(a draft chapter from Ayurveda: an Ecotherapy for our Time, forthcoming)
We can dream of the story of human medicine through the progression of the elements, from earth to space. Today, we sit on the juncture between fire and air modalities. But we long for an older water medicine.
We began with earth medicine, derived from a sense of here, from the grasses and herbs that grow underfoot and in rings that widen from the camp and village. A valley is nourished by a river god, and a sprite protects the forest within the radius of a single day’s walking. Wounds are sealed with the tree resins that are also used to fletch arrows, and then plastered with the same clay from which simple pots are pinched. Earth-medicine people depend upon their material roots and the psychic sensations of place. When they lose contact with the earth they know, they suffer. In the early 1980s, Hmong refugees from the highlands of Cambodia began to die of no apparent cause in their government-subsidized housing in Chicago. The phenomenon was called “Sudden Unexpected Death Syndrome.” Health care workers were baffled, until an elder finally told them: “It’s because we can’t feel the mountains.” (Siegel and Conquergood, 1985)
Earth medicine wove the local tangle of textures, aromas and well-trodden pathways into the safety of a home that made and remade us daily. We were so much of the here that we enforced taboos against eating the food of another tribe. Nourishing yourself from an unknown part of the earth would change you, shift your allegiances, make you Other.
Earth gives an exteroceptive medicine, dependent on constant and reliable sensual contact with familiar surroundings. The goodness of a food or a juice or an herb or the flesh of an animal is a function of its constancy in tribal memory, and its coherence with the landscape of which you and your forebears are an intrinsic part.
The theory of homeodynamism that is slowly coming to displace the homeostatic model of Claude Bernard — which from its mid-19th century root has dominated physiological theory — is perhaps a memory of earth medicine. Homeodynamism says that the flesh is not self-enclosed, self-supporting, and able on its own to maintain internal equilibrium. Balanced health is, rather, an interdependent intimacy between the person, her people, and her land. She feels in a failed crop the withering of her flesh. She feels her own blood thicken as she sees her river thick with salmon.
Some earth medicines carry strong currents of water-feeling within them. The songlines of the indigenous Australians described by Bruce Chatwin (1987) are streams of life that flow through the land, creating a web of meanings that the person must travel and sing along to be whole, and to participate in the continual rejuvenation of the earth. Traveling the lines and singing their stories transforms the earth into a coherent body of pulsing currents.
Water medicine evolves from our earliest sense of the world as an impersonal swirl of complementary, and at times antagonistic energies which collide and dovetail on the path to equilibrium. So too becomes our flesh. As we flow through the world, the world flows through us — in different textures depending upon where we are and our personal elemental biases, but with structure and sense, and not according to the whim of plant or animal spirits. Caprice melts into necessity, and the feeling of a system emerges, along with agency. A more autonomous self appears. The older earth way felt the sickened flesh to be possessed by local gods, animated from within to serve the needs of the land. As the currents of life are re-imagined according to naturalistic forces, the grip of divine possession loosens. Vayu, the old Vedic wind-god, who used to take up residence in the lungs, generalizes to prana and vata. Agni, the fire-god, who ruled the liver and spleen with force, now generalizes to the simplicity of a single candle flame at the solar plexus. Soma, the god of milk and nectar, who possessed the senses with sweetness and fullness, is now the mucoidal principle of phlegm. We are still possessed, but now by nature, and not by agencies we cannot understand or reason with. We are possessed by weather and sunlight and rain, and these we can study.
We begin to pay closer attention to the internal sensations of thickness, warmth, and movement. The clay, fire, and wind we’ve relied on for generations as external tools of stability, cooking, and diffusion are now seen as powers internal to the flesh. Water medicine makes its home in an internal space. The flesh is felt to be made and animated by, but to also contain an aqueous vitalism — prana, chi, dunameis (in Sanskrit, Chinese, and Greek) — which can intermingle in harmony, or overflow and rupture its boundaries towards death. With water medicine, this dualism of flesh as container and energy as the temporarily-contained emerges, just as Axial Age thinkers throughout the ancient world are beginning to codify the first speculative distinctions between “body” and “soul”. The English word “body” carries an etymological echo of this early framing of life-force as a contained liquid. “Body” comes down to us through the Old German word botahha, which means “tub” (Fields, 12), and carries the sound of “bottle”. The first “soul” or “essence” was liquid. Perhaps the idea first occurred to us simply, through the squeezing of fruits.
