SOME OLD MANUSCRIPTS

THE RANASINGHE MANUSCRIPT

A very old palm-leaf manuscript in Dr. Ranasinghe's private library contains illustrations of 22 types of needles recommended for puncturing nerve centres.  Modern acupuncturists do not use so many.  Human figures marked with tiny circles indicating acupunctural points are also found in the manuscript.  It states that it is the 'Salla Vidiya' chapter of the Sarartha Sangraha.  The entire book is in Sinhalese prose.

Dr. Ranasinghe's interest in the evidence of acupunctural and cauterization practice of traditional Sinhalese medicine stems purely from his interest in the history and culture of Sri Lanka.  In his treatment of patients who visit his clinic, he is guided entirely by modern science as augmented through Chinese rediscoveries.  Maps and illustrations of the latest set of acupunctural points and channels adorn the walls of this clinic.

A Marga officer was present when a boy of about 11 years of age, suffering from asthma, was brought to the clinic.  As the boy lay supine on the clinic bed, Dr. Ranasinghe inserted needles in several places on his face, ears, chest, etc.  Not a drop of blood oozed out.  There was no sign of pain at all on the boy's face when the needles were inserted.  Other patients were similarly treated and their clinic cards were signed.  Each card has 16 places for the doctor to initial.  Dr. Ranasinghe says that the maximum number of visits a patient will make is 16 before he or she is completely cured.  Some patients need moxibustion, which the doctor does through direct or indirect heating, depending on the case.  The founders of the Attaragama school would indeed be proud to see these achievements of the son of a physician whom they trained.

THE W.A. DE SILVA MANUSCRIPT

The W.A. de Silva manuscript in the Colombo Museum Library is written on palm leaf.  One of its covers hears the title Äs Vedakama (Treatment of eye diseases), but the first twelve leaves deal with puncture and cauterization.  The next eight leaves form a separate text dealing with remedies for eye diseases.

The earlier twelve leaves are of immediate interest to us.  The pages are 'numbered' with letters, in the customary Sinhalese fashion.  Leaf ka is missing.  The first leaf extant is marked kā.  The next eleven leaves are marked ki, kī, ku, kū, kr, krr, kī, ke, kai, and ko.  Their reverse sides are not lettered in that manner.  The lettered pages bear these symbols at the left side of each leaf, while lith ephemeris symbols are used at the right edge as an additional method of marking pages.

The manuscript is illustrated with seven pictures of human beings.  Punctural points are indicated with small circles, just as in Chinese books before the discovery of channels of bodily energy.  It may be noticed that the figures have round Mongoloid faces rather than triangular faces.

Explicit instructions are given for puncturing at prescribed points, e.g., 'For all ailments puncture the three nerves of the foot.'

The 107 critical points called marma sthāna are also referred to.  The author prohibits puncturing at such points.  For purposes of blood-letting there are places which may be punctured: 'Puncture the nerves and let out the blood.'

The practitioner should embrocate some points on the body and cauterize others: 'For pain in the forehead embrocate the bulging cheeks,' and 'Cauterize at the two extremities.'

The last statement in the manuscript is: 'Salla Vidiya ends.  May there be success.'

Figure 25 - Acupunctural/cauterization points in traditional Sinhala medicine, as illustrated in the W.A. de Silva manuscript.  (Courtesy of the Colombo Museum Library).

The benediction is repeated later, since additional matter has been appended.

Another palm-leaf manuscript in W.A. de Silva's collection is fragment consisting of three leaves only.  Its contents are rewritten on a paper which wraps the book.  We are informed there that a Buddhist monk named Manik Maya requested a minister named Erdi Mal to go to the Naga world and bring back three needles to use in surgical treatments.

A more complete but slightly differing version of the story is given in the Pelmadulla manuscript, a palm-leaf manuscript in the Raja Maha Vihara, Pelmadulla.

THE PELMADULLA MANUSCRIPT A

There is a photostat of this Pelmadulla manuscript in the Department of National Archives, Colombo.  It recounts the story of a king who set out on a journey accompanied by his minister.  Suddenly the minister was felled by a stroke of paralysis and lay unconscious on the ground.  The king then consulted a deity who advised surgical treatment and suggested that the king of the Naga world be interviewed immediately for relevant favours.  The Buddhist monk Maya thereupon went to the Naga world and informed the Naga king of what had happened.  Responding favourably the king opened his cupboard and took three needles from a bottle and handed them over to the monk, who took them and administered appropriate treatment.

In the subsequent pages the author explains the techniques of acupuncture, cauterization, etc.  Critical loci which should not be punctured are also described.

Treatment for ailing horses and cocks is discussed.  The use of the word sävulā for cock on page kr indicates that the manuscript was made after the twelfth century.  Sävulā is derived from Tamil.  The popular Sinhalese word for cock is kukulā.  Another interesting word in this manuscript is kurumentuwa in the sense of 'control'.  It occurs on page ki and helps us to narrow the period to the post-Portuguese era.  The traditions recorded are, however, very old.  The illustration of an Asura damsel on the reverse of page ki, for instance, throws light on the inhabitants of pre-Vijayan Sri Lanka.

