Today was my first day doing clinical observation with Dr. Koirala at his second clinic in Putalisadak. Yesterday was an amazing tour with Anil. Saturday my dad arrived. The last week or so has been constant action...
Starting with the tour, which was maybe the fourth one I've been on with Anil: we went to two towns just outside of the city, one where most of the traditional woodwork is produced, the other where mustard seed oil used to be produced for the whole country. While the details of the tour were beyond fascinating, I would be doing him an injustice by trying to recreate the experience, so I won't; however, a few of the basic ideas he emphasizes in all his tours are finally so drilled into my head that I can put them down here. Since he's an engineer and an urban planning expert, he often speaks about how to make a city a functional, successful place for its inhabitants. There are four pillars of such a place. First, he says, you want a place to be livable, so that the people living there have what they need and some of what they want. In order to make a place livable, it needs to be managed. If the management is going to be effective, the people in charge need to be accountable. And the only way to get people who will be honestly accountable is to ensure that the place has something competitive to make it bankable.
So, say a place has a competitive product, like wood, and craftsmanship to work with it, making it bankable. There is the question of how to ensure that the artisans--who are the fundamental link in the chain--earn enough money from the natural resources to sustain their lives. Assuming they sell, for example, some pieces to Anil directly for his restoration work, they receive payment for that: P1. But that alone can't sustain their family, so they also do work making windows and decorations for hotels and commercial enterprises, which brings in a second income: P2. In addition, Anil and his wife run an organization called Crafted in Kathmandu, wherein artists' work is exported to Manhattan and sold through catalogues in small numbers, bringing in P3. With P1, P2, and P3 together, the families can support themselves and continue their work authentically. Authenticity is something Anil takes very seriously, and every craftsman learns about the history and reasoning behind the details of what it is they do. For example, they know why in the final scene on the wheel depicting the 12 scenes of the Buddha's life, the food shown is mushroom instead of pork; though there is debate about whether he was poisoned by one or the other, it is likely that he abstained from eating meat (especially pork) and thus it was mushrooms. The debate is cause by the fact that the word in the text from which the art is derived can translate as either food. This is the level of knowledge each artisan has....it's astounding.
He also speaks a great deal on the iconography of the Buddha, and one fundamental aspect of Buddhist iconography is the lotus. For those who aren't familiar, the symbolism of the lotus is the following; the roots of the lotus begin in the earth, which is material form. It then grows through the water, which represents illusion, in order to blossom in the air, or emptiness. This is the same path that the Buddha followed. Similarly, the symbols on the Nepali coin are meant to represent the attributes of a leader. On each side of the square mandala on the coin is a symbol, including a knife (ability to defeat enemies), wheat grain (provide for the people), staff (diplomacy for negotiation), and a conch shell (mobilizing the people).
So those are just a few tiny snippets of what Anil teaches us on the tours. I admire him immensely.
Clinical study today was a totally different experience than taking class, of course. It's hard to describe when I know I'll be leaving out so much essential and fascinating information. Dr. Koirala's clinic was a little hard to find because it's in an area of town I haven't been to before, so I accidentally wound up visiting the Nepal Health Society. It sounds official and has a large office space in a big modern new building, but when I walked through the doorway, I found it empty but for a single desk and some wooden standing dividers. A young woman and a young man were sitting on two chairs in the unlit apartment, doing nothing, as there was absolutely nothing to be done in such a space. However, there was a phone, and the woman helped me to get directions going to the right place. She seemed very sharp, and I left wondering why the place was so deserted: alive but defunct at the same time.
When I arrived at Dr. Koirala's clinic, more of a storefront with a room in the back, it was already almost 5PM and the place was very busy. A Nepali boy in the front asked me if I was American and then led me to the back room, where Dr. K was in consultation with two men already. I watched him go through three or four patients, with intermittent translation or explanation. I caught a tiny bit of what was going just from my scarce understanding of Nepali--negligible from a medical or academic perspective, certainly, but something nonetheless. I also felt a patient's pulse for the first time, which was interesting. The whole perception of the room, the patient, myself changed when I was in the position of having to interact physically with the patient. I'm sure the nerve-wracking aspect would or will change over time, but it was definitely an experience this time. Then another girl came in, a Nepali medical student doing an internship with Dr. K as well (just clinical observation). We shared notes and she translated conversation for me, and generally it was a helpful situation.
The room itself was very small, painted white but not pristine, let alone sterile, like clinics in the States. The examining table had a cloth covering, which naturally wasn't changed between patients, as the average time he spent with each person was around 15-20 minutes and there were countless people waiting to be seen. When I left at a little after 7PM he was still going strong. The other girl said that he usually stays until 8PM or later, every day. He examined each patient in much the same way; feeling their legs, checking the knee joint movement, prodding the abdominal area, sometimes checking the throat, eyes, or tongue, or a specific area if someone complained. One difference I noticed about the way he examined men and women was that while he felt around the ribs and chest area, even with the stethoscope, he would ask the women about their children. Inevitably they had something like four children, with various situations, and it was always at the same moment that he invited them to tell him briefly about their situation. In discussing this with my dad after, we deduced that it was a deflective measure he took so that their emotional attachment to the topic would allow them to relax while he was feeling a perhaps sensitive part of the body, at least for a conservative culture like Nepal's. Maybe I will ask him about this specifically at some point.
