THE PULSE OF SIDDHA MEDICINE

A basic understanding of the Siddha tradition’s understanding of the human system and its constituents is a prerequisite for an appreciation of what the physician is reading in the “pulse.” Within this tradition it is held that there are 96 different tattvas, or basic essences, which compose the human body. Here three are important; the muppini or the three “humours.” Similar to the three doshas in Ayurvedic medicine, these three humours are sometimes described as air/wind, heat/bile and water/phlegm. Traditionally they are labeled vatham, pittam and kapham. When a physician is reading the pulse of a patient, he/she is reading the three humours, which are important not merely in themselves, but also in their proportions to one another.

It is crucial to understand that the pinis in Siddha medicine reveal different types of relationships via physiology than ones traditionally held in biomedical models. First, Siddha medicine posits that the ratios of humours reflect either a state of health or a state of disease. Next, these different humours correspond to various systems and functions within the body, which are all connected via the interaction of the pinis. Thus basic Siddha physiology reveals that the pulse is a microcosm of sorts for elucidating the Siddha medical tradition as a whole.
As Kamil Zvelebil writes, “no disease can be purely local, isolated, unconnected with other parts and functions of the organism; hence no disease should be treated in isolation” (Zvelebil 1996, 35). Furthermore, treatment is understood as a way of assisting the human system to return to an optimal state of balance, rather than getting rid of a disease. In sum, taking the pulse in Siddha medicine is an evaluation of the quality and relationship of different humours in the body as a whole. Each of these humors relates to different tattvas, or elements of the body, which are understood as interconnected and interdependent. Further, the treatment of imbalance is an attempt to restore equilibrium within the humours, rather than the isolation of a symptom and its treatment as in biomedicine.

Biomedical doctors are trained to read a single diastolic-systolic pulse, which they interpret as a sign or index of the patient who they are observing often with the assistance of a stethoscope. Generally, the pulse is used as an indicator of regular heartbeat, and once the rate, rhythm and character are deemed acceptable, the doctor proceeds with other diagnostic procedures. Often considered a cursory or even perfunctory procedure, taking the pulse in biomedicine has a relatively small place in the process of diagnosis, unless something is noted to be significantly deviant from the norm.

In contrast, reading the pulse in the Siddha medical tradition is central to diagnosis. The physician reads not just one pulse, but six different pulses, and this method requires significant time and physical contact with the hands. Taking the pulse has three stages: stula nilai (the gross sensory stage), ul nilai (the inner stage) and cama nilai (the equal stage) (Daniel 102-3, in Howes 1999). Through each stage, the Siddha physician moves more closely to a diagnosis, and in the final stage literally “takes the place” of the patient.

In the first stage, the “apparently ‘passive’ fingertips of the physician objects and objectifies the dynamic and hitherto unrestricted flow of blood in the radial artery” Next, the “physician becomes aware of the rhythmic undulations of his own pulses in addition to the ones felt in the patient’s radial artery” (Ibid.). Finally, “the physician modulates the etai and natai of his own pulses so that they become confluent and concordant with the pulses of the patient… It is only at this stage that the Siddha physician believes that he ‘knows the humoral disorder of the patient” (Ibid.).

These three stages of pulse reading disclose a fundamental feature of Siddha medicine which is infinitely different than Western biomedicine. A Siddha physician’s skill in diagnosis is defined by his/her ability to become the same, however briefly, with the patient. Only after experiencing this state in his/her body is the Siddha physician able to diagnose and prescribe treatment.
To conclude, it is interesting to note the way that suffering is understood in the Siddha medical tradition in contrast to biomedicine. Within Siddha medicine, “Suffering is something that can be shared and must be shared by someone else, especially the physician.”(Daniel 109, in Howes 1999) This perspective on suffering is a radical departure from the objectification and alienation often experienced by patients in the Western biomedical system.

In sum, Siddha physiology itself presents a completely different model for understanding disease and health. This is a world where the forces of nature are connected to the forces of illness and also of recovery. In other words, Siddha medical philosophy extends beyond the boundaries of physical, social and environmental factors. The forces and influences that are understood to operate in the universe are an integral part of the human system.
Most importantly, the Siddha physician is understood as one who shares in suffering and who literally in-corporates the patient’s illness, for a brief moment. This relationship between patient and doctor reveals the general orientation in Siddha medicine which prioritizes the relationship and connection between elements rather than their distinction and separation.