Sot. Sci. Med. Vol. 28, No. 9, pp. 963-970, 1989 027%9536j89 53.00 + 0.

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Printed in Great Britain. All rights r~~rvcd Copyright ,r 1989 Pergamon Press plc

AYURVEDA: A MULTILECTIC INTERPRETATION

CAROLYN R. NORDSTROM
Peace and Conflict Studies, University of California, Berkeley, CA 94720, U.S.A.

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

Key worcis-Ayurveda, health epistemology, Sri Lanka, multilectic

INTRODUCTION: THE ARGUMENT and doctrines that patients navigate in an attempt to

When I arrived in Sri Lanka to study the countrys
complex plural medical system, I expected people
to tell me about Ayurveda, the predominant
empirical indigenous medical tradition in South Asia.
More often, they used Ayurveda to tell me about
themselves.
Statements such as the following were commonly
heard in conversations among Sri Lankans: The
political system is like the body, and the parties are
like humors: if they are maintained in a balance, the
system is healthy. But if one gains ascendancy over
the others and begins to dominate, the balance is lost
and abuses can follow-the system can become un-
healthy. In another vein, people say: He is a sema
person (sema is the humor or water of phlegm)-you
know, he is overweight, congested, sweats a lot, but
usually maintains a cheerful expression. In a third
example; one day, after a particularly severe drought
season that had resulted in critical water shortages
and epidemics, the first rain fell heralding the start of
the monsoon season. An older woman in the house
I lived in looked out onto the rain, smiled and said
Balanna, sanipai (Look, it is health).
The argument will he developed in this paper that
the traditional medical concepts used to explain
illness and health are not restricted to the level of the
biological or the realm of the medical during episodes
of disease among the Sri Lankans. Bather, these
concepts exist in a complicated interrelationship with
broader social issues facing individuals. The interplay
between these various levels of human interaction
provides knowledge and conceptual frameworks that
are used to address epistemological and ontological
concerns as well.
Because of this complexity of health ideology,
health care operates on several levels for the Sri
Lankans. On one level are the infrastructural ele-
ments of the health care system: the institutions,
practitioners, clinical formats, and medical traditions
gain and maintain well-being. Equally important, but
existing on another phenomenological level, is the
popular body of knowledge maintained within the
general society that orients the average person to
critical issues of illness and well-being and to the
broader systems defining health in the country.
Specifically, the article addresses the idea that
because the Sri Lankan concept of self is defined as
comprising an extensive number of interactive levels
that include social, environmental, and cosmological
relationships as well as more personal and biological
ones, the dynamics of health and illness, and the
medical traditions that define and treat these states,
are more complex and multifaceted than a simple
perusal of the medical institutions themselves. As
these relationships are interactive by nature, the
various traditions of health care addressing different
arenas of illness etiology must be integrated as well
into a comprehensive framework.
What is of interest in this paper is the popular body
of knowledge based on the tenets of Ayurveda and
Sinhala beheth (Sinhala medicine), but not confined
to the textual tenets of these traditions. Not only does
this body of knowledge explain the health issues
facing the Sri Lankans, it provides metaphors [l] that
are used to explain the many aspects of life that
impinge on notions of personhood and its expression
in the daily world. This popular body of knowledge,
understood by practitioners and lay alike, is not only
a knowledge system that elucidates illness and health
care processes as experienced by the patient during
illness episodes and the ongoing maintenance of
health, but is also a meaning system that orients the
general population towards questions of a more
comprehensive epistemological nature, regardless of
the medical tradition specifically utilized or the rela-
tive proximity of an illness.
I will use the term multilectic to emphasize the
fluid and dynamic relationships which exist among
conceptual categories in Sri Lankan orientations
963
964 CAROLYN
toward Ayurveda. These conceptual categories derive
their dynamic quality from their openness, recep-
tivity, and mutually influential interrelationships, and
from their ability to encompass multiple meanings at
the same time. In contrast to the idea of a dialectic
in which opposition and contradictory processes,
or what Hegel [2] might term determinate negation,
are central to perception, Sri Lankans perceive
noncontradictory relationships among categories
which Westerners might view as discreet (Martin,
personal communication). A primary example of
this developed in this paper is the Sri Lankan con-
ceptualization of the self and its interaction with
fundamental attitudes toward health, and more
specifically, in the notion of state as it is used
to discuss simultaneously a persons physiological
condition, their existential and phenomenological
realities in life, and their relations as a collection
of people bounded by social-level ideas of state
or nationhood. This kind of conceptual fluidity
reinforces the centrality and power of the notion of
health in Sri Lankan culture which concomitantly
strengthens the viability of traditional medical
epistemological frameworks rooted in Ayurveda.