Again, there's just too much to say. It's quite late so I'm off for now...hopefully will get enough sleep to wake up and do yoga.
Monday, April 21, 2008
Friday, April 18, 2008
Bhasma Preparation Tests
Bhasmas are the Ayurvedic mineral preparations, produced in many cases by the same pharmaceutical companies that produce herbal medicines. The bhasmas, however, require not only different ingredients but different additional herbs and and methods of preparation, done in separate rooms, with--naturally--different costs. These are the ten classical methods of testing whether or not a bhasma preparation is finished, i.e. purified. It should be noted here that pure does not mean undiluted, but rather in a form that is harmless to the body and can be assimilated by it. Though pharmaceutical companies in India and Nepal currently use chemical testing to ensure the safety of the bhasma preparations (and in Nepal, most only produce herbal preparations), these methods are still used and are widely respected.
Nepali/Sanskrit name is first, followed by literal English translation in parentheses.
1) WARITARA (Water/flooded): If the bhasma is fully prepared, it will float on the surface of water, indicating lightness.
2) REKHAPURNA (Lines/full): Indicates that the bhasma in prepared form should be fine. When taken between thumb and forefinger, the fine powder will fill the lines of the fingerprint.
3) APUNARBHAV (Unchanged): Indicates that the bhasma should retain its original form, especially color, despite mixing with other substances: the mitrapanchak or five substances; molasses, gunja, sohaga, honey, and ghee, when heated.
4) UTTANIA (Moving): A grain of rice, barley, etc. will float over the preparation like a swan on a lake.
5) NIRUJA: When prepared, bhasma heated with a silver plate will stick to it. The form will remain unchanged.
6) NISWADU (Taste): The bhasma should be completely tasteless. Sour, bitter, or sweet tones indicate incomplete preparation.
7) NISCHANDRA (Sparking): There should be no shining or sparkly particles in the bhasma; they show unchanged substance, particularly for gold, silver, and mica.
8) AWAMI (Biological): When a tiny bit of the bhasma has been put on the tip of the tongue, there should be no effect. Impure bhasma will cause nausea or vomiting.
9) AMLA (Sour): When bhasma is put with citrus juice, especially lemon, it should retain its color and original form.
10) NIRDHUM (Smokeless): Finished bhasma will not emit any smoke when put over fire, while the impure form emits smoke.
All these ten tests are carried out for each preparation. A few companies still use these classical tests, but mostly use modern testing methods now. Many of the preparations have been shown to be impure and cause kidney problems and other side effects. If any problem is found with the bhasma through these tests, the bhasma preparation process must be repeated.
Next time: the scintillating details of Chyawanprash preparation!
Nepali/Sanskrit name is first, followed by literal English translation in parentheses.
1) WARITARA (Water/flooded): If the bhasma is fully prepared, it will float on the surface of water, indicating lightness.
2) REKHAPURNA (Lines/full): Indicates that the bhasma in prepared form should be fine. When taken between thumb and forefinger, the fine powder will fill the lines of the fingerprint.
3) APUNARBHAV (Unchanged): Indicates that the bhasma should retain its original form, especially color, despite mixing with other substances: the mitrapanchak or five substances; molasses, gunja, sohaga, honey, and ghee, when heated.
4) UTTANIA (Moving): A grain of rice, barley, etc. will float over the preparation like a swan on a lake.
5) NIRUJA: When prepared, bhasma heated with a silver plate will stick to it. The form will remain unchanged.
6) NISWADU (Taste): The bhasma should be completely tasteless. Sour, bitter, or sweet tones indicate incomplete preparation.
7) NISCHANDRA (Sparking): There should be no shining or sparkly particles in the bhasma; they show unchanged substance, particularly for gold, silver, and mica.
8) AWAMI (Biological): When a tiny bit of the bhasma has been put on the tip of the tongue, there should be no effect. Impure bhasma will cause nausea or vomiting.
9) AMLA (Sour): When bhasma is put with citrus juice, especially lemon, it should retain its color and original form.
10) NIRDHUM (Smokeless): Finished bhasma will not emit any smoke when put over fire, while the impure form emits smoke.
All these ten tests are carried out for each preparation. A few companies still use these classical tests, but mostly use modern testing methods now. Many of the preparations have been shown to be impure and cause kidney problems and other side effects. If any problem is found with the bhasma through these tests, the bhasma preparation process must be repeated.
Next time: the scintillating details of Chyawanprash preparation!
Thursday, April 17, 2008
The Daring Tale of Dorje in Tibet
This evening I had the chance to sit in on one of Caitlyn's lessons with Dorje*. Instead of language, though, the topic of choice was Dorje's recollection of his dangerous and very illegal trip back to Tibet to visit his parents in Lhasa for a month several years ago. He studied in Dharamsala at one of the Tibetan refugee schools (and, curiously like most Tibetans I've met here, had a private audience with His Holiness there to secure his education), and during a three-month break after exams he came to Nepal to visit his uncle, then working at a monastery in Kathmandu. His uncle suggested that Dorje's parents, whom he hadn't seen in about ten years, would really like to see him, and that it would be a very good thing if he could go back to Lhasa and visit...for whatever reason, whether it was homesickness or the recklessness of youth, he decided to go for it. Mind that this is despite having no refugee card, no passport from any country; no identification papers of any kind whatsoever.
