1200-1600: Asthma in ancient Korea

If you were an asthmatic living in Ancient Korea you would have had to wait until the 13th century before you had any options available to you other than folk medicine.  

Folk medicine was basic philosophies and treatments of various disease processes handed down from generation to generation to anyone interested in learning them.  Remedies usually consisted of simple things such as concocting herbal remedies, applying ointments, drinking teas, or soothing massages.  (1)

It was around the 12th and 13th centuries when medical philosophies of Traditional Chinese Medicine started to influence Korean physicians, which were recorded in various Chinese texts.  Yet the first medical texts in Korea simply consisted of compilations of folk medicine, which up to this time was passed on only by word of mouth

It was in 1236 that all the folk medicine of the day was compiled into one treaties called "Hyang-yak kugup  pang" or "Emergency Remedies of Folk Medicine."  It's the oldest medical texts written by a Korean. (2)

At about the same time several other such treaties were compiled, including "Samhwaja hyangyak pang," or "Folk Remedies of Samhwaja."This was mainly a diagnostic guide.  (3)

All the medical wisdom from these books were compiled in 1433 into "Hyangyak chipsong pang," or "Compilations of Native Korean Prescriptions."  (4) Two centuries later, in 1610,  Korean philosopher Ho Chun compiled all the medical wisdom up to his time in "Tongui pogam," or "Exemplar of Korean Medicine."  (5)

Mark Jackson, in his book "On Asthma:  The Biography," explains that Korean physicians believed asthma-like symptoms or coughing were caused by excessive eating, fear and shock.  While folk medicine was the original treatment for any ailment, various remedies from Chinese medical texts worked their way into Korean medicine. (6)

While Traditional Chinese Medicine influenced Korean medicine, Korean texts were likewise respected in China.  It wasn't until the 18th century that Eastern and Western civilizations shared medical wisdom.  

Click here for more asthma history.

References:

1. WebMD,  http://dictionary.webmd.com/terms/folk-medicine
2. Lee, Ki-baik, "A New History of Korea," 1984, Korea, page 171
3. Lee, ibid, page 171
4. Lee, ibid, page 171
5. Jackson, Mark, "Asthma: The Biography," 2006, New York, page 43
6. Jackson, ibid, page page 43

500 A.D. Asthma in Ancient Japan

Fuiwara no teika ( (1162-1241)

If you lived with asthma in ancient Korea and Japan your asthma may have been recognized, yet treatment would have been mainly supportive.  It wasn't until the 6th century A.D. that Chinese medical ideals -- mainly in the form of the Nei Ching -- spread to these nations.

Chinese medicine was referred to as canpo in Japan, and asthma-like symptoms were referred to as zensoku as early as 700 A.D.  (1)

The most famous asthmatic in Ancient Japan was Fujiwara no Teika who is considered one of the most famous poets in Japanese history.  Legend has it that his poems became well read due to his cordial relationship with the Emporor Go-Toba (1180-1239).

Japanese children learned early that there were 404 different kinds of illnesses, and they learned of the various herbal formulas used as remedies, most of them indigenous to the region.  One interesting remedy for asthma was by eating a potion containing earthworms dried under the sun, cooled and then boiled.

Most asthma remedies were similar to what was recommended by Traditional Chinese Medicine.  So prior to the 6th century Japanese asthmatics would have been recognized although there wasn't much anyone could do other than offer support.

Yet if you were afflicted with breathing difficulties in the 6th century you would have had available to you many of the same treatments available to Chinese asthmatics, including Ma Huang, a very efficient bronchodilator.

Click here for more asthma history.

References:

1. Jackson, Mark, "Asthma: A biography," 2006, New York, page...

25 BC-50 AD: Celcus spearheads quest to define asthma

So what would life be like for the asthmatic when Jesus and Caesar walked the earth? From my investigations into this era I'd imagine the best remedy might simply be to tough it out, as many of the recommended remedies seem like they'd be worse than the disease. Of course this was true of most medicine prior to the 20th century.

