THE DOCTRINE OF THE THREE HUMORS IN TRADITIONAL INDIAN MEDICINE AND THE ALLEGED ANTIQUITY OF TAMIL SIDDHA MEDICINE.

• Author: SCHARFE, HARTMUT

1. SIDDHA AND AYURVEDA

   THIS STUDY REALLY BEGAN IN 1968 at the Second World Tamil Conference in Madras, where the organizers had arranged for an exhibit of traditional Tamil medicine, with a large number of Siddha(1) practitioners present. Theirs was obviously an ancient art, and attempts have been made in recent decades to give it wider currency.(2) Just how old is Siddha medicine and how does it relate to the better known Ayurveda, since one can immediately see that they have much in common and are practiced side by side in south India? My interest was aroused, as one who had strayed from the family profession of medicine, and I felt an urge to bring light to this mystery of medical history.

   Almost from the beginning I was confronted with conflicting claims put forth in the strongest terms. Tamil practitioners tend to insist on the highest antiquity for their tradition, whereas V. Raghavan, the noted Sanskrit scholar, once told me years ago that Siddha medicine is nothing but a derivative of Ayurveda. If one views these claims against the background of tension persisting between the propagandists of Tamil culture, on the one hand, and brahmins (even Tamil brahmins), on the other, which has marked much of this century, one might be tempted to reject both claims as biased. But the claim of Ayurveda is backed by one obvious trump card: the terminology of Siddha medicine is overwhelmingly based on Sanskrit. Siddha texts speak of the three tatu or tocam, i.e., vata, pittam, and cilettumam, undeniably Tamil reflections of Sanskrit dhatu, dosa, vata, pitta, and slesman, as the basic constituents of the body; the same is true for much of the anatomical vocabulary: kayam 'body,' nadi 'nerve, artery,' nayana 'eye' are found even in the titles of various Siddha texts, such as Kaya-karpa, Nadi-nul, Nayana-viti.

   One Siddha practitioner countered (in conversation) with the argument that it was fashionable for many centuries to replace old Tamil names and terms with more "prestigious" Sanskrit expressions, just as we see a replacement of the old place names Cirrampalam (frequently in the seventh-century Tevaram; e.g., at 1.1) or Tillai (Tiruvacakam 8.5) with today's Citamparam (Chidambaram)(3); older Kutantai and Kuta-mukku "Pot-nose" by Kumpakonam (i.e., Kumbha-ghona).(4) Still, it would be difficult to accept such a massive change of terminology in a medicine that--at least in minds and statements of contemporary practitioners(5)--prides itself in being distinctively Tamil.

   Several authors have attempted to demonstrate the high antiquity of Siddha medicine by alleged references to Siddha practices in the old Sangam literature.(6) We can see that these references to human anatomy and certain treatments indicate that two thousand years ago the Tamils had knowledge of and names for certain parts of the human body (who would have doubted that?) and that they knew of some practices of treatment and healing. The word maruntu "medicine, medication" is common in the Sangam poems, and there are references to medical men maruttuvan (pl. maruttuvar); two poets have the word attached to their names: Maruttuvan Tamotaranar (i.e., Damodara)(7) and Maruttuvan Nallaccutanar.(8) Some form of medical practice can probably be found in any society; but there is nothing that points specifically to the practice of Siddha or of Ayurveda medicine in the time of the Sangam poetry.

   The first reference to Ayurveda is found in Cilappatikaram V.44, where ayulvetar "experts in Ayurveda" are said to live in the center of town next to priests and astrologers.(9) The Cilappatikaram is one of the later Sangam texts and is now tentatively dated by K. Zvelebil to about A.D. 450.(10) Still later, probably, is the Tirukkural,(11) which states in stanza 941: "The three, having wind (vali) as first, as they (i.e., these three)(12) increase or diminish, will cause disease (noy)." This is an obvious reference to the wind, bile, and phlegm that play a crucial role in the pathology of both Siddha medicine and Ayurveda. But the poet used no comprehensive term for this triad--neither the word dosa nor any of its Tamil equivalents that we find in typical Siddha texts.