At the first checkpost, he had to swim across a river, traveling with a monk and a guide who they paid Rs.1K. He and the monk parted ways when they reached the first town, where he befriended a local Tibetan man at the bar and managed to find a place to stay that night. He had only 500 Chinese yuan starting out. The next day he got a lift to the next checkpoint after lying to a truck driver and saying he had identification. When the driver went in to sign the register, Dorje buried himself in the back hidden from view, and on they went to the next town. However, the driver changed his course, no longer heading to Lhasa. Dorje refused to pay him as a result, and told the same lie to another bus driver, heading to the third checkpoint--there were seven between his departure point and Lhasa! At this point he had to hide in the truck from policemen searching it, and the driver became very angry at Dorje for lying about having ID. He could have been in a lot of trouble, and dumped Dorje at the next town, refusing to take him any further.
However, he had suggested a lie for Dorje to tell the next unhappy driver to pick him up: that he was a tour guide between Lhasa and the border town, and had lost all of his belongings and papers on the last tour. Dorje employed this lie to the first person he met at, again, the local bar; but the man didn't buy it and said he knew Dorje was from India. Eventually Dorje went to bed at a hotel. Around 6AM he heard knocking on the door...terrified that someone had told the authorities and it was officials coming to arrest him, he opened the door; it was the man he had befriended, who said there was an army truck leaving right away for Lhasa and he should try to hitch a ride with them. At first he was too afraid, but he realized it was as good a chance as any and quickly went down to scope out the situation.
There was one Chinese army man and one Tibetan traveling in the truck, and Dorje pleaded his case to the Tibetan. The man asked him whether he was lying, suspicious, but relented, spoke to the Chinese guy, and offered Dorje a ride. Sympathizing with his alleged predicament, they bought all his meals, plenty of beers and cigarettes, and went sailing through the remaining checkpoints with no more investigation than a respectful salute from the checkpoint guards. When they reached the town near Lhasa, they dropped him off with good wishes. He walked the rest of the way to Lhasa the next day, after a night at a lovely hotel with a friend from grade school who he ran into--a rich tourists' guide--and called his parents for their happy reunion. When he described it to us, I could see in my mind his father walking towards him, crying from joy, so happy to see his son return.
He was very daring and reckless to undertake that journey, but everything worked out, and luck was on his side. What a tale to tell his schoolmates about how he spent his summer break!...it was exciting to hear, but in the end, the story is really quite sad. It's sad that the state of things is such that so much pain and separation is the norm between parents and children, and that Dorje had to risk his entire future in order to visit his home.
Yesterday, Karma came over to visit--a very charismatic and precocious ten year old in the neighborhood, and very popular with everyone at the house. As always, he sang some Hindi and Tibetan songs for us, complete with dance moves. Even more eventfully, his third tooth fell out (I always forget that we all lose our teeth as kids). When I asked whether he would put it under his pillow, he was just confused--it turns out that Tibetans save their teeth and offer them to the deities when they visit a particular place--I think the name was Yanglashe. Interesting...he had shaved the words "Free Tibet" into his hair last week, but his school made him shave it all off. Too bad. However, the wall of the gompa on our street is now covered in black graffitti calling for Tibet's freedom and a stop to the killing, in both English and Tibetan language. As Tais rightly pointed out, it's not the right place for protest vandalism...but I think a sort of desperation is taking over some of the would-be demonstrators.
The Maoists, who are dominating the election results, have threatened to begin deporting Tibetans who protest against China. They want to develop Nepal's fairly good relationship with China (delusionally, they believe China has done more for the country than India) and support the "one China" policy. Obviously this would be a huge human rights violation, since it's clear that the people sent back to China would be dealt with in a way nobody on Earth should be. It's all speculation right now, but there's definitely a precariousness to the situation. Caitlyn said that Amchi-la has been shaking his head and lamenting the Maoist victory every few minutes during downtime at the clinic.
Meanwhile I've been greatly enjoying classes with Dr. Adhikari and Dr. Ghimire. The time goes quickly. Tomorrow is a field trip to Ghodavari with someone I've not met yet (his named is Bhupendra), to get some hands-on experience with medicinal plant collection...or at least recognition!
There really aren't enough hours in the day. I've been doing a lot of research the past week or so on the history of the Orthodox church in India, linking the churches in Persia and India, for a whole host of reasons that are too complex and disorganized right now to go into here. Suffice it to say that a few things I've been reading seem connected in a way that, so far as I can tell right now, have not been even remotely adequately researched...too bad my knowledge is so pathetic and time and mobility so limited. I've decided to focus on the basic parallels between the Orthodox church (particularly its emphasis of the concept of Christus Medicus) and Eastern medicine, and go into the relationship between them only vaguely, because I can't substantiate any claims well enough. Maybe, eventually, it will be possible.
Leaving the academic nitty-gritty aside, I'm devouring all the writing of William Dalrymple, hunting his overviews for hints that lead into ever deeper waters. Even abandoning my searches, his travels make for great entertainment...I'm learning more from his retrospectives than I did in all of high school history. It's a fascinating distraction from the details of Ayurvedic pharmacology, which are becoming ever more intricate.