Aurelius Cornelius Celsus was a voluminous writer. While

most of his works have been lost to history, his medical treaties

became one of the most read books during the Renaissance.

The second century A.D. was a very "fruitful era of literature and philosophy." (1, pages xxi, xxii) It is for this reason we have resources available to help us learn what was known about asthma at that time and the remedies to treat it. Among those influential to medicine in this era are Pliny the Elder, Seneca the Younger and Aurelius Cornelius Celsus.

The contributions of Pliney and Seneca will be expounded upon in a separate post. In this post I will shine the light on Celsus.
Although, we must be sure we are shining the light on the right Celsus, for this name was among the most popular of that time. The name Celsus in 2nd century Rome was akin to names like Bob or John in 21st century Europe or the United States of America. (5, pages 32-33)

Our Celsus can be seen as we enter the courtyard of one of the homes, reclining back comfortably on a couch with the tablets set firmly upon his knee. With a pen he writes about asthma today, a symptom he learned about during his philosophic studies. (5, pages 32-33)

Already in his repertoire were treaties on philosophy, architecture, rhetoric, agriculture and war. He also wrote a book called "The True Word," in which he attacked Christianity, the newest philosophy of his era.

Yet all those treaties would eventually be lost to history. The only remaining treaties that we have of his is his Treaties Medicina, of which he wrote about medicine and surgery. The first eight books were on medicine, the first four of which treated internal diseases with diet and regimen. The fifth and sixth dealt with pharmacology, or the drugs used to treat diseases. The seventh and eighth dealt with surgery. (5, page 32-33)(3, page 74)

He was born Aurelius Cornelius Celsus in 25 A.D. to respectable parents in Greece. He was a stoic, meaning he did not believe in an after life. He was also well learned, meaning that he was educated in all the knowledge of the day. His specialty became pharmaceutics, medicine, surgery, war, and architecture, all of which he, as noted above, wrote voluminously about.

His writings were later described as "diligent" and "attentive." (2, pages 425-5) Yet while some say that his skills as a surgeon were "second to none," (1, page xvii) others suspect he may not have practiced what he preached, that he was neither a physician nor a surgeon. (2, pages 425-5)

He rose above his peers by paying attention to all aspects of medicine, rather than just one. For instance, prior to his time medicine was divided into three parts: (9, page 33)

• Dietetic: Curing by diet
• Pharmaceutic:  Curing by medicine
• Chirurgic: Curing by manual operations (knife, cupping, etc.)(5, page 33)

Celsus became the first to preach the importance of all three. (5, page 33)
Perhaps it was for these reason that his medical writings were "ignored by Roman practitioners of his day, and his name is mentioned only four times by the medieval commentators," said medical historian Fielding Hudson Garrison in the 1913 edition of his book "An introduction to the history of medicine." (3, page 74)

Not until 1478 would he get his revenge. In this year his book, De Re Medicina, would become the first medical treaties printed on the Gutenberg Printing Press. The treaties would then pass " through more separate editions than almost any other scientific treaties," said Garrison (3, page 74)
This was partly due to the fact it was a medical treaties, but more due to the fact of the way it was written. "It was due largely to the purity and precision of his literary style, his elegant Latinity assured him the title of 'Cicero medicorum,'" said Garrison. (3, page 74)

Medical historian Thomas Lindsley Bradford, in his 1898 book “Quiz questions on the history of medicine said that his medical treaties was a "test of Latin scholarship, and of a liberal education, for if the student was familiar with Celsus he received the purest Latin of the Augustinian Age." (5, page 33)

Along with his writings on medicine and surgery, he also described the history of medicine, giving descriptions of over 72 medical authors, although all have been lost except for the works of Hippocrates. He likewise provides us with the most precise account of medicine at the time of Jesus, describing both the Dogmatic and the Empiric Schools of medicine. (3, page 74)(5, page 33)

Celsus defended the idea that anatomy was important in medicine, so he was definitely not an Empiric, who, as we will learn later, did not support the notion that anatomy was important to medicine. Despite this, "his knowledge of anatomy was somewhat superficial." (5, page 33)

Regardless of how he was perceived in the past, Celsus remains an important figure in our history of asthma. It is thanks to him that we learn what physicians knew about asthma during the time of Jesus.