The manuscript ends with a description of the ascent and descent in the body of certain mystic forces.  Their movement varies at different hours and on different weekdays and corresponds to the phases of the moon.

THE PELMADULLA MANUSCRIPT B

Sinhala Rajjuruvange Behet Geyi äs Veda Pota is the title of a manuscript found at Purana Vihara Temple, Pelmadulla, and published in the Ceylon National Museum's Manuscript Series, volume III.  Its last chapter deals with puncturing and cauterization.  This chapter actually begins with a sentence which states that Salla Vidiya is being expounded.

It discusses the points which should not be punctured.  Next it discusses what acupuncture is and what specific illnesses it is good for.  The expression 'cauterize forcefully with the needle' occurring there is very significant.  The manuscript has a set of illustrations showing Sinhalese puncturing and cauterization instruments.  The author lays down the rule that puncturing or cauterization should be done when the mystic forces of kalā, soolam, and maru do not influence the loci concerned.

THE ANTON JAYASOORIYA MANUSCRIPT

Dr. Anton Jayasooriya of the Colombo South Hospital has in his collection a palm-leaf manuscript which is an important record of Sri Lanka's ancient tradition in the field of acupuncture.  It has illustrations of needles used in the past by local physicians.  The acupunctural nerve centres of the elephant's body are also explained and illustrated in it.  Its style, handwriting, and methodical presentation make it a unique document.

THE NEVILLE MANUSCRIPTS

Hugh Nevill (1847-1897) collected two palm-leaf manuscripts on ancient acupunctural traditions of the Sinhalese.  The manuscripts are now preserved in the British Museum, London, together with other palm-leaf manuscripts from Hugh Nevill's collection.

THE GANEGODA MANUSCRIPT

Ganegoda Purana Vihara Temple in Pananwela, Miella, near Hakmana, has a palm-leaf manuscript on Sinhalese acupuncture techniques.

THE WIJESURIYA MANUSCRIPT

The Wijesuriya Manuscript was found in the library of Mr. Dayananda Wijesuriya, a farmer residing in Gurupokune, Hungama, in the Tangalle area.  He inherited it from his grandfather, Don Christian Weerasuriya, an Ayurvedic physician.  It is written on palm leaf, and its version of Salla Vidiya is given in 120 stanzas, some of which are identical to stanzas in the Samaratne manuscript.  Appended to the main text is another long poem, Sara Vidiya, which also deals with acupuncture treatment.  Critical points which should not be punctured are also explained in detail in the Wijesuriya Manuscript.

AYURVEDIC CONCEPTS

The theory of health and ill-health on which these medical treatises are based is connected to the concept of tridosha expounded in standard Sanskrit works of Ayurveda.  The works of Susruta, Caraka, and Vagbhata are the best known of such Sanskrit books.

They are all agreed on defining ill-health as a state of imbalance of the tridoshas - vāta, pitta, and sleshma.  These three principles are sometimes translated 'wind', 'bile', and 'phlegm', but that is rather misleading.  They are types of energy which have to be kept in balance for the sake of health.  In some instances the use of surgical instruments is necessary for that purpose.

The Susruta of the seventh century B.C. refers to 101 types of blunt instruments and 21 kinds of sharp instruments used in surgery - e.g., needles, scissors, awls, dilators, catheters, syringes, finger guards, trocars, forcepts, pincers.  The Susruta also speaks of extraction by moving to and fro, raising and incising, contracting and curling up, moving a foreign body, turning it around, pressing out, loosening, excision, incision, dissection, suturing, puncturing, etc.  Laparatomy, extraction of a foetus, lithotomy, and removal of a fistula had all been done in ancient India.

According to the theory of health in Ayurvedic medicine, a well-balanced metabolism should ensure that the facilities of smell, taste, sight, hearing, and touch remain efficient.  So also should the mouth, hands and feet, organs of speech, excretory and reproductory organs be capable of functioning satisfactorily.

There are diseases caused by cuts, serpent bites, injuries, etc. infectious diseases arise mainly from the absence of internal immunity.  Nutritional and metabolic imbalances, inflammation, and growths are examples of other internal causes of disease.  Hate, fear, anxiety, pride, etc. are mental states of disease.  Insanity is also mental in that sense but it is amenable to drugs and tranquilizers at least partially.  Senile decay is a natural disease for which the treatment is spiritual reawakening.  In other types of disease, drugs, diets, and techniques have to be resorted to so that the cause of the disease may be rooted our and the force of the disease itself be reduced.

The concept of the healthy person as one in whom the three principles of vāta, pitta, and sleshma are in a state of balance is basic in Ayurveda.  Every person is a complex of these three types.  Their state of balance fluctuates from person to person and even within each individual.  This tridosha equilibrium applies to animals and plants, too.  Ancient physicians knew this and extended their healing services to both the animal and vegetable kingdoms.

The individual's psychosomatic group is therefore important in Ayurveda.  For instance, a person who is predominantly of the pitta type tends to suffer from irritations or as a result of eating food with an abundance of chillies, ginger, alcohol, etc.  The same food will not produce the same illnesses in a person of the sleshma type.  It is therefore 'more important in Ayurveda to know what type of patient has to be treated for a disease than to know what type of disease has to be cured in a patient.'