On an even lighter note, I've never been so into pop culture in my life. The charm of Bollywood movies has inspired me to take my insignificant base of Nepali language and apply it to learning Hindi (which is remarkably similar--all Nepalis understand Hindi, hence why Indian pop culture extends to Kathmandu movie theaters and CD players). If I ever do travel in India (probably to Kerala) it will be useful. In the meantime, I just want to be able to swoon about the "King Khan" in his own language. Besides his movie-star attraction, I've also recently been introduced to the alleged "best dancer in the world", Hrithik Roshan, who totally knocks Wade Robson out of the picture; inspiration-wise, he inherited a great deal of Michael Jackson's legendary moves. The uniquely Indian hubris is fast becoming a leisure-time pleasure for me. Aside from the Indian, of course, there are some specifically Nepali cultural delights I've come across, such as the hit songs of Naran Gopal, a classic Nepali old-timer whose music can be heard in taxis across the valley.
It's gotten astonishingly hot over the past two weeks and several of my afternoons have been wasted at the dead oasis of the Hyatt's swimming pool. Must resist the temptation to indulge in the delicious laziness there, and take full advantage of the last month I have here. There are so many things I want to do and see, it's overwhelming. I'm really enchanted with Nepal, and though a part of me is ready to return to New York, another part feels that this has really been my home, and wishes to stay.
At the first checkpost, he had to swim across a river, traveling with a monk and a guide who they paid Rs.1K. He and the monk parted ways when they reached the first town, where he befriended a local Tibetan man at the bar and managed to find a place to stay that night. He had only 500 Chinese yuan starting out. The next day he got a lift to the next checkpoint after lying to a truck driver and saying he had identification. When the driver went in to sign the register, Dorje buried himself in the back hidden from view, and on they went to the next town. However, the driver changed his course, no longer heading to Lhasa. Dorje refused to pay him as a result, and told the same lie to another bus driver, heading to the third checkpoint--there were seven between his departure point and Lhasa! At this point he had to hide in the truck from policemen searching it, and the driver became very angry at Dorje for lying about having ID. He could have been in a lot of trouble, and dumped Dorje at the next town, refusing to take him any further.
However, he had suggested a lie for Dorje to tell the next unhappy driver to pick him up: that he was a tour guide between Lhasa and the border town, and had lost all of his belongings and papers on the last tour. Dorje employed this lie to the first person he met at, again, the local bar; but the man didn't buy it and said he knew Dorje was from India. Eventually Dorje went to bed at a hotel. Around 6AM he heard knocking on the door...terrified that someone had told the authorities and it was officials coming to arrest him, he opened the door; it was the man he had befriended, who said there was an army truck leaving right away for Lhasa and he should try to hitch a ride with them. At first he was too afraid, but he realized it was as good a chance as any and quickly went down to scope out the situation.
There was one Chinese army man and one Tibetan traveling in the truck, and Dorje pleaded his case to the Tibetan. The man asked him whether he was lying, suspicious, but relented, spoke to the Chinese guy, and offered Dorje a ride. Sympathizing with his alleged predicament, they bought all his meals, plenty of beers and cigarettes, and went sailing through the remaining checkpoints with no more investigation than a respectful salute from the checkpoint guards. When they reached the town near Lhasa, they dropped him off with good wishes. He walked the rest of the way to Lhasa the next day, after a night at a lovely hotel with a friend from grade school who he ran into--a rich tourists' guide--and called his parents for their happy reunion. When he described it to us, I could see in my mind his father walking towards him, crying from joy, so happy to see his son return.
He was very daring and reckless to undertake that journey, but everything worked out, and luck was on his side. What a tale to tell his schoolmates about how he spent his summer break!...it was exciting to hear, but in the end, the story is really quite sad. It's sad that the state of things is such that so much pain and separation is the norm between parents and children, and that Dorje had to risk his entire future in order to visit his home.
Yesterday, Karma came over to visit--a very charismatic and precocious ten year old in the neighborhood, and very popular with everyone at the house. As always, he sang some Hindi and Tibetan songs for us, complete with dance moves. Even more eventfully, his third tooth fell out (I always forget that we all lose our teeth as kids). When I asked whether he would put it under his pillow, he was just confused--it turns out that Tibetans save their teeth and offer them to the deities when they visit a particular place--I think the name was Yanglashe. Interesting...he had shaved the words "Free Tibet" into his hair last week, but his school made him shave it all off. Too bad. However, the wall of the gompa on our street is now covered in black graffitti calling for Tibet's freedom and a stop to the killing, in both English and Tibetan language. As Tais rightly pointed out, it's not the right place for protest vandalism...but I think a sort of desperation is taking over some of the would-be demonstrators.
The Maoists, who are dominating the election results, have threatened to begin deporting Tibetans who protest against China. They want to develop Nepal's fairly good relationship with China (delusionally, they believe China has done more for the country than India) and support the "one China" policy. Obviously this would be a huge human rights violation, since it's clear that the people sent back to China would be dealt with in a way nobody on Earth should be. It's all speculation right now, but there's definitely a precariousness to the situation. Caitlyn said that Amchi-la has been shaking his head and lamenting the Maoist victory every few minutes during downtime at the clinic.
Meanwhile I've been greatly enjoying classes with Dr. Adhikari and Dr. Ghimire. The time goes quickly. Tomorrow is a field trip to Ghodavari with someone I've not met yet (his named is Bhupendra), to get some hands-on experience with medicinal plant collection...or at least recognition!