As a medical writer Celsus emulated Hippocrates, and parts of his books are word per word transcriptions from the "Hippocratic Corpus."  In fact, Celsus did this so often that one later author, Nicholas Mondaris, referred to him as the "Ape of Hippocrates." (1, pages 259-61)

The Treaties on Medicine written by Celsus would become the first
medical treaties printed on the Gutenberg Printing Press.
 It would go on to pass through more editions than
any other scientific treaties.  

Yet he incorporated into his treaties the latest wisdom of his day, plus some of his own ideas.  This is clearly evident in his writings on asthma.

When asthma was first defined by Hippocrates in 400 B.C., it was often difficult to distinguish between the causes of dyspnea, and therefore they were grouped under the umbrella term asthma. Thus, all that caused dyspnea were referred to as asthma.

Celsus, on the other hand, believed asthma was more than just dyspnea, and for this reason he provided us with our first description of asthma as more than simply a blanket term.

Celsus wrote the following:

Est etiam circa fauces malum, quod apud Gracos aliud aliudque nomen habet. Orane in difflcultate spirandi consistit; sed haec dum modica est, neque ex toto strangulat, appellator. Cum vehementior est, ut spirare aeger sine sono et anhelatione non possit; cum accessit id quoque, ne nisi recta cervice spiritus trahatur. (4, page 10)

By the above, which is taken from John Charles Thorowgood 1890 book "Asthma and Chronic Bronchitis," we learn that Celsus believed there were three thoracic disorders that resulted in difficulty of breathing, and they varied by their "degree of violence":

1. Dyspnea:  Moderate, unsuffocative breathing without a wheeze; it's chronic
2. Asthma:  Vehement breathing that is sonorous and wheezing; it's acute
3. Orthopnea:  Breathing only takes place in an erect position; it's acute (1, pages 259-61) (4, page 10)

By the order above, Celsus implies that asthma is the "mean" level of difficulty of breathing, with dyspnea being less severe than asthma, and orthopnea being more severe than asthma. (4, page 10)

He was also the first to describe asthma as a specific condition involving constriction of the air passages in the lungs, and he was likewise the first to describe a wheeze. He described an attack of asthma this way:

The symptoms common to these are, that on account of the constriction of the respiratory passage, the breath is emitted with a sibilous noise (whistle or wheeze), there is pain in the chest and precordia (over the heart), sometimes also in the shoulder; and that sometimes departs, sometimes returns; in addition to these a slight cough accedes. (1, pages 260)

His remedy for asthma included any of the following:

1. Blood letting (common remedy for just about any ailment)
2. Milk (to relax the bowels)
3. Purging of the bowels with enemas (clysters) or injections if necessary
4. Hydromel (honey diluted in water
5. Head must be kept high in bed
6. Thorax relieved by fomentations (warm, moist medicincal compress)
7. Thorax relieved by hot cataplasms (a heated medical dressing, either dry or moist)
8. Malagma (lotion or salve) or iris ointment after fomentations and cataplasms (these act as emollients to soften skin to make chest movements easier)
9. Hydromel as a drink (mixture of water and honey)
10. Bruised root of capers has been boiled
11. Nitre or white cresses fried, bruised, then mixed up with honey and given as electuary (oral, by mouth)
12. Honey, galbanum, and turpentine resin boiled together and, when they are coalesced to the size of a bean, dissolved under the tongue daily
13. Impure sulfur or southernwood triturated together in a glass of wine and sipped warm
14. Fox's liver dried, hardened and pounded into a powder and sprinkled on a drink (such as wine)
15. Eating the fresh, roasted lungs of a fox (but you can't cook it with iron utensils)
16. Gruels (watery porridge) and mild food
17. Light austere wine
18. Sometimes a vomit (Emetics)
19. Anything that promotes urine (diuretics make you pee, but they probably believed they were full of poisons that caused the humors to be imbalanced)
20. Gentle walking (nothing more) 
21. Massage (he referred to it as friction; it's done to move poisons around the body to balance the humors and to make breathing easier) (1, pages 259-61)

While some of these were later proven to have medical significance, most were simply palliative, and some were downright barbaric.  Still, his ideas were studied and followed for many years after his death.

