Traditional medicine systems in Sri Lanka
By: Dr. Pathirage Kamal Perera (PhD)
Sri Lanka is a country with a very old civilization and Ayurveda has been a widely practiced medical system throughout the ages. Traditional medicine has been practiced in Sri Lanka for more than 3,000 years. At present, there are four systems of traditional medical systems in Sri Lanka are dominant viz. Ayurveda, Siddha, Unani and Deshiya Chikitsa (Sri Lankan traditional medicine system ). About 60 to 70% of the rural population relies on traditional and natural medicine for their primary health care. Therefore Herbal drugs are essential components of traditional medical system in Sri Lanka. Number of Ayurveda physicians registered under the Sri Lanka Ayurveda Medical council is around 19,754 as at 31st December,2010 as per the statistics available. Out of the General physicians Ayurveda counts 84.6%; Siddha system 12.7% and Unani 2.7 %. Among the special physicians Ayurveda counts 96.5%; Siddha system 2.9% and Unani 0.6%. Apart from the above registered physicians at the Ayurveda Medical Council, there are more than 8000 Traditional Medical Practitioners practicing medicines who are decedents of reputed families with secret formulae to cure deceases engaged in Public Health Care.
There is a large traditional knowledge from Sri Lankan unique none formalized traditional medical system known as “Deshiya Chikitsa”. The community relies on this system for many treatments including for the treatment of eye diseases, fractures and dislocations, burns and scalds, boils and carbuncles and cancers. Some of the practitioners specializing in fractures and dislocations are of such high reputation that they are often the first choice for treatment even by sections of the community accustomed to allopathic (western) medicine. There are more traditional knowledge based on ola-leaf manuscripts and ancient books on traditional medical system. Still these texts traditional knowledge are uncovered for public health development. Sri Lanka need to develop a national project for preserves these manuscripts and ancient books on traditional medical system for future research to develop health products. There is urgency for digitalized these knowledge for research and developments. It will become easily accessible for this traditional knowledge for research and public health development. The Traditional Knowledge Digital Library launched by the Government of India, is an example of how ancient knowledge available in the ancient scriptures made digitally accessible.
Sri Lanka Ayurvedic Drugs Corporation which was incorporated in 1969 by the government extra ordinary gazette notification No. 14853/1 dated 11May 1969 under the provision of State Industrial Corporation Act. No. 49 of 1957 as the pioneer of manufacturing and marketing of Ayurvedic Drugs to the government hospitals, Ayurvedic physicians and private sector has been playing the major role in health sector in Sri Lanka for more than 40 years. As a policy, the Corporation is mainly focused on quality of medicines and service to the general public rather than operating as a business entity.
The Government Department of Ayurveda, Sri Lanka has documented the national formalized medicinal system in the three volumes of Part I of the Ayurveda Pharmacopoeia. The Pharmacopoeia identifies the raw materials used by physicians using the indigenous system, drugs that should be prescribed for various diseases, and methods of preparation for different drugs. Although the Pharmacopoeia claims to deal with all three formalized systems, it concentrates mainly on Ayurveda.
Plants used in the local Ayurveda system have been botanically described, and many of these have been investigated for their biological activities by scientists in the universities and research institutes. Bandaranayake Memorial Ayurvedic Research Institute was established for the development of Ayurveda and Traditional Medicine in Sri Lanka through research on related fields including clinical research, drug research, community based research and literary research. There are two main University affiliated research and educational state Ayurveda Institutes in Sri Lanka. The Institute of Indigenous Medicine is the premier Higher Educational Institute in Sri Lanka that provides instructions in Ayurveda, Unani and Indigenous system of medicine at undergraduate and postgraduate levels. The college of Ayurveda was first started in the Island (1929), subsequently upgraded and affiliated to the University of Colombo in the year 1977 as the Institute of Indigenous Medicine. Gampaha Wickramarachchi Ayurveda Institute is affiliated to the University of Kelaniya.
Introduction to “Sri Lankan Ayurveda”
The term “Ayurveda” is a combination of two Sanskirt words: “Ayur” (ayuh) meaning life and Veda meaning Science of Knowledge. Ayurveda could therefore be translated into English as “The science of life “. Thousands of years before modern medicine provided evidence for the mind – body relation; the traditional practitioners of Sri Lanka developed Sri Lankan Ayurveda which continues to be one of the sophisticated and powerful minds – body health systems.
The Ayurveda system of healing believes in treatment of not just the part affected by disease but the individual as a whole. It emphasizes on the harmony of mind, spirit and body in curing the body and focus is on prevention rather than cure. Ayurveda is a comprehensive and scientific system of medicine based on natural products, promoting a healthy & long life, and can coexist with modern medicine. Ayurveda has two main objectives:
- Roga Nivaranaya – To protect and maintain the health of a healthy person by strengthening of the immune system (Preventive and Social medicine)
- Roga Pratikara – To treat the root cause of the disease and disease and manage the disease where it has already occurred (Therapeutics)
Concept of “Ayurveda”
The universe includes human beings, animals and plants, and is made up of the Pancha Maha Bhuta (five great elements) – Apo, Thejo, Vayo, Pruthuvia and Akasha. The human body is also made of these five elements. Accordingly, the elements in the universe and the elements in the human body reveal a common origin. These common factors create a harmony between man and the universe and there is a co-relation between the universe and the human body. In the external universe there are three main causative factors – the sun, moon, and wind. In the human body there are three constituent elements – Vata, Pita and Kapha (Tri Dosha).
Every human being is made up of the 3 Dosha, namely Vata, Pita and Kapha. Tri Doshas are the main active forces in our body. They regulate all function of the organs in the body. The construction of our body, its maintenance and disintegration are mainly due to these Tri Dosha. When Vata, Pita, Kapha are in a state of equilibrium a human being will have a healthy state of body. An imbalance of the Tri Dosha may lead to diseases.
Kapha (Sem) – is the force of attraction and helps to prevent the disintegration of the human body. It has adhesive power and is responsible for the formation and maintenance of the body and regulates its temperature. The moon is responsible for cooling and regulating the temperature around the universe.
Vata (Va)- is the moving power or principle of movement in the human body. In the external universe the wind is the principle of the movement: but Vatha should not be compared with the wind, as it is a kind of energy, which is an internal force.
Pita (Pith) – controls the metabolic functions inside the body. The sun is the energy of conversion and is represented by fire: when anything comes in contact with heat it changes its appearance. Pitha Dosha inside the human body is said to have this conversion power.
Prakurti- Personalized medicine
The individual constitution of each person is called “Prakurthi.” The meaning of Prakurthi is “nature” or “the original form” (“the first creation”) every person acquires his own Prakurthi at the time of conception. When the sperm and the ovum unite inside the uterus, the predominant Dosha produce specific characteristics/ features. This Prakurthi remains constant throughout the person’s life. The predominant Dosha of a person is today commonly referred to as “body type”.
When we consider different individuals and their dietary requirements, their behavior and tolerance to the environment, we find that they have different needs to survive as healthy individuals. Even two people of the same age, weight, and height may have different needs and tolerance to different types and amounts of food, drink and activity. So it is clear that tolerance to food, environment, behavior, mental and physical activity etc. depends on the constitution of the person. For examples if an excess of Vata is present in an individual, his constitution will be Vata. In the same way Pita dominance leads to Pita constitution. Prakurthi usually represents the disease proneness of the person. For example, Kapha Prakurthi people tend to suffer from Kapha diseases like obesity, or colds. The correct determination of a person’s Prakurti requires a careful examination by a specialist. According to the personality type all the treatment protocols are made (Personalized Medicine/Pharmacogenomics). Therefore the Prakruti or body type has a strong influence in the determining of Sri Lankan Ayurveda Treatment.
Dhatu and Mala
Dhatu is a term for tissues. The human body consists of seven basic tissues known as “Sapta Dhatu”. Usually Dhatu gives support to the body or sustains it. When these Dhatu are defective they affect the maintenance and nutrition of the body and lead to diseases.
Mala is a term for waste products. The human body produces three main waste products that i.e. stools, urine and sweat. It is important that these waste products are expelled from the body regularly, or else they collect as toxins.
Agni and Ama
The other important principle governing the basic physiology of Ayurveda is Agni. Ayurveda believes that any disturbance in digestion and metabolism leads to the formation of toxins (Ama), which give rise to diseases. Agni governs this disturbance of digestion and metabolism.
When there is an imbalance of the Tri Dosha or Saptha Dhatu or Agni, the disease process begins. The balanced state of the things mentioned above is responsible for the natural immunity of the person. Therefore Ayurveda is a holistic medicine system that treats for enhance human cell immunity.
Ayurveda as a therapeutic system
Shamana Chikithsa (Curing of diseases) manages the symptoms of the disease and treats the cause of the disease with the help of various Ayurveda medicine and therapies. In Ayurveda there are thousands of medicines consisting of herbs, minerals, and biological products, which are used singly, or jointly to suppress and cure diseases, particularly when the disease is at an early stage. At another level of healing, Ayurveda prevents and eliminates disease before the symptoms manifest. To be able to do this, we have to consider our life style, environment, work and psychological conditions. We need to remove those factors of our lives that make us vulnerable to disease. Health then becomes a matter of continuing adjustment, and achieving a balanced life style.
Our modern life style is such that we invariably move away from our natural balanced state. The food we eat, the air and noise pollution we face, the stress at work, and balancing competing interest of work and family all add up to build toxin which collect in various parts of the body and lead to disease. So Ayurveda recommends a system of purification with natural ingredients and therapies to collect the toxins in specific parts of the body, and then expel them from the body. This purification process also includes a process of rejuvenation and strengthening of the immune system to prolong well-being. This life enhancement therapy aims at improving our vitality and enables us to delay the aging process and live longer. This aspect of Ayurveda is called “Shodana Chikitsa”.