There really aren't enough hours in the day. I've been doing a lot of research the past week or so on the history of the Orthodox church in India, linking the churches in Persia and India, for a whole host of reasons that are too complex and disorganized right now to go into here. Suffice it to say that a few things I've been reading seem connected in a way that, so far as I can tell right now, have not been even remotely adequately researched...too bad my knowledge is so pathetic and time and mobility so limited. I've decided to focus on the basic parallels between the Orthodox church (particularly its emphasis of the concept of Christus Medicus) and Eastern medicine, and go into the relationship between them only vaguely, because I can't substantiate any claims well enough. Maybe, eventually, it will be possible.
Leaving the academic nitty-gritty aside, I'm devouring all the writing of William Dalrymple, hunting his overviews for hints that lead into ever deeper waters. Even abandoning my searches, his travels make for great entertainment...I'm learning more from his retrospectives than I did in all of high school history. It's a fascinating distraction from the details of Ayurvedic pharmacology, which are becoming ever more intricate.
On an even lighter note, I've never been so into pop culture in my life. The charm of Bollywood movies has inspired me to take my insignificant base of Nepali language and apply it to learning Hindi (which is remarkably similar--all Nepalis understand Hindi, hence why Indian pop culture extends to Kathmandu movie theaters and CD players). If I ever do travel in India (probably to Kerala) it will be useful. In the meantime, I just want to be able to swoon about the "King Khan" in his own language. Besides his movie-star attraction, I've also recently been introduced to the alleged "best dancer in the world", Hrithik Roshan, who totally knocks Wade Robson out of the picture; inspiration-wise, he inherited a great deal of Michael Jackson's legendary moves. The uniquely Indian hubris is fast becoming a leisure-time pleasure for me. Aside from the Indian, of course, there are some specifically Nepali cultural delights I've come across, such as the hit songs of Naran Gopal, a classic Nepali old-timer whose music can be heard in taxis across the valley.
It's gotten astonishingly hot over the past two weeks and several of my afternoons have been wasted at the dead oasis of the Hyatt's swimming pool. Must resist the temptation to indulge in the delicious laziness there, and take full advantage of the last month I have here. There are so many things I want to do and see, it's overwhelming. I'm really enchanted with Nepal, and though a part of me is ready to return to New York, another part feels that this has really been my home, and wishes to stay.
Monday, April 7, 2008
So it goes
Today many of the Tibetan men and boys shaved their heads to show respect for the monks who have been killed in the protests against the Chinese occupation of Tibet. Most of the women and girls wore black. Around the stupa there were some creative spins on this gesture, like shaving the words "save Tibet" and the shape of the Tibetan flag onto boys' heads...hopefully tomorrow I can unobstrusively catch some pictures. The political heat continues to rise locally as well, what with elections being three days away, and transportation ends (non-government vehicles are officially banned from the streets) starting on the 9th. Until then, the parties are making the most of the public roads, with bullhorn-toting political activists in parades and cars plastered with posters at every other intersection. A few days ago five bombs went off in various government buildings--just pipe bombs, nobody injured, maybe a few exploded walls--and the U.S. Embassy sent out warnings through email. Email or not, I'm sure we'd all be staying indoors on the 10th, but I am looking forward to seeing how the elections actually go down. This will be a really historic time if things happen in a fairly fair way, and it could mean good progress for the country, or at least a prediction of good progress in two years' time (when this assembly is supposed to finish the new constitution).
Sadly there's nothing up-to-the-minute to report as far as classes are concerned because I've been sick with a fever and other ailments for the last few days. My best guess is that it's related to the strange weather, which went from increasingly hot to absurdly cold and stormy in the last week. Hopefully resuming yoga and spending some time in the sunlight will help finish off the last of whatever bug took hold of my insides.
Before I got sick most of my classes were on various details of Ayurvedic pharmacology that I think few would be interested to read, so I'll refrain from posting the lists and details. Among the more fascinating topics was the kinds of preparations used to purify heavy metals used in some Ayurvedic preparations (gold, lead, mercury, etc.) which have received very bad press in Western medicine. Of course, these preparations aren't meant to be used long-term (Kopila said only one month out of the year and depending upon all sorts of things), but even with qualifications there have been side effects due to dosage or simple misuse. After hearing about the methods used to make them suitable for ingestion, I still have some reservations, and would certainly have to know that the doctor was exceedingly trustworthy and attentive. Fortunately, my impressions of Dr. Koirala go beyond that, and learning from him and people he considers highly makes iffy questions like these easier to learn about and explore with an open mind.
As there's no electricity right now and the laptop's battery life is rapidly dwindling, I'll update with juicier news soon.
Sadly there's nothing up-to-the-minute to report as far as classes are concerned because I've been sick with a fever and other ailments for the last few days. My best guess is that it's related to the strange weather, which went from increasingly hot to absurdly cold and stormy in the last week. Hopefully resuming yoga and spending some time in the sunlight will help finish off the last of whatever bug took hold of my insides.