TRADITIONAL MEDICAL LITERATURE

Most of the writers of Sanskrit works on Ayurveda were from northern India.  Sri Lankan medical tradition is pre-Mahayana.  Nevertheless, it is possible that traditional Chinese medicine at least influenced Sri Lankan and Southern Indian practice in the early years of the Christian era when Buddhist monks travelled from southern India and Sri Lanka to China carrying the message of Mahayana Buddhism.  A mantra mentioned in the Prayogaratnāvaliya must have been a relic of the Mahayana which prevailed in Sri Lanka several centuries prior to the period in which that book was produced.

The standard Sanskrit works Susruta, Charaka, Vagbhata, and others were studied in Sri Lanka from the earliest times.  Several paraphrases and translations of these texts were published in Sinhalese from time to time.  For instance W. James Fernando and W. Arnolis Fernando of Panadura published Venerable Nanavimala Tissa's summary and paraphrase of the Susruta.  It contained illustrations of surgical instruments and explanations of their use.  The book described some instruments which were used in blood-letting (visravana), other instruments which were necessary in puncturing (vidhyana), and still other instruments which were required for different medical and surgical purposes.

In South India the Siddha system developed with the blessings and initiative of realized saints who were masters of the art and science of healing both the body and the mind.  Sage Agastya is mentioned in that connection as being on a par with the ablest physicians of North India.

Scholar-physicians and monarchs of Sri Lanka, too, made useful contributions to Ayurveda.  The Arka Prākasa is attributed to King Rāvana.  King Buddhadasa of the fourth century A.D. wrote the Sarartha Sangraha.  Chapter 37, stanza 96 of the Mahavamsa (fifth century A.D.) describes the Sarartha Sangraha as epitomizing all the schools of healing:

Sabbesam vejja satthānam

Katvā sarattha sangaham

Thapesi vejje dīpassa

Tikicchattham anagāte

This means, 'He extracted the essence of all the schools of medicine and placed it at the disposal of the island's physicians for future healing purposes.'

A part of the Sarartha Sangraha was edited by P.G. Gunasekera and printed at the Mahabodhi Press in the 1920s.  It gives the Sanskrit original along with a paraphrase in Sinhalese.  Some other editions have only a free rendering of the Sarartha Sangraha in Sinhalese prose without the original Sanskrit.

In the thirteenth century there was a revival of the study of medical literature.  Bhesajja Manjusā was written in that period in Pali verse by the head of the Pancha Pirivena.  Later in the same century the head of the Mayūrapāda Pirivena wrote in Sinhalese two major works, Yogarnavaya and Prayogaratnāvaliya.  This author is better known for his Pujavali, a book on Buddhism in Sinhalese prose.

The next important work we hear of is the Yogaratnākara in 4,557 Sinhalese stanzas.  The book is attributed to a monk who was known as Monaragammana Thera.  It was intended to be a translation of a Sanskrit work.  The substance of the Sinhalese stanzas of Monaragammana Thera is found in the Sinhalese prose work Vara Yogasāraya also attributed to the same monk.

Mahayana influence predominated in Sri Lanka between the first century and the thirteenth century.  Sri Lanka's earlier associations also must have been more with Burma, Annam, Thailand, Cambodia, China, and the rest of South-East Asia than with India.  Otherwise the Indian influence would not have waited till after the thirteenth century to make its presence felt in vocabulary, custom, popular beliefs, and legends.

In the fourteenth, fifteenth, and sixteenth centuries there was constant contact with South Indian culture as well as with Islamic culture.  Their influence on traditional medicine continued in subsequent periods.  With the arrival of the European powers, eastern medical techniques came under closer observation and in some instances gave much-needed publicity to eastern methods of healing.  For instance, the Geschichte und Beschreibung von Japan by Engelbert Kaempfer (1651-1716) gives a Japanese chart of cauterization points which correspond broadly to some of the points mentioned in our Salla Vidiya.

Cauterization as a technique of treatment may have been in vogue in the East in the sixteenth century and afterwards too.  It was then probably associated with blood-letting by puncture.  The various Sinhalese texts known as Salla Vidiya may have been produced at that time in order to meet a social demand for such knowledge.

But the writers of those texts presented their subject matter with more regard for maintaining records of traditional knowledge than for putting forward consistent theses.  Thus most of those works refer to the Susruta theory of 107 marma sthanas which should not be punctured.  While mentioning these prohibited marma sthanas they advocate blood-letting and puncturing.  Hence there may have been a  persistent cry for a consistent theory in that connection.  It is quite possible that the author of the original of the Samararatne manuscript fulfilled such a demand by producing a text which left out marma sthanas altogether and concentrated on cauterization.  Fortunately, most of the places for cauterization indicated by him were identical with acupuncture points.  In stanza 55 he makes a passing reference to an occasion when the upper nerve of the heel of a patient was punctured as a remedy for hiccups.  The expression nila dahanaya mentioned on the last page of the Samararatne manuscript further implies cauterization at the acupuncture points.

Words of South Indian origin occur in the Salla Vidiya.  They point to South Indian influence which was predominant not only in the reigns of the last four kings of Kandy but also earlier in the reign of King Narendrasinghe (1706-1739), whose queen was from Malabar.

