“Madam. All the Ayurvedic massage centres on these tourist-type beaches are totally commercial businesses.” Saying which the Ayurvedic doctor, who was himself running an Ayurvedic massage centre on a “tourist-type beach” – Kovalam to be exact – smiled in conscious virtue as one who was, as he professed, practically the only serious doctor in Kovalam. And as one who had opened his centre for purely philanthropic purposes. If people forced him to accept money, of course, he wasn’t going to break their hearts. It was unnecessary for him to have put both ‘commercial’ and ‘business’ in one sentence but it added muscle to the point he was making.

I had just that morning been accosted politely by a young man who was distributing pamphlets of Ayurvedic massages to passing tourists in the same way they hand out announcements of coaching classes or new food take-away joints or a fancy sari sales (“last 3 days, only due to Heavy Public Demand”) in other cities. I had not known doctors to advertise like this before, but then this was Kerala, and more importantly, this was ‘Kerala Ayurveda’, and Kovalam was the nerve centre of foreign tourists in peak season ready to try out the local and the exotic.

Kovalam was great fun. Its crescent-shaped main beach provided a visual definition of what ‘hotbed’ might mean – it was a hotbed of eating, drinking, swimming, surfing, sunbathing and shopping right on the sea’s edge. The wind and spray from waves of the Arabian Sea mingled with the smoke and scent of seafood sizzlers regularly. It was October and everyone was in a good mood.

Kerala-Ayurveda3_TI

Kerala-Ayurveda2_TI

Prashant Panjiar
The centre of all things Ayurveda, Kerala is a haven of wellness
The centre of all things Ayurveda, Kerala is a haven of wellness

Varkala was shades better than Kovalam. It was quieter and much lovelier. Varkala too offered everything that Kovalam did – cuisines, necklaces and T-shirts galore – but the high red cliffs adjoining the sea were an enchanting sight that trumped Kovalam for me. In October, the sacred Papanasam Beach below the cliffs was just big enough to accommodate the pandits under umbrellas and their patrons, but by November the waters would recede and it would become broad and hospitable for all. Foreign tourists stayed up on the cliff, among the commercial delights, viewing the sea from vantage points, and colonising little enclaves in the cliff folds, away from Papanasam.

At both the beach spots, possibly because I was looking out for it, every third place seemed to be an Ayurveda centre. With the young man handing out Ayurveda massage pamphlets, it became clear that like everybody else – the food shack that gives unlicensed beer in steel glasses, the Tibetan jewellery seller, the purveyor of ‘Boom Shiva’ T-shirts – the Ayurvedic doctors too had to make their money while the ‘season’ lasted.

All this seemed oh-so-far from the time earnest and scholarly Vaidyas in early 20th-century Kerala were trying to modernise and organise Ayurveda. And impossibly far from the time the  ‘fathers’ of Ayurveda, Sushruta or Charaka, had written their texts in the 6th and 3rd centuries BCE. I understood Ayurveda as a philosophy, practice and methodology that included an understanding of the body – what constitutes it, its state of balance, its health and disease – of diagnosis, of extensive knowledge of plant, mineral and vegetable matter and their therapeutic properties, preparation of medicines, and many kinds of treatments. Literally translated as “the science of life” in all brochures for tourists, Ayurveda was well expressed in Charaka’s terms as that which protects ‘Ayus’; Ayus including “body, sense organs, mind, soul, that factor which is responsible for preventing decay and death, which sustains the body and guides the process of rebirth”. And here, in the land of Ayurveda, I could see nothing but offers of massages.

Healing session in progress
Healing session in progress

My exploration of Ayurveda in the state of Kerala had to include some questions I had been pondering over – What is this phenomenon called ‘Kerala Ayurveda’? How had it come about? Why is only Kerala and no other state so successfully associated with Ayurveda today? Is it simply a triumph of good tourism advertising? And, finally, what was the connection between that Ayurveda and these massages that people keep harping on about?