We asthmatics should be thankful to Celsus for spearheading -- although he didn't know it at the time -- a 3,000 year effort to define asthma as a disease of its own. You can decide for yourself if you'd have been satisfied with his remedies for your asthma,  or if you would rather have just stayed home and suffered.

References:

1. Celsus, Aurelius Cornelius, "De Medicina," translated by L. Targa, London, pages xiiv-xxiii, "The Life of Cornelius Aurelius Celsus," by J. Rhodius and translated from Almeloveen's Lugduni Batavorum
2. Parr, Bartholomew Par, M.D., "The London Medical Dictionary," 1809, London, Vol. 1, pages 425-5 
3. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
4. Thorowgood, John C., "Asthma and Chronic Bronchitis: A New Edition of Notes on Asthma and Bronchial Asthma," 1894, London, Bailliere, Tyndall, & Cox
5. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

62 B.C.: Seneca the asthma philosopherx

"What in fact makes people who are morally unenlightened by the experience of physical distress is their failure to acquire the habit of contentment with the spirit.  They have instead been preoccupied by the body.. so do not go out of your way to make your troubles any more tiresome than they are and burden yourself with fretting."  Seneca

Like the writings of Pliney the Elder, Seneca's writings became well read, and Seneca became one of the most well known philosophers.  In one of his letters to Lucilius, a friend and correspondent of Seneca's, Seneca provided a description of asthma, although he doesn't use the term asthma.

 Sculpture of Seneca by Puerta de Almodóvar in Córdoba, Spain

From his 54th letter to his friend Lucius (who also had asthma and catarrh), we get Seneca's description of asthma from "On Asthma and Death" as translated by Richard M. Gummere:

My ill health had allowed me a long furlough, when suddenly it resumed the attack.  "what kind of ill-health?" you say.  And you surely have a right to ask; for it is true that no kind is unknown to me.  But I have been consigned, so to speak, to one special ailment.  I do not know why I should call it by its Greek name; for it is well enough described as "shortness of breath."  It's attack is of very brief duration, like that of a squall at sea; it usually ends within an hour.  Who indeed could breathe his last for long?  I have passed through all the ills and dangers of the flesh; but nothing seems to me more troublesome than this.  And naturally so; for anything else may be called illness; but this is a sort of continued 'last gasp.'  Hence physicians call it 'practising how to die."  For some day the breath will succeed in doing what it has so often essayed (breath will succeed in doing what it is supposed to do). 

In letter 65 he wrote about his and his friend Lucius's catarrh*:

"I am all the more sorry to hear about your constant catarrh, and the spells of feverishness that go with it when it becomes protracted to the point of being chronic, because this kind of ill health is something I have experienced myself.  In its early stages I refused to let it bother me, being still young enough to adapt a defiant attitude to sickness and put up with hardships, but eventually I succumbed to it altogether.  Reduced to a state of complete emaciation, I had arrived at a point where the catahhral discharges were virtually carrying me away with them altogether.  On many an occasion I felt the urge to cut my life short there and then, and was only held back by the thoughts of my father who had been the kindest of fathers to me and was then in his old age.  Having in mind now how bravely I was capable of bearing the loss, I commanded myself to live.  There are times when even to live an act of bravery."

This was probably saying a lot back then, because I can imagine living in a state of shortness of breath.  And I can imagine this coupled with the misery of allergies on top of that.

Yet I cannot imagine what those two ailments would be like when there was no cure and no remedy that really provided any relief.  It must have been pure hell to live like that.  I can understand how he might be compelled to think about just ending the misery right "there and then."