We should, however, remember that it was King Narendrasinghe who took the first step in the eighteenth century to kindle interest in traditional medical literature.  He came across a palm-leaf manuscript of the Pali work Bhesajja Manjusā (thirteenth century) and requested Venerably Welivita Saranankara to edit it with a Sinhalese paraphrase.  That request was duly fulfilled within a reasonable time.  The king was so pleased with the Sinhalese paraphrase that he gave Venerable Saranankara an elephant as a present.  But he could not make use of it because he was a monk.  So he donated the elephant to Moragammana Mohottala, a layman.

Saranankara's paraphrase of the Bhesajja Manjusā in the eighteenth century ushered in a renaissance in the study of traditional Sinhalese medicine.  Thereafter, scholars in temple schools (pirivenas) began to study medicine in addition to Pali, Sanskrit, astrology, and Buddhism.

King Narendrasinghe's four successors were Sri Wijaya Rajasinghe (1739-1747), Kirti Sri Rajasinghe (1747-1780), Sri Rajadhi Rajasinghe (1780-1798), and Sri Wickrema Rajasinghe (1798-1815).  That there was South Indian influence during their reigns was corroborated in the eighteenth century by Sailendrasinghe.  He belonged to a school of medicine derived from Ramachandra, the erudite visitor from Andhra Pradesh who came to Totagamuwa in the fifteenth century and met Sri Rahula.  Sailendrasinghe mentioned in his Sinhalese work Vaidya Chintamani Bhaisajya Sangraha that he was translating from a South Indian work bearing a similar name.  It was later identified as Andra Vaidya Chintamani.

Sailendrasinghe lived in the eighteenth century in the time of King Narendrasinghe and served as the king's personal physician.  The king was pleased with his services and conferred on him the title of Sri Raja Vaidyashekhara.  He experimented with the medical preparations recommended by Caraka, Susruta, and Vāgbhata.  He also consulted the works of others and summarized his findings in his Vattoru Veda Potha.

P.M.P ABEYSINGHE

The production of Sinhalese books on traditional medicine has continued up to modern times.  Older books have been retranslated, reedited, and republished.  New compilation have been made from information given in numerous works.  We may mention here again a Sinhalese prose work on cauterization, Agni Karma Vidhi, by P.M.P. Abeysinghe (Colombo, 1934).  It is of interest that the button instrument referred to in our Sala Vidiya is explained and illustrated on page 5 of Abeysinghe's book.

Abeysinghe says that the button instrument, because its cauterizing end was in the shape of a jambu fruit, was called jāmbavaustha in Sanskrit, and that such instruments, made in various shapes, were collectively called yantras.  He mentions the opinion given in Susruta that there were 101 instruments of this type.  He also gives Sanskrit names for various other instruments: the instrument referred to in our manuscript as suraya was called valaya salākā in Sanskrit; katuva was called pratisārinī salākā; and sulumbuwa was called bindu salākā.  He further quotes Vagbhata's view that there could be no limit to the humber of instruments because as many couls be made as the nature of the different ailments demanded.

P.M.P. Abeysinghe was born in Udahewaheta near Hanguranketa in Kandy district in 1893.  His father was the Korale headman of the Gangapalatha division of Udahewaheta.  After his primary education at Hanguranketa Christian Missionary School, Abeysinghe entered St. Benedict's College, Colombo, for his secondary education.  He passed his college finals and went back to Hanguranketa and studied traditional medicine at Raja Maha Vihara Temple in Arattana, where he was taught by the chief incumbent monk, Venerably P. Chandajothi.  Later Abeysinghe went to India and followed a course of studies at the Astanga Ayurveda Vaidya Vidyalaya in Calcutta.

Figure 26 - Illustration of the bottama (button instrument for cauterizing) from P.M.P. Abeysinghe's book Agni Karma Vidhi.

In his leisure he associated with pandits of Calcutta and specialized in Sanskrit poetry.  They honoured him by conferring on him the title of Kavi Cintāmani.  Back in Sri Lanka he composed Sinhalese poetry, edited a periodical, and started the first Ayurvedic college on the island.  When the state authorities opened the College of Indigenous Medicine at Borella, Colombo, Abeysinghe was nominated to the Board and appointed visiting lecturer in Ayurvedic theory.  Still later when the Vidyodaya University was started, Abeysinghe was invited to deliver lectures there in Hindi language and literature.

Besides his book on cauterization he wrote several other prose works in Sinhalese and on non-medical topics.  He died in 1965.

Adequate source material for books on traditional medicine was always available to our writers and physicians.  They oculd therefore produce informative books on treatment of children's diseases, snake-bite poisoning, ailments of plants and trees, and illnesses of cattle and elephants.  There was a comprehensive collection of traditional information concerning the behavior of elephants.

Books like Gava Siddhi Saraya elucidate the principles of cauterization as applicable to the diseases of cattle.  The manuscript Nila Vidum Sastraya extends those principles so as to apply them to cocks and horses.  If temple libraries are searched and their manuscripts on medicine carefully read, many facts pertaining to ancient veterinary science will probably be revealed.  But it so happens that ancient physicians made a better study of elephants than of other animals.