   The oldest existing Siddha text is the Tirumantiram,(13) whose date scholars have tried to establish through elaborate investigations of who quotes or refers to whom. Does a reference in Tirumantiram 1646 (1619) to the five mandalas of the Tamil country point to an early date?(14) Does Sundaramurti (ninth century) in his Tiruttonda-ttokai (5.5) refer to the author of the Tirumantiram when he mentions a certain Tirumular? Based on how a scholar evaluates these references, the estimated date varies from the fifth century A.D.(15) to the eleventh century. A reference to the nine Nathasiddhas in Tirumantiram 3067(16) and the description of the concepts of the Buddhist Kalacakra school in section III, chapter 14(17) are taken by R. Venkatraman(18) as an indication that this text belongs to the tenth or eleventh century and that its author, Tirumular, must be distinguished from the Tirumular mentioned by Sundaramurti.(19) We must also consider the possibility that our text of the Tirumantiram contains later additions.(20) The earliest clear reference to the Tirumantiram is found in a twelfth-century work, Sekkilar's Tiruttondar Puranam.(21) A commentary (eleventh or twelfth century?) on the Yapparunkalam quotes Tirumantiram 204 (247), with slight variations.(22)

   The exact dating of the Tirumantiram is of minor importance in the present context, because the text contains no specific references to Siddha medical doctrines.(23) There is no mention of diagnostics by feeling the pulse,(24) the pharmacological use of heavy metals,(25) or even the theory of the three toca, though wind, bile, and phlegm as the cause of trouble are known (see below).

   The bulk of the texts associated with the thought and medicine of the Siddhas appears to be much later. Two Siddha scholars(26) readily admitted to me that the language of these rather voluminous texts is late, probably not older than the sixteenth century A.D., and R. Venkatraman's investigations of these works and the legends connected with the names of their presumed authors confirm this--but could these works be the written reflections of an oral tradition that goes back to a hoary past? Or, to put it in another way, between the two competing medical systems--Siddha and Ayurveda--which way did the borrowing go?

   The key to the solution of this problem is, I think, the presumed role of the three faults or humors in man's physical well-being common to contemporary Siddha and Ayurveda medicines. In modern times we read and hear of tiridosam or tiritocam, simple adaptations of a Sanskrit tri-dosam to Tamil phonology. Muttocam replaces Sanskrit tri 'three' with the Tamil equivalent mu (with shortening of the /u/ in composition). Older--and more problematic--is mu-kkurram 'the three evils' of the soul in Naladiyar 190 (seventh century?), i.e., kamam 'desire,' vekuli 'anger,' and mayakkam 'confusion,'(27) which apparently have no medical connotations. The three blemishes (munrrula kurram) in Tirumantiram 2435f. (2396f.) are lust, anger, and ignorance--also ethical, not medical problems. Mu-kkurram would thus be similar to mu-mmalam 'three impurities' in Tirumantiram 343 (329), i.e., "egoity, karma, maya" in the words of B. Natarajan. Notice in contrast the different terminology, when in Tirumantiram 727 (707) yoga practiced at dusk is said to remove phlegm (ai);(28) at noon, the treacherous wind (vata); at dawn, bile (pitta)--allowing the yogin to escape old age. Here phlegm, wind, and bile are all seen as evils to be gotten rid of, as in some medical texts; and yet no general term, such as, e.g., "three evils," is used for phlegm, wind, and bile. Tirumantiram 458 (442)(29) refers to a balance of qualities that is beneficial for an infant, but I very much doubt that this is a reference to the "balance of the dosas." Only in more recent Siddha texts, it seems(30)--and in contemporary writings(31)--we are told that health is based on a balance of the three "faults" or "evils," i.e., wind, bile, and phlegm. In contemporary usage, these three, called tiri-tosam or mu-ttosam 'three faults' or mu-ppini 'three maladies'(32) are supposed to be balanced for good health. These three are often referred to in English writings (on both schools of traditional Indian medicine) as the three "humo[u]rs," as if this term(33) made their role in maintaining good health more acceptable. The introduction of the term is caused by an insidious side-glance at Greek medicine, where the four humors (the word used is xvuoi 'juices')(34)--blood, phlegm, yellow bile, and black bile(35)--play a central role in the texts of the hippocratic corpus (perhaps rather in the younger texts of this corpus). There is yet another reason why the term is ill-suited to Indian medicine as a common term for wind, bile, and phlegm: wind is obviously not a fluid or "humor" in the ordinary sense of the word. Use of the term in any discussion of Indian medicine creates the doubtful presumption of a similarity to or even a dependence on the Greek medical tradition, which could at best, perhaps, be established as a result of a thorough investigation.

   It seems strange that positive well-being should be based on a balance of evils; one would at least like to see an explanation for this peculiar way of looking at things. A survey of the Tamil tradition fails to turn up convincing evidence of how the view evolved, but the late attestation of the tri-dosa theory in Tamil medicine may offer a clue. The seemingly odd expression could have been borrowed from a tradition where its evolution was more meaningful. In the following pages I shall try to show that this was, in fact, the case. The theory of the three "faults" as fundamental to health and illness evolves, as it were, under the influence of philosophical ideas...