Wednesday, December 21, 2011

100 A.D.: Asthma in Ancient India

If you lived in India prior to the time of Jesus chances are asthma would not be recognized as anything specific.  The condition was probably caused because the person was in some way immoral or impure, and the disease was treated by incantations, hymns, prayers or charms (1)

Their religion is Hindu, and they called their homeland "Aryavarta," which means "Homeland of Aryan."  They refer to Aryan by its original use, which is to "designate the Hindoos."   As early as 3,000 years before Christ they were familiar with astronomical science, fixing calendars, predicting eclipses, stages of moon, motions of planets, mathematics, decimal system, geometry, trigonometry, chemistry, music, architecture, law, philosophy and medicine.  (7, page 14)

They believe in a creator, and "the Veda is supposed to be His revealed knowledge.  If knowledge could be created, instruction, they argue, would, as a rule, be futile.  From time immemorial it is being handed down from father to son, from preceptor to disciple."    (7, page 18)

They had no system of writing, so many of their discoveries were made without due credit.  Many of these discoveries were made long before people in the west were given credit for the same discoveries.

For example, Mathematics, including the Pythagorean Theorem, was invented in India long before Pythagoras (500 B.C). Yet Pythagoras is given credit because he introduced the theorem to western civilization.  The phases of the moon and motions of the planets were understood long before Ptolemy was given credit.  They were philosophical long before the Greeks, and they may even have understood medicine long before the Egyptians.  Even the Veda is believed to be over 4,000 years old. (7, page 14)

The science of medicine is part of the veda, and is referred to as Ayur Veda" or Ayurveda, which means the "science of life."   They believed medical knowledge was revealed to them by their creator, (7, page 2324)

Similar to the Hippocratic humoral theory, the Indians believed disease was the result of an imbalance of the three humors: vata (wind), pitta (bile) and kafa (phlegm).  Health was maintained when these were in balance.  They all "fill the whole body which they support," yet all have a principle seat: (7, page 85)
  • Vata:  Between the feet and umbilicus
  • Pitta:  Between the umbilicus and the heart
  • Kafa:  Between the heart and vertex
Movement is controlled by the vata, and there are five kinds: udana, prana, samana, apana, and vyana.  The one we are interested in is the prana, which is "situated in the chest and passes through the mouth and nose, and is the means of respiration and performing deglutition (swallowing).  When it is deranged it produces hiccough, asthma, etc." (7, page 87)

Diagnosis was made based on this humoral theory, and so too was the chosen treatment.  Historians believe this system was in place "for ages" before Hippocrates created his humoral theory of medicine, and that he borrowed from this Hindoo system of medicine.  (7, page 99)

The first writings in Ancient India were religious in nature, and some provide us with our first glimpse into the medical knowledge of that era.  One such text is the Regveda, written around 1200 B.C, which lists over 731 incantations, hymns, prayers and charms to "protect people against enemies, witchcraft, lightning, worms, and all kinds of disease, or to provide for them welfare and long life, freedom from fear, recovery of virility, the love of a girl, a husband, fecundity, successful pregnancy, a male child, relief from insanity and other diseases, or even to take care of such trivial matters as 'to fasten and increase the hair.'" (1)

The first Indian medical texts are the Charaka, Susruta and Vagbhata, although historians have trouble pinning them to any specific date.  The writings are ancient, perhaps the same prose once relayed from father to son, and some say they are the Ancient Indian version of the Hippocratic writings.  (1)  Since they provide no insight into our disease (asthma), it's hard to tell what life would be like for the asthmatic in this era.

However, in all probability, if you lived with asthma in India during the first century A.D. your illness would be recognized by physicians, who -- if you had access to them -- would prescribe a variety teas and inhalants to ease your suffering.

The Caraka Samhita is a a two volume medical book compiled by Caraka, physician to the King Kanishka in Sanskrit around the first century A.D.  The book is full of descriptions of diseases and remedies supposedly from the Hindu god Brahma to the Vedic sage Atreya.  (2)

Indian mixing a remedy from the Caraka Samhita (a)
It provides a description of Tamaka Swasa, with swasa meaning breathlessness.  It's a condition that closely resembles our modern description of asthma such as wheezing, shortness of breath, increased phlegm and coughing (kawa).  When severe it may result in sweating, trouble lying down and trouble speaking.  (3)

Tamaka Swasa is believed to be caused by cooling of the body that results in an imbalance of the bodily humors that ultimately results in excessive phlegm that blocks the air passages.  (4)

The condition was believed to be aggravated by cooler or humid environments. Cold foods, such as milk, were believed to increase phlegm, which may contribute to worsening asthma. Certain hot foods could also aggravate it. (2, page 44)

Yet if needed, the recommended treatment mainly consisted of methods to balance the humors and warm the body, and might have included: (5)
  • Steam
  • Inhaled Cinnamon
  • Castor bean oil
  • An insect resin
  • Tumeric
  • Arsenics
  • Inhaling stramonium (or belladona) 
  • Herbal ointments  
Other remedies may include:
  • Camels milk (7, page 130)
  • Leaves of Camellia sinensis served as a tea
  • Adhatoda visaca (expectorant)
  • Camellia Sinensis (bronchodilator)
Datura and stramonium would have given the asthmatic some relief from an attack. It was dried, crushed, stuffed into pipes, and the smoke was inhaled.  This remedy was introduced to the modern world in the early 19th century and became a popular asthma remedy mainly in the form of asthma cigarettes.