NILA POINTS

Points and zones on the body of elephants were recognized from very early times as having special significance.  Striking such nila points is like talking to the elephants in a language they can understand.  By prodding these points, mahouts, or elephant-handlers, communicate instructions to the animal to stop, proceed, raise the trunk, lower the front right foot, etc.  There are unpublished Sinhalese palm-leaf manuscripts dealing with this subject of 'elephant science'.

P.E.P. Deraniyagala, former director of the Colombo National Museum, also mentions the word nila in connection with control points on the elephant's body.  His book Some Extinct Elephants, Their Relatives and the Two Living Species (Colombo, 1955) states that old Sinhalese palm-leaf manuscripts set out in detail some points on the body of the elephant (pp. 68 ff.).  These are the nila points, or nerve centres, which are goaded by the mahout.  Deraniyagala explains that 'they are sensitive spots located all over the body' and that they enable a mahout to force the animal to kneel, raise a limb, raise the trunk, move, or trumpet.  These reactions are induced as a series of reflex actions either by pressing, pulling, or striking the appropriate areas.

Deraniyagala is quoted by Felix Mann in Acupuncture: Cure of Many Diseases (London, 1971, p. 12).

Nila in the context pointed out by Deraniyagala implies function centres on the body of the elephant.

Our ancestors who observed that the animal performed a specific action when certain points on its body were prodded may have thought further and in an inductive leap inferred that even in the human body there could be similar places.  At about the same time, soldiers who had been wounded by arrows may have found that subsequently ailments in other parts of their bodies were healed.  Only comparison and co-ordination of relevant empirical knowledge was needed to discover nila points in man.  Puncture as a healing technique may have had such a background in Sri Lanka.

It is equally possible that with the development of other forms of medicine our nila vidum sastra went out of use.  In this later period, anyone suggesting that one place on the body could be treated to cure an ailment in another part of the body would have been considered to be talking incoherently.

Such an opinion was actually current in the thirteenth century.  The Sinhalese prose work Saddharma Ratnavali, written in that century, ridiculed the technique of applying medicine at the back of the neck as a remedy for filaria on the foot (ed. D.B. Jayatilaka [Colombo, 1952], p. 55).  This was a veiled hint directed at contemporary physicians who were probably working on the theory underlying acupuncture practice.  And in the twentieth century Aldous Huxley suggests the possibility of there being people who would doubt the claim made by acupuncturists that one spot on the body could be treated for an ailment somewhere else on the body: 'That a needle stuck into one's foot should improve the functioning of one's liver is obviously incredible.  It can't be believed because, in terms of currently accepted physiological theory it makes no sense.  Within our system of explanation there is no reason why the needle-prick should be followed by an improvement of liver function' (Aldous Huxley's Foreward to Felix Mann's Acupuncture: Cure of Many Diseases [London, 1971], p. v).

In the predicament in which the author of Saddharma Ratnavali and presumably some of his contemporaries also found themselves, the practice of working on the theory of nila points may have given rise to the expression nilanavā in Sinhalese meaning 'confuses', 'darkens', 'confounds'.  The use of the word nila euphamistically in the sense of dark blue, black, or blue-black would have lent support to such a usage.

In colloquial Sinhalese, nilankāra venavā has a meaning of being overcome by a sensation of being blinded in a moment of fainting.  The Sälalihini Sandesa (fifteenth century) uses the expression maga nilamin in stanza 34 in the sense of confusing one's bearing on the road.  The traditional explanation mentioned in the paraphrase is 'spreading neela colour on the road'.  As the name of a colour, neela most precisely  means blue, but it can be used somewhat loosely to mean green also.  The Kavyasekara of the fifteenth century has in stanza 39 of canto 3 the verbal form nilana in the sense of 'spreading darkness'.  The line nilana kusa tana pela there implies that kusa grass reflected in the river spreads patches of darkness.

In Sanskrit the verb nilati is used in rare instances in the sense of incoherently arguing confusing issues.  This meaning runs parallel to the sense of Sinhala nilana.  There is nothing surprising in this because there have been occasions when spoken languages enriched Sanskrit.  This Sanskrit verb nilati may have been derived from Sinhalese.  In early Sanskrit there are no instances of nila being used in the sense of office.  Nor do we come across the word niladhārī in early Sanskrit although it sounds like a Sanskrit word.

Let us come back to the word nila in Sinhalese.  The sense of function centre could easily give rise first to the sense of functioning itself, and second to the sense of command (when the mahout, for instance, commands the elephant to perform a specific act).  Instances may be found in two thirteenth-century works, Saddharma Ratnavali (p. 66, line 39) and Pujavali (ed. Saddhatissa, p. 356, line 4).  The fourteenth-century Saddharmalankara has the sentence Ē ē desayata bhiksūn vahansē nila kota (ed. Sarananda, p. 340, line 36), which means that someone assigned monks specifically for various countries.

In the fifteenth century we find the word nila similarly used in a periphrastic verbal form in the Jataka Pota.  In the Ummaga Jataka we come across asaku sadā nila karavā (ed. Gunananda [Kalutara], p. 298, line 16).  Again, we find tepi sälakū tänama nila karavā (p. 318), which means, 'assign the very place you thought of'.  And in the smae book we read ape geya nila kota gannā tekma (p. 316, line 21), meaning 'until we authorize specifically and take possession of the house'.