‘Very ancient tradition’

I tried to talk to doctors in the many Ayurveda centres I visit in coastal south Kerala about this, and get responses that sound the same across the board with the words “very ancient tradition” said more times than once. Ayurveda is “the world’s original healing system being over 5,000 years old”, they say at Parasuram Health Centre at Kovalam. It is “the secret knowledge of life transferred to sages by god”, proclaims Ayurveda Bhavan. According to a brochure at Sri Dhanwantari Matam, one of Thiruvananthapuram’s most respected names in Ayurveda pharmacy, the practice “evolved more than 5,000 years ago”, while the Kerala Tourism website insists that it “evolved some time around 600 BCE”. It seems clear enough that the tradition is ancient, but in places like Kerala, where the inflow of foreigners is so strong and the business of impressing them with the glory of Indian civilisation so profitable, a word like “ancient” is used repeatedly till it loses all meaning and specificity. And, standing in front of “visit once, best massage, henna design and facial”, was it surprising I had lost the thread that connected the phenomenon of Nalanda with the phenomenon of Varkala?

Courtesy Kairali Resort
Natural ingredients are a vital part of any Ayurvedic treatment
Natural ingredients are a vital part of any Ayurvedic treatment

Difficult to date accurately, Ayurveda – or at least some discussion on health and medicine – is present in the Atharva Veda, put together around the 10th century BCE. Everyone who has been educated in India knows of Sushruta, who compiled the Sushruta Samhita possibly in the 6th century BCE and Charaka, who compiled the Charaka Samhita, again possibly, in the 3rd century BCE. Ayurveda-nationalists proudly call Sushruta “the first surgeon in the world”; he classified diff-erent types of surgeries and procedures and described many surgical instruments. And Charaka is the source of many therapeutic theories and applications that are used today.

Historically, it is believed that both author-practitioners were part of a long tradition of oral teachings transmitted from teacher to student, and they, in turn, had their own pupils. Thus, each Samhita is understood to be a collection of writings that puts together older writings and oral transmissions, and also includes much later additions, possibly from students in the tradition of these two greats.

Dhanvantari is the third most historically significant character when it comes to Ayurveda in Kerala. Dhanvantari appears in the Puranas as a physician of the gods, and is believed to be the source of Ayurvedic knowledge. In Kerala and Tamil Nadu (but nowhere else in India) there are temples to him and many Ayurvedic pharmacies, clinics and formulations in Kerala are named after him.

Kerala-Ayurveda8_TI

Courtesy Taj Malabar
Oils and herbs used in Ayurvedic medicine
Oils and herbs used in Ayurvedic medicine

We know that Ayurveda flourished in the 1st millennium BCE, that Charaka and Sushruta’s Samhitas were taught in the ancient universities of Nalanda and Takshashila, and that Nagarjuna, the famous Buddhist monk of the 1st century CE, was also an expert on Ayurvedic herbs and treatments.

Kerala is unique in as much as it lays claim to a direct thread that connects this Ayurvedic antiquity to modern times. In the 5th century CE, Vagbhatta, a scholar in the tradition of Charaka and the author of the third seminal text of Ayurveda called Ashtanga Hridaya Samhita, came to Kerala, and, it is believed, personally taught 18 students here. Eight families of Ayurveda practitioners emerged from these students, collectively called the Ashtavaidya of Kerala. Of these, only three practising families remain today. Fascinating as repositories of tradition, Ashtavaidyas are also an indicator of the larger, widely disseminated presence of Vaidyas in Kerala.

Interestingly, Kerala’s Vaidyas give much more importance to Vagbhatta’s Ashtanga Hridaya than to other classical texts. Several commentaries on this book and new texts following from this school of thought (such as Sahasrayogam, Chikitsamanjari, Vaidyamanorama) came up in Sanskrit and Malayalam in the region, and the Kerala style of Ayurvedic practice evolved to become different from that of the rest of the country.

Vivek R Nair
Herbal poultices being prepared at Jiji’s Massage Centre in Kovalam
Herbal poultices being prepared at Jiji’s Massage Centre in Kovalam

Hallo, please, Panchakarma?

Ayurveda centres in this part of the world consider their existence wasted if there’s no ‘Panchakarma’ in their name. ‘Jiji Ayurvedic Massage and Panchakarma Clinic Centre’ goes one; ‘Dr Ajay Kumar’s Panchakarma Speciality Centre’ goes another, ‘Mother Ayurvedic Medicines Panchakarma and Infertility Hospital’ goes a third. Entering coastal Kerala is like entering an uninterrupted kingdom of something called Panchakarma and it takes a long time for the outsider to understand what part of Kerala Ayurveda this is. The only foreign tourist among those I asked, who could even begin to answer this, said, “It means five actions”. But what five actions?