Yet life is special, and there are few who get to enjoy this special gift.  Seneca realized this.  He used his father to provide himself the courage to go on. 

In letter 65 he described to his friend Lucius and what he did to survive the attacks of asthma and catarrh*. 

"Let me tell you the things that provided me consolation in those days, telling you to begin with that the thoughts which brought me this peace of mind had all the effects of medical treatment.  Comforting thoughts contribute to a person's cure; anything which raises his spirit benefits him physically as well.  It was my Stoic studies that really saved me.  For the fact I was able to leave my bed and was restored to health I give the credit to philosophy.  I owe her -- and it is the least of my obligations to her -- my life.  But my friends also made a considerable contribution to my health.  I found a great deal of relief in their cheering remarks, in the hours they spent at my bedside and in their conversations with me.  There is nothing, my good Lucius, quite like the devotion of one's friends for supporting one in illness and restoring one to health, and for dispelling one's anticipation of dread and death.  I even came to feel that I could not really die when these were the people I would leave surviving me, or perhaps I should say I came to think I would continue to live because of them, if not among them; for it seemed to me that in death I would not be passing on my spirit to them.  These things gave me the willingness to help my own recovery and endure all the pain.  It is quite pathetic, after all, if one has put the will to die behind one, to be without the will to life.

Another remedy he later adds "is to turn your mind to other thoughts and in that way get away from your suffering.  Call to mind things which you have done that have been upright and courteous; run over in your mind the finest parts that have been played.  And cast your memory over the things you have most admired."

No potions.  No magic.  No herbs.  Seneca might have been one of the first asthma experts to recommend, mainly due to his own experiences, the importance of relaxing to control your asthma.
Click here for more asthma history.

*Campbell, Robin, Lucius Annaeus Seneca, "Letters from a Stoic: Epistulae morales ad Lucilium, " Penguin, 1969, letter LXXVII.

"There then are your remedies." 

1281-1348: Xi defines asthma for China

The next person to make a significant impact on the "flow" of asthma wisdom through Ancient China was InZhu Dan Xi (also known as Zhu Zhenheng). 

He lived from 1281-1348 A.D, and was born to a medical family.  He believed his family received poor medical care when he was young, and therefore became determined to learn about medicine.  (1)

He believed over indulgence depleted the essence of yin and caused chronic diseases.  His most significant recommendation was temperance. (2)

He continued to describe diseases as an imbalance of the humors as was described in the Nei Ching some 2,000 years earlier, and as described in Ancient Egypt and Western Civilizations.

InZhu Dan Xi (1281-1348)

Xi is often regarded as the first Chinese physician to provide a modern description of asthma.  He combined chuan and Xiao to come up with chuan xiao, which many historians believe is similar to the Western world's description of asthma. (3)

From this time on Chinese physicians believed Chuan xiao was caused by an imbalance of yin and yang, which are polar opposites, and "obstruction to the flow of Qi by phlegm in the airways,  according to Mark Jackson in his book "Asthma: The Biography."

Ma Huang continued to be a common therapy for the treatment of any respiratory ailments along with "Qi supporting" liquorice and gypsum decoction, "Yin syndrome asthma was treated with Yin Returning elixer."  (4)

Since Ma Huang was a much better bronchodilator than any western treatment for asthma, Chinese asthmatics had it at least a little better off than their contemporaries in the rest of the world, or so one might imagine.

Click here for more asthma history.

References:  

1. Beijing Medical Museum of TCM
2. "Chu Tan-chi [Zhu Danxi/Zhu Zhenheng; 1280-1358 A.D.," Chinese Medicine History,  http://www.taijichinesemedicine.com/zhudanxi.htm
3. Jackson, Mark, "Asthma: The Biography," 1998, New York, page 41
4. Jackson, ibid, page 41

150-219: The Chinese Sage of Medicine

Zhang at work

If you had asthma in China prior to the 3rd century A.D. your doctor may have recommend a remedy of drinking a bitter tasting tea made from dried stems of the Ma Huang plant.