INTRODUCTION: THE DATA
Data for this paper was collected during 2 years of
study in Sri Lanka in 1982-83, and in subsequent
field visits each of several months duration in 1985,
1986 and 1988. Research was conducted in an area in
the southern part of the island, and included both
urban and rural settings. In an attempt to understand
the full dynamic of the Sri Lankan health care system,
extensive interviews were conducted with people
representing all aspects of the health care system:
with cosmopolitan, Ayurvedic and indigenous prac-
titioners, and with both patients and people from the
general populace not currently suffering an illness.
Attention was given to addressing as broad a repre-
sentation of the population as possible, and inter-
views crossed a full range of caste, class, occupation,
age, and gender divisions. The area I worked in is
predominately Sinhalese, but my work included
Tamils and Muslims living in the area as well. As
Siddha and Unani medicines are not well represented
in the south, few health care distinctions along these
lines were evident among groups, and thus unless
the materials collected reflect a distinctly Sinhala
Buddhist orientation, the term Sri Lankan, rather
than Sinhalese, is used to denote commonly
held general assumptions shared throughout the
community.
The Ayurveda medical tradition of Sri Lanka is
broadly similar to that operating in India with two
exceptions. Over the centuries, the medical practices
and conceptualizations in Sri Lanka have adapted to
the specific health care problems and lifestyles of the
island, and, for the Sinhalese, reflect an intersection
with basic Buddhist philosophies.
In order to understand the full dynamic of
Ayurveda and its influence on the lives as well as
the health of the Sri Lankans, it is important to
understand the concept of self these people hold, the
way in which this intersects with the demands created
to maintain this self in health, and the mechanisms
R. NORDSTROM
Ayurveda affords toward this end. The broad-based
social dynamic rooted in popular Ayurveda that
emerges in this paper reflects the fundamental views
held by practitioners, patients, and the general popu-
lation alike: it is an integral part of the basic social
knowledge by which people articulate themselves
vis-ci-vis their world and their health in general. The
following sections are a condensation of the Sri
Lankans own words. I have stated elsewhere [3] that
the sophisticated knowledge the average Sri Lankan
holds concerning health care and ideology, and the
ease with which they can articulate this is in large part
responsible for the very high indices of health enjoyed
by the Sri Lankan people (41.
As my interest in this paper lies primarily with the
popular knowledge and meaning systems operating in
Sri Lanka, and not with the more formal textual
traditions defining medical care, I have chosen not
to delve into lengthy explanations of the formal
philosophies defining medical traditions that are
basically relegated only to educated practitioners.
For more in-depth works on these topics, the
reader can refer to Obeyesekere [5,6]; Nordstrom [7];
Wijeratne [8]; and Wanninayaka (91 on Ayurveda;
Amarasingham [IO]; Waxler [1 I]; Yalman [12]; and
Obeyesekere [ 131on health care processes; and Carter
[14]; Gombrich (15, 161;De Silva [17]; Ratnapala [IS];
and Wickramasinghe [19] on Buddhism; and Daniel
[20] on Tamil knowledge systems.
I-HE CONCEPT OF SELF IN ILLSESS
AND IN HEALTH
The Sinhaleses conception of self is multifaceted
and, in essence, multi-existential. Made up of five
basic universal elements (water, fire, air, earth, and
space), people are no more than a collection of
chemical elements, and no less than an essential
part of the universe. Because of this, they affect, and
are affected by, processes taking place in their world
and the universe they exist in. This is an orientation
that infuses Buddhist philosophy alongside
compatible Ayurvedic concepts into general cultural
traditions basic to the Sinhalese. People thus conceive
of themselves as being comprised, and as existing,
simultaneously on these dynamically different but
fundamentally complimentary phenomenological
planes. They are, in essence, equally detined by these
varying realities, and being so defined, they likewise
define the world and the universe they comprise.
