Pluralism in Indian Medicine: Medical Lore As A Genre of Medical Knowledge

Pluralism in Indian medicine: Medical
lore as a genre of medical knowledge
V. Sujatha
When engaging in cross-cultural comparisons, medical anthropology has often tended to

employ dichotomous typologies. This results in a reductionist analysis that obliterates the
complexities within medical cultures and assimilates them into one homogenous type.
This article makes a case for studying the different sources of medical knowledge within
the category of ‘Indian medicine’ as they emerge from the differing ontological positions
yet intersecting practices of laymen and experts. It goes on to explore the epistemological
implications of this pluralism. The article explores the multiple genres of medical knowledge
prevalent among people in a region in central Tamil Nadu to examine the relationship be-
tween professional, folk and lay practitioners. This analysis shows the complexity of medical
knowledge and highlights the inadequacy of established dichotomies.
I
Introduction
Anthropologists accord differential treatment to folk conceptions, or
the understanding of lay people, in different spheres of life. In the domain
of religion, folk conceptions are regarded as legitimate and valid and are
treated with appropriate gravity. But in domains deemed to be ‘scientific’,
such as medicine, physiology, agriculture and architecture, folk concep-
tions tend to be treated mainly as ‘subjective’ beliefs and not as valid
forms of knowledge. This is a pity because sociological engagement with
folk knowledge in precisely these ‘scientific’ domains can provide insights
into alternative conceptions of epistemological categories such as the
V. Sujatha is an Associate Professor in the Centre for the Study of Social Systems,
Jawaharlal Nehru University, New Delhi. E-mail: sujathav@mail.jnu.ac.in
Contributions to Indian Sociology (n.s.) 41, 2 (2007): 169–202

SAGE Publications Los Angeles/London/New Delhi/Singapore
DOI: 10.1177/006996670704100202
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170 / V. SUJATHA
‘body’, ‘space’, ‘habitat’ and ‘natural forces’. Such an approach can open
up an arena of conceptions other than the formalised and professionalised
systems of knowledge in the same domain. It may also illuminate the
structure of knowledge and the politics of its dispersion.
Health is a domain par excellence in which the confluence of practical
needs, inherited knowledge and people’s ingenuity is clearly demon-
strated. By virtue of its disciplinary orientation, namely, to study cultures
‘other’ than the Western, anthropological classification of medical sys-
tems and knowledge systems in general, has always been dualistic. The
binaries of ‘biomedical’ and ‘ethno-medical’ systems (Fabrega 1972);
‘illness’ (defined by the people, therefore cultural) and ‘disease’ (defined
by biomedicine or allopathy, therefore physiological reality) (Kleinman
1980); ‘episteme’ and ‘techne’ (Marglin 1990) and ‘epistemic knowing’
(Western) and ‘gnostic knowing’ (Eastern) (Bates 1995), are some not-
able examples of dualistic classification.1
In dualistic typologies such as these, ‘tribal’, ‘folk’, ‘feminine’, ‘Asian’
are all described primarily as ‘non-Western’ forms of knowledge and are
defined only in relation to the West. Such reductionism seeks to contain
the diverse genres of the so-called ‘non-Western’ knowledges, or for that
matter, even the diverse genres of Western knowledge, in one undiffer-
entiated category. For instance, Tambiah yokes together a range of con-
trasting types of consciousness—such as Freud’s ‘primary/instinctual’
and ‘secondary/logical’, ‘feminine’ and ‘masculine’—to construct polar
opposites of the East and West, and then attempts to find a ‘shared space’
between them (Tambiah 1990: 63). In the resultant typology, instrumental
action, experimentation, logical thinking, individualism and causality
are all attributes of one form of knowledge, namely ‘Western science’,
as against the attributes of expressive action, meaningful performance,
holistic thinking, sociocentricism and participation, on the side of the
unidentified ‘other’ (ibid.: 85–109).
In an apparent attempt at transcending the ethnocentric bias that marks
anthropological engagements with non-Western knowledge systems, the
phenomenological anthropology of Good (1994) tries to avoid dualistic
categories by accommodating multiple voices—‘heteroglossia’—in the
1
‘Logical’ and ‘mystical’ mentality (Levy-Bruhl 1966, cited in Tambiah 1990: 85);
‘science’ (Western) and ‘religion’ (Eastern) (Tambiah 1990); ‘science’ (biology) and ‘art/
poetry’ (Ayurveda) (Zimmermann 1982) are other such typologies.

Pluralism in Indian medicine / 171
study of the disease experience: apart from the physician’s expert opinion,
the voices of the paramedical staff and the patient’s experience are part
of the understanding of the illness situation. The narratives of the patient
and other actors, exemplifying the meanings that they attach to the illness
situation, are thus considered central to the healing process. Illness nar-
ratives are examined across cultures to identify the constant human elem-
ent. The purpose of Good’s work is to augment the humane element in
biomedicine, by making doctors more sensitive to patients’ experiences.
However, while addressing non-Western medical systems, the crux of
his investigation is the attitude a rational person (here, the Western med-
ical anthropologist) should take when confronted with a system that is
not explicable in terms of Western biomedicine. Good’s conclusion is to
admit ‘other’ experiences as parallel truths. This approach makes an effort
to be culturally relativist and to acknowledge the plurality of medical
knowledge. Yet, like other anthropological excursions into non-Western
societies, it too is ultimately limited by being chiefly an instrument for
defining the West’s own identity or deciding the attitude the West should
take toward the ‘other’.2
Approaches that see the ‘other’ only in terms of, or opposed to the
West, ignore the internal logic and nuances of ‘other’ knowledge systems.
There is, therefore, an urgent need to examine the multiplicity and dynam-
ics within the so-called ‘other’; between, say, Chinese and African medi-
cine, or Indian and Chinese medicine and so on, and to grapple with
regional diversities and patterns before attempting any full-fledged debate
on civilisational differences between Western and Eastern medical sys-
tems. An essential step in this direction would be the sociological study
of medical knowledge within heterogeneous societies.
In the Indian context, multiple systems of professional medical know-
ledge of varying provenance and vintage, namely ayurveda, siddha, unani,
biomedicine and homeopathy coexist in the health arena. This phenom-
enon of therapeutic or medical pluralism has received some attention in
writings on medical anthropology and the sociology of medicine in India
(Leslie 1976; Minocha 1980). What explains why people resort to one
system of medicine or another? What is the rationale behind their health
behaviour? How do practitioners of ayurveda, siddha, or unani adapt to
2
Sudhir Kakar (1991) conducts a similar comparative exercise with respect to mental
health in India.

172 / V. SUJATHA
this coexistence of therapies? What are the mechanisms of legitimation?

These are some of the common questions addressed while the focus is
on medical pluralism.
At the same time, indigenous systems of medicine like ayurveda, siddha
and unani consist of several genres of medical knowledge within them-
selves. The common characteristic of such systems of medicine is that
they are internally differentiated into various tiers of medical knowledge
and skill—experiential, textual, inherited and incorporated.3 This is unlike
expert-centric and highly professionalised systems of medicine like
biomedicine or even laboratory-centred ayurveda, where the patient or
the non-expert, henceforth referred to as the ‘layman’, is a passive actor
in the production of medical knowledge.
This article argues that the pluralism of genres within a given medical
system, the parallel existence of folk and professional genres of medical
knowledge, and the interchange between these genres, are critical elem-
ents in the nature and mode of production of medical knowledge in India.
The permutation and combination of different levels of textual and profes-
sionalised knowledge produce configurations of medical knowledge which
are far more complex than what is conveyed by the dichotomous classi-
fication, ‘folk’ and ‘classical’ medicine. As we shall see, these fields of
knowledge may be better understood as nodes in a network rather than
as dichotomous entities; for instance, folk streams also have texts while
professional traditions need not be based only on ancient classical texts.
I use the term ‘structural pluralism’ to refer to this pluralism of genres
of medical knowledge within a system that emerges from the different
cognitive positions of the expert, the semi-professional and the patient/
layman. Structural pluralism has to be distinguished from medical or
therapeutic pluralism, namely the coexistence of many systems of
therapy—biomedicine, ayurveda, acupressure and homeopathy.
It would be hard to understand how ayurveda, siddha or unani are
being transformed today in the context of medical/therapeutic pluralism
without an idea of the internal structure of their knowledge. Studies on
ayurveda, siddha or unani that focus only on one aspect of the medical
3
I use the terms ‘inherited knowledge’ and ‘incorporated knowledge’ to denote know-
ledge that is handed over and that which is acquired through ongoing experience,
respectively.