Water medicine softens our fetish upon our land while placing health and balance inside the wandering or cosmopolitan flesh. It is interoceptive, more homeostatic than earth medicine, more independent of the landscape, more portable, and now translatable between cultures. Internal space is palpated newly, and inner movements are metaphorized to rain and irrigation. Hippocrates suggests that phlegm resides gelid in the brain, and that a portion of illnesses emerge when it melts due to heating circumstances and descends to clog the channels of respiration and digestion. (Pitman, 176) Water medicine interiorizes visions of a broader ecology, visualizing the healthy flesh as a dialogue amongst boundaried zones – mountains, valleys, rivers, lakes – everything in its place.
The watery ethos constitutes the beginning of a medical theory that goes beyond earth-story to focus on a sense of subjective feeling and internal travel: a story of flows and confluences, waves and eddies, channels and dykes, foam and silt. Therapy develops to enhance or subdue the currents. Massage eases liquid vitalities along dried pathways, pressure points open dykes – ideally gently – and herbs accelerate or quiet the flowing of saliva, mucous, blood, urine, stool, menses. Patients are encouraged to vomit and purge liquid impurities, or to cleanse themselves by letting blood. In a parallel path, martial techniques develop that disrupt or release fluid vitality in catastrophic ways. Warriors memorize the weakest points of the circulatory web to attack them with blows or blades that cause mortal spillage.
The inner liquids of life are assigned various temperatures, savours, and actions. Some cool, sweeten, and congeal, while others heat, spice, and acidify. Some waters build and others pucker and strip away. The tastes are sweet, acrid, insipid, sour, salty, bitter, bilious, briny, pungent, sulphuric, astringent. Health is invoked through principles of balance, blending, and homogeneity. Cooking becomes a central metaphor, alongside themes of irrigation. The enemy of health is the isolated fluid or taste that wicks, spreads, or pools its influence into inappropriate channels. Fluids that trickle are enriched, while fluids that coarse rapidly are given narrower channels. Balance hearkens back to the resting continuity of the sea.
With its goal of harmonious blending, water medicine predicts the primary drive of the psychotherapeutics that would emerge two millennia later: all things must be integrated. Memories are to integrate with present realities, old selves with new, private selves with public, shadows with light, and unconscious with conscious knowledge. Water medicine is inclusionary. The most watery of psychotherapies – Gestalt – employs metaphors of digestion and circulation towards the integration of hidden selves.
Further, the fluids of vitality, whether characterized as breath or blood or nectar or light, are at once universalized — discoverable in anyone — but also as personalized as a family recipe for soup. Constitution emerges as a framework for explaining how we all share the same ingredients, and yet express an infinite variety of taste-blends through our personhood. In India, the masala — the “mixture” — emerges as the staple of the family kitchen. Dozens of spices in distinct ratios are roasted and ground according to closely-guarded recipes thought to enhance a family’s unique gifts and vitality. A family’s masala carries the keys of its pleasure, fertility, and adaptability. It can be taken in a jar to foreign lands to normalize novel foods into its balanced aromas. Water medicine mirrors the body now free to travel overland: its unique essence can be bottled.
In its concentration on tastes and sensations, the medical imagination under the thrall of water begins to dream of what it cannot see, a skill that will drive all medical research, even to the present day. The masterworks of Ayurveda, Traditional Chinese Medicine, and the Hippocratics are codified by 400 of the common era. But as it dreams the unseen, medicine also reaches for new ways of seeing. Aqueous theories of energetic flow depend upon an invisible but felt internal flesh, and they last for as long as flesh remains closed to the eye. In the west, water medicine dries up under the blaze of surgery lamps. The vitalities it carried will vanish into medical myth, and suppressed interoceptions.