Pancha (five) Karma (actions) are five kinds of detoxifying processes that in themselves cleanse the body, and also make it ready to receive other Ayurvedic treatments and medication. Vamana (emesis) is a process of therapeutic vomiting, which helps throw out waste matter from the stomach and thoracic cavity. Virechana (purgation) throws out accumulated toxins from the intestines. Vasti is therapeutic enema to cleanse the colon. Nasya is the taking of medicated oils through the nose to target the head and sinus area. Raktamoksha (bloodletting) is hardly followed nowadays, but is the process of locally letting out diseased blood from the affected area.

Ayurvedic Panchakarma has not been followed in the rest of India as it has in Kerala. It is also more effective in Kerala because of the almost year-round humid climate of the state. Processes that are an integral part of Panchakarma preparation activities — Snehana (applying oils internally or externally) and Swedana (making the patient sweat) — work very well since the humidity helps open up the pores of the body, making oil absorption more effective.

Pizhichil treatment
Pizhichil treatment

Many of us who grew up in the small towns of north India remember the gent who was given the honorific ‘Vaidya ji’. We may also remember our childhood sickly selves being fed Chyawanprash. But none of us were introduced to Panchakarma. This is a Kerala speciality. Typically, whether you say “Panchakarma” or “Ayurvedic treatment”, in Kochi or Kovalam or Varkala, tourists more or less end up understanding these as “massage”. My favourite is Varkala’s lovely cliff area, where they offer you refreshments, massages and souvenirs at par – “Hallo, please, fresh seafood?” “Hallo, please, Ayurveda massage?” “Hallo, please Kashmiri shawl?” – exactly in the same intonation.

Oily massage

If the entire gamut of philosophy, knowledge and methodologies that is Ayurveda gets condensed into “massage” in many visitors’ minds, it’s a pity, but there is also some kind of rationale behind it. The obvious rationale is that tourists are migratory birds and would not stay at a place for long enough to get serious long-term treatment done. They get their relaxing massage and let it go at that. Also, tourists new to a system of medicine (which, in Ayurveda’s case, has been in the news for unscrupulous pharmacies putting steroids in their drugs, and for harmful levels of metal content) would prefer to be massaged than to ingest medicines. Historically, however, there’s some validity to Kerala Ayurveda being associated overwhelmingly with body treatments because it was in Kerala that some of the now-famous massages originated.

Detailed consultations are an integral part of Ayurveda
Detailed consultations are an integral part of Ayurveda

For instance, the near-divine experience of Dhara and Navarakizhi is very much a Kerala phenomenon. Dhara is the treatment in which medicated warm oil (or buttermilk, coconut water, herbal decoctions, as the case may demand) is poured on the forehead of the patient and moved across it in a steady trickle. This is considered excellent for stress-related disorders, degenerative brain disorders and sleep-related problems.

In Navarakizhi, the body is massaged with warm linen poultices packed with rice cooked in cow’s milk and other healing agents. This treatment is very good for degenerative muscle diseases. Just try either of them on a tired mind or achy muscles someday and you’ll bless your masseur, your doctor, Dhanvantari, Vagbhatta… the entire lot.

The Ayurveda I encounter in coastal Kerala is not being practised Vaidyas. Everywhere I look I find “Dr so and so, BAMS”. In Kochi, Kumarakom, Alleppey, Thiruvananthapuram, Kovalam, Varkala… BAMS or Bachelor of Ayurvedic Medicine and Surgery. It’s a degree given by select Ayurvedic medical colleges in the country, but none so prolific, it seems, as the Government Ayurveda College in Thiruvananthapuram. The college, which had opened in 1889 when Thiruvananthapuram was capital of the Travancore Kingdom, can claim to be the oldest Ayurvedic institution in the country.

The charitable wing of Arya Vaidyasala
The charitable wing of Arya Vaidyasala

Travancore was ruled by a series of kings and queens known for their progressive stance on education and social reform in the 19th and 20th centuries. It was a good time for people like ‘Renaissance man’ Vaidyaratnam PS Varier, the founder of the nationally respected Kottakkal Arya Vaidyasala, today the prime Ayurvedic medicine hospital in the country. PS Varier is a personality interestingly located at the cusp of Ayurvedic transformation; he had an Ashtavaidya as his guru, studied Allopathy and then went on to found the modernised Ayurvedic pharmacopoeia and practice. In 1884, another Vaidya, N Vasudevan Unni, the palace physician of Travancore, established the Vasudev Vilasam Aryavaidyasala, which has now grown into the renowned Vasudev Vilasam group today, right in the Fort area of Thiruvananthapuram.