system, either text or practice, tend to lose sight of the dialectical relation-
ship between them. For instance, based on structuralist analysis of one
medical classic, Ashtangahridaya, Zimmermann (1982) concludes that
ayurveda is so coherent and symmetrical that it is good poetry rather
than the science of biology. On the other hand, based on the ethnographic
fieldwork of a few practitioners, Langford (2002) introduces ayurveda
as an eclectic set of healing practices that does not deserve the label
‘system’. Such a characterisation is oblivious of the epistemological grid
that informs seemingly diverse concepts and practices. One of the ob-
jectives of this article is to argue that a sociology of knowledge perspective
to the study of medicine in India is a prior and necessary step for studying
health behaviour in the context of medical pluralism.
In this article, I address structural pluralism by mapping the differ-
ent genres of medical knowledge in a region. While doing so, the focus
is on the medical conceptions and practices of ordinary people, namely,
medical lore and its epistemological basis. ‘Medical lore’ (Sujatha 2003)
is a key concept here. My aim is to establish that ‘medical lore’ is a rele-
vant category of enquiry in contemporary India. This study, among others,
(Balasubramanian and Radhika 1989; Rao 1986; Subash Chandran 1995)
shows that medical lore exists as a knowledge system built around a set
of concepts about the body, health and disease, with certain underlying
epistemological principles. Characteristically emerging from and vali-
dated by people’s lived experience, medical lore is based on people’s
understanding of their bodies and their bodies’ environments.
The epistemological autonomy and coherence of such lay knowledge
depends on two factors: first, it is not dismissed as false or invalid know-
ledge by the professionals and thereby undermined by their negative
campaign. Thus, ayurveda and siddha professionals may consider this
knowledge to be unrefined or incomplete but they do not challenge its
validity and disfranchise it.4 Second, such knowledge is of an enduring
or long-standing character. That is, the mutual validation of concepts
and practices has to occur in the living experience of the concerned people
in a sustained manner for several generations. I call this set of people’s
knowledge and skills which have stood the test of time, ‘medical lore’ or
4
This however may not be true of professional ayurveda and siddha doctors associated
with laboratory-centred Research and Development.

174 / V. SUJATHA
‘folk knowledge’. I distinguish it from simple ‘lay knowledge’, a term

generally used in the context of biomedicine to describe the idiosyncra-
sies of individual illness experience which is believed to be lacking in
coherence.
This article is based on a field study conducted in 1989–92; the analy-
sis is supplemented by data from a field study carried out in 2005 with
practitioners in coastal Tamil Nadu. The locale of the study consisted of a
core area of eight villages and a few adjoining towns in Thirupattur taluk,
Pasumpon Thevar Thirumagan District (now called Sivaganga District).
Biomedicine did have a conspicuous presence in this region and was
widely sought for certain specific conditions but, as I discuss later, the
conceptual framework that informed villagers’ understanding of health-
related phenomena was different from that of biomedicine. Most of my
informants did not strictly differentiate between professional systems of
medicine like ayurveda, siddha, homeopathy or biomedicine. For them,
there was their vaidya (folk practitioner) who was available in the village
and the doctor (biomedical or siddha professional) who sat in the hospital.
But when they talked of medicines, they distinguished between kaatu
(forest) marundhu (medicine), kadai sarakku5 marundhu (dry medicine
from the indigenous drugstore used by siddha/ayurveda practitioners)
and aaspathiri marundhu (hospital medicine consisting of tablets and
injections).6 In the following section, I describe the local economy and
ecology, as they relate to people’s diets and health.
II
Villagers’ perspective on ecology, diet and health
The villages in my area of study are connected by private and government
bus service, have a post office, two health centres in the vicinity (one run
by the Swedish mission and another by the state government), and an
arts college and a government hospital within a radius of 16 km. The ini-
tial response of the people to questions about their own medicines was
5
‘Sarakku’ is also a term used in siddha literature. There is an entire corpus called
sarakku vaippu in siddha medicine that details the procedures involved in storing medicinal
substances for a long time.
6
Villagers often classify hospital medicine along with chemical fertilisers and
pesticides.

that they visited the health centre when they fell sick and there was nothing
more to say. Gradually, over a period of two years of incremental dis-
cussion and observation, the pattern in their conceptions of body, disease,
health and related subjects could be discerned.7
The region does not have any major industry and is a drought-prone
area of small and middle farmers dependent on rain-fed agriculture.
According to oral history accounts, high castes once populated the area
and the ancient Shiva temple here attracted pilgrims and mendicants
from far and wide. A major epidemic about a hundred years ago is said
to have killed and driven out upper caste groups like the Brahmins and
the Chettiars from the area. Now, the major caste groups in the region
are the Valayar, Paraiyar, Pallar, Melakarar, Konar, Kallar and Maravar.
There are also some Muslim households. The Valayar are numerically
dominant and the panchayat president belongs to this caste, but they are
considered to be ‘backward’. The Paraiyar and Pallar are Scheduled Castes.
The Paraiyar community is the best-educated, with a number of graduates,
and has better access to employment. The Melakarars, now known as Isai
Vellalars, used to be temple musicians and continue to live in the streets
facing the 1st-century Shiva temple mentioned earlier. Although they
are well off, they have a low status in the social hierarchy because of
their association with the devadasi system. The Konar are mostly engaged
in cattle-rearing and the Muslims are traders of agricultural produce in
nearby towns. The rest are small and marginal farmers.
Poor soil productivity and rocky terrain coupled with small landhold-
ings limit the nature and range of agricultural activities in the area. The
Block Development Office characterised this cluster of villages as ‘back-
ward’. In one village, about 70 per cent of the households had cash in-
comes that would qualify them as being ‘Below Poverty Line’. About
80 per cent of the population could not read and write. Besides, most of
them belonged to the Valayar community which is described by govern-
ment officials as being resistant to civilisation and development. Yet, the
records of the village health workers showed that the common health
parameters of the region were about the same as the corresponding figures
for the state as a whole and there had been no epidemic in the area in the
past fifty years. To put it crudely, people did not seem to be as sickly as
their ‘backwardness’ would lead one to expect.
7
For a detailed account of their conceptions, see Sujatha (2003).

176 / V. SUJATHA
This paradox prompted me to examine villagers’ health practices but,

when I probed, it seemed as though they followed no specific health
regimen. About disease villagers say, ‘Everybody has a disease; nobody
is free from it’. Or, ‘everything contains a vyaadi (constitutional trait or
property).8 When you eat different kinds of foodstuffs, the vyaadi in one
will offset the vyaadi in another and you will get the benefit of all’.
About nutrition, one would hear, ‘What is nutrition? Everything is nutri-
tious. Even kancharai (Strychnos nux-vomica) is so; it serves a purpose
doesn’t it?’9 ‘Everything is food and all foods are healthy’. Only after
prolonged discussions were more explanations forthcoming.
The notion of the tiregam (body) was a central feature in any charac-
terisation of disease by the villagers. Their conceptions were corporeal
in that, although they recognised many possible causes of disease, they
believed that the actual source of disease lay in the body itself: ‘Where
does disease come from? It is there in your body itself!’ Disease is not
seen as an abnormal or pathological condition to be eradicated. The body
is prone to disease by its very nature, being composed of several parts
and processes which, at any point in time, are bound to malfunction. Ac-
cording to the villagers, every body is constituted in a particular way
at birth, depending on the constitutional tendencies of the parents at the
time of conception. Thus every body system entails a kind of predis-
position by its very constitution. This constitutional property also seems
to be true of other species in nature. Trees, cattle and earth also have
constitutions that predispose them to certain kinds of properties and
growth patterns. While every body is predisposed to certain diseases,
whether a disease actually occurs depends on the ‘quality of blood’ of
the person, which in turn is a function of the balance between their diet
and lifestyle. For instance, during an interview, the medical officer at the
nearest government hospital attributed diarrhoea among breast-fed infants
to the dirt on the mother’s breast. But elderly women in the village attri-
buted it to the fact that nursing mothers, who worked away from their
8
The term ‘vyaadi’ also refers to disease and is used here in this double sense. (The
interviews for the study were conducted in Tamil. The Tamil terms and citations in the
paper are free translations done by the author.)
9
Kancharai or the strychnine tree bears extremely poisonous seeds which are used in
indigenous medicine.