Another instance of the word nila in the sense of specific authority occurs in line 11 of the Oruvala Copper Plate Record (Epigraphia Zeylanica, 3: pp. 51 ff.): me gameta sathayawa nila la bala lā balētā dun raja kenek, meaning 'a monarch who, as a friend of the village, gave (land) specifying authority and power' (H.W. Codrington's translation is, 'who helps this village by giving the necessary services and authority').

It was easy for the word nila in this sense of specified authority to give rise to nilame, implying an authorized administrative officer.  The nominative singular ending ē in this word shows that it goes back to a very old era; otherwise we should get the form nilamā with the ending ā, but such a usage was never current. (The older ending in ē is found in belē, which means 'soldier': Belē balām kerē [Sidat Sangara], 'The soldier does a soldier's work.')

There is a Tamil word nilam, but it means 'earth' or 'moon'.  The Tamil word nilei means 'house'.  In Sanskrit, nilaya means 'a residence'.  In Sinhalese, nila in the sense of 'earth' occurs in the Sigiriya Graffiti (eighth century): sav siri bar nila busu, meaning 'the prosperous [mountain] come down to earth.'

Dham Piyā Atuvā Gätapadaya, belonging to the tenth century, has paskam guna nilayen (ed. Jayatilaka, p. 151, lines 15-18), meaning, 'from the resting place of the fivefold sense pleasures.'  The same book has paskam gunata nonilay, meaning 'not a resting place for the fivefold sense pleasures.'  Another phrase is keles nilayaneni, meaning 'from the resting place of defilments'.  The Jataka Pota has idin ek nilayak ladumō nam (ed. Gunananda [Kalutara], p. 316, line 12), which means, 'if we get one residence'.  It should be noted that the word used in these citations from the Dham Piyā Atuvā Gätapada and the Jataka Pota is nilaya and not nila.

The historical beginnings of the word nila are obviously very old.  Let us be alert for more conclusive evidence which should come to light soon.  We may safely say that the theory of acupuncture was not unknown to Sri Lankans of ancient times.

VIDAYARATNE

One of the physicians with whom we discussed various aspects of acupuncture was Ayurvedic Dr. M.G.A. Vidyaratne, Lecturer at the Ayurvedic Institute, Borella, who asserted emphatically that acupuncture therapy was practised in Sri Lanka long long ago.  His version of the history of acupuncture in our country was interspersed with autobiographical digressions, mildly emotional outbursts which might have resulted in evocative poetry had they been recollected in tranquility.

It was a moving story by a sensitive scholar who had better knowledge of his subject than of the ways of the world.  He was a pioneer in the study and practice of acupuncture in Sri Lanka.  By the 1960s he had written a book on aspects of the critical loci in the human body, which he later subitted as a thesis for the H.P.A. (Higher Proficiency in Ayurveda) examination.  Written in Sinhalese, it bore the title Marma Vijnānaya ('Ascertainment of Critical Loci in the Human Body').  In 1969 he was awarded the H.P.A. certificate.

The subject of marma sthanas had baffled many practitioners.  A total of 107 such points had been mentioned in textbooks and practitioners had been instructed to avoid puncturing these places.  Most manuscripts of the Salla Vidiya in their varying versions had merely recounted the traditional teaching on the subject but had not given a clear theory of nila loci and places for blood-letting in relation to the prohibited marma sthanas.  The author of the Samararatne manuscript's original Salla Vidiya had maintained logical consistency by leaving out puncturing and restricting himself to an exposition of a comprehensible theory of cauterization only.

Dr. Vidyaratne entered the controversial territory of marma sthanas and surveyed the entire area from various points of view mentioned in Sanskrit, Sinhalese, and English sources.  In all, 160 typed pages of his thesis contain quotations not only from Susruta, Vāgbhata, Yogaratnakāra, Angustha Tantra, and Pratikarma Sangraha but also from Chinese textbooks and even from Japanese works on karate.  Many Sanskrit and Sinhalese terms are given along with their English equivalents.  Graphic illustrations add to the value of Dr. Vidyaratne's explanations.

It was clear to our investigators that considerable labour and thought had gone into the compilation of the thesis.  But there was much more worth seeing on Dr. Vidyaratne's table.  Heaps of notes, sketches, graphs, files, newspaper cuttings, and other documents lay scattered all over.  They were tangible evidence of the efforts he had taken to keep track of 12,067 punctural points traditionally mentioned in an old Sinhalese stanza which he quoted:

Anguta patula siyalanga velū nahara pita

In pita velū nava siyayak nahara pita

Säka neva balā däna gannē mē lesata

Delos dās häta hat palaki vidumata

His early training in Ayurveda was under his father, Ayurvedic Dr. M.G.A. Vidyaratne of Dematageda.  The son has the same initials as his father.  The son is M.G. Ariyatilaka Vidyaratne while his father is consulted by people seeking Ayurvedic treatment.  The son (47 years old) often seeks his advice in controversial technicalities of traditional medicine.  Their ancestors had been residents of Moratuwa.  They served in the Western Province as independent astrologers and physicians.