In 1888 the mild bronchodilator theophylline was derived from the Camellia Sinensis.  Theophylline was proven to benefit asthma in the 1950s and became a top line asthma remedy in the 1970s and 80s.

Adhotoda visaca is a shrub that stinks so bad goats won't go near it, hence the name was derived from the term for goat, adu.  The leaves, roots or flowers of the plant were fixed in various forms and used to improve a cough and help with phlegm expectoration.  It therefore was used to help remove excessive phlegm from the body to balance the humors. (6)

According to globalherbalsupplies.com adhotoda visaca continues to be recommended by some as an alternative, a natural, antispasmotic, bronchodilator and expectorant.  The leaves may be dried, crushed and smoked in pipes to relieve asthma symptoms. (7)

Mark Jackson, in his article "'Divine Stramonium': The Rise and Fall of Smoking for Asthma," explains that inhaling the smoke of various herbs for their hallucinogenic and therapeutic effects was common in India.  He writes: (8, page 174)
As P Ram Manohar has suggested, within the Indian context exposure to smoke incorporated a variety of practices and purposes: homa, a religious fire offering intended to improve the general environment; dhupa , a form of fumigation carried out to protect people from both cold and demons; and dhuma, the predominantly therapeutic inhalation of smoke from a pipe, recommended by traditional ayurvedic practitioners. Although smoking was known occasionally to trigger respiratory distress, inhaling smoke from herbal mixtures through a pipe was advocated for the treatment of asthma and coughs, along with a variety of other respiratory conditions. (9)
Such remedies made their way to America and Europe early in the 19th century and were quickly incorporated as remedies for respiratory ailments such as asthma.  As we continue our asthma history, we will find many asthma physicians in the 19th century recommending to asthmatics that they inhale the smoke of various burned herbal preparations, either by stuffing them in pipes, rolling them as cigarettes, or simply by igniting them on paper and inhaling the smoke through a funnel made of paper or a magazine.

Jackson also describes an inhaler of sorts that was used by ancient Greek physicians that consisted of a small pot with a hole in the lid into which a reed stick was inserted.  Various medical preparations, including herbal remedies and resinous gums, were inserted into the solutions placed in the pot, which were then heated over a stove or fire, and the steam of which was inhaled to provide breathing relief.  (8, page 174)

The medicine may also be taken in by linctus or syrup.  (8, page 174) As the Greeks migrated around the world, they must have been introduced to such remedies from the Indians, thus introducing them to Greek medicine.  I'm speculating here, although such speculations are necessary when there is not accurate knowledge of when and how such remedies were introduced. The true inventors of such therapy may never be known.

Jackson believes that the Indians, including most ancient civilizations, believed asthma-like ailments to be caused by "cold, moist constitutions: it was for this reason that asthma was often considered to be more common in children and women.  Within this conceptual framework, the inhalation of smoke or fumes was intended to relieve the obstruction by heating and drying the phlegm and aiding expectoration." Such tradition continued through ancient Greece, ancient Rome, and through the Middle Ages. (8, page 174-175)

Despite these natural remedies in ancient India, the most common or preferred medical treatment was usually an improved lifestyle. Ayurvic advice included an improved diet, adequate sleep, rest, exercise and massage to ease the mind.  It was believed relaxation and improved social and living conditions enhanced the healing process.

Ayurvic medicine is a philosophy of medicine that has continued to modern times in India and Sri Lanka, although with many advances.  Many of the treatments recommended, particularly yoga, are still considered to be an alternative therapy for treating asthma to this day.

Click here for more asthma history.

References:
  1. Sigerist, Henry Ernest, "History of Medicine," volume II, "Early Greek, Hindu, and Persian Medicine," 1961, Oxford University Press, page 151, 179, 182
  2. Jackson, Mark, "Asthma: The Biography," 2009, New York, page 44
  3. Brenner, Barry E, "Emergency Medicine," 1999, page 2
  4. Hahn, Mark, Marcia C. Inhorn, "Anthropology and public health:  Bridging differences in culture and society," 2009, New York, page 80
  5. Brenner Barry E, op. cit., page 2
  6. Premila, M.S., "Ayurvic Herbs," 2006, page 86
  7. Jee, Bhagvat Sinh, "A short history of Aryan medical science," 1896, London, MacMillan and Co.
  8. Jackson, Mark, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma," Medical History, 2010, 54: 171-194
  9. Jackson, "'Divine Stramonium,'" ibid, page 173, referenced from: P Ram Manohar, ‘Smoking and Ayurvedic medicine in India’, in Sander L Gilman and Zhou Xun (eds), Smoke: a global history of smoking, London, Reaktion Books, 2004, pp. 68–75
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