homes as labourers on daily wages, were compelled to violate dietary

rules. For the medical officer, the lack of cleanliness around the mother’s
breast is the cause of diarrhoea, whereas for the elderly women the ailment
is due to the vitiated quality of breast milk as a result of faulty diet. It is
not that the villagers disregard hygiene, but rather that they do not consider
mud to be dirty. As cultivators, their bodies have always been in contact
with mud. In their view, if there is a compatibility between diet and the
body system, an external factor such as the lack of hygiene cannot by
itself ‘cause’ disease. As they put it, ‘Disease originates inside the body’.
The villagers have a simple diet of cooked cereal and sambar (a curry
of lentils and vegetables), which is based on principles that are not codified
but are nevertheless salient. Of the four or five cereals available (finger
millet, pearl millet, kodo millet, and little millet), a different cereal is
cooked every day, sometimes one during day and another at night, thereby
maximising variety in the diet. Similarly, different kinds of green vege-
tables are always cooked and eaten together instead of separately, a prac-
tice that, according to many villagers, creates ‘good quality of blood’.
Villagers also consume a variety of meats that they get from the adjoining
forests—rabbit, bandicoot and crane. Variety in the diet is thus a funda-
mental principle of health because it enables one foodstuff to balance
the extreme effects or deficiencies of another.
This varied diet is not only an ingenious adaptation to an environment
marked by poor soil productivity and drought, it is also informed by
theory. Variety in food, according to the villagers, is the way to acclimatise
and condition the body to the range of elements in its habitat. Food is
prepared by transforming water, plants and animals, and its ingestion
introduces external ecology into the body. Human-made elements that
are inserted into ecology—fertilisers and pesticides, for example—also
make their way in this fashion into the human body. One informant de-
scribed the food-body relation thus: ‘Everything germinates from the
chemicals we use. We add them to the very seeds we sow into the earth.
A baby has them within when it is born. All that we eat, where else will it
go?’ The ‘seed’ that goes to make the foetus, and the food that its mother
eats, contain the chemical inputs applied to the seeds sown, which then
become an intrinsic part of the body system. A comment by an elderly
man contrasting people of his age with the younger generation paraphrases
this idea: ‘We are not made of coffee and snacks. Our parents ate food
grains and porridge and we are made of food grains’. In this sense, the

178 / V. SUJATHA
body is seen as being constituted by food which is the vehicle by which

external ecology is internalised.
For such villagers, the ideal of health is the koravan (nomad) who
eats all kinds of foodstuffs without discriminating between them.10 Such
a person can eat cooked, uncooked, hot or cold food, and can drink any
water—pond, well or tap—and not fall sick. The goat is also admired for
its ability to eat all kinds of leaves, including those of the kancharai tree.
It is said that, except for aadu thoda illai (Adathoda vasica), there is no
plant that the goat does not eat. Villagers add that the goat is so adaptable
that, even though it is basically herbivorous, during droughts when pas-
tures are dry, it even eats leeches. Its blood is enriched by the various
substances it ingests and the potential noxious elements neutralise each
other. Goat’s milk is therefore ‘free of disease’. Folk practitioners fre-
quently use goat’s milk as a medium for administering medications.11
Over the past ten years, major changes in cropping patterns have oc-
curred in the area. During this period, there has been an increase in the
incidence of skin diseases. The allopathic doctors in the government
hospital attribute this to the villagers’ ‘unhygienic lifestyle’—working
in mud, bathing in a common tank and so on. But in the villagers’ minds,
this rash of diseases is the consequence of a violation of the variety prin-
ciple in their present lifestyle. The declining availability of traditional
food grains, the reduced production of pulses due to commercial cropping,
and their own inability to afford alternatives,12 have forced them to eat a
limited variety of pulses like thattai payaru (Dolichos catiang) and vege-
tables like the red pumpkin and the brinjal, which are described as karappan
(that which vitiates the quality of blood). In the absence of other neutralis-
ing foodstuffs, people are prone to skin problems of many kinds. Villagers
10
A koravan is a person belonging to the nomadic group Koravas, who roam about in
the forests, village and city.
11
It is also the practice with professional practitioners of siddha medicine and has been
mentioned in their ancient text Agastya Sutiram or Agattiyar Ayirathi Ayyinuru (Agastiyar’s
One Thousand Five Hundred Verses), a general treatise on materia medica attributed to
the sage Agastiyar, the earliest of the eighteen siddhars (wandering sages and mendicants
who sought higher yogic powers). Though the details of the author and the text are difficult
to ascertain, the text is believed to be more than 1300 years old. Agastiyar is said to have
lived in 1500 BCE though literary references to his authorship are to be found in texts
from the 8th century CE.
12
Most of them are small farmers who also work as wage labourers in quarries and
fields and do not have much cash in hand.

point out that they have been working in mud and bathing in the common
pond for generations together, whereas the skin problems correspond to
the period when there has been a major change in their diet.
The villagers seem to have a similar corporeal conception of some
mental ailments as well. According to them, only a total derangement in
conscious behaviour caused by a sudden shock or ‘slip’ in the brain war-
rants the label pithu (madness). The treatment for pithu is physical, involv-
ing medicinal applications on the head, or even shock treatment in the
hospital. When faced with aberrations in behaviour that biomedicine terms
as ‘neuroses’, villagers perceive these not as mental diseases requiring
medical treatment, but as behavioural problems related to maladjustment
to one’s social environment. According to them, spirit possession is a
distinct class of problems and should not to be mixed up with pithu or
behavioural problems.
In terms of many such themes and substantive ideas, the region’s dif-
ferent social groups provide a more or less coherent picture of the body,
its conditions of health and causes of disease. These include notions that
relate bodily practices to local ecology through ideas about drinking water,
bathing, defecation, contagion and treatment. In other words, irrespective
of caste, class and religion, there is a degree of homogeneity in people’s
conceptions of ecology, body, health and disease, such that their sum can
be called the medical lore of the region.
III
Varieties of medical practices
Within the larger unity of beliefs about ecology, diet and health, there is
considerable individual variation in interest and knowledge on the subject.
Some villagers are inclined to consciously look out for herbs and examine
their effects and discover more remedies. Women seem to know more
herbal remedies, especially for children’s diseases. There are some differ-
ences in health practices, in that some social groups have adopted profes-
sional biomedical inputs more than others. For instance, those who choose
to go to the hospital for childbirth cannot observe the customary post-
natal dietary specifications during their stay. The ingredients used in home
medications vary with caste and occupation. For example, the Valayars
who are familiar with the hills use more roots than the Paraiyars who are

180 / V. SUJATHA
engaged in agriculture and who use herbs for the same ailment. On the
other hand, the Melakarars, a non-agricultural caste, tend to rely on dried
herbs purchased from the indigenous drugstore in the town. Families have
‘pet’ herbs that they use for a broad spectrum of ailments. Older Muslims
know the herbs as well as anybody else, but the younger generation en-
gaged in trading activities knows less than its non-Muslim counterpart.
Generalised knowledge
These individual variations notwithstanding, there is a shared fund of

knowledge among ordinary people for handling everyday problems
like the common cold, headache, menstrual pain, body ache, dandruff,
constipation and so on, whether they are actually used or not. Any person
can list about ten different herbal remedies for the common cold alone.
The remedies include external treatments like fomentation or the appli-
cation of lotions and pastes, or internal medication or a combination of
both. There are many kinds of fomentations and applications involving
different degrees of complexity. There are norms about which herbs are
suitable for infants, children and adults; there are rules regarding which
part of a plant to use according to its potency; and rules about which com-
bination of herbs to use. People also learn to process herbs for internal
consumption, whether pounded, ground, boiled, roasted or buried under
ashes. For instance, raw herbal juices are never given to infants but are
‘broken’ by cooking in a prescribed way with certain other mandatory
ingredients. The drinking water given to a feverish infant is also ‘broken’
in this manner.
Not only can most people name medicinal plants but they can also
identify the exact location in the vicinity where they are to be found. Boys
and girls are aware of about five remedies each for common ailments.
There are elderly people who only specialise in diagnosing fevers; some
others dispense medicines for sprains, indigestion, boils, thorn pricks,
including that from poisonous plants. There is a medicinal and diet regi-
men for the lifecycle events of women. Herbal and food preparations for
the post-puberty, pre-natal and post-natal periods are prescribed along
with the appropriate rituals.
Even as the villagers say that they visit the hospital most of the time,
they still make medicinal preparations involving more than thirty herbs