Shodana chikithsa (Prevention of diseases) is one the most important and advanced techniques in Ayurveda and is an internal purification process. Purification can be used to cure diseases and at the same time to promote the healthy state of the body. It is thus a unique science. It is possible to successfully cure a number of difficult diseases like Arthritis, Paralysis etc with the help of Shodana Chikithsa. Shodana chikitsa removes the Ama and Mala (toxins) from the body and restores the balance of the Doshas. Shodana Chikitsa consists of a three-stage purification process as follows:
Purva Karma – preparatory purification prior to the main purification
Pradhana Karma – the main five purification methods (known as Panchakarma treatment)
Paschath Karma – post rejuvenation therapy.
Ayurveda Ingredients and Pharmaceutics
Ayurveda mentions many different methods of treatments to overcome the diseases and maintain a healthy state of the body and it uses many forms of herbal preparations. Ayurveda utilizes all the parts of the herbs, such as leaves, roots, flowers, fruits, stem, bark, in making of herbal preparations. Ayurveda herbal preparations are specially designed according to ancient authentic formulas (recipes), which have been using for hundreds of years with good clinical results.
KASHAYA /Decoctions – Herbs are usually administered in the form of a decoction to cure many diseases. Generally decoctions are prepared as follows. Place 60 grams of herbs in an earthen pot and put 8 cups of water (1920ml) , and boil the mixture over a low flame till the liquid reduced to one cup (240ml) . Kashaya is freshly prepared and the medicine is taken twelve hours gap.
SWARASA /Fresh Juice – The fresh juice of an herb is called Swarasa. It is made by crushing the fresh herb and finally straining the juice through a strainer.
KALKA / Paste – The paste of an herb is obtained by crushing the fresh plant until it becomes a soft mass. In this process we use fresh herbs or dried herbs, with water or other juices. These pastes can be given orally. The paste can also be used as an external application to reduce pain or inflammation.
PHANT / Hot infusions – Generally Phant is an instant decoction. Boiling water is added to the herbs and allowed to set for period of time (more than 30 minutes). The strained infusion is then used in many ways.
CHOORNA / Powders – Powders are common herbal preparations in Ayurveda. They are traditionally prepared with the help of mortar and pestle and then filter through a linen cloth. Choorna is usually taken with honey, milk, juice or hot water.
VATI / Pills – Herbal powders are triturated with juice or oils and prepared as little pills called “Vati”. They are also taken orally with honey, milk, juice or hot water.
ASAWA and ARISHTA / Herbal elixirs- Natural process of fermentation is used to prepare this. It contains fresh juices of herbs or raisins, juggery and a large number of herbal compounds and grapes. Spices are also included. The mixture is placed in special wooden barrels, and allowed to ferment for a period of 30 – 90 days. This method of preparation can be considered as the first biotechnological involvement in medicine.
MEDICATED OILS – Take purified oil (Example; Sesame oil) in a stainless steel vessel and heat it mildly. Add increments of herbal paste (Kalka). Stir thoroughly while adding decoction and boiled over a long period of time (sometime two weeks) until it reaches the perfect consistency.
Is Ayurveda medicine safe?
Ayurveda medicine uses a variety of products and practices. Some of these products—which may contain herbs, minerals, or metals—may be harmful, particularly if used improperly or without the direction of a trained practitioner. For example, some herbs can cause side effects or interact with conventional medicines (Botanical drug interactions). Also, ingesting some metals, such as lead, can be poisonous. Therefore in current system of practice patients need to visit educated Ayurveda practitioners who are qualified with accepted Ayurveda degree (Bachelor of Ayurveda Medicine and Surgery).These practitioners are experienced with Ayurveda and modern pharmacology. Ayurveda practice is not like a western/allopathic practice. In western medicine all the drugs are provided by importing as finished pharmaceuticals. But in Ayurveda drugs are prepared by the practitioners with their own capacity. So any one who practice Ayurveda in any specialty it is utmost important to learn Ayurveda and modern pharmacology.
Is Ayurvedic medicine effective?
Some research studies have shown Ayurveda medicine, including herbal products, for specific conditions are effective. However, there aren’t enough well-controlled clinical trials and systematic research reviews—the gold standard for Western medical research—to prove that the approaches are beneficial yet. Therefore it is necessary to conduct research for these medicines to popularize and develop as evidence based medicine.
We are pleased to inform that we will be carrying a series of articles on Ayurveda treatment for the benefit of tourist who visits Sri Lanka seeking Ayurvedic treatment.
Senior Lecturer | Department of Ayurveda Pharmacologyand Pharmaceutics | Institute of Indigenous Medicine, University of Colombo, Rajagiriya, Sri Lanka | Consultant Physician at National Ayurveda Teaching Hospital, Sri Lanka | Visiting Professor in Pharmacology