he clean the environment andprovide clean water.Population pressures, people said, cause an excessof garbage, and garbage attracts insects and animalsthat can introduce and transmit disease.. Waterbecomes polluted as too many people are forcedto wash clothing and household items, bathe, andevacuate in one area. Pollution fouls the air and thesoil, and increasing demands for food resourcesprompts the use of petrochemicals and insecticidesthat introduce poisons into the foods people eat.People were not as concerned with populationgrowth, and the concomitant pressures caused by thisin and of itself, as much as with the aforementionedconsequences, and with the fact that polluted andpoorly managed agricultural and environmental pro-grams hampered the communitys ability to meetbasic subsistence needs. These concerns are well-grounded. Though Sri Lanka has one of the highestsets of health indices for all Third World countries,50 of the children are malnourished and it isestimated that over half of the major diseases sufferedare water-borne [22,23]. In a more specific example,the Superintendent of Health of the district I workedin told me that in recent years there had been atremendous increase in the number of cases of severeinsecticide poisoning (through skin contamination) infield workers.Social environment is as important a concept tohealth as is physical environment. Impoverishment,

    stressful or antagonistic work environments, andbeing away from family and home and feeling lonelyor unhappy in circumstances one doesnt like are afew examples of the many situations that can affectones health and well-being. On a broader scale,another commonly voiced opinion about the impactof the society on the individual was summarized bythe person who explained to me:If the government is good a healthy nation exists. But if itis bad, if it is corrupt and selfish, jobs will not be available,schools will not be properly staffed, land will not bedeveloped and cared for, and the people will be unhappy.They will sicken and die, or they will revolt. If there islighting among the people and antagonisms between groups,everyone will suffer. It is an unhealthy state then.

    THE SRI LANKAN PLURAL MEDICAL SYSTEMThe Sinhalese have an extensive plural medical

    system tailored to these myriad levels of ill-health anddisorder. While it may seem that many of the forcesthat impinge upon health, such as those of a social,metaphysical, and cosmological nature, are not easilychanged so that positive health may accrue, in fact,all of these can be influenced by the services ofspecialists so that the amelioration of ill-health cantake place. Because these forces exist as dynamicphenomena, and not as static properties, their natureand the concomitant impact they have on individualschange over time, and they are amenable to curativerituals.Within the encompassing framework of healthcare, each of the healing traditions is directed towarda specific arena of care defined by the etiologicalagent(s) deemed responsible for the dis-ease. Cos-mopolitan (Dostora) and indigenous traditions ofAyurveda and Sinhala medicine (Veda) are empir-ical means to reestablish health within the body [6].The latter two medical traditions also emphasizepreventive health care [9]. Local-level healers, infor-mally trained primary health care specialists, helpcorrect personal problems and everyday physio-logical and emotional complaints [24].Buddhist priests (Hamaduruwa) and lay priests(Kapurala) attend to supernatural and metaphysicaldisturbances, and are responsible for the spiritual andemotional well-being of the communities they serve[13, 14, 17,251. Exorcists (Adura) control the eviland demonic when it disrupts the world of the livingto cause misfortune and disease, and they help torectify negative cosmological patterns influencingthe well-being of individuals and communities (261.Astrologers (Gurunnanse) assess planetary patternsand cosmological relationships, and advise onways of correcting negative influences in these realms(271. Oracles (Pena-karaya) and fortune-tellers(Shastra-karaya) discern interpersonal, social, andsupernatural problems and ascertain solutions forthem [9, 121.AI1 of these categories of healers and traditions ofdiagnosis and treatment described above tend tocome into play during the course of a Sri Lankanslife [lo]. For any given illness, one or more causalfactors may trigger the disease process. For eachspecific domain of etiological agent involved in an

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    Ayurveda: a multileetic interpretation 967illness episode, the appropriate healer must beconsulted to ensure that health is regained.For example, negative planetary influences mayfoster emotional disturbances in a person that leavehim or her open to demonic attack. Such an attackmay upset the correct balance of the bodys threehumors, and the resulting imbalance can produce aphysical disease. Medicine given for the physicalproblem alone will not successfully cure the disorder,for the underlying causes have not been treated. Inaddition to medicine, the services of specialists whoare able to determine the exact root cause(s) ofthe problem, and can either treat these or refer thepatient to practitioners who can, are essential inregaining health. Thus a patient may consult a cos-mopolitan physician and/or a Veda, an astrologer,and a religious and/or ritual specialist in the courseof a single illness.None of the healing traditions, in and of them-selves, can address all the levels that constitute aperson and determine well-being. Both the prac-titioners and the formal doctrines that define theirpractice are formally restricted to specific domainsof diagnosis and treatment, as described above(although in actual practice there are healthspecialists that amalgamate several different healingtraditions).Within the general society, however, these varioustraditions are not seen as complete healing systems bythemselves in that they do not address all of thelevels of illness etiology, and thus the various healingtraditions are not viewed as competing systems ofmedicine. Rather, they are seen as complementaryoptions variously available to patients dependingon their needs. (Practitioners, as distinct from thegeneral population which holds the above views,do not always have such an expansive view of theplural health care system, and may view the differenttraditions as competing as far as their practiceis concerned. This, however, holds only for theirprofessional orientation, for when practitionersthemselves become sick and revert to a patient status,they tend to employ the same popular paradigms ofhealth care knowledge used by the general populaceand approach the health care universe as a moreintegrated comprehensive whole.)The ability to synthesize these various healingdomains into a coherent encompassing frameworkrests, then, on the general patient population andon the popular paradigms of health they maintainin defining illness and health care options. The re-lationship between illness episodes and treatmentchoices is an interactive one: the assessment of whatetiological agent(s) underlay the development of theillness dictate which healers a patient will seek out,and the efficacy of the ensuing treatments will deter-mine if the initial assumptions are supported (theillness responds to treatment and the patient im-proves), or if further causal factors are explored andtreatments sought (the illness doesnt respond to theinitial treatments). In the latter case the initial de-cisions concerning etiological agents and treatmentsare not deemed inaccurate, but simply incomplete,and an expanding framework of causal factors andrelated treatments ensues until the patient is finallycured.

    POPULAR PARADIGMS OF HEALTH KNOWLEDGEGiven the fact that the Sri Lankan concept of self,and thus of health, is so broadly defined, a theoreticalframework-a popular body of knowledge-mustexist that is capable of integrating these diverse

    realms and the formal traditions that define them.Ayurveda/Sinhala medicine provides the foun-dation for such an encompassing explanatory modelfor the general population. As such, it exists both as amedical tradition in the traditional sense of the term,and as well, as a social knowledge system appliedgenerally in the society to address epistemologicaland existential concerns in a way meaningful to theaverage person as well as to the more eruditetextually-trained practitioners and philosophers.Sinhala beheth is not viewed as more of a folktradition than Ayurveda in Sri Lanka. Structurally,the two conform more to Leslies [28] model ofnonprofessionalized versus professionalized Ayur-veda respectively. Professionalized Ayurveda refersto the system whereby practitioners gain a formaleducation in Ayurveda universities and rely on pro-fessional texts, organizations, hospitals and clinics,and manufactured pharmaceuticals in their practice.In nonprofessionalized Ayurveda, practitioners learntheir medical skills through a lengthy apprenticeshipto a master, often a family member, or from templeschools or informal medical organizations (althoughthe latter two are far less commonly found today).Given the high literacy rate in Sri Lanka ( 197 1: males:85.2 ; females: 70.7 , with current figures showingcontinuing increases [29]), most nonprofessionalpractitioners are also trained in Ayurveda and/orindigenous medicine texts written in Sinhala orTamil, and sometimes Pali (the formal traditionallanguage of Buddhism).To the average Sri Lankan, however, the non-professionalized distinction is nonevident: .the ar-duous apprenticeship process (4 years for a universitymedical degree sounds remarkably short to many),the well-maintained clinics and shops for consul-tations and medicines, and the quality of thecare associated with the practitioners of Sinhalabeheth is as formally professionalized as thatoffered by university trained and institutionally basedAyurvedic practitioners.In the Sri Lankan context, to label the informal,popular body of knowledge Ayurveda is a misnomer.Among the general populace in Sri Lanka the termAyurveda has come to signify the professionalizedform of the indigenous medical tradition, and onethat is often integrationist in policy; that is, it followsa model whereby the principles of Ayurveda are wedto the infrastructural and therapeutic patterns ofcosmoplitan medicine. The pure form of apprentice-learned. empirical indigenous medicine is referred toas Sinhala beheth (Sinhala medicine), or Tamilvaittiyam (Tamil medicine).Sinhala beheth itself exists on two planes,although only one is officially recognized. There isa formal empirical medical orientation based onwritten texts and established therapies for both pre-ventive and curative health care. In addition, there isa more informal popular body of knowledge thatorients the average Sinhalese toward the many mani-

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    968 C ROLYN R. NORDSTROMfestations of illness and health that are fundamentalto the world as they know it. This includes not onlytheir perception of health concepts, but the epi-sternological systems they use to explain them. Thislatter system of knowledge is interactive by nature,linking patients both to broader socio-cultural issuesin the society, and to the array of infrastructures,practitioners, and ideologies of health care. (Thisdistinction between formal and popular healthknowledge is similar to the one that Obeyesekere [30]makes in terms of textual and popular Buddhism, butit is more encompassing in nature as it includesmedical, religious, ecological and social traditions.)It is this form of popular Sinhala medicine thatprovides a paradigm capable of synthesizing peoplescomplex conceptions of self and health. This body ofknowledge is shared throughout the general society,and is distinguished from the more classical doctrinesof medicine, religion, and public health that ulti-mately give definition to it. Its bases in synergistic yetcompeting parts, in the concept of doss (trouble)coming from the Tridosa (the Theory of the ThreeHumors), and in balance and harmony and theircounterparts, are drawn from Ayurvedic doctrine,but they are not limited to it. Because of thisit provides an accessible and comprehensibleconceptual framework mediating the diverse medicaltraditions.This popular body of knowledge is not specificallygrounded in any doctrinal base, nor does it exist asan institutionalized or written tradition. Because it isnot the textual orientation itself, but the generaloverlying principles inherent in it that are used tocodify diverse sets of information, it can as easilyincorporate the pathogenic germ theory of cosmo-politan medicine as it can the demonic possession ofexorcistic traditions, the effects of negative karma, orof harmful planetary configurations-all of whichcan seriously jeopardize the internal humoral balanceof individuals and the external social and spiritualrelationships they engage in. It is thus capable ofrendering whole the myriad levels that define person-hood and the diverse healing traditions available inSri Lanka.The concept of state provides a crux for thisorientation. The conceptualization of state is derivedfrom the complex notions of personhood held by SriLankans, and derives a more encompassing usagefrom further extended linkages with notions of ill-ness, health and Ayurveda/Sinhala medical traditionsas they are rooted in popular knowledge paradigms.It provides a conceptual framework that is bothflexible and dynamic, and yet fundamentally coherentacross time and space. As such, it is capable ofordering broad-based existential concepts of being asthey are variously expressed when the simple verbinnawa-to be-comes to life in its intersectionwith the complex reality of being. Epistemologybecomes ontology in this intersection-the abstractedlinguistic symbol, to be, by virtue of its very use islived, and by thus referencing this fact of beingcognitively, it becomes as well a fundamentalaffirmation of existence for the person constructingan I am. statement.This double dynamic of being, as a cognitiveconstruct and as experiential reality, underlies the

    evaluation of state. The complex nature of theCOnCept of state as it is used in Sri Lanka derives inpart from the fact that the two perceptual categoriesdefining its parameters represent distinctly differentphenomenological and cognitive categories whichmust nonetheless be considered synergistically interms of their encompassing coherent relationships inorder to make sense. This represents neither a syn-thesis of divergent elements toward any one unity asin the dialectic, nor a Western-based model of linearprocess that sequentially analyses single categories asdiscrete, divided units. The different categories donot exist in contradictory relationships of any kind,but represent different order of phenomena viewedsimultaneously as distinct and interrelated completedynamics. As with the concept of self in health, thisrepresents a multilectic orientation,State can refer to an individuals particular physio-logical condition at a specific time and place. At thesame time it can summarize a persons existential orphenomenological place in life. As well, it can beused in the sense of a collection of people, a boundedsense of nationhood. The state of an individual isultimately defined by all of these definitions inherentin the term.The first two uses of the concept of state werediscussed in examples given above (in the sectionon The Concept of Self in Illness and Health):the impact that pathogens and humoral imbalances,interpersonal relationships and emotions, gods anddemons, and the effects that supraphysical processeshave on the health of a person. In the first case, onecan be sick (sanipannae; asanipai; leda) [hereand now] because of short-term illnesses causedby humoral imbalance, the attack of a demon,cosmological disturbances, or toxic agents carried bysuch vectors as food and water.In the second meaning of state, one can also suffermore long-term disabilities caused by circumstancesmore existential in nature: widowhood; the effectsof karuma; poverty; polluted environs (both inthe sense of pirisidunae, not clean physically, orkilutuwi, impure conditionally or existentially), orunhappy social relationships. Chronic diseasesalso fall into this category. This includes not onlylong-term physical disabilities, but more complexsocio-physical conditions as well. A daughter,explaining the plight of her mother to me, clarifiedthe latter instance:When my mother attained age (had her first menstruation)she suffered a bad fright, and she has never been the samesince. For 25 years now she has had pains in her body,paralysis at night, and periodic fits. Some say she is ayakleda (patient with an illness caused by demonic attack),others say she has heart problems and high blood pressure.But after spending tens of thousands of rupees on scores ofdifferent kinds of practitioners over the years with onlylimited success, we all agree that the illness has gotten intoher bones. We doubt if she will ever get completely betternow.

    The third use of the concept of state, that of ashared socio-political identity (often using national-istic, ethnic, and cultural constructs to define asociety-level membership), also follows the sameprinciples. In its healthiness or unhealthiness, thestate in this usage can impinge directly on a persons

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    Ayurveda: a multilectic interpretation 969well-being. A graphic example of this is given byDaniel [20] in his discussion of the nationwideinterethnic violence taking place in Sri Lankabetween the Sinhalese and the Tamils. Danielsdiscussion centers on a Tamil indigenous medicalpractitioner. Although this does not representSinhala beheth, strong parallels exist between thisand Tamil vaittiyam (Tamil medicine) in terms ofthe popular (as distinct from the textual) body ofknowledge discussed in this paper. The followingexcerpt from Daniels paper is the direct quote of anindigenous medical practitioners analysis of thestate of the country in conflict. (The rioting citedhere refers to the communal conflict between Tamilsand Sinhalese resulting from the 1983 nationwideriots in which over a thousand Tamils were killed.)When there is a lot of sorrow there is a great amount of tearsformed in the body; mainly in the head. If tears dont flowthen they coagulate into bile. The heat of anger fires thetears which coagulate into bile. This bile may look likephlegm. But it is mostly bile. But this heat is all internal. Itdries up the tears into phlegm and bile, and this phlegm andbile block the channels in the head and in the body, mainlyin the head. This is bad. This is what has happened to theseboys [involved in rioting]. Look at the weather. It is cool.We have had more rain this year than in any other year. Thewinds are cool. The amity talks (referring to the attemptedpeace talks between the Tamils and Sinhalese that wastaking place in Colombo) are also like cool breezes. But thisis very bad. It drives the heat inside the body. Into thecentral channels of the body. This is very bad. It blocks thechannels. When the channels are blocked you cant remem-ber. To get better we must all remember. The Tamils mustremember. The Sinhalese must remember. What we need isa dry spell with lots of dry wind. The people must weep andweep a lot until their tears cool this land. Now the Sinhalesesoldiers urinate on our rice fields. The rice field is our god.Urine is hot. Our country is hot. These rains hide thefact that this country is sick with heat. They do not reallycool the land. First the land must cool down. It must trulycool down. Only then can human beings cool down. Toreally cool the land we need tears. Lots of tears to cool it.This land has not wept enough. It is hot. This land is sick.

    For the Sri Lankans, then, the popular bodyof knowledge based in, but not limited to,Sinhala/Tamil medical frameworks provides not onlyexplanatory models for medical problems, but is usedto orient them toward epistemological and onto-logical concerns as well. It is the only comprehensiveconceptual framework capable of mediating all of thestates-all of the levels of existence-that definepersonhood. In addition, as this exists in the form ofpopular knowledge that is shared throughout society[31,32] rather than as a formal written doctrine,it provides an integrated basis for social discoursethat cross-cuts the various social groupings andhierarchies that are recognized in society. It addresseshumans and life in general and is not restricted byany gender, age, or social distinction(s). It thus standsas a mechanism that links the population rather thandividing it.The tradition of Ayurveda/Sinhala beheth that isfound in practical application in the villages andhomes of Sri Lankans has a fundamental relevancebeyond the healing arts delineated in the texts of thetradition. The basic philosophies of Ayurveda pro-vide a series of metaphors that are applicable to anymajor conceptual system characterized by balance

    and disorder, health and dis-ease. Thus Ayurvedadoes not exist simply as a medical tradition, nor is itconfined solely to the discourse of medicine. On onelevel, this popular body of knowledge provides amechanism for integrating the various traditions ofhealth care into a coherent encompassing frameworkfor patients. In addition, the impact of Ayurvedaextends beyond issues of illness and health in thelife of the Sri Lankans to provide an explanatoryframework capable of synthesizing the many facets ofSri Lankan life, and concepts drawn from this bodyof theory are used to explain that life itself.THE ROLE OF INDIGENOUS MEDICINE

    IN HEALTH CAREA number of authors have written that in recentyears the practice of cosmopolitan medicine is eclips-ing indigenous healing traditions. Some argue thatindigenous medicine will fade as a viable option in thefuture, and others postulate that it will blend with

    cosmopolitan medicine, forming a sort of compositetradition. Some recognize the importance of in-digenous medicine in health care, but say it is gener-ally second in preference to cosmopolitan care[6, 11,33-361.The data from Sri Lanka presented here challengesthese assumptions, demonstrating that regardless ofthe actual healing tradition activated during illness(whether cosmopolitan, Ayurveda, or indigenous),Ayurveda, as a popular conceptual knowledge sys-tem, is often the means by which patients orientthemselves ais-a-vis the illness episode and the heal-ing endeavors in general. Because this popular bodyof knowledge is crucial in explaining the relativewell-being of a person, and his or her everyday world,it remains central to the lives of the Sri Lankans. ASsuch, it reflects and reinforces traditions and valuesthat are considered fundamental to the society.For the Sri Lankans, this is not a dynamic that canbe reduced to diadic oppositionals and contradictoryforces; mind/body, individual/society, or to pairedsets of fundamental competing humors or life con-stituents. It is the interplay of a more complexinterrelationship of multiple factors, spanning themany levels on which the self is made evident, and themany arenas in which individuals engage in thecourse of their days and their lives that is, in essence,a multilectic process.

    In addition to representing a healing tradition,Ayurveda/Sinhala beheth, as a popular paradigm,is an epistemological and ontological explanatoryframework grounded in, and referencing, the mostfundamental aspects of life and society for the SriLankans. Because of this, Ayurveda and indigenousmedicine will in all likelihood continue to exert aprofound influence in the lives of the Sri Lankans,and to operate as a central explanatory frameworkfor people confronted by illness, misfortune, andexistential angst in a world where they define them-selves and their relationship to life in terms of amultilectic orientation based on ideals of health.REFERENCES

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