at home. For instance, pala kadiya marundhu (medicine with many ingre-
dients), a preparation of about fifty herbs, stems and roots, is given every
month at a specified time to infants from the age of three months to one
year, especially in the Valayar, Kallar and Maravar households.13 This is
an immunisation package against the major diseases to which infants
are prone. The preparation of the medicine becomes a collective effort
if there are two or three infants in the neighbourhood. The Chettiars, a
dominant community in the region, employ Valayar women to prepare
the pala kadiya marundhu for the children in their households. ‘Medicinal’
meats—like pork for piles, fox meat for certain kinds of respiratory dis-
eases, and a host of preparations using snails, earthworms, snakes and
other animal substances are also consumed, but are prepared by specific
caste groups. Pork is normally a taboo for all the groups here but the
taboo is lifted if pork is consumed for medicinal purpose, provided that
it is cooked outside the home.
Specialised knowledge: Folk practitioners
Vaidyas or village-level practitioners (henceforth folk practitioners) spe-

cialise in a specific cluster of related diseases. Bone-setting, muscular
pains and blood clots make up one cluster. Kamaalai (jaundice) and sogai
(diseases of blood, including anaemia) are another. Visha chikitsa (liter-
ally, venom or poison-healing) or the treatment of bites from poisonous
snakes, scorpions and insects, and skin diseases is yet another cluster.
Practitioners who treat conditions like venomous bites, pilavai (carbuncle)
and injury caused by poisonous thorns chant mantras (incantations) after
giving the medicine. No chanting is involved for bone-setting, rat bites,
jaundice, fits and the like. Practitioners belong to many different castes
and most of them have acquired their knowledge from a family member.
Both men and women are practitioners though women are less conspicu-
ous in fields like visha chikitsa.
Medical practice is not the means of livelihood for folk practitioners;
they are either farmers or work in the quarries. It is almost a taboo to
accept fees from a local person; a kaanikai (token offering) to the vaidya’s
presiding deity is permissible but it is left to the client’s discretion. The
practitioner is accountable to fellow villagers whose ire is hard to escape
13
Other groups like the Muslims have a simpler version of this.

182 / V. SUJATHA
if the treatment does not work; I observed a practitioner being grilled

about something he had recommended. If the clients are from outside
the area, they pay for the medicine. Often this does not cover the cost of
the ingredients and the effort involved in preparing the medicine. In one
instance, a visha vaidya treated a young man from outside the village
who was frothing at the mouth after being bitten by a viper. After the
internal medication and rounds of chanting with a bunch of neem leaves,
when the patient’s condition improved, his wife casually handed over
Rs 2 to the vaidya and walked away. If practitioners cannot afford to
give free treatment, they instruct the users or their families to prepare
the medicine at their own home wherever possible. Folk practitioners
are different from the full-time or professional practitioners whose liveli-
hood depends on medical practice. The latter operate in small towns and
they charge for their services, though they have to reduce their fees for
the local villagers. In general, the amount to be paid is open to negotiation
and vaidyas who are always at the losing end tend to assess the patient’s
financial status before preparing the medicine.
Discussions about illness, their causes and prescriptions, figure in
ordinary conversations and are the informal rituals for harnessing and
augmenting collectively-held knowledge. For instance, news about a
diabetic Muslim man who was asked by the doctor to discontinue eating
rice in favour of chapati,14 prompted people to examine the chapati
whenever they got to see it; its possible effects on the body system were
a matter of discussion in the tea shop. It is notable that the effects of
chemical fertilisers and pesticides on the health of plants, animals and
human beings are the most discussed topic in the village (Sujatha 2001).
Everybody that I met in the area, even those who were not my informants,
had given some thought to this issue and brought it up even in casual
conversation. The agricultural officer of this area claimed that villagers
were resistant to change because they refused to accept the chemical
inputs distributed at subsidised rates by the state government. This ‘resist-
ance’ may be evidence that the public debate on the subject of synthetic
chemicals has been translated into action in the village.
14
Chapati is not part of the regular diet in interior Tamil Nadu.

IV
Modes of diagnosis: Medical lore
Observing the body in both normalcy and when afflicted by disease is a
primary method in the villagers’ approach to gaining medical knowledge.
For my informants, the most important sources of information about
the body are its products—urine, stool, blood, semen, spit and such. Any
variations in their quantity and quality signify changes in body processes.
For instance, the increased quantity of stools produced when rice supplied
by the public distribution system is consumed indicates that this rice is
of very poor quality because most of it ‘comes out’ as excrement and
very little is ‘left’ for the body. This, villagers say, is also corroborated
by the fact that eating this rice does not satiate them and they feel hungry
soon after a meal. An old woman who treats children’s diseases, remarked,
‘When a baby is ill, I smell the stools and find out whether the mother
has eaten groundnuts or mangoes. If she has, I first scold her for not con-
trolling her urge to eat heavy foods and, only then, suggest the medicine’.
The violation of diet restrictions by the mother during the lactation period
can thus be detected. Observing the mucus plug in the eye of an infant is
a way of identifying the ‘congestion’ caused by an internal injury to the
chest.
‘Feeling’ the disease is another means of pinpointing what is happening
inside one’s body. A variety of terms is used to characterise the subtle
variations in the experience of disease and pain. For instance, stomach
(vayitru) ache is described by different terms—vayitru vali, vayitru
porumal, vayitru kammudhal, vayitru erichal, vayitru kaduppu, vayitru
ecivu, vayitru vekkaalam, and so on. Similarly, problems due to water
retention in the head (mandai or thalai) are many—mandai kottu, thalai
baaram, otrai thalaivali, mandai kaaichal, and so on. These terms are
not synonyms, nor do they merely express different degrees of pain. These
words represent differences in the kind of pain being experienced and
their underlying causes. For instance, vayitru vali denotes a stomach
ache while erichal denotes a burning sensation, while ecivu is a kind of
pulling pain in the muscles. The diagnostic significance of ‘experiencing
the body’ seems to be important to the folk practitioner as well: ‘We can
only give medicines for diseases. It is up to the patient to maintain dietary
restrictions—to know what to eat, “feel” the effect and regulate food
habits accordingly’.

184 / V. SUJATHA
Very often informants reported that they diagnose and treat their
ailments by trial and error. As one respondent put it,
Even the doctor does that. If we go to him with a stomach ache, he will
be able to give medicines only after asking us whether it is indigestion
or anything else. With all his equipment, he cannot diagnose independ-
ently and find out what is wrong unless we describe the ailment to
him. He gives some medicine. If the ache persists, he will give another
one; if that does not work he will give an injection and the pain may
go. We say that the doctor has cured the ailment because we see only
the total effect. But we do not realise that even the doctor cannot know
at once what the ailment is and how it is to be cured. He also learns
from trial and error.
It thus becomes apparent why a conclusive and correct diagnosis in the

first instance is considered unusual. This explains the villagers’ receptive-
ness to the diagnostic technology of hospital medicine which is considered
to be highly effective, especially with regard to infant diseases. People
refer with awe to incubation technology as something that ‘generates
life’ (uyir undaakurathu) in a premature baby. However, they do not ac-
cept the prescription of tonics and injections for a normal infant on the
grounds that so many hospital medicines inside a tiny body could harm
its delicate mechanism. Women are notorious for not complying with
what is prescribed by the hospital as post-natal medication. The fact that
people primarily associate biomedicine with its curative functions may
also explain their reluctance to use it in the absence of disease.
Observing plants and animals, studying their behaviour and thinking
about their similarities and differences with humans gives villagers
insights into their own body systems and their embeddedness in a larger
system. While explaining the need to use organic manure, it is said, ‘If
you have to lift something heavy, you should have eaten enough. Can
you eat little and lift more? Even the car needs petrol to run. So also the
earth. Only if you feed it with manure will it raise the yield’. An oft-
quoted proverb here is that ‘The well-fed man can be known from a
(healthy) village, (just as the) the well-fed land could be seen in its crop’.
While talking of chemical fertilisers and pesticides, people would ask,
‘If the chemicals were so potent as to raise the yield from five to eight

bags, will this potency not act on our digestive organs at least with half
its force if we eat this food regularly?’ Others would observe, ‘Because
of dumping more and more chemicals, the soil is dying. Its blood evap-
orates in the absorbing heat of the chemicals just as our blood gets dried
by them. Now, the earth needs the fertilisers and we need a tonic all the
time’.15 ‘One cup of pesticide in a bucket of water makes the water throb,
imagine its effect on our digestive organs!’ These beliefs are corroborated
by their observation that there has been a sustained increase of heat-
related disorders in the human, cattle and crop populations ever since
synthetic chemicals came to be used in the village. The soil lacks innate
fertility and the crops grown on it are ‘lifeless’, as inferred from the fact
that they do not satisfy hunger. The crops, the cattle that consume the
hay from the crops, and the human beings who consume crops and cattle
products are all losing their strength and need to be supported by fertilisers
and injections. Here the earth becomes a metonym for the human body,
while chemicals and injections are their respective intake.
Assessing the causes of poor lactation in some mothers, a woman
pointed out, ‘Do we not see that the cow does not produce milk if it does
not eat enough? So the woman who eats less secretes less milk. After all
milk comes from blood and blood from food’. Knowledge gained from
observing other species in the same habitat is also at times a metaphor
for understanding human bodily processes. Falling of hair was graphically
described by another informant: ‘The fall period comes in the months of
Panguni and Chithirai (mid-March to mid-May). The leaves fall from
trees and so does hair, both due to heat. Just as the tree regains its foliage,
hair growth will resume’.
Villagers’ diagnostic methods can best be appreciated if we examine
children’s diseases. Since infants cannot express their disease experience,
it has to be deduced from other behavioural clues. The way an infant
cries, the tone of its voice, the smell of its hands and forehead, the twitch-
ing of its eyebrows,the size of its stomach, the noise produced when the
stomach is patted, its appetite, how it drinks milk; and the form, colour
and smell of its stools are noted. The common problem of infantile diar-
rhoea is thus classified in at least four ways (see Table 1):
15
Akhil Gupta’s informants in northern India also associated chemical fertilisers with
‘declining strength of the land’ which then required more chemical inputs to sustain the
soil (Gupta 1998: 258).

186 / V. SUJATHA
Table 1
Classification of Infantile Diarrhoea
Main Problem Other Symptoms Disease

Loose motions The infant rolls on the ground Pirali
while crying, avoids the lap and
seeks cooler ground.
Loose motions The stomach is bloated and Oodhu pirali
makes a particular sound when
patted.
Loose, greenish stools Fever and foul smell in the palms Maantham
with foul smell and mouth.
Loose motions Belly makes a hollow sound Kudaletram, caused by
when patted. holding the baby in an
awkward position.
Thus is described the medical lore of lay practitioners in the village.

Vaidyas or folk practitioners constitute a more specialised group within
medical lore. The following section looks at the sources of their knowledge.
V
Modes of diagnosis: folk practitioners
As described, techniques of observation, interpretation and experimen-
tation are intrinsic to medical practice. These sources of knowledge can
be deployed and refined only in association with knowledge derived from
other sources. There is a dynamic relationship between knowledge ac-
quired from actual practice and that transmitted from one generation to
the next. Knowledge is also acquired from wandering mendicants versed
in medical texts. The translation of these sets of knowledges into ongoing
practices allows medical lore to be modified, augmented and transformed.
It is this process of medical praxis—the dialectical synthesis of knowledge
and practice—among folk practitioners that I describe in this section.
For folk practitioners, disease classification, diagnosis and treatment
may be based on codified knowledge acquired from the previous gener-
ation. Such knowledge allows them to distinguish between curable and
incurable diseases. It enables them to identify a disease from the disorders
that may accompany it. For instance, vayitru vekkaalam (stomach dis-
order) is associated with a burning sensation in the eyes and while passing

urine. In the case of children, an injury to the internal organs is linked to

fever and congestion around the injured spot. By identifying the related
disorders, a folk practitioner gets to know the nature of the main problem
a person is suffering from.
The prescription and preparation of medicines is a primary site for
the synthesis of inherited (codified) and experiential knowledge. Every
stage in the preparation, right from identifying, collecting and classifying
various plant substances to processing them, adding other ingredients,
and observing their effect on the user, calls for knowledge of the sub-
stances and their properties. This becomes the basis for modifying recipes
and substituting ingredients as the case may demand. Once they master
the basic principles of drug action, vaidyas can proceed from the known
to the less-known and unknown aspects of aetiology and diagnosis. The
disease is understood through the medicine to which it responds. Unlike
laboratory experimentation which is conducted under controlled con-
ditions, these experiments are carried out in situ. In his analysis of the
ayurvedic vaidya who constructs an account of the disease on the basis
of the prescription, Gananath Obeyesekere (1992) calls this method
‘samyogic experimentation’.16 The same medicine may then be tried for
another disease which, in the vaidya’s judgment, belongs to the same order.
If the disease is cured, one may infer that the disease possesses charac-
teristics that can be controlled by the medicine (kattu kolradhu). The
practitioner, however, still has to decide the dosage and the combination
of ingredients on a case-by-case basis, after judging the digestive ability
of the patient and, at times, his/her financial ability as well.
Diagnosis and treatment may be based upon codified knowledge that
folk practitioners inherit in the form of a text or acquire from a family
member. In the initial stages of learning, such knowledge about diseases,
their indications and therapeutic methods, is provided in the condensed
form of verses that may be committed to memory. Through learning the
terminologies of the disease classification system and the pharmacopoeias
by rote, the vaidyas internalise centuries of inherited knowledge which
they then improvise upon in practice. The ability to interpret memorised
16
Samyoga means ‘conjunction or combination (which can be separated)’ (Dwarakanath
1998: 34). Samyogic experimentation is informed by certain principles found in the medical
texts for combining medicinal substances.

188 / V. SUJATHA
traditional knowledge comes from observation during apprenticeship. A

visha chikitsa vaidya mentioned that he had recipes for antidotes against
sixty-four different kinds of venoms, recipes that he had acquired from
his grandfather. He had memorised the indication for each kind of venom
and would recite them to himself periodically, such as during an eclipse.17
Generally, the kind of venom involved is identified by the person who has
been bitten, who is likely to have seen the snake. Otherwise, the standard
procedure of diagnosis is to administer a specific root to the patient, the
taste of which indicates the kind of venom—if the root tastes sour then it
is a cobra bite, if the root tastes sweet then it is a viper bite and so on. The
association between the taste of the root and the kind of venom is thus
codified and memorised.
Inherited knowledge in a particular field may be comprehensive and
detailed in nature, as in the case of the texts used by an eleventh generation
vaidya from a southern coastal district of Tamil Nadu who specialises in
the treatment of eye diseases. The vaidya, who is in his late 1960s, explained
how, as a young man, he had memorised the relevant verses from the
Telugu texts. The texts describe ninety-six kinds of disorders of the eye,
the indications of sixteen kinds of incurable disorders among them, and
the method of treatment for the rest. Adding that he may not now remem-
ber all the verses, the vaidya mentioned that he had come to internalise
them over the course of about fifty years of practice. According to him,
all the eye diseases he had encountered in his long career fell into the
categories listed and he had not had any major problem in identifying
them. The medicines to be administered for each disease, the norms re-
garding dosage, frequency and other restrictions are also indicated in
the texts. The vaidya maintained notes of his experience in interpreting
the texts while treating a difficult case. He explained that the original
Telugu texts were written around the early 17th century by his forefathers,
though—he added in a lighter vein—the story told to him in childhood
was that the texts were bestowed on his ancestors by their family deity.
The textual sources used by folk practitioners range from ancestral
palm leaf texts, to printed books of the early 20th century or recently
17
Recitation during an eclipse is a common ritual among practitioners who use memor-
ised verses for healing. It is believed that such a ritual enhances the healing power of the
verses as well as the practitioner.

