Healthcare in Ancient Sri Lanka
Our behet oruwa, (herbal bath) I believe, is the best symbol for our ancient healthcare system in Sri Lanka and this cultural treasure from Medirigiriya shows how we treat our ancient traditions.
Ancient healthcare as a subject has to go back to pre-historic times. Herbal and other forms of medicine would have been used long before man invented writing, so we do not have any records.
The oldest evidence available is from the study of the 'Iceman'
In 1991 on the Italian Alps, a dead body of a man was found. The man had died 5300 years ago. Probably no human corpse had been put through so much study in post mortem examinations. Our interest on this dead body is because the scientists had discovered eggs of an intestinal parasite, Trichuris trichura, in his rectum. This discovery would have just gone unnoticed if not for the fact that the Iceman had carried a pouch. In it was found a lump of bracket fungus, Piptoporus betulinus, a mushroom which contained an acid which was laxative, and a resin that was toxic to bacteria and intestinal parasites. This showed that either the man himself could not only diagnose his illness, but know how to treat it, or there was a medicine man or woman in his village who had prescribed the treatment.
If there had been any such well preserved bodies of our pre-historic Lankans, we too could have found some information of their healthcare practices. Let us hope that one day soon our new generation of archaeologists would be able to uncover such evidence.
About our own healthcare system, let me start with a quote from the Culawamsa.
"A young man was drinking a little water in which were frog's eggs. An egg penetrating by the nostril entered his skull. it opened and was a frog; it grew and dwelt there. At the approach of the rainy season the young man was greatly tortured by it. The King1 split the skull, took out the frog, put the parts of the skull together again, and cured the young man at once."
This was 1600 years ago.
And this is the interpretation given by Dr. John Atygalle, in 1917, (about 90 years ago.)
"The operation might have been cephalotomy, for the removal of hydatid tumour, occasionally met with as we know within the cranium, and it is not a little interesting to observe that the cluster of hydatid growths, when seen under the microscope, is not unlike a group of young or half-grown toads after they have shed their tails. We also know, on the authority of Scobold, that one medium by which the echinococci find their way into the human frame is by the drinking of foul water."
(Sinhalese Materia Medica. John Attygalla MD first published 1917. Introduction page IX.)
This is a very rare disease and today surgeons need MR imaging to locate the cysts! I brought up this incident to draw your attention to the fact that in ancient Sri Lanka, diagnosis, medicine and surgery were so highly advanced.
Healthcare in Ancient Sri Lanka, would go back about 5000 years if the Ravana story is true, as he was said to be a great physician and had written several books on healthcare. Even if Ravana was a mythical figure, some form of indigenous medical treatment would have existed long before the arrival of Vijaya and the Indians. Mother goddess, Ancestral worship, like the Nee Yakku of the Veddhas, Tree worship would have been part of the treatment for ailments. As more and more groups migrated from India, some of the Ayurvedic systems would have been brought in by them. Arrival of Buddhism had brought the healthcare system associated with the pirivenas and the temples and this complex system has been considered as Deshiya Chikitsa.
When we talk of Healthcare we think of hospitals and we take pride in the claim that the first ever health centres were established in Sri Lanka during the time of Pandukhabaya, and that the first dedicated hospital in the world was established at Mihintale. But what should come to our mind is about keeping ourselves healthy. Hospitals should be the last resort, or when ill-health could not be avoided. Till a few decades ago, our village folk believed that being admitted to a hospital meant a person would not go home alive, because it was the last resort. Till then the village physician could treat them successfully.
Pandukabhaya's hospitals could be the imagination of Mahanama thera or an attempt to bolster Pandukabahaya's image. The word used was Sivikasotthi sala which has been interpreted as a lying-in home. The term most often used was thimbiri-ge, the temporary hut built outside the house, by using wood of the timbiri tree, where the woman gave birth to the child. Maternity homes may have been built in the crowded urban areas, where there may not have been enough space in the home gardens to put up a thimbirige.
The term timibirige could also have been used for more permanent lying-in homes, as recorded in the pillar inscription by Kassapa IV.
There is the pillar inscription found at Mandalagiri (Medirigiriya) during the time Kassapa V, again refers to a hospital and that goats and fowls shall be assigned to the hospital and Paranavithana suggests that they could have been animals killed by accident.
Kiribathvehera pillar inscription mentions a Behet-ge, was it a dispensary or where special medicne was prepared? Kassapa V in the Anuradhapura slab inscription mentions a Raj Vedahal. (Royal hospital?) Polonnaruwa council chamber inscription mentions a Vedahala to which a one pala of Sudhingur is to be given annually. Paranavitana identified it as 'dried ginger', and it would have been a major component of the medication used then to be of such importance.
We also find caves which had been donated by physicians, at Piccandiyava we find Veja Bamana Gobutiya , and Rajangana, Upasaka Veja Mitaka. Pujawaliya and Sadharmalankaraya refer to vinnambu (midwife).
Prof. Siriwira identifies four types of hospitals in Ancient Lanka. These hospitals can be broadly divided into four categories viz: (a) monastic hospitals where in-house treatment was provided for ailing monks for short or long periods; (b) hospitals for laymen where in-house treatment was provided (c) maternity homes and (d) hospitals where only outdoor treatment was provided.
The hospital at Mihintale, established around the 9th cent. has been identified as the oldest hospital in the world. It probably consisted of a large waiting room for patients, two examination rooms, a dispensary and 32 rooms for indoor patients. There had been another room for immersion therapy in a behet oruwa, and a jantaghara. This hospital could have catered for the laity too, in addition to the residents monks, but several other hospitals in the city of Anuradhapura may have been for the monks only.
Even though these hospitals were meant either for the monks, or for the public, were they open to the common folk. Inequality would have existed, the women who considered themselves of having royal blood, or who were from rich families, would not have been willing to share the lying in home with the less equal people. It could have been the same with the hospitals, where only the families of royalty, high officials or rich merchants could receive treatment. Even if the hospitals had been put up with all good intentions for the treatment of all mankind, in practice preference would always be for the rich and the powerful. In that case these hospitals could have been like the modern day private hospitals, out of reach of the have-nots.
The ordinary people would have tried their best to avoid falling ill or depended on home remedies. When we were kids we were told not to get wet in the rain, or eat cold things after getting wet, instead now our children are encouraged to eat ice cream in the rain so we could treat them with a so-called herbal remedy.
In my novels i have taken the liberty to describe three hospitals in Lanka, about which we do not have any historical or literary evidence. In katbitha i have placed a hospital in what is now known as Ramakele, near Sigiriya. Then in The Healer & the drug pusher, a hospital in Jaffna and an eye hospital in the present Maligawila. Because i believe there could have been such hospitals in these places and also many other monasteries in our country. Culawamsa mention that king Aggabhodi I (600 AD) had built a hospital for the blind at Kanagama, probably identified as Dombegoda today, near Maligawila.
i do not have many photographs, and so i had to borrow from an article published by Prof. Leelananda Prematilleke and Prof. Arjuna Aluvihare. A few years ago when i visited Arankele, i was not allowed to take photographs of the Jantaghara. Photography had been banned by the Dept. of Archaeology and the reason given was photos of historic sites were used in commercial advertisements!
The ancient hospitals discovered and excavated around the island show clearly how they had been designed and constructed in keeping with the Deshiya Chikitsa philosophy and science. The hospitals were on very large flat land or terraced, providing a lot of open spaces with aesthetically laid out gardens. The buildings would have allowed the maximum ