Introduction

Species that live today have evolved a variety of ways of protecting themselves from predators and parasites, large and small, in their environment. Certain fungi produce antibiotics, lethal to parasites, and secure themselves from getting infected. Higher plants evolved various classes of defensive biochemicals like alkaloids, glycosides, terpenes, saponines, cellulose, lignin etc. which acted as toxins, inhibitors of respiration, irritants, diuretics, emetics, mutagenics, carcinogenics, purgatives, indigestibles etc. (Howell, 2003; Huffman, 2009). Many animal species selectively feed on substances of therapeutic value from nature. From creatures with brains the size of pinheads to birds, and lizards, elephants, and chimpanzees all share a survival trait – that of self-medication, by eating things that make them feel better, or prevent disease, kill parasites, or aid digestion. Somehow they know to ingest certain plants or use them in unusual ways when they need them (Shukin, 2014). Thus dogs and cats instinctively treat themselves during illness or indigestion by feeding on the durva grass, Cynodon dactylon, which induces vomiting in case of indigestion or food poisoning (Kandwal and Sharma, 2011)

Such observations in the past, and their own experiences through generations, paved the way for development of medical systems by every human society. Beliefs and practices relating to disease are the products of indigenous cultural development and are not explicitly derived from the conceptual framework of modern medicine (Hughes, 1968). Food and medicine greatly overlap in the diet, especially among the indigenous communities world over. Among the Hausa tribe of Nigeria 30% of the plant species identifed as food were used in medicine. It was also found that 89% of the plants which they used for treating malaria were also used in food (Etkin and Ross, 1983; Etkin, 1996). The concept of ‘functional food’ frst arose in Japan in 1980’s when the country was faced with an aging population and increased health costs. Japan’s Ministry of Health and Family Welfare prepared a compilation of ‘Foods for Specifed Health Use’ (FOSHU). By 2002, 300 such foods got FOSHU status (Mangathayaru, 2013). At the time when antibiotics and other pharmacy products did not exist, a bulb of garlic meant a whole pharmacy industry. Garlic’s therapeutic uses were known to ancient Sumerians, Egyptians and Chinese even 4000 years back (Petrovska and Cekovska, 2010). Today, garlic is considered a wonderfood for its antibacterial, antibiotic, antioxidant, anticarcinogenic and hyperlipermic effects, as source of supplements like minerals, vitamins and enzymes, for cholesterol reduction, in controlling hypertension, prevention of thrombosis and so on (-ibid-). Kassaian et al., (2009) observed that type 2 diabetes mellitus can be controlled by consuming seeds of fenugreek (Trigonella foenum-graecum), soaked in hot water. Interestingly, an ethnobotanical study of 200 persons in Jammu showed that, 8.9% of them, who were diabetic, consumed a teaspoon of fenugreek soaked overnight in a glass of water early morning (Aggarwal and Kotwal, 2009). For blood enrichment, 70% of the surveyed subjects consumed pomgegranates and dates (-ibid-). Whether based on faith or fact, ‘punicalagins’ in pomegranate beneft heart and blood vessels. In vitro, animal and human trials showed that various pomegranate constituents prevented and reduced atherosclerosis; its juice inhibited serum ACE and reduced systolic blood pressure in hypertensive patients. Juice consumption (via antioxidative mechanisms) signifcantly reduced carotid artery stenosis and improved myocardial perfusion (Jurenka, 2008). Bittergourd (Momordica charantia), is well known in Indian folk healing practices and its regular use is believed to beneft diabetics. It has antidiabetic compounds like charantin, vicine, polypeptide-p etc. with proven hypoglycemic effects and other unspecifc bioactive substances like antioxidants (Krawinkel and Keding, 2006).

Codifcation of traditional medical knowledge

The World Health Organization defnes traditional medicine as “the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illnesses (WHO, 2000)”. Every human society must have developed a system of medicine, may be based on medicinal substances, incantations, magic and rituals, which to the modern world looks meaningless. Traditional Medicine (TM) is not only vital for health care, but also an income for many and integral to the community’s identity (Abbott, 2014). TM in India can be classifed into codifed (Ayurveda, Unani, Siddha) and non-codifed (folk medicine) systems (Upadhya et al., 2014). TM takes care of the primary health needs of about 70% of the Indian population (WHO, 2002). TM with a systematic body of knowledge in the form of pharmacopoeias, or ancient works like Ayurveda, Chinese and Tibetan medicine, Siddha, Unani etc. belongs to the codifed system whereas non-codifed system of traditional medicine or folk medicine, is transmitted by oral means (Upadhya et al., 2014).The codifed medical systems have their beginnings in noncodifed traditions (Narayanaswami, 1981). From Hippocrates onward physicians agreed that there were no certainties in medicine, only probabilities and approximations. Experience was transmitted through human sensations; the gift of observation and instinct played big role. Medicine began to move greatly toward a purely scientifc orientation only with the ‘stormy development of natural sciences’ during the 19th century (Laqueur, 1995).
As regards codifed medical tradition is concerned even the Rig Veda, composed in a dimly lit period of human history, contains not many details on medicinal herbs or formulations. But a holistic concept of health based on herbs is found in the Hymn XCVII. Praise of Herbs (Griffth, 1896):

Let fruitful plants, and fruitless, those that blossom, and the blossomless, Urged onward by Bṛhaspati, release us from our pain and grief.
Soma was considered the ‘King of all the plants’. The collection of a medicinal herb was more a devotional exercise:
All Plants that hear this speech, and those that have departed far away, Come all assembled and confer your healing power upon this Herb

Rudra, associated with mountainous places, is extolled for his healing powers. Having a thousand remedies, he is the greatest of physicians. He has two exclusive epithets, jalaasa (cooling) and jalaasabheshaja (cooling remedies). Maruts, the sons of Rudra, are the carriers of these pure and wholesome medicines. The Rig Veda also extolls the Asvin brothers as divine physicians and speediest deliverers of distress in general, healing with their remedies, restoring sight, curing the sick and the maimed (Macdonell, 1917). The Atharva Veda is a compendium of medicine in its various stages of evolution and contains the most primitive as well as some of the most highly developed stages of therapy. While AV stresses the extraordinary powers of charms and amulets in healing diseases it highlights importance to Kayacikitsa (treatment of body internally and externally), a branch of Ayurveda (Prasad, 2002).
Charaka Samhita perhaps, is the frst attempt at a systematic documentation of well-organized ideas, facts and conclusions of debates on Ayurveda in the form of a Samhita (compendium); although its original sources are attributed to Agnivesha and beyond to Atreya, bordering on prehistory, Charaka redacted these earlier works (around 200 BC?) and Dridhaabala (4th century AD) further revised it. Charaka, in his work of codifed Ayurveda, containing 120 chapters, was the frst to introduce rational angle to the science of medicine (Valiyathan, 2003). Sushruta Samhita is a celebrated treatise on medicine and surgery in Ayurveda, its date of composition still unsettled. Vagbhata, who established a sound theoretical base for Ayurveda lived sometime in the early centuries of C E. Attributed with the authorship of two classics Astamgahridayasamhita (AH) and Astangasamgraha (AS), he was considered a Buddhist, because of his explicit praise for the Buddha in his texts, under the title ‘Unprecedented Teacher’. AH’s primary focus is on internal medicine. Both the AH and the AS became extremely popular in Kerala (Menon, 2008, Valiathan, 2010).

The Great Epics: a tale of two medical systems
Ayurveda would have been well known during the Epic period. The numerous plants that fgure in Ramayana are also well known Ayurvedic plants, such as Ankola (Alangium salvilfolium), Arjuna (Terminalia arjuna), Ashoka (Saraca asoca), Aswatta (Ficus religiosa), Bilva (Aegle marmelos), Chandana (Santalum album), Chuta (Mangifera indica), Devada- ru (Cedrus deodara), Dhava (Anogeissus latifolia), Jambu (Syzygium cumini), Karnikara (Cassia fstula), Khadira (Acacia catechu), Kimshuka, Plaksha (Butea monosperma), Kurantaka (Barleria prionitis), Lodhra (Symplocos racemosa), Madhuka (Madhuca indica), Nyagrodha (Ficus bengalensis), Pippali (Piper longum), Punnaga (Calophyllum inophyllum), Salmali (Bombax ceiba), Shami(Prosopis cineraria), Surakta (Pterocarpus santalinus) etc. (Source: Flora of the Indian epic period; From Wikipedia). At the same time the identity of Sanjeevani and few other herbs used for reviving critically wounded Lakshmana continues to be a mystery. Prescribed by Sushena, introduced as a vanara-vaidya (monkey physician), as Ravana’s vaidya and as father-in-law of Sugriva, Sanjeevani could have been at the best a herb of folk tradition or otherwise a myth. For the world of science Sanjeevani remains a mystery. The Epics hardly any mention of medicines used in the folk traditionby indigenous tribes to semi-divine beings like Nishadas, Kinnaras, Kiratas, Yakshas, Nagas, Danavas, Daityas etc. Flora of Mahabharata also has similar elements as in Ramayana, again with least mention of folk medicines.

Rise of priesthood and fall of physicians in social hierarchy

Rise of Brahminic priesthood and importance given to ritualism during the early half of frst millennium BC witnessed hardening attitudes towards the medical practitioners because of the latter’s contacts with contagion, impurity and pollution (Chakravarti and Ray, 2011). Despite having wealth of medical formulations in it the Atharva Veda relied more on charms and prayers than on medicines and surgery, for maladies ranging from manias to poisonous stings and bites, fevers and fractures (Bloomfeld, 1897). The divine Asvin brothers were extolled as great healers among Rig Vedic gods (Macdonell, 1917) had fallen in status mainly because they were physicians. Taittiriya Samhita of the Black Yajurveda and the Satapatha Brahmana of the White Yajurveda denounced the Asvins: The gods said of these two (Asvins): Impure are they, wandering among men as physicians. The physician is impure, unft for sacrifces. Therefore, the brahmana must not practice medicine (Taittiriya Samhita ). The gods said to the Asvins: ‘We will not invite you; you have wandered and mixed among men, performing cure” (Satapatha Brahmana; Chakravarti and Ray, 2011) Rise of the mixed castes as physicians The denouncement of the physicians amounted to rise of mixed castes in the medical profession Whereas Charaka had eulogized the higher ranking of physicians as “earned not inherited”, as in Charaka Samhita, Vol.6, their social status in reality kept tumbling down with time from their exalted position in the Rig Veda to Atharva Veda and further down to the status of Shudras by the early historic period. Manusmiriti mentions about Ambastha, a mixed caste of Brahmana and Vaisya who were specialized in the art of healing (Buhler, 1886). However, being in relatively higher order than other physicians of lower order, Ambashtas were preferred by the Brahmins to others, the proof for existence of vaidyas of lower orders as well, mostly the practitioners of noncodifed folk medicines.

Buddhism and systematic integration of folk medicine into Ayurveda

Buddhism in India had deep correlation with human suffering and illness. Buddha himself was a physician and surgeon. Numerous kinds of traditional medical practices like use of salves, astringent decoctions, fumigation; even excision of proud flesh in chronic ulcers etc. were approved by Buddha, including the use of purgatives for eliminating excess of doshas. (Valiathan; http://textofvideo.nptel.iitm.ac.in).78 M. D. Subash Chandran On the importance of taking care of the sick, Buddha appealed to the monks: “You, O monks, have neither a father nor a mother who could nurse you …. if you do not nurse one another, who, then, will nurse you? Whoever, O monks, would nurse me, he should nurse the sick” (Zysk, 1998). Ayurvedic medicine gained many of its major features from the work of heterodox ascetics and the Indian medicine progressed signifcantly during early period of Buddhism. The Buddhists imbibed the concepts of Ayurveda and with Buddhism these concepts spread far and wide. Buddhist Samghas are considered to be the world’s oldest and most widespread social institutions involved with treatment of the sick. The Buddhist viharas also became centres of healthcare for both the monks as well as for people. The famous surgical procedure of removal of the cataract described and practiced during Susruta’s time reached China, probably through Buddhist pilgrim monks than through Ayurvedic physicians from India (Birnbaum, 1979; Zysk, 1996 & 1998). Derogation of physicians and their exclusion from the Brahmanic social structure and religious activities implies that they existed outside mainstream society and were probably organised into sects who roamed the countryside as ‘roving physicians’. They earned their livelihood by administering cures and increased their knowledge by keen observation and by exchanging medical data with other healers whom they encountered (Prasad, 2007; Udwadia, 2000). The Buddhist Jataka stories have rich accounts of medical cures by physicians and surgeons.

Revival of Hindu medical profession

Medical profession regained respectability among the Hindus by early 6th century once again within the Brahminic religious institutions. The Brahmanical/ Vaishnava temple must have modelled the medical facilities within its premise on the well-established Buddhist practice of having an arogyavihara within the monastery. Charaka Samhita and the Susruta Samhita, emerged not only as the main source of the medical knowledge but also as texts reflecting the Buddhist secular traditions. There are also epigraphic evidences of Shiva temples accommodating medical centres. From South India was reported several instances of athurasalai (hospitals) within Hindu religious premises (Chakravarti and Ray, 2011).

The issues and objectives

Despite the widely acknowledged richness of traditional healing practices in India, of the coexistence and complementarity of codifed and oral traditions of medicine through generations, a paradigm shift towards smothering of the folk healing practices as well as of traditional Ayurvedic practitioners, due to lack of requisite qualifcations, has been happening, necessitating the current study. Major part of the study is aimed towards evaluating these important but informal sectors of health care, in an historical perspective, through case studies. The major focus for the case study is on tracing out and evaluate the role of Kerala’s Ezhava community in medical practice. Although affected badly by social stratifcation that prevailed in Kerala through centuries the Ezhavas were able to carry on with their healing practices unimpeded, until drastic change of situation more in the post-independent period. For developing a comparison of the present status of folk healing and to evaluate its contemporary role in the society a case study involving a cross section of folk healers or ethnomedical practitioners in Uttara Kannada district of South Indian west coast was conducted. After examining various socio-cultural and regulatory frameworks on medical practice in India, and on realizing the great role of indigenous health care systems in contemporary society, the article envisions how best ethnomedical practices can be revived and brought into a legitimate system to complement the medical pluralism that has been the hall mark traditional healthcare in India, without in any way disparaging the modern systems of medical care or challenging existing regulations and norms for medical practice in the country.