After a short stay at Nalanda Vidyalaya, Colombo, young Vidyaratne joined St. Mary's College, Veyangoda, in 1939.  Later he came back to the capital city to study at Lorenz College.  Still later, in 1958, he entered the College of Indigenous Medicine at Borella.  While attending lectures there, he appeared for the diploma examination in Ayurveda conducted by an association called the Vidyachakra Sangamaya, a private body of examiners headed by Ayurvedic Dr. R. Buddhadasa.  In 1961 Vidyaratne was awarded the Diploma in Ayurvedic Medicine and Surgery.  In 1963 he passed the final examination held by the authorities of the College of Indigenous Medicine and obtained his D.I.M.S. certificate.

Three years later, in 1966, he joined the staff of that college as a demonstrator in anatomy.  Since 1968 he has been a lecturer in Ayurvedic therapeutics at the same institution.

Alluding to the legend of the ancient Sri Lankan minister who once set out on a journey but found himself unable to proceed because of a sudden paralytic stroke, Dr. Vidyaratne said that it was acupuncture treatment that cured the minister and enabled him to resume his journey.  That was long ago.  But Dr. Vidyaratne went on to say that in more recent times, in 1958, a Sri Lankan cabinet minister, Mrs. Vimala Wijewardene, went to China and brought back news of miracles which were being done there with needles.  That minister's public utterances stimulated Vidyaratne's interest in the subject.  He was then a student at the College of Indigenous Medicine, Borella.  It was in that year that the idea of writing Marma Vijnanaya took shape in his mind.

In the early 1970s, government sources evinced fresh interest in acupuncture.  The Ministry of Planning called for applications from physicians who had knowledge of the traditional teaching on acupuncture and allied fields.  This was mentioned in banner headlines on the front page of the Silumina (a Sinhalese weekly) on 3 March 1974.

In response to the advertisement, Dr. Vidyaratne met with Planning Ministry officials.  He was not aware of there being any other applicants.  The ministry officials requested Dr. Vidyaratne to formulate a scheme for the learning and teaching of acupuncture and for research in the field.  He prepared a memorandum after consulting physicians of the calibre of Ayurvedic Dr. Samarawickrema of Kottegoda, Matara, who had in his possession palm-leaf manuscripts on acupuncture as well as old needles which were relevant to acupuncture.  On 4 September 1977 the Silumina carried a feature article by Tusita Malalasekera describing the services which Dr. Vidyaratne was performing in his clinic.  That article, published under a title which meant 'Revival of Ancient Acupuncture', carried photographs of patients whose illnesses had been cured by acupuncture treatment.  One of the patients was an old woman who had been dumb but regained the power of speech after treatment by Dr. Vidyaratne.  A similar article appeared in the Priyavi (another Sinhalese weekly) of 15 September 1977.  Editors were then keen on publishing such articles in order to publicize acupuncture.  It was also suggested that a three-storey building be put up in Cotta Road for acupuncture studies and that pending completion of the building the subject of acupuncture be introduced into the syllabuses.  That second suggestion was put into effect and Dr. Vidyaratne was requested to deliver lectures on acupuncture.

THE WORLD HEALTH ORGANIZATION (WHO)

Despite obstacles, Dr. Vidyaratne continued his clinic services and attended to his teaching assignments as usual.  In August 1979 he was chosen for a short course of training held at the Peradeniya University Campus.  It was conducted by the World Health Organization's Medical Education Unit for the South-East Asian region.  Dr. Vidyaratne was one of three Ayurvedic physicians selected to attend the course.  The other 20 physicians participating were doctors qualified in allopathic medicine.  One aim of the course was to enquire into problems facing teachers of medicine.  Dr. Vidyaratne brought up the need for facilities to teach acupuncture.

Traditional physicians should be pleased to hear of this interest taken by WHO.  Further instance, the Daily Mirror carried an article by Peter Ozoriw with the heading 'W.H.O. Urges Blending Western and Traditional Medicine'.  It mentioned a WHO report which referred to a resolution by the Executive Board of WHO calling on its Director-General to promote traditional medicine and to assist interested governments.  The article went on to say that subsequently the Danish International Development Agency contributed $115,000 for the relevant 1979 programme of WHO and pledged to contribute a further $500,000 over the next five years.

Dogmatic opponents of Ayurveda ought to know that the WHO report referred to above condemned 'the tendency in some quarters of the medical profession to regard traditional medicine as a practice in decline'.  Ways and means should be found to integrate the best of traditional medicine and to utilize fully 'its availability, accessibility, and acceptability', the report said.  It confirmed that acupuncture was part and parcel of the traditional system of medicine.  It also said that, according to Dr. R.H. Bannerman of WHO at least 70 diseases could be cured by acupuncture.

These comments by WHO experts should be respected by those who entertain the view that Ayurvedic physicians are incapable of benefiting from a course of acupuncture studies in the People's Republic of China.  Instead of two ro three scholarships per year the programme should envisage giving at least 500 scholarships over the next 20 to 25 years, as Manel Tampoe suggested in her article 'Towards an Ayurvedic Renaissance', published in the Ceylon Daily News on 29 November 1978.