published popular medical recipe books. Of these, the last are more com-
mon in towns and cities. The older texts seem to be an inventory of the
classes of diseases treated by folk practitioners, including details of symp-
toms and the recipe for the relevant medication for those symptoms,
given in verse form. The terminology employed in the texts corresponds
with currently prevalent disease categories, but the terminology for the
ingredients used in medicinal preparations could not be deciphered easily.
About 40 per cent of the practitioners I met possessed palm leaf manu-
scripts that they had memorised and could put into practice, even though
they were listed as ‘illiterate’ by the Block Development Office. The rest
had either lost them or never had any.
Besides relying upon memorised texts, practitioners employ other tech-
niques of diagnosis as well. Naadi pariksha (pulse examination), which
is a key mode of diagnosis among professional ayurveda practitioners,
is not the primary mode of diagnosis among folk practitioners. It is
only applied in specific instances by certain kinds of practitioners like
those specialising in visha chikitsa or the setting of bones. For instance,
the pulse is read in order to find out whether a person bitten by a snake
is unconscious because of fear or because of the venom and to ascertain
whether the patient will survive if treated. A young visha vaidya men-
tioned that he refused to treat a person who was bitten by a cobra and
directed him to the hospital on learning through the naadi that his medicine
would not help since the snake bite had occurred several hours ago. If
the patient died on the vaidya’s premises, it would hurt his reputation.
Mana utthi (intuition) plays an important role in diagnosis.18 Mana
utthi, which was mentioned at least once by all the informant practitioners
in this study, is the capacity to sense the solution to a problem based on
a quick appraisal of the resources at hand. Such intuition seems to occur
during moments of intense involvement in the problem and most often
in the event of a crisis. A middle-aged visha vaidya explained how he
was once confronted with a patient who had been bitten by a snake and
was brought in an unconscious state. The snake had not been identified
and so the vaidya had to take a quick decision regarding the kind of
18
The term is probably a version of yukti in sanskritised Tamil. Yukti is a type of in-
ference, mentioned in the ayurvedic text Charaka Samhita (see footnote 20), which is
employed when several causes may be associated with one effect.

190 / V. SUJATHA
medicine to be given. The urgency of the situation required that all avail-
able clues be instantly analysed—if the person had been working with
bunches of coconut or palm leaves, it was likely to be a panaisan snake
which lives in coconut and palm trees; if he had cried out in pain after
the bite, it could not be a cobra because a cobra bite is not very painful;
if there was a swelling then it was likely to be a viper and so on. Bone-
setters also often mentioned mana utthi as their aid in critical diagnostic
situations.
A woman practitioner who prepared medicated massage oils (thuvala
poduthal) for a cluster of infant diseases known by the generic name
kanai,19 narrated how she had not cared to learn anything from her mother
who was a practitioner specialising in kanai, but how on a stormy night
when she was alone with her child who had convulsions, she realised the
value of the medicine and prayed to her dead mother. The location of the
basic herbs occurred to her suddenly as she remembered her mother’s
herb-collecting expeditions on the way to the field. So she ventured out
in the rain, got the herbs and prepared the oil, recalling the method of
preparation that she had constantly observed at home. Ever since her
child was saved, she has been preparing the medicated oils for outsiders
on payment basis. She also provides some oil at low or no cost to her
fellow villagers.
Though diagnostic criteria are standardised to some extent, their ap-
plication depends on the aptitude and skills of the vaidyas, which are bound
to vary. This variability calls for thought and the exercise of judgment on
the part of the lay person who shares a cognitive universe with the vaidya
and who is a participant in diagnosis, therapy and prevention. Villagers
frequently say that wise health behaviour is to take preventive measures
when any threat is expected. For instance, a breastfeeding mother should
start taking the herbs that facilitate digestion two days before eating heavy
foods and during the mango and jackfruit season, knowing that these
fruits are hard to resist. Either she should be wise enough to take the medi-
cines in advance or firm enough not to yield to temptation. ‘A woman
19
Kanai is the generic term used to refer to a cluster of infant diseases ranging from
primary complex (congestion in the lungs and cough due to bacterial infection) to
convulsions.

who does not tie her taste buds does not have a baby; one who does not
tie her stomach does not have her husband’, is a common saying. Villagers
note and discuss variations in season, plant and animal growth patterns
and in bodily rhythms like appetite, defecation and sleep. Everyday as-
pects of their experience of the disease thus acquire an epistemic status
and get codified in a system of terms and proverbs that are constantly
validated in living experience. The vaidya’s specialised knowledge is
thus deployed in conjunction with the active participation of the lay person
whose knowledge lies within the same cognitive universe.
The methods of diagnosis, treatment and prevention discussed earlier
are simple and may occasionally be employed by urban, formally edu-
cated people too. However, it is the villagers’ sustained application for
several decades within the framework of inherited knowledge that has
yielded a coherent knowledge system. We could try to trace medical lore
in a city but, without the sustained ability to validate cumulative experi-
ences in a habitat, our metropolitan experiences in hybrid environments
could at best generate what may be termed ‘lay ideas’—incoherent, sub-
altern or invisible knowledges in localities or slums (Prasad 2005). Further,
in a health care system predicated on the monopoly of expert knowledge,
like the contemporary, technology-intensive biomedical or ayurvedic
clinic, lay experiences would not be accepted as constituting valid know-
ledge of the body if not supported by diagnostic technology (Cooper 1999;
Schoenberg and Drew 2002). The blurred boundary between lay person
and expert, who share a coherent knowledge system, is thus a key factor
which distinguishes indigenous medicine from biomedicine.
VI
Professional practitioners
The full-time or professional practitioners of indigenous medicine are
generally located in small towns and cities and earn their livelihood from
medical practice. Those professional practitioners who live in small towns
close to the villages are knowledgeable about local health concepts and
practices. Some of them accept that folk health practices have some ra-
tionale but an equal number opine that folk practices are crude and at
times erroneous. There does not appear to be a definite pattern in the caste

192 / V. SUJATHA
affiliation of professional practitioners. Nor could I detect a major dif-

ference between the practice of ayurveda and siddha.20 The only pattern
that emerges is that, as the physical and cultural distance from the village
increases, the professional practitioners’ practical knowledge of herbs
and their involvement in the preparation of medicines gets weaker.
There are many kinds of professional practitioners. Those knowledge-
able about ayurvedic and siddha texts include a class of pundits with
scholarly knowledge of the original Sanskrit/Tamil texts. They belong
to caste groups which hold relatively high positions in the social hierarchy,
including Brahmin and Pillai. These pundits do not practice medicine
and their interest in the medical texts is primarily linguistic or historical.
There are also college-trained ayurveda and siddha doctors in the bigger
towns that, in the eyes of most villagers, are indistinguishable from allo-
pathic doctors. These college-trained doctors prescribe ready-made medi-
cines in plastic containers. In small towns, however, the doctors do not
use drugs sold by big companies like Dabur or Himalaya, but those manu-
factured by local companies run by siddha or ayurveda and naturopathy
practitioners in the region. Practitioners in bigger towns like Karaikudi
continue to have medicines prepared on their premises by hired workers,
while in Chennai city, the proportion of those preparing medicines in-
house is smaller. Practitioners in Chennai tend to prescribe ready-made
drugs manufactured by local or larger companies. In the town, there are
also practitioners whose qualifications as physicians are dubious in that
they neither have traditional knowledge nor contemporary institutional
training. They administer all kinds of treatments: ayurvedic, homeopathic
and allopathic, including injections and sutures.
Professional practitioners include both generalists and specialists with
widely varying levels of adherence to medical texts. Half of the profes-
sional practitioners I talked to in the small towns do not draw upon the
original ayurveda or siddha medical classics and rely either on vernacular,
family texts or experiential knowledge acquired through apprenticeship.
20
Practitioners pointed to the greater use of minerals in siddha medicine, but did not
discern any major difference in theoretical or methodological principles. Scholars of siddha
philosophy opined that siddha was basically a system of knowledge aimed at achieving
the eight siddhis (highest yogic powers) through systematic cultivation of the body. Siddha
medicine is thus an outcome of a larger pursuit to achieve physical immortality. Ayurveda,
on the other hand, is a full-fledged medical system, a science of life, intended to alleviate
human suffering and disease, paving the way towards health and well-being.