They equally determine, and are determined by, the
universe they populate.
The Sinhalese state they do not draw sharp
mind/body, individual/social, or personicosmos dis-
tinctions in their assessments of personhood. All
these levels coalesce to define a person. People are
made up of biological, mental, and emotional pro-
cesses. They interact in life through a series of social
role associations, and are a fundamental part of
the society and the environment (both physical and
social) they live in. They are shaped by religious and
philosophical epistemology, and are an inherent
part of a larger metaphysical and cosmological world.
In popular conception, the Sinhalese tend to see
all of these domains, from biological to social and
cosmological, as processes which run according to the
 Ayurveda: a multilectic interpretation 965

same basic principles. This view tends to focus on For example, a healthy mental/emotional balance
concepts of synergistic, interrelated configurations is as important to physical health as is a strong
and the effects of balance and imbalance, harmony constitution, and the two are not separated by the Sri
and trouble. Balance and harmony themselves are Lankans
comprised of many elements: of the properties of heat
and coolness that affect the health of a system, of
sweetness and bitterness that give it flavor, of order
and disorder that characterize it, and of the positive
and negative alignment of parts that defines its nature
at any given point in time.
This orientation represents a multilectic approach
to issues of an existential nature. Each of these
phenomenological domains is essential to defining
being, yet makes sense only in its definitional
relationships to the other domains it is perceived
as being in interaction with. This entails a set of
mutually influential interrelationships that exists in
a dynamic such that each of the categories maintains
a coherency of nature, while at the same time
being fundamentally defined by the nature and
characteristics of the other related processes and the
composition of the whole.
This is not a directional process, as is usually
associated with the dialectic, but one that is necessary
to the maintenance of the integrity of the whoIe as it
exists over time and space. The multilectic does not
stand in oppostion to the dialectic, nor is it intended
to replace it: it addresses a different order of concep-
tual categories and their related phenomenological
processes. While they can be used separately in theory
and analysis, they represent compatible concepts that
can be used together to highlight the relationships of
phenomenologically divergent processes.
While a multicausal orientation is basic to this
approach, it is not sufficient in explaining it. The
process is more complex in that discrete factors
cannot ultimately be identified as basic components
in a process of reduction: to the Sri Lankan, the part
cannot accurately be distinguished as isolated from
the whole, nor the cause separated in explanation
from the effect. In the multilectic, a universe, and a
universe of knowledge, is being continuously created
and maintained by the various parts and parts-as-
wholes simultaneously, and as well by the processes
and dynamics of the relationships themselves as they
generate and define existential domains.
Given the fact that all of the aspects of life and self
as defined by the Sri Lankans are perceived as
existing in a dynamic relationship, a disturbance in
any of these realms can jeopardize an individuals
immediate well-being. Well-being, then, is not as-
sessed solely in terms of an individuals physical and
mental health, but as a set of positive relationships
with the people and processes in the persons world.
This includes not only a rounded intellect and
balanced emotional states, but also fulfilling social
relationships, a clean environment, a stable society,
and a proper conliguration of supernatural and
cosmological forces.
Though the Sinhalese recognize the physical
suffering of illness, they may trace its origins to
disruptions taking place in any of the many levels of
existence that define the self. In the same way, friction
in any of these realms in and of itself is ultimately a
signal of unhealthiness for the people who are a part
of it.
966 CAROLYN
Issues of environmental cleanliness are closely
related to religious principles of purity and whole-
someness and are fundamentally tied to notions
of health and illness for Sri Lankans. The Gods do
not like dirty environments, and neither do the Sri
Lankans. The public generally recognizes the vectors
of many infectious diseases, and during an outbreak
they may explain the ultimate etiology as a Gods
wrath, but realize the immediate etiology as patho-
genic infection. They will thus direct their energies to
isolating patients and monitoring the cleanliness of
food, water resources, and sanitary conditions as well
as conducting rituals to appease the God(s).