The study of Salla Vidiya and other time-honored texts will spur Ayurvedic graduates to do research and build on the experience of early physician-writers.  Even the programme sponsored by Dr. Ponnamperuma of the University of Maryland, USA, in collaboration with the Institute of Ayurvedic Research, Nawinna, Sri Lanka, presupposes the perusal of Ayurvedic texts for comparative studies in traditional prescriptions.

In the present climate of opinion, acupuncture will form a link between traditional medicine and modern medicine.  The claims of acupuncture are no longer dismissed as the effects of hypnosis and auto-suggestion.  Sometime ago Ayurvedic Dr. W.I. Fernando, Lecturer at the Ayurvedic Institute, Cotta Road, Borella, and President of the Congress of Ayurvedic Physicians of Sri Lanka, went to China and saw acupuncture techniques utilized in anaesthesia.  Our physicians are convinced that much can be achieved by patient research.  Traditional medicine in Sri Lanka has a bright future to look forward to.

SOCIAL COMPOSITION OF THE EDUCATED CLASS

In Sri Lanka, Ayurvedic physicians were a very important component of the educated class in late medieval times - a class which was numerically small but highly respected by the people.  Members of the sangha (Buddhist clergy), Ayurvedic physicians, architects, and designers, as well as sections of the royalty and nobility, jointly composed the small class of literate persons in medieval society.  The cultural achievements of that society were the product of the efforts of this class as well as of the class of literate, semi-literate, or non-literate artisans, artists, dancers, and musicians who often received their knowledge and skills through oral tradition.

What is important to note is that the educated as well as the cultural élite of late medieval society in southern Sri Lanka came from all castes and not from any one particular caste.  The Buddhist sangha - the most literate section of late medieval society - had recruits from at least the Goyigama, Karāva, Salagama, and Durāva castes in the Matara and Hambantota districts in the eighteenth century.  Architects and designers of temples and other buildings usually came from the Navandannā caste, while the temple artists, musicians, and dancers generally came from the Näkathi caste.  Astrologers came largely, though not exclusively, from the Näkathi caste.  Sculptors and carvers came from the Navadannā caste, while the great Sinhala poets of the late medieval period in southern Sri Lanka came from all castes - e.g., Ven. Sitināmaluwē Dhammojothi (1672-1760), Durāva caste; Ven. Karatota Sri Dhammārāma (1734-1827), Goigama caste; Virthāmulla Gamagē Don Jānvi de Silva Abeygunawardena Samarajeewa Paththāyamē Lēkam (eighteenth century), Durāva caste; Ven. Vēhällē Sri Dhammadinna (1679-1775), Goigama caste; Virthāmulla Gamagē Dōna Isabel Perumal Cornelia Garaman Nōna (1746-1814), Durāva caste; Chandrābarana Näkatigē Sādā Baranaganitacharya (eighteenth century), Näkathi caste; Dissānayake Mudliyar of Matara (eighteenth century), Goigama caste; Ven. Sālyālē Maniratana (eighteenth century), Goigama caste; Don Juwanis Amadōru Opisara Mahattaya (late eighteenth to early nineteenth century), Karāva caste; Orukemē Muhandiram (late eighteenth to early nineteenth century), Rajaka/Radā caste.

The present study shows clearly that the community of professional Ayurvedic physicians in the Matara and Hambantota districts during the late medieval period was also composed of persons of various castes; the evidence shows that there were families of Goigama, Karāva, Salagama, Durāva, Näkathi, Rajaka (Radā), and Devawamsika (Wahumpura) physicians receiving the highest social esteem from the people during this period.  The caste system of late medieval Sri Lanka as it found expression in the Matara and Hambantota districts was much less rigid than its Indian counterpart.

Our survey of the diffusion of a particular medical technology clearly shows how the Buddhist temple played a critical role in the dissemination of knowledge across the boundaries of caste.  Children of all castes were free to come to the temple, learn reading and writing, and use the temple library.  The monks were always willing to teach those who cared to learn and instruct them in specified branches of learning such as medicine.  Though, sociologically speaking, late medieval society in southern Sri Lanka was stratified according to caste, the intellectuals, the clergy, the technologists, the thinkers, the doctors, the writers, and the poets came from all castes and enjoyed immense respect from the people.  At this level society was much more open and egalitarian than scholars who are unduly influenced by the traditional Indian model would like us to believe.

It can be maintained that the relative openness of medieval Sinhalese society as contrasted with traditional Indian society was influenced by the humanitarian world view advocated by the monks and regularly preached at village temple gatherings on full-moon days.  Though the idea that human life was only a brief sojourn in the vast expanse of samsara (continuous cycle of births and deaths) and that any person who belongs to a given caste in this birth may have been a member of some other caste in a previous birth was common to both Hinduism and Buddhism, this idea influenced practical social relations in a much more meaningful way in Buddhist society because the close social relationship between the Buddhist clergy and laity in village social organization in Buddhist countries such as Sri Lanka contrasted sharply with the rigid structural distancing in the relationship between the Hindu clergy (Brahmins) and the Hindu laity in traditional Indian society.  When studying the modalities of the transfer of the particular medical technology described in this paper it is important to note that both the social spread and the spatial diffusion of the technology within Sri Lanka were significantly influenced by the humanitarian ideology and the institutional organization of Buddhism in Sri Lanka.