Before I got sick most of my classes were on various details of Ayurvedic pharmacology that I think few would be interested to read, so I'll refrain from posting the lists and details. Among the more fascinating topics was the kinds of preparations used to purify heavy metals used in some Ayurvedic preparations (gold, lead, mercury, etc.) which have received very bad press in Western medicine. Of course, these preparations aren't meant to be used long-term (Kopila said only one month out of the year and depending upon all sorts of things), but even with qualifications there have been side effects due to dosage or simple misuse. After hearing about the methods used to make them suitable for ingestion, I still have some reservations, and would certainly have to know that the doctor was exceedingly trustworthy and attentive. Fortunately, my impressions of Dr. Koirala go beyond that, and learning from him and people he considers highly makes iffy questions like these easier to learn about and explore with an open mind.
As there's no electricity right now and the laptop's battery life is rapidly dwindling, I'll update with juicier news soon.
Tuesday, April 1, 2008
Basic Principles of Understanding Medicine
This entry will have a fair amount of Nepali medical jargon. Be warned! Also, be warned that this is more like a detailed cosmology of medicine than a textbook outline. I'm really only typing it up so I have a chance to study it, haha.
Class today was awesome but overwhelming. It was my first lesson with Dr. S.M. Adhikari, who happens to be Kopila's father, and occupies a position as the expert in medicinal plants in the Ministry of Medicine in the (so-called) government of Nepal and is President of the association of doctors. I am outrageously lucky to be taking class with him, and they are all so generous to me--with time and energy, which is even greater than material generosity. I feel humbled by how much effort they are putting into making my time here absolutely everything it can be. Until I go home I will be taking class with four doctors, covering so much ground...Dr. Koirala has immense wisdom, and his spiritual understanding of medicine is beyond what can be taught with words or pictures; Kopila brings the new perspective of the coming generation of doctors; her classmate Dr. L.P. Ghimire has a specialized knowledge of Ayurvedic pharmacology, and Dr. Adhikari is a most respected expert senior doctor...how amazing. And I get hours upon hours of time with them one-on-one. Pure teaching, and in Dr. Koirala's case, I feel that a great part of it is beyond that, into the realm of transmission.
Caitlyn had a very funny idea for an April Fool's Day trick to play on Yanik, which went over semi-well. We found it hilarious anyway...she called him up and told him I had run off to Nagarkot indefinitely with Sid, the bass player at Jazz Upstairs, and that my dad had called her panicking because I'd sent him an email letting him know I was skipping out of my program to go gallivanting. Yanik fell for it, but I think it got a little confused at some point. Quite funny anyway! And ama-la is very tricky; she got Caitiln to drink black tea thinking it was juice, which reminded me strongly of drinking the horrifying-tasting herbal concoction my dad used to drink when my mother indiscriminately put it into a Coke bottle and stuck it in the fridge.
Tonight are my remaining Watson interviews. Tomorrow we go to Gokharna for yoga in the morning, which will be new and interesting. With lessons getting so intense, I've had practically zero time to work on things for school back at home, which is going to be a problem soon...
Anyway, notes on the basic principles of understanding medicine:
There are three fundamental concepts of Ayurveda that the rest are founded on. One is pancamahabhuta, which is the five elements (earth, water, fire, air, space). The next is tridosha, which is the manifestation of the pancamahabhuta in vata, pitta, and kapha. The third is sattpadartha, which literally translates to "word which has meaning" and represents all that can be described in physical terms.
The ancient rishis or seers remembered six things that are the foundation of every science, including Ayurveda. We say "remembered" because the knowledge existed in the universe, and through their spiritual efforts they were able to channel this knowledge and turn it into a system for human use. These six things are as follows:
1) DRAVYA: Matter and material. There are nine aspects of dravya, which are the pancamahabhuta (5 discrete elements), time, direction or place, mind, and soul. The power of all matter comes from these aspects. Pancamahabhuta is animated by the power of the soul, the mind is the leader of all sense organs, and no phenomenon can be separated from its time and place. By saying the mind is the leader of the sense organs, we mean that for example vision is a sense organ, and its seat is the eye. Thus the power of the sense organ is the mind. These 5 aspects of dravya, counting pancamahabhuta now as one aspect, are known as the Causal elements. All other elements are the Effectual elements, because they are dependent upon these, and have their existence only as manifestations of the pancamahabhuta.
2) GUNAS: Properties or qualities of matter. The sartha refers to those gunas which can be perceived by the sense organs (which is the majority and the significant part according to pharmacology), though there are also those gunas which describe the structural aspect of the tridosha, which are invisible and intangible. The gunas can be further classified into the spiritual, the (meta)physical. The physical can be further classified into the specific and the general. There are 6 spiritual gunas, which can only be felt and are not found in senseless or nonliving dravya, such as desire, happiness, etc. The specific physical gunas are 5, specific to each sense organ; the general physical gunas are the 20 characteristics that distinguish the doshas (i.e. coarse, unctuous, sharp, etc.) and the 10 para apara, which are other distinguishing qualities (i.e. brightness, relative distance, etc.). These properties belong to the body, food, and medicine, which is why they are used to treat disease. There is a broad total of 41 properties. These gunas all stem from the greater emanations of the three mahagunas (greater gunas), which are the sattvic, rajasic, and tamasic qualities; these are understood as the speeds of vibration (fast, medium, slow), the active, passive, and neutral principles, etc.