During one survey I conducted in both an urban
and a rural area in the south of Sri Lanka, I asked
people what request(s) they would present the Min-
ister of Health if he came to their homes inquiring
about how to improve health standards in the com-
munity. In conducting this research, I was careful to
interview as representative a sample of the population
as possible, and spent as much time with the more
rural, economically poor, and less formally educated
families as I did with the more affluent urban popu-
lace and the health care practitioners. One of the
more surprising aspects of this study was that virtu-
ally everyone I talked with had a fairly well-
developed explanatory model that shared the same
basic elements of the body of popular knowledge
described here. The sentiments outlined here reflect
commonly held views regardless of peoples gender,
economic, occupational, or educational background.
In answering the above question, many of the people,
after responding that the Minister of Health would
never come to their house in the first place, and that
was one of the proplems, said that if such a thing
were to pass, one of the first requests they would
make would be that he clean the environment and
provide clean water.
Population pressures, people said, cause an excess
of garbage, and garbage attracts insects and animals
that can introduce and transmit disease.. Water
becomes polluted as too many people are forced
to wash clothing and household items, bathe, and
evacuate in one area. Pollution fouls the air and the
soil, and increasing demands for food resources
prompts the use of petrochemicals and insecticides
that introduce poisons into the foods people eat.
People were not as concerned with population
growth, and the concomitant pressures caused by this
in and of itself, as much as with the aforementioned
consequences, and with the fact that polluted and
poorly managed agricultural and environmental pro-
grams hampered the communitys ability to meet
basic subsistence needs. These concerns are well-
grounded. Though Sri Lanka has one of the highest
sets of health indices for all Third World countries,
50% of the children are malnourished and it is
estimated that over half of the major diseases suffered
are water-borne [22,23]. In a more specific example,
the Superintendent of Health of the district I worked
in told me that in recent years there had been a
tremendous increase in the number of cases of severe
insecticide poisoning (through skin contamination) in
field workers.
Social environment is as important a concept to
health as is physical environment. Impoverishment,
R. NORIXTROM
stressful or antagonistic work environments, and
being away from family and home and feeling lonely
or unhappy in circumstances one doesnt like are a
few examples of the many situations that can affect
ones health and well-being. On a broader scale,
another commonly voiced opinion about the impact
of the society on the individual was summarized by
the person who explained to me:
If the government is good a healthy nation exists. But if it
is bad, if it is corrupt and selfish, jobs will not be available,
schools will not be properly staffed, land will not be
developed and cared for, and the people will be unhappy.
They will sicken and die, or they will revolt. If there is
lighting among the people and antagonisms between groups,
everyone will suffer. It is an unhealthy state then.
THE SRI LANKAN PLURAL MEDICAL SYSTEM
The Sinhalese have an extensive plural medical
system tailored to these myriad levels of ill-health and
disorder. While it may seem that many of the forces
that impinge upon health, such as those of a social,
metaphysical, and cosmological nature, are not easily
changed so that positive health may accrue, in fact,
all of these can be influenced by the services of
specialists so that the amelioration of ill-health can
take place. Because these forces exist as dynamic
phenomena, and not as static properties, their nature
and the concomitant impact they have on individuals
change over time, and they are amenable to curative
rituals.
Within the encompassing framework of health
care, each of the healing traditions is directed toward
a specific arena of care defined by the etiological
agent(s) deemed responsible for the dis-ease. Cos-
mopolitan (Dostora) and indigenous traditions of
Ayurveda and Sinhala medicine (Veda) are empir-
ical means to reestablish health within the body [6].
The latter two medical traditions also emphasize
preventive health care [9]. Local-level healers, infor-
mally trained primary health care specialists, help
correct personal problems and everyday physio-
logical and emotional complaints [24].
Buddhist priests (Hamaduruwa) and lay priests
(Kapurala) attend to supernatural and metaphysical
disturbances, and are responsible for the spiritual and
emotional well-being of the communities they serve
[13, 14, 17,251. Exorcists (Adura) control the evil
and demonic when it disrupts the world of the living
to cause misfortune and disease, and they help to
rectify negative cosmological patterns influencing
the well-being of individuals and communities (261.
Astrologers (Gurunnanse) assess planetary patterns
and cosmological relationships, and advise on
ways of correcting negative influences in these realms
(271. Oracles (Pena-karaya) and fortune-tellers
(Shastra-karaya) discern interpersonal, social, and
supernatural problems and ascertain solutions for
them [9, 121.
