[Buddha-l] Re: Aama do.sa I

[Dan Lusthaus]

Joy,

> I don't mean to denigrate the "medical knowledge" of the past, but your
descriptions raise some questions. Can we really talk about medical
knowledge in a pre-science period where e.g. notions like psychosomatic
disorders weren't known) ?

Why do you assume that Indian (or for that matter Greek, Chinese, Islamic)
medicine were unaware of psychosomatic issues? On the contrary, it is in the
post-Descartes world -- in what your are implying the is science period -- 
that psychosomatic issues have become problematic. Descartes made
extensional (material) things and thought things absolutely separate
substances (he ridiculously posited the pineal gland as the magical bridge
between them). "Scientists" and metaphysicians have been trying to put the
two substances back together ever since. In the science era a disease is
only real once it can be found under a microscope.

In the Caraka-samhita, on the contrary, physical and mental (emotional,
etc.) factors can be mutually causative (that is what psycho-soma means in
Greek). For instance, in the Vimaanasthaana chapter (from which the quotes
about aama were drawn), when introducing the problem of improper food
intake, it says:

"food deficient in quantity [i.e., too much or too little] will produce the
following symptoms:
1. impairment of the strength, complexion and plumpness;
2. distension and misperistalsis in the abdomen;
3. impairment of longevity, virility and ojas;
4. affliction of body, mind, intellect and senses..."

And a few lines later:

"In addition to the intake of food in excess, the following factors also
affect the body by vitiating the undigested food product:
1. Untimely intake of food and drinks, which are heavy, ununctuous, cold,
dry, despisable, constipative, irritant, unclean and mutually contradictory;
2. intake of food and drinks when the individual is afflicted with passion,
anger, greed, confusion, envy, bashfulness, grief, indigestion, anxiety and
fear.
Thus it is said:-
Wholesome food taken even in proper quantity do not get properly digested
when the individual is afflicted with grief, anger, sorrow, excessive sleep
and excessive vigil."

After the food discussion this same chapter goes on to define debate
(vaada), proper and fallacious arguments (and is the earliest extant Indian
text to do so -- all the subsequent traditions, such as Nyaya, the
Buddhists, etc., draw their vocabulary of these matters from this
treatise!), and states:

"The debate among physicians relates to nothing else but the science of
medicine. The various details about statements and rejoinders as well as
fundamental principles (of the debates) mentioned above of course relate to
all the scriptures. A physician should make statements with due regard to
the principles of debates. He should not make statements of the context or
contrary to scriptural prescriptions or without due examination or
irrelevant, confused or too sketchy statements. Whatever he states should BE
BASED ON ARGUMENTS. All debates equipped with arguments and flawlessness go
a long way towards proper treatment because they enhance the enlightening
powers of mental faculty. The mental faculty undisturbed well accomplishes
all the objects in view."

By "scripture," here it means aapta -- the authoritative traditional lore
that has been accumulated through investigation, tested, continuously
debated and bone fide.

Sounds fairly scientific, don't you think?


>Where would we have to draw the line between the legitimate doctors of
those days and the charlatans?

We, as non-physicians, are the intended dupes of the charlatans, so they
will make it hard for us to tell the difference. The CS provides some
guidelines, but primarily makes exposing frauds the responsibility of other
physicians. Unfortunately for the patient, the charlatan will be exposed by
the failure of his treatment, an event that comes too late to be of any use
to a patient who is a victim of a fatal hoax.


> It's hard to imagine (and my imagination is my final judge, so please
remain within its limits) for me that the majority of the people had access
to those legitimate treaty writing doctors who probably only worked for
courts and the higher classes.

Actually, the charlatans' main targets were the court and the wealthy -- con
men are in it for the money.

> So what "doctors" did most people see if they saw any at all?

I don't know the socio-economic distribution of doctors, or percentage
present per population in India in the past. The Caraka-samhita does not
promote the idea of only serving the well-to-do, but takes, in many places,
a compassionate view toward all sufferers, similar to the Hippocratic
spirit. The economics of medicine remains a problem, even today (especially
in the US).

> And perhaps the legitimate doctors were less contemptuous of charlatanish
methods, providing they had some effect?

An effective treatment is not charlatan. CS is not trying to beat folk
medicine into oblivion. What it promotes is providing the best possible
care. If something works, study and adopt it. The charlatans it complains
about are those who are pretenders with outrageous but seductive claims, who
separate the wealthy from their money but never had the means to cure the
disease. And the tone with which CS visits that subject suggests there were
quite a few of those. CS is nothing if not practical in almost all matters.

>Perhaps they were not exposing charlatans, but fighting rivals.

Rivals debate (see above). Charlatans run like scared mice from the light of
exposure.

>In our "rationalist" world it is easy to expose a charlatan for his not
complying with scientific methods, but what scientific methods could an
Indian charlatan be accused of for not complying with?

His lack of knowledge of the aapta, and inability to properly debate
alternatives.

> In a world where macrocosm, microcosm and mesocosm are considered so
intermingled, not to say one, do you think the legitimate doctors managed to
keep their knowledge purely medical?

I'm not sure what "purely medical" means. Medicine is about health and life
and what complicates that, and what to do about maximizing health and
minimizing or curing the complications. So medicine is a large as life
itself. What box do you want to confine it to?

Dan Lusthaus