The professional practitioners were clearer than the folk practitioners in

their use of medical terminologies. Interestingly, though several profes-
sional practitioners did not refer to the medical classics, the methods of
diagnosis they follow and the terms they use are codified in the classics,
knowledge of which they had acquired from their predecessors. Thus
I could find a hundred-year-old medical formula for kanai in current use
with a family of practitioners in a small town who specialise in childhood
diseases. Another 100-year-old formula for ilam pillai vatham (roughly
translated as ‘polio’) continues to be used by the vaidya now in charge
of the century-old ayurvedic hospital. The professional ayurveda or siddha
practitioners in bigger towns like Karaikudi and Pondicherry clearly iden-
tify with a formal system of medicine and are more conversant with the
original ayurveda or siddha texts as well as with the terminologies of
biomedicine.
Very few indigenous medical practitioners in this region have read
the classical treatises of Charaka or Sushruta.21 The written sources on
medicine to which most of them refer are Tamil texts on ayurveda or
siddha authored by leading professional, hereditary vaidyas of the region
who lived a few hundred years ago. The manuscript libraries at Thanjavur
and Chennai stock several such vernacular medical texts on plant sciences,
the treatment of livestock including elephants, treatment of venomous
bites, women’s diseases and so on. Tamil palm leaf manuscripts compris-
ing medical theory, inventories of common diseases and pharmacology,
written by regionally-renowned vaidyas, were brought out in print at the
beginning of the 20th century. Local patrons sponsored the publication
of such manuscripts at the behest of the descendants of these vaidyas.
Such books are currently available in town markets. During fieldwork,
I found two such printed versions of original palm leaf manuscripts in
Tamil in an old bookstore. These texts are a compendium of the author’s
inherited and experiential knowledge, codified in verse form.22 In his
preface to the 1929 text, P. Pandithurai, the then jamindar (landlord) of
Ramanathapuram, states that there was a need to create awareness about
21
The Charaka Samhita (c. 8th century BC) and the Sushruta Samhita (c. 6th century
BC) are compendia of ayurvedic knowledge written in Sanskrit and named after their pri-
mary authors/compilers.
22
They are in venpa form—a kind of Tamil verse structured in three and a half lines,
each with specified grammatical characteristics.

194 / V. SUJATHA
the true knowledge of ayurveda and restore its greatness amidst fake
claims and quackery:
There are many ayurveda texts in Sanskrit and Tamil written by our
ancestors. Though great vaidyas follow the methods of these texts, in
the later period several texts make false claims in the name of ancestors
and cause confusion.... While ayurveda is doing very well in other
countries due to the serious research of their own scholars, it is painful
to know that our people have brought disgrace to this ancient know-
ledge. My respected father, who realised the value of this knowledge
and its future prospects, had commissioned this effort in order to dis-
seminate the true/correct medical procedures among one and all. He
has got Shri Muthukarupa Pillai, who was a writer in his office and
who belongs to a family of Tamil vaidyas and who is a highly experi-
enced swadeshi (indigenous) vaidya conversant with unani and English
medicine, to write this treatise and record only those medicines found
to be effective in his valuable experience (1929: 1–2).
Pandithurai goes on to add that the book was in great demand even as
a palm leaf manuscript and that the first edition of its printed version
was sold out, necessitating this second edition. Another text from 1890,
Balavagada Thirattu (Compilation on Children’s Diseases), deals exclu-
sively with children’s diseases and categorises these diseases with details
of their symptoms, including both physiological and behavioural mani-
festations. This book states that it subsumes the contents of two other texts
on the same subject, one of which is Dhanvantari’s treatise Balavagadam.
Both the books outline basic ayurvedic principles and start with the
panchabhautic (of the five elements)23 nature of substances and analyse
diseases in terms of their tridosha (three etiological factors, sometimes
translated as ‘humours’)24 effects. But the diseases listed and their termin-
ologies are similar to those existing in the contemporary medical lore of
the region and seem to pertain to the same local conditions, showing the
overlap between older textual knowledge and current medical practice.
23
The Panchabhuta doctrine of matter, on which the ayurvedic classics are based, sets
out the elements of the external world of man as apprehended by his/her five senses.
24
In ayurveda, all bodily processes are believed to be governed by the balance of the
three doshas—vata, pitta and kapha.

VII
Conclusion: Medical lore as a node
in a network of medical knowledges
As the previous sections show, the structure of indigenous medicine pre-
sents a more complex picture in the field than can be accounted for by
simple dichotomies: medical lore cannot be considered as only oral, nor
can we say that professional ayurveda and siddha are exclusively textual.
More important, however, is the point that medical lore is not merely a
diluted version of textual knowledge. Rather, it has its own epistemic
autonomy. For instance, physical work, to which the villagers assign
great importance in their theory of health and whose impact on the body
system they thoroughly analyse, does not find any corresponding em-
phasis among professional practitioners in the nearby towns, nor is it
discussed in detail in the texts. Studies from other parts of the country
also corroborate that the number of plant and animal substances used by
lay and folk practitioners far exceeds what is listed in the texts (Voluntary
Health Associations of India 1999). Ideas like the variety principle in
diet, the concept of ‘quality of blood’ and a host of therapeutic practices
like the pala kadiya marundhu are instances of the collective ingenuity
of the people of this region and sufficiently demonstrate that medical
lore is an autonomous knowledge system that has emerged from the ex-
periential contexts of their lives.
Yet, certain beliefs such as the concept of compatibility;25 the theory
of disease as intrinsic to the body system; the centrality of food in notions
of health; correspondences between human, plant and animal life; and
the critique of synthetic fertilisers and hybrid seeds seem to coincide
with those found in the local health traditions of other regions (Nichter
1986, 1992; Subash Chandran 1995; Vasavi 1994), as well as in the pro-
fessional and textual traditions (Dasgupta 1975; Dwarakanath 1967;
Dwarakanath and Vaidyanathan 1977; Pillai 1973; Shanmugavelu 1987).
25
Compatibility between food and body is a key concept in the villagers’ explanation
of health and disease. Besides the plants and animals consumed as food and medicine,
food also includes air and water ingested from the environment. The body includes the
amount of physical exertion, namely lifestyle. Not only should there be a balance between
food and the body, but the substances ingested as food should also be mutually compatible.
For more details, see Sujatha (2002).

196 / V. SUJATHA
At times, there is also a similarity at the level of specific practices like

applying the paste of the theetan kottai (Strychnos potatorum) seed inside
the pots used for storing water, which is also indicated in siddha texts as
a method for purifying water. In fact, local tradition’s diagnostic pro-
cedures, like examining the disease experience and, in the case of infants’
diseases, interpreting behavioural symptoms, would not be inconsistent
with professional systems of indigenous medicine. The fundamental cog-
nitive categories of villagers’ analysis are also similar to the principles
of padartha vignana (the science of substances) based on the panchabhuta
(five elements) theory that we find in the original ayurveda and siddha
texts. The epistemic similarity of medical lore to other genres of medical
knowledge across cultural boundaries is intriguing, especially since most
of the villagers have not travelled far, are culturally far-removed from
the classical traditions, and were not exposed to media inputs at the time
of the study.
While a detailed historical analysis of the institutional practices of
indigenous medicine will throw more light on the matter, my field study
provides some preliminary clues about the social networks that serve as
links between various genres of knowledge. The indigenous drugstore
in the towns where practitioners and common people regularly interact
has been an important node in this network. The store keeper is generally
a vaidya or a person who is knowledgeable about herbs, medicinal sub-
stances and their properties. So the store is a sort of a meeting-point for
folk, professional practitioners and the common people, a site of consult-
ations and exchange of information. In the light of this link, it is not sur-
prising that people perceive modern pharmacists as the folk practitioners
of biomedicine and expect them to prescribe medicines and offer medical
advice, practices that are illegal in the context of biomedicine, where
diagnosis and prescription are the monopoly of the doctor, who is distinct
from the pharmacist.
Wandering mendicants seem to be another node in the network of
medical knowledge transfer. My informants recalled the visit of a men-
dicant within the past three decades and remembered that he stayed in
the village for years and trained a novice in visha chikitsa after discover-
ing that there was no vaidya in the village to handle cases of venomous
bites. The history of siddha and ayurveda also indicates that some of the
original medicine men were roving physicians (Chattopadhyay 1977).