AI1 of these categories of healers and traditions of
diagnosis and treatment described above tend to
come into play during the course of a Sri Lankans
life [lo]. For any given illness, one or more causal
factors may trigger the disease process. For each
specific domain of etiological agent involved in an
 Ayurveda: a multileetic interpretation
illness episode, the appropriate healer must be
consulted to ensure that health is regained.
For example, negative planetary influences may
foster emotional disturbances in a person that leave
him or her open to demonic attack. Such an attack
may upset the correct balance of the bodys three
humors, and the resulting imbalance can produce a
physical disease. Medicine given for the physical
problem alone will not successfully cure the disorder,
for the underlying causes have not been treated. In
addition to medicine, the services of specialists who
are able to determine the exact root cause(s) of
the problem, and can either treat these or refer the
patient to practitioners who can, are essential in
regaining health. Thus a patient may consult a cos-
mopolitan physician and/or a Veda, an astrologer,
and a religious and/or ritual specialist in the course
of a single illness.
None of the healing traditions, in and of them-
selves, can address all the levels that constitute a
person and determine well-being. Both the prac-
titioners and the formal doctrines that define their
practice are formally restricted to specific domains
of diagnosis and treatment, as described above
(although in actual practice there are health
specialists that amalgamate several different healing
traditions).
Within the general society, however, these various
traditions are not seen as complete healing systems by
themselves in that they do not address all of the
levels of illness etiology, and thus the various healing
traditions are not viewed as competing systems of
medicine. Rather, they are seen as complementary
options variously available to patients depending
on their needs. (Practitioners, as distinct from the
general population which holds the above views,
do not always have such an expansive view of the
plural health care system, and may view the different
traditions as competing as far as their practice
is concerned. This, however, holds only for their
professional orientation, for when practitioners
themselves become sick and revert to a patient status,
they tend to employ the same popular paradigms of
health care knowledge used by the general populace
and approach the health care universe as a more
integrated comprehensive whole.)
The ability to synthesize these various healing
domains into a coherent encompassing framework
rests, then, on the general patient population and
on the popular paradigms of health they maintain
in defining illness and health care options. The re-
lationship between illness episodes and treatment
choices is an interactive one: the assessment of what
etiological agent(s) underlay the development of the
illness dictate which healers a patient will seek out,
and the efficacy of the ensuing treatments will deter-
mine if the initial assumptions are supported (the
illness responds to treatment and the patient im-
proves), or if further causal factors are explored and
treatments sought (the illness doesnt respond to the
initial treatments). In the latter case the initial de-
cisions concerning etiological agents and treatments
are not deemed inaccurate, but simply incomplete,
and an expanding framework of causal factors and
related treatments ensues until the patient is finally
cured.
967
POPULAR PARADIGMS OF HEALTH KNOWLEDGE
Given the fact that the Sri Lankan concept of self,
and thus of health, is so broadly defined, a theoretical
framework-a popular body of knowledge-must
exist that is capable of integrating these diverse
realms and the formal traditions that define them.
Ayurveda/Sinhala medicine provides the foun-
dation for such an encompassing explanatory model
for the general population. As such, it exists both as a
medical tradition in the traditional sense of the term,
and as well, as a social knowledge system applied
generally in the society to address epistemological
and existential concerns in a way meaningful to the
average person as well as to the more erudite
textually-trained practitioners and philosophers.
Sinhala beheth is not viewed as more of a folk
tradition than Ayurveda in Sri Lanka. Structurally,
the two conform more to Leslies [28] model of
nonprofessionalized versus professionalized Ayur-
veda respectively. Professionalized Ayurveda refers
to the system whereby practitioners gain a formal
education in Ayurveda universities and rely on pro-
fessional texts, organizations, hospitals and clinics,
and manufactured pharmaceuticals in their practice.
In nonprofessionalized Ayurveda, practitioners learn
their medical skills through a lengthy apprenticeship
to a master, often a family member, or from temple
schools or informal medical organizations (although
the latter two are far less commonly found today).