This remedy made your breathing better, and your cough often subsided too.  The trick was your physician would have to remember it and the formula to concoct it.

You see, there were few books with medical wisdom for your physician to reference.  Most medical knowledge, especially regarding herbal remedies, were passed on from one generation to the next to anyone who wanted to learn about it.

This all changed around 220 A.D., and it all changed because of a war that causes a virus to strike the village of a man named Zang Zhong Jing (also known as Zhang Ji).
Legend has it  he was 50 when two-thirds of his village died of a fever in a short span of ten years, and that inspired him to become an expert on ancient medical text, such as the Nei Ching  and the Hippocratic Corpus.

This resulted in him writing a medical book that helped shape Chinese medicine, and resulted in him becoming well known to the Chinese medical community by giving birth to Traditional Chinese Medicine. (1)

His book was called "Shanghan Zabing Lun" which translates in English to "Treatise on Cold Pathogenic and Miscellaneous Diseases."  It's a compilation of the medical wisdom from all those who lived before him.

Yet his book was lost in a war, and was not available until 1065 when the rulers of China saw a need for these old books and formed the Bureau for Collation of Medical Books of the Song Dynasty.  Wang Shu-He collected what he could of Zhang's writings and recompiled them into two books he called the "Shang Lun," which translates into "Treaties on Cold Induced Fevers."

The two books were:

• Shan Han Lun (On Cold Damage), a compilation of herbal remedies to treat infectious diseases that cause a fever
• Jinkui Yaolue (Essential Prescriptions of the Golden Coffer), which records his clinical experiences

These books describe methods of diagnosing, treating, and monitoring the effect of treatment. He recommended the importance of using the pulse not only to diagnose as Huang Ti recommended 1000 years earlier in his book "Nei Ching," but to monitor the course of treatment.

He was also the first to mention artificial respiration.  And he also  recommended forcing water down a person's throat who attempted suicide by poisoning to bring up the poison, and this is a technique similar to what is used in hospitals today. (3)

Like Hippocrates, Zhung recommended against the practice of physicians taking advantage of patient  naivety for the purpose of making a profit.  He noted that some physicians concocted bogus formulas and sold them as viable remedies.  He berated this practice and encouraged good medical ethics.  

So his books were very helpful to Chinese physicians and their patients.  Yet of most importance were the formulas he calculated for collecting and concocting herbal remedies for many of the ailments of his day, especially those that are contagious and cause fevers like what wiped out his village.

One of the neatest things about Zhang's herbal formulas is that many are still used to this day, and many have even been proven by science to be effective remedies.  This includes as description of asthma-like symptoms in Jinkui Yaolue and a formula for creating a remedy using Ma Huang. He described breathlessness or panting as chuan, and wheezing as xiao. (2)

His works have earned him the respect of Chinese Historians as one of the best physicians of all time, so much so that he's often referred to as the sage of medicine.  Actually some consider him to be a god, and others believe his existence was merely a legend.

While revered in China, his works also influenced and forever changed the way medicine was practiced in Japan, Korea, Vietnam and Mongolia.  Many of his formulas for herbal remedies are still used as effective treatment for many ailments, and many have even been proven effective by modern scientists.  

He's such a significant "legend" that his books continue to be required readings for any student of Traditional Chinese Medicine.  (4)

(Considering this fame, little is known about his life, nor exact dates associated with his life.  It's estimated he lived from 150-219 A.D, yet many historians continue to debate these dates.)

Click here for more asthma history

References:

1. Selin, Helaine, ed., "Encyclopedia of the History of Science, Technology, and Medicine in Non-Western Cultures," 1997, Netherlands, page 893
2. Jackson, Mark, "Asthma: The Biography," 1998, New York, page 41
3. Selin, Op. Cit, page page 893
4. "Chinese Herbal Formulas and Application," chapter 1, page 31

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 23, 24)

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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