3) KARMA: Action. Initiation or change of property or structure. Without karma there can be no modification of any state of existence, and in medicine helps us to understand the pharmacological action and therapeutic effect. There are two types of medicinal karma: pathophysiological and pharmacological. Change within the body is effected by drugs/medicine. To get the desired change, action is necessary. The qualities we cannot perceive directly, we can know by their action. In the sense of pharmacology we must see the action of the medicine in order to identify it, and to know whether it is an original or a duplicate substance. The drug alone does not perform the action; it must have qualities which must belong to material.
4 & 5) SAMANYA and VISHESHA: Similarity and difference. These two must always be taken and understood together. Similarity is the general that phenomena (or bodies, foods, medicines, etc.) have in common; the differences are specific and differentiate or separate the existence of one from another. What we perceive with the sense organs must have differences, but we all have common consciousness as the power behind perception. For example, my eyes are blue and another person's might be brown; my skin is pink but another's might be black; still, we all (generally) have two eyes, the same skin, etc.
6) SAMAVAYA: Relationship. There is an inherent relation between material and the properties or qualities that describe it. The continuity of this relationship, which applies to not only material but also the gunas and the karma, is inherent. However, as Krishnamurti famously said, "the description is not the described", and this is the principle meant by samavaya. For example, we call haritaki by its name because we both know and believe that it has certain qualities, properties, potency, and action. If it does not have this action or potency, this taste, this feel, this appearance, and so forth, it is not haritaki. If we say "this is hot", it must have a heating quality, otherwise it is not hot. In the same way, an action cannot happen without the property denoting that action. This relationship can have degrees of complexity as well; i.e. we may say something is dry, but its action might cause unctuousness in the body.
Regarding the dravya, the living body comes in contact with medicine and diet. Their use and prescription is based on the principle of similarity and dissimilarity. Dravya causes action on the living body due to its properties. Time, proportion, etc. may differ, but the properties that are the same will increase the same (like increases like). In other words, properties differ by way of the Causal elements, but need balance of the pancamahabhuta regardless.
Now we wonder how these processes actually occur. According to Ayurveda, the power of transformation is called agni, and in terms of the human body primarily refers to digestion and other metabolic processes. There are three main types of agni to be concerned with here: digestive, pancabhutic (enables the conversion, for example, of vegetables into nutrients--one form of the elements into another), and of the dhatus (bodily tissues or constituents). All of this acts and passes through the srota, or channels of the body. All the bodily systems (respiratory, circulatory, urinary, etc.) are srota; some are not visible, some are. They allow travel and passage throughout the body. All of this varies slightly in the body of each individual, which is why the patient's constitution must be considered wholly and in relationship to its aspects when prescribing medicine.
There are only three effects that dravya can have on the living body. One is to maintain, prevent, or cure disease; one is to have no action, and one is to cause disease. Whatever drug or medicine might be used, can only have these effects. The effects can only be had by either increasing or decreasing the dravya, the guna(s), or the karma, etc. in the body. Thus we measure by increase/decrease, excess/deficiency, etc. The dhatus and tridosha are the same depending on their state. It is also important to note that everything is necessary in the body in some amount. Even the excreta (stool, sweat, urine) are necessary in some amount; without them there is no state of health.
Class today was awesome but overwhelming. It was my first lesson with Dr. S.M. Adhikari, who happens to be Kopila's father, and occupies a position as the expert in medicinal plants in the Ministry of Medicine in the (so-called) government of Nepal and is President of the association of doctors. I am outrageously lucky to be taking class with him, and they are all so generous to me--with time and energy, which is even greater than material generosity. I feel humbled by how much effort they are putting into making my time here absolutely everything it can be. Until I go home I will be taking class with four doctors, covering so much ground...Dr. Koirala has immense wisdom, and his spiritual understanding of medicine is beyond what can be taught with words or pictures; Kopila brings the new perspective of the coming generation of doctors; her classmate Dr. L.P. Ghimire has a specialized knowledge of Ayurvedic pharmacology, and Dr. Adhikari is a most respected expert senior doctor...how amazing. And I get hours upon hours of time with them one-on-one. Pure teaching, and in Dr. Koirala's case, I feel that a great part of it is beyond that, into the realm of transmission.
Caitlyn had a very funny idea for an April Fool's Day trick to play on Yanik, which went over semi-well. We found it hilarious anyway...she called him up and told him I had run off to Nagarkot indefinitely with Sid, the bass player at Jazz Upstairs, and that my dad had called her panicking because I'd sent him an email letting him know I was skipping out of my program to go gallivanting. Yanik fell for it, but I think it got a little confused at some point. Quite funny anyway! And ama-la is very tricky; she got Caitiln to drink black tea thinking it was juice, which reminded me strongly of drinking the horrifying-tasting herbal concoction my dad used to drink when my mother indiscriminately put it into a Coke bottle and stuck it in the fridge.
Tonight are my remaining Watson interviews. Tomorrow we go to Gokharna for yoga in the morning, which will be new and interesting. With lessons getting so intense, I've had practically zero time to work on things for school back at home, which is going to be a problem soon...
Anyway, notes on the basic principles of understanding medicine:
There are three fundamental concepts of Ayurveda that the rest are founded on. One is pancamahabhuta, which is the five elements (earth, water, fire, air, space). The next is tridosha, which is the manifestation of the pancamahabhuta in vata, pitta, and kapha. The third is sattpadartha, which literally translates to "word which has meaning" and represents all that can be described in physical terms.