Given the high literacy rate in Sri Lanka ( 197 1: males:
85.2%; females: 70.7%, with current figures showing
continuing increases [29]), most nonprofessional
practitioners are also trained in Ayurveda and/or
indigenous medicine texts written in Sinhala or
Tamil, and sometimes Pali (the formal traditional
language of Buddhism).
To the average Sri Lankan, however, the non-
professionalized distinction is nonevident: .the ar-
duous apprenticeship process (4 years for a university
medical degree sounds remarkably short to many),
the well-maintained clinics and shops for consul-
tations and medicines, and the quality of the
care associated with the practitioners of Sinhala
beheth is as formally professionalized as that
offered by university trained and institutionally based
Ayurvedic practitioners.
In the Sri Lankan context, to label the informal,
popular body of knowledge Ayurveda is a misnomer.
Among the general populace in Sri Lanka the term
Ayurveda has come to signify the professionalized
form of the indigenous medical tradition, and one
that is often integrationist in policy; that is, it follows
a model whereby the principles of Ayurveda are wed
to the infrastructural and therapeutic patterns of
cosmoplitan medicine. The pure form of apprentice-
learned. empirical indigenous medicine is referred to
as Sinhala beheth (Sinhala medicine), or Tamil
vaittiyam (Tamil medicine).
Sinhala beheth itself exists on two planes,
although only one is officially recognized. There is
a formal empirical medical orientation based on
written texts and established therapies for both pre-
ventive and curative health care. In addition, there is
a more informal popular body of knowledge that
orients the average Sinhalese toward the many mani-
968 CAROLYN
festations of illness and health that are fundamental
to the world as they know it. This includes not only
their perception of health concepts, but the epi-
sternological systems they use to explain them. This
latter system of knowledge is interactive by nature,
linking patients both to broader socio-cultural issues
in the society, and to the array of infrastructures,
practitioners, and ideologies of health care. (This
distinction between formal and popular health
knowledge is similar to the one that Obeyesekere [30]
makes in terms of textual and popular Buddhism, but
it is more encompassing in nature as it includes
medical, religious, ecological and social traditions.)
It is this form of popular Sinhala medicine that
provides a paradigm capable of synthesizing peoples
complex conceptions of self and health. This body of
knowledge is shared throughout the general society,
and is distinguished from the more classical doctrines
of medicine, religion, and public health that ulti-
mately give definition to it. Its bases in synergistic yet
competing parts, in the concept of doss (trouble)
coming from the Tridosa (the Theory of the Three
Humors), and in balance and harmony and their
counterparts, are drawn from Ayurvedic doctrine,
but they are not limited to it. Because of this
it provides an accessible and comprehensible
conceptual framework mediating the diverse medical
traditions.
This popular body of knowledge is not specifically
grounded in any doctrinal base, nor does it exist as
an institutionalized or written tradition. Because it is
not the textual orientation itself, but the general
overlying principles inherent in it that are used to
codify diverse sets of information, it can as easily
incorporate the pathogenic germ theory of cosmo-
politan medicine as it can the demonic possession of
exorcistic traditions, the effects of negative karma, or
of harmful planetary configurations-all of which
can seriously jeopardize the internal humoral balance
of individuals and the external social and spiritual
relationships they engage in. It is thus capable of
rendering whole the myriad levels that define person-
hood and the diverse healing traditions available in
Sri Lanka.
The concept of state provides a crux for this
orientation. The conceptualization of state is derived
from the complex notions of personhood held by Sri
Lankans, and derives a more encompassing usage
from further extended linkages with notions of ill-
ness, health and Ayurveda/Sinhala medical traditions
as they are rooted in popular knowledge paradigms.
It provides a conceptual framework that is both
flexible and dynamic, and yet fundamentally coherent
across time and space. As such, it is capable of
ordering broad-based existential concepts of being as
they are variously expressed when the simple verb
innawa-to be-comes to life in its intersection
with the complex reality of being. Epistemology
becomes ontology in this intersection-the abstracted
linguistic symbol, to be, by virtue of its very use is
lived, and by thus referencing this fact of being
cognitively, it becomes as well a fundamental
affirmation of existence for the person constructing
an I am. . . statement.