Institutionalised procedures in the preparation and dispensation of

medicines have also led to the dispersion of medical knowledge. Proces-
sing herbs and roots involve time-consuming, multi-stage activities such
as grinding, pounding, roasting and cooking. Professional vaidyas employ
locals or relatives to help in the processing of medicinal substances; a
long acquaintance with the processes enables some of these ‘helpers’ to
prepare and dispense certain medicines in their own villages.
Professional practitioners also contact local people to obtain herbs
from the forest and to identify them. Several folk practitioners are pri-
marily engaged in collecting herbs which they also supply to professional
practitioners. Knowledgeable village elders are consulted about the local
names and properties of herbs and the association between herb collectors
and a practitioner may last for several decades.
When they cannot afford to prepare the medicine, the vaidyas instruct
their patients to procure the listed ingredients and prepare it on their own.
The collection of herbs and the preparation of medicines by the user has
been a key source of knowledge-dispersion as people come to learn the
properties of the prescribed substances. Enterprising people remember
the recipes of herbal preparations and use them when needed. This prac-
tice of self-medication occurs all over the country but is legally prohibited
in the case of biomedical drugs. In the case of folk medicine, the practice
of allowing users to prepare the medicine dissolves the knowledge-divide
between expert and lay person.
A number of herbs, roots and other medicinal products find their way
into the daily fare of the villagers according to seasonal changes, such
that they regularly consume rasam (lentil gruel) with herbs that offer
relief from body ache during the harvest season, and another preparation
with herbs for common cold and fever during the rainy season, and so
on. Members of the Muslim community and those of higher castes prepare
a halwa (sweet dish) made of medicinal substances, pulses, dry fruits,
nuts, jaggery, and ghee to be eaten by girls for a year after menarche in
order to ‘strengthen the pelvic region’, exemplifying the siddha dictum,
‘food is medicine; medicine is food’. The boundaries between food and
medicinal preparations being blurred, the latter are at times only more
complex food preparations. Further, the infrastructure needed for prepar-
ing medicines—grinding stone, mud pots, hearth, firewood, warm ash and
the like, are available in all the homes. The prevalence of basic epistemic
and technological infrastructure to identify the requisite pharmacopoeias

198 / V. SUJATHA
and to prepare the medicines within the household makes a virtue of

what biomedicine, with its emphasis on the primacy of expert knowledge,
would regard as a dangerous practice.
The fact that things like chemical fertilisers, coffee, new vegetables,
soap and arrack, that periodically make their debut in the village are
examined, and their impact on the body system discussed, is proof of an
epistemological grid through which the people here analyse new and old
phenomena. By virtue of being validated in living experience, the elem-
ents of this framework, as we have seen, are derived from the systematic
and trained use of the five senses in conjunction with inferential know-
ledge. For instance, most villagers do not buy the palm oil supplied to
them at subsidised rates through the public distribution system of the
state government. They say that palm oil causes vatham (diseases of the
nerves) in the long run. Surprisingly, this was corroborated by a college-
educated siddha doctor/lecturer who explained that, according to
Agastya’s ancient treatise, palm oil aggravates vatham. It is remarkable
that the villagers’ independent analysis of palm oil in terms of its texture,
consistency and smell corresponds to that of a text more than a 1000
years old, not only substantively but also in the mode of knowing. Con-
sidering the fact that the villagers neither know of Agastya or his text, it
is interesting that their conclusions about palm oil are based on the prin-
ciples of guna padam (science of substances) in siddha.
Resemblances in the substantive contents of medical lore and other
genres can be explained with reference to social networks of cultural ex-
change or even dismissed as incidental in view of the differences. But
how do we understand the similarity in the epistemology of medical lore
and classical traditions? Medical lore’s basis in sensory knowledge, which
is analysed through inferences made within the framework of traditional
categories, is quite close to the epistemology discussed in the ancient
Sanskrit medical texts: pratyaksha (knowledge gained through the
senses), anumana (inference) and apta upadesa (advice from appropriate
authority). One probable explanation is to see textual knowledge itself
as the collation, codification and formalisation of local health traditions,
a process similar to McKim Marriott’s (1955) notion of universalisation.
Instead of being a single-event, one-way process, it must have involved
several levels and stages. The distinction that folklorists make between
the mode of origin and the mode of transmission of cultural elements is
relevant here (Finnegan 1977). They argue that oral and written traditions

of the same theme coexist, borrow from each other and may be trans-
formed into one other. For example, folk tales have been the source of
some classical epics. But the epics have also been preserved for thousands
of years through oral and narrative versions that exist independent of the
written form. In the chain of transmissions, there may be multiple con-
versions from oral to written and vice versa, as also from oral to oral and
written to written. ‘Any conception of a one-to-one diffusion process
would be simplistic since secondary lines of oral and written descent,
as well as interaction between them are likely’ (Blackburn and Ramanujan
1986: 4). A tale may originate in the oral form and continue in it and, at
some point, may be written down with new and creative features appear-
ing in the written medium.
The basic analytical categories of indigenous medicine may have
undergone such multiple transmissions from one genre to another. Trad-
itions of agricultural and ecological knowledge in south India seem to
have thrived even without a textual framework for several centuries (Ludden
1996). Their living presence can be attributed to the fact that, even though
professional systems of indigenous medicine may regard folk knowledge
as unrefined, diluted or even inferior, in the final analysis, they do not
negate its validity or that of its sources.
The study of structural pluralism in the field of medicine and elsewhere
opens up several lines of enquiry that require further exploration. In a
heterogeneous and dynamic society like India, with its caste and class
hierarchies and regional and ethnic variations in constant flux, medical
lore may not always be coherent and live. The interaction between bio-
medicine, homeopathy and the folk knowledge of the region may lead to
the emergence of hybrid forms such as biomedical lore or indigenised
biomedicine, which require further study. In other parts of the world, lay
medical knowledge poses a potentially powerful challenge to the increas-
ing medicalisation of life created by the dominance of expert knowledge
(Williams and Calnan 1996). In India, too, the political implications of
the existence of coherent knowledge systems at the grassroots level are
significant and demand greater attention than they have received so far.
Contemporary revivalist efforts, however, ignore this crucial aspect of
Indian indigenous medicine. The Central Council for Research on Ayurveda
and Siddha (CCRAS), its attendant research organisations and pharma-
ceutical companies appropriate the therapies and recipes of medical lore

200 / V. SUJATHA
but negate the underlying concepts and disease categories as unscientific

and invalid from the viewpoint of the laboratory epistemology to which
they now subscribe.
The race for a place in the pluralistic health market is obliterating the
true significance of folk medical traditions in Indian medicine. Padartha
vignana, or the science of substances, has been marginalised in the cur-
riculum of most ayurveda and siddha degree courses. The entry of
industrially-manufactured drugs in the metropolises has made it redundant
for the ayurveda or siddha doctor to know about herbs and their properties.
The site of ayurvedic drug research is now the laboratory—the arena of
multinational companies. In sum, indigenous Indian medicine now serves
many interests—nationalist, private corporate, tourist, and the like. In
the booming economy of biomedicalised ayurveda that indigenous Indian
medicine is now becoming, there is no epistemic status for medical lore.
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Pluralism in Indian medicine: Medical

lore as a genre of medical knowledge

When engaging in cross-cultural comparisons, medical anthropology has often tended to

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this coexistence of therapies? What are the mechanisms of legitimation?

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‘folk knowledge’. I distinguish it from simple ‘lay knowledge’, a term

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This paradox prompted me to examine villagers’ health practices but,

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homes as labourers on daily wages, were compelled to violate dietary

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body is seen as being constituted by food which is the vehicle by which

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These individual variations notwithstanding, there is a shared fund of

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Specialised knowledge: Folk practitioners

Vaidyas or village-level practitioners (henceforth folk practitioners) spe-

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if the treatment does not work; I observed a practitioner being grilled

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It thus becomes apparent why a conclusive and correct diagnosis in the

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Main Problem Other Symptoms Disease

Thus is described the medical lore of lay practitioners in the village.

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urine. In the case of children, an injury to the internal organs is linked to

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traditional knowledge comes from observation during apprenticeship. A

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