The ancient rishis or seers remembered six things that are the foundation of every science, including Ayurveda. We say "remembered" because the knowledge existed in the universe, and through their spiritual efforts they were able to channel this knowledge and turn it into a system for human use. These six things are as follows:
1) DRAVYA: Matter and material. There are nine aspects of dravya, which are the pancamahabhuta (5 discrete elements), time, direction or place, mind, and soul. The power of all matter comes from these aspects. Pancamahabhuta is animated by the power of the soul, the mind is the leader of all sense organs, and no phenomenon can be separated from its time and place. By saying the mind is the leader of the sense organs, we mean that for example vision is a sense organ, and its seat is the eye. Thus the power of the sense organ is the mind. These 5 aspects of dravya, counting pancamahabhuta now as one aspect, are known as the Causal elements. All other elements are the Effectual elements, because they are dependent upon these, and have their existence only as manifestations of the pancamahabhuta.
2) GUNAS: Properties or qualities of matter. The sartha refers to those gunas which can be perceived by the sense organs (which is the majority and the significant part according to pharmacology), though there are also those gunas which describe the structural aspect of the tridosha, which are invisible and intangible. The gunas can be further classified into the spiritual, the (meta)physical. The physical can be further classified into the specific and the general. There are 6 spiritual gunas, which can only be felt and are not found in senseless or nonliving dravya, such as desire, happiness, etc. The specific physical gunas are 5, specific to each sense organ; the general physical gunas are the 20 characteristics that distinguish the doshas (i.e. coarse, unctuous, sharp, etc.) and the 10 para apara, which are other distinguishing qualities (i.e. brightness, relative distance, etc.). These properties belong to the body, food, and medicine, which is why they are used to treat disease. There is a broad total of 41 properties. These gunas all stem from the greater emanations of the three mahagunas (greater gunas), which are the sattvic, rajasic, and tamasic qualities; these are understood as the speeds of vibration (fast, medium, slow), the active, passive, and neutral principles, etc.
3) KARMA: Action. Initiation or change of property or structure. Without karma there can be no modification of any state of existence, and in medicine helps us to understand the pharmacological action and therapeutic effect. There are two types of medicinal karma: pathophysiological and pharmacological. Change within the body is effected by drugs/medicine. To get the desired change, action is necessary. The qualities we cannot perceive directly, we can know by their action. In the sense of pharmacology we must see the action of the medicine in order to identify it, and to know whether it is an original or a duplicate substance. The drug alone does not perform the action; it must have qualities which must belong to material.
4 & 5) SAMANYA and VISHESHA: Similarity and difference. These two must always be taken and understood together. Similarity is the general that phenomena (or bodies, foods, medicines, etc.) have in common; the differences are specific and differentiate or separate the existence of one from another. What we perceive with the sense organs must have differences, but we all have common consciousness as the power behind perception. For example, my eyes are blue and another person's might be brown; my skin is pink but another's might be black; still, we all (generally) have two eyes, the same skin, etc.
6) SAMAVAYA: Relationship. There is an inherent relation between material and the properties or qualities that describe it. The continuity of this relationship, which applies to not only material but also the gunas and the karma, is inherent. However, as Krishnamurti famously said, "the description is not the described", and this is the principle meant by samavaya. For example, we call haritaki by its name because we both know and believe that it has certain qualities, properties, potency, and action. If it does not have this action or potency, this taste, this feel, this appearance, and so forth, it is not haritaki. If we say "this is hot", it must have a heating quality, otherwise it is not hot. In the same way, an action cannot happen without the property denoting that action. This relationship can have degrees of complexity as well; i.e. we may say something is dry, but its action might cause unctuousness in the body.
Regarding the dravya, the living body comes in contact with medicine and diet. Their use and prescription is based on the principle of similarity and dissimilarity. Dravya causes action on the living body due to its properties. Time, proportion, etc. may differ, but the properties that are the same will increase the same (like increases like). In other words, properties differ by way of the Causal elements, but need balance of the pancamahabhuta regardless.
Now we wonder how these processes actually occur. According to Ayurveda, the power of transformation is called agni, and in terms of the human body primarily refers to digestion and other metabolic processes. There are three main types of agni to be concerned with here: digestive, pancabhutic (enables the conversion, for example, of vegetables into nutrients--one form of the elements into another), and of the dhatus (bodily tissues or constituents). All of this acts and passes through the srota, or channels of the body. All the bodily systems (respiratory, circulatory, urinary, etc.) are srota; some are not visible, some are. They allow travel and passage throughout the body. All of this varies slightly in the body of each individual, which is why the patient's constitution must be considered wholly and in relationship to its aspects when prescribing medicine.
There are only three effects that dravya can have on the living body. One is to maintain, prevent, or cure disease; one is to have no action, and one is to cause disease. Whatever drug or medicine might be used, can only have these effects. The effects can only be had by either increasing or decreasing the dravya, the guna(s), or the karma, etc. in the body. Thus we measure by increase/decrease, excess/deficiency, etc. The dhatus and tridosha are the same depending on their state. It is also important to note that everything is necessary in the body in some amount. Even the excreta (stool, sweat, urine) are necessary in some amount; without them there is no state of health.
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