They manufacture medicines, offer doctors and treatments and run nursing homes. It was in this context that an Ayurvedic Pathshala founded at East Fort, Thiruvananthapuram in 1889, which started with just 15 students, went on to become the Government Ayurvedic College and has now churned out enough BAMS degree holders to fill all the Panchakarma centres of God’s Own Country.

But are these Ayurveda/ Panchakarma centres like the usual doctors’ clinics or nursing homes, just like Ayurvedic equivalents of an Allopath’s clinic? Well, if you are asking about ‘Kerala’, they mostly are. But if you are asking about ‘God’s Own Country’ (or  “tourist-type beaches”, as my doctor-friend said), the story is different. Concerned that a lot of quacks or unqualified masseurs might give a bad name to Ayurveda, making inbound tourism suffer, the Kerala government made it mandatory for all Ayurvedic centres to have a degree-holding doctor attached to them.

A signboard to an Ayurvedic centre
A signboard to an Ayurvedic centre

For hotels that wanted to run their own massage centres, or for independent centres, which had been running on the strength of just masseurs, a doctor now became essential. Many had to hire doctors for just this purpose – to grace the hotel or centre with their presence for the benefit of licence-checking government inspectors. The doctors in turn got a salary, and sometimes, such as when the owner was an absentee foreigner himself, the doctor got to be the doctor-manager.

Such doctors haunt Varkala-Kovalam from October to March and have other arrangements for the rest of the year. There is, of course, the odd practitioner who stays the whole year and is happy to treat locals and not just offer massages to tourists. But, by and large, why would such a doctor take the trouble to rent prime property right on the beach? In season, they may get up to 10–15 massage cases a day. Up one beach and down another, they all reassure me that their centre is a place of serious treatment, not like the others, where “lady therapists” give massage to “gents”, giving Ayurveda a bad name. Not in my centre, they say, but in so many others. This is the main refrain of most Ayurvedic doctors here. Not being a male foreign tourist, I am given no opportunity to experience the truth behind the claim.

My favourite memory is of a young man who seems a shining example of encouraging women in the workplace. He too is a purveyor of handbills for a Panchakarma centre and infertility clinic, which is a little off the beachside path. Polite, insistent, full of approving adjectives for the centre in question, he leads me to it and, leaving me in the capable of hands of the lady doctor, goes back to his post. It turns out that he is the doctor’s husband.

Poultice dipped in oil for Kizhi massage 
Poultice dipped in oil for Kizhi massage

When in Kerala…

In the midst of all this massaging, Ayurveda flourishes in all its aspects. The one-off massage is a valid facet of Ayurveda as long as it is done by qualified people with good quality oils and under no false pretences or claims. By and large, in Varkala and Kovalam beach areas, general body massages such as the Abhyanga are available for ₹1,300–1,500, treatments involving Dhara for ₹1,500–2,200 and treatments involving Kizhi ₹1,575 and upwards. The masseurs are usually very competent.

Getting a simple massage done is called Sukha Chikitsa: this treatment is simply for pleasure, and is good for general circulation and instant relaxation. Even for such massages, if you have any illness, do consult the doctor before choosing your massage or oil. Don’t let anyone fool you into thinking that, nice as a one-off massage is, you’ll get some medical benefit from it. And prepare to get very oily. In Ayurveda, oil is not just a massage facilitator but a medium for carrying therapeutic herbs in which the patient needs to be slathered, and I mean that quite literally. Take a change of clothes if you are particular. Don’t take for granted that there will be a bathroom or hot water to bathe, ask first. I learned that the hard way!

Sukha Chikitsa apart, if you want to get treated for specific ailments, there are excellent Ayurveda centres in the state, from the widely respected Kottakkal Arya Vaidyasala where they do rigorous research on diseases and treatments to the happy mix of beautifully located and very capable hospital-resorts, such as Somatheeram, Kairali or Keraleeyam. You can also check keralatourism.org for Ayurvedic treatment centres that have been given the Green Leaf or Olive Leaf certification by the Government of Kerala.