In 1533, Andreas Vesalius, then 19 years old, arrived in Paris to learn anatomy and physiology as inherited from the Hippocratic master Galen (AD 129-200 approx), whose theories of fluid vitalities still ruled the medicine of the day. Vesalius saw that his instructors were using the ancient drawings of pigs and monkeys that had served anatomy classes for over a millennium, and found that the internal flesh was treated with a kind of prim disregard. Siddhartha Mukherjee in his chapter “Vanishing Humours” (2010) quotes a letter from Vesalius: “Aside from the eight muscles of the abdomen, badly mangled and in the wrong order, no one had ever shown a muscle to me, nor any bone, much less the succession of nerves, veins, and arteries.” So the young surgeon undertook to elevate dissection to an art, spending a decade collecting corpses from execution grounds and alleyways, meticulously separating the finest layers of tissue from each other and drawing everything he saw. He had set out to prove the genius of Galen, but found through his labour that the vital fluids where nowhere in the tissues. Nor were the channels Galen described anywhere to be found. Vesalius deconstructed Galen with the simplest use of quill and ink. The interoceptive medicine of water began its slow evaporation as the first print run of his book De Humani Corporis Fabrica sold out. Anatomical precision in India was stymied by religious taboo until Madhusudan Gupta performed the first dissection of a corpse in Calcutta on January 10th of 1836, cheered into the dryness of modernity by his British sponsors. The dissection taboo is one of the main reasons that Ayurveda enjoyed a longer life than Galen’s medicine, and why it stands today as a rich and continuous lexicon for the poetry of being alive, getting sick, recovering, strengthening, and pouring forth fertility.
The new surgical epistemology was visual. What was real was what could be seen. But it could be seen only if exposed, and exposed only if dead, or in the critical trauma that was early surgery. So begins the medicine of fire, a masculine and frantic enterprise, turning the flesh inside out to surrender an overdetermined — i.e., lifeless — truth. (Foucault) Surgery tries to make the internal body a surface of exteroception. An internal feeling would now remain nameless and meaningless, until it was denuded and devitalized by the blade. This reified the split between “body” and “soul” that water medicines had only hinted at in their metaphors of pooling, channels, and pitchers.
Galen’s poetry of the flesh withdrew into poetry on the page: the interoceptive was no longer under the purview of science, and philosophers were doctors no longer. The split between physics and metaphysics hardened. In the west, subjectivity and interiority retreated to the humanities as categories for study, where a sense of the invisible-but-felt remained – most obviously in the natural world, according to the Romantics. In 1798, Wordsworth writes: “Sweet is the lore which Nature brings; / Our meddling intellect / Mis-shapes the beauteous forms of things : — / We murder to dissect.” Had he been clearer that his enemy was partly visual epistemology, his third line might have read “Neglects the sensuous touch of things.” The cleft between visually-oriented medicine and the now-nameless interoceptive world contains the seed of the earliest air medicine: the talking cure, whose primary medium is breath, and speech, and, prior to Freud, is conveyed through oral poetry.
Fire medicine burns ever hotter down through the ages. Surgeries become more radical. Cautery and acids seal the hot wounds. In the 1880s, Marie and Pierre Curie dredged a primal fire from the earth itself, using water as a solvent: “from several tons of pitchblende, four hundred tons of washing water, and hundreds of buckets of distilled sludge waste”, they rendered one-tenth of a gram of an element that burned “with such feverish intensity that it glowered with a hypnotic blue light in the dark, consuming itself.” Marie Curie named the element radium, Greek for “light”. Radiation therapy was born — a silent, searing heat that attacked and burned the DNA of cancer cells, and every other cell it illuminated. Alongside the external fire of radiation, new forms of internal fire were being blended by the first oncologists. Chemotherapy hearkened back to water medicine in method, if not elemental texture or temperature: as a systemic approach, it flooded the tissues with liquid flame.
We see medicine specialize as our scopes of attention narrow. The ornate systems of flesh-channels for liquid vitalities require specialized and coordinated training above and beyond the osmotic learning of the local herbs. The fiery precision of surgery and radiation add critical layers of focus and years of hands-on training, and its visual epistemology drapes the site of the incision away from the rest of the person. As medicine shifts paradigms from earth to water to fire, specialization intensifies, diseases are framed more tightly, the flesh shrinks into objectified parts, the zones of personhood are further splintered into the structural, biochemical, kinesiological, and and dietetic, and interventions become more aggressive and directed at later and later stages of etiology.
Earth treats in stillness, and only if you go to it. Water treats in transit, slowly, in widening rings of absorption. Fire treats quickly from a single centre of cutting or ignition. Fire is employed in acute circumstances with acute results.
On the medieval tail-end of the water-medicine era, Ayurvedic physicians tried to incorporate the speed and devastation of fire into their medications by incinerating metals including arsenic, lead, and mercury into ash over days and days in underground kilns, and then infusing the resulting powders into liquid carriers. Vaidyas offered these alchemical bhasmas, born of earth and fire and delivered through water, as panaceas for instantaneous healing from fatal diseases, as though they foresaw their growing irrelevance in the coming age of surgery and rational biochemistry. The bhasmas always failed their magical promise, and today their vestiges, packaged in poorly-labeled plastic bottles and distributed through the alt-health global economy, cause heavy-metal poisoning in those who long for “ancient” cures. Water medicine loses itself when it tries to compete with fire medicine.