This double dynamic of being, as a cognitive
construct and as experiential reality, underlies the
R. NORDSTROM
evaluation of state. The complex nature of the
COnCept of state as it is used in Sri Lanka derives in
part from the fact that the two perceptual categories
defining its parameters represent distinctly different
phenomenological and cognitive categories which
must nonetheless be considered synergistically in
terms of their encompassing coherent relationships in
order to make sense. This represents neither a syn-
thesis of divergent elements toward any one unity as
in the dialectic, nor a Western-based model of linear
process that sequentially analyses single categories as
discrete, divided units. The different categories do
not exist in contradictory relationships of any kind,
but represent different order of phenomena viewed
simultaneously as distinct and interrelated complete
dynamics. As with the concept of self in health, this
represents a multilectic orientation,
State can refer to an individuals particular physio-
logical condition at a specific time and place. At the
same time it can summarize a persons existential or
phenomenological place in life. As well, it can be
used in the sense of a collection of people, a bounded
sense of nationhood. The state of an individual is
ultimately defined by all of these definitions inherent
in the term.
The first two uses of the concept of state were
discussed in examples given above (in the section
on The Concept of Self in Illness and Health):
the impact that pathogens and humoral imbalances,
interpersonal relationships and emotions, gods and
demons, and the effects that supraphysical processes
have on the health of a person. In the first case, one
can be sick (sanipannae; asanipai; leda) [here
and now] because of short-term illnesses caused
by humoral imbalance, the attack of a demon,
cosmological disturbances, or toxic agents carried by
such vectors as food and water.
In the second meaning of state, one can also suffer
more long-term disabilities caused by circumstances
more existential in nature: widowhood; the effects
of karuma; poverty; polluted environs (both in
the sense of pirisidunae, not clean physically, or
kilutuwi, impure conditionally or existentially), or
unhappy social relationships. Chronic diseases
also fall into this category. This includes not only
long-term physical disabilities, but more complex
socio-physical conditions as well. A daughter,
explaining the plight of her mother to me, clarified
the latter instance:
When my mother attained age (had her first menstruation)
she suffered a bad fright, and she has never been the same
since. For 25 years now she has had pains in her body,
paralysis at night, and periodic fits. Some say she is a
yakleda (patient with an illness caused by demonic attack),
others say she has heart problems and high blood pressure.
But after spending tens of thousands of rupees on scores of
different kinds of practitioners over the years with only
limited success, we all agree that the illness has gotten into
her bones. We doubt if she will ever get completely better
now.
The third use of the concept of state, that of a
shared socio-political identity (often using national-
istic, ethnic, and cultural constructs to define a
society-level membership), also follows the same
principles. In its healthiness or unhealthiness, the
state in this usage can impinge directly on a persons
 Ayurveda: a multilectic interpretation
well-being. A graphic example of this is given by
Daniel [20] in his discussion of the nationwide
interethnic violence taking place in Sri Lanka
between the Sinhalese and the Tamils. Daniels
discussion centers on a Tamil indigenous medical
practitioner. Although this does not represent
Sinhala beheth, strong parallels exist between this
and Tamil vaittiyam (Tamil medicine) in terms of
the popular (as distinct from the textual) body of
knowledge discussed in this paper. The following
excerpt from Daniels paper is the direct quote of an
indigenous medical practitioners analysis of the
state of the country in conflict. (The rioting cited
here refers to the communal conflict between Tamils
and Sinhalese resulting from the 1983 nationwide
riots in which over a thousand Tamils were killed.)
When there is a lot of sorrow there is a great amount of tears
formed in the body; mainly in the head. If tears dont flow
then they coagulate into bile. The heat of anger fires the
tears which coagulate into bile. This bile may look like
phlegm. But it is mostly bile. But this heat is all internal. It
dries up the tears into phlegm and bile, and this phlegm and
bile block the channels in the head and in the body, mainly
in the head. This is bad. This is what has happened to these
boys [involved in rioting]. Look at the weather. It is cool.
We have had more rain this year than in any other year. The
winds are cool. The amity talks (referring to the attempted
peace talks between the Tamils and Sinhalese that was
taking place in Colombo) are also like cool breezes. But this
is very bad. It drives the heat inside the body. Into the
central channels of the body. This is very bad. It blocks the
channels. When the channels are blocked you cant remem-
ber. To get better we must all remember. The Tamils must
remember. The Sinhalese must remember. What we need is
a dry spell with lots of dry wind. The people must weep and
weep a lot until their tears cool this land. Now the Sinhalese
soldiers urinate on our rice fields. The rice field is our god.
Urine is hot. Our country is hot. These rains hide the
fact that this country is sick with heat. They do not really
cool the land. First the land must cool down. It must truly
cool down. Only then can human beings cool down. To
really cool the land we need tears. Lots of tears to cool it.
This land has not wept enough. It is hot. This land is sick.
For the Sri Lankans, then, the popular body
of knowledge based in, but not limited to,
Sinhala/Tamil medical frameworks provides not only
explanatory models for medical problems, but is used
to orient them toward epistemological and onto-
logical concerns as well. It is the only comprehensive
conceptual framework capable of mediating all of the
states-all of the levels of existence-that define
personhood. In addition, as this exists in the form of
popular knowledge that is shared throughout society
[31,32] rather than as a formal written doctrine,
it provides an integrated basis for social discourse
that cross-cuts the various social groupings and
hierarchies that are recognized in society. It addresses
humans and life in general and is not restricted by
any gender, age, or social distinction(s). It thus stands
as a mechanism that links the population rather than
dividing it.
The tradition of Ayurveda/Sinhala beheth that is
found in practical application in the villages and
homes of Sri Lankans has a fundamental relevance
beyond the healing arts delineated in the texts of the
tradition. The basic philosophies of Ayurveda pro-
vide a series of metaphors that are applicable to any
major conceptual system characterized by balance
969
and disorder, health and dis-ease. Thus Ayurveda
does not exist simply as a medical tradition, nor is it
confined solely to the discourse of medicine. On one
level, this popular body of knowledge provides a
mechanism for integrating the various traditions of
health care into a coherent encompassing framework
for patients. In addition, the impact of Ayurveda
extends beyond issues of illness and health in the
life of the Sri Lankans to provide an explanatory
framework capable of synthesizing the many facets of
Sri Lankan life, and concepts drawn from this body
of theory are used to explain that life itself.
THE ROLE OF INDIGENOUS MEDICINE
IN HEALTH CARE
A number of authors have written that in recent
years the practice of cosmopolitan medicine is eclips-
ing indigenous healing traditions. Some argue that
indigenous medicine will fade as a viable option in the
future, and others postulate that it will blend with
cosmopolitan medicine, forming a sort of composite
tradition. Some recognize the importance of in-
digenous medicine in health care, but say it is gener-
ally second in preference to cosmopolitan care
[6, 11,33-361.
The data from Sri Lanka presented here challenges
these assumptions, demonstrating that regardless of
the actual healing tradition activated during illness
(whether cosmopolitan, Ayurveda, or indigenous),
Ayurveda, as a popular conceptual knowledge sys-
tem, is often the means by which patients orient
themselves ais-a-vis the illness episode and the heal-
ing endeavors in general. Because this popular body
of knowledge is crucial in explaining the relative
well-being of a person, and his or her everyday world,
it remains central to the lives of the Sri Lankans. AS
such, it reflects and reinforces traditions and values
that are considered fundamental to the society.
For the Sri Lankans, this is not a dynamic that can
be reduced to diadic oppositionals and contradictory
forces; mind/body, individual/society, or to paired
sets of fundamental competing humors or life con-
stituents. It is the interplay of a more complex
interrelationship of multiple factors, spanning the
many levels on which the self is made evident, and the
many arenas in which individuals engage in the
course of their days and their lives that is, in essence,
a multilectic process.
In addition to representing a healing tradition,
Ayurveda/Sinhala beheth, as a popular paradigm,
is an epistemological and ontological explanatory
framework grounded in, and referencing, the most
fundamental aspects of life and society for the Sri
Lankans. Because of this, Ayurveda and indigenous
medicine will in all likelihood continue to exert a
profound influence in the lives of the Sri Lankans,
and to operate as a central explanatory framework
for people confronted by illness, misfortune, and
existential angst in a world where they define them-
selves and their relationship to life in terms of a
multilectic orientation based on ideals of health.
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