I believe we’re in the last chapter of the fire-medicine story. Treatments have cooled down. Radical, scorched-earth, surgeries – such as the double radical mastectomies innovated by William Halsted in the 1880s, are virtually unknown today. Objectifying an etiology to a specific disease site is now known to fail: imbalances always seep around boundaries. Radiation and chemical therapies have become more subtle and targeted, are applied in series, and have an almost tidal rhythm. New insights into the auto-immune nature of many inflammatory disorders have encouraged research into alkalizing treatments, and, more radically, corticosteroid treatments that actually suppress the over-reactive fire of the stressed and self-isolated immune system.
As fire medicine cools, air medicine emerges: through the subtleties of homeopathy, the headiness of genetic studies or epidemiology, and in the relationships we can now posit between cognitive behavioural therapy or mindfulness practices and decreased cortisol levels, and increased vagal tone. Air medicine thinks, reflects, imagines. It amasses data and dreams of genetically modifying disease factors. It is interested in psychoneuroimmunology, and suspicious of the old hard dualisms. Air medicine blows where it wills with interdisciplinary excitement. Researchers at the Mayo Clinic can now take yoga classes on their lunch breaks.
In the natural history of yoga and Ayurveda, space element is the connective principle by which all other elements find their position and function. I think this is the medicine we truly want. We have largely forgotten the former paradigms, but we still feel them in our bones. Our earth medicine comes to us now through our farmer’s markets and the herbalists who know the local terrain. Our water medicine comes to us through massage and acupuncture and hydrotherapy and daily routine exercises and constitutional counseling. Our fire medicine intervenes in acute situations, pouring fury upon fury. Our air medicine tabulates and hypothesizes, and suggests expansive, multi-layered approaches. In an ideal cultural history, an earlier medicine would never be rejected outright as a new paradigm takes hold, for fear of psychic rupturing. However our epistemology shifts, we keep the older forms, hidden in the same way we retain our own previous ages: my toddler squatting in the earth, my ten year-old swimming in the lake, my teenager setting his first vulnerable fires in the world, my middle-aged man, combining these ages as I breathe in the morning air.
It’s important for those of us interested in Ayurveda to understand its place in medical history, and to stop trying to shoehorn into our zeitgeist, as though it could replace everything that followed it. Its Iron Age embodied poetry is beautiful and integrating to us, but severely limited in the functionality we have come to expect from biomedicine. It does not understand biochemistry. It did not have an accurate view of the internal organs until 120 years ago. It did not admit of the germ theory of disease. It did not conjure vaccinations, or antibiotics. It could not safely amputate a gangrenous limb. It could not have saved the lives of my partner and child while they struggled through obstructed labour. The worldview and practice of Ayurveda has not contributed any significant medical advancement in human culture since its cannon of texts was formalized around the ninth century, although the echoes of water medicine generally have largely inspired whatever bias towards holism and integration biomedicine wants to conceal.
But these limitations, if accepted honestly by practitioners, are actually great strengths. We should be happy that Ayurveda has not substantially advanced since the late Axial period. It is precisely because of its technological and research stagnation that it can remember for us who we were before our empirical-rational sciences obscured and objectified the interoceptive, subjective flesh. Ayurveda softens the medical gaze by remembering an age in which we listened to our own circulation, and felt-into our own waves of cohesion, heat, and movement. Ayurveda is valuable today – perhaps even essential to a disembodied species – insofar as it reawakens an internal physician of sensations, alert to the waves of heaviness, inflammation, and scatteredness that are predictive of illness. Ayurveda provides the hands and the hearing of a poet, blind from birth.
When I practice Ayurveda, I often feel myself standing at the threshold between childhood and adulthood. Around eleven or twelve years old. The earth and water of childhood have given me support and nourishment and wonder at life. There is a cognitive faculty that is just beginning to ignite. Water is about to give way to fire. Pleasure is about to give way to analysis. Abiding is about to give way to doing, and magic is giving way to the empirical-rational. I’m connected enough to the right-brain of childhood to feel what the client is feeling directly. I can feel the left-brain fire beginning to discern and determine – but it’s unformed. In the transition from water medicine to fire medicine, we lost something similar to what we lose crossing the threshold of adolescence, into a sharper, narrower, brighter kind of knowledge. Ayurveda reanimates a rich shadow. It pours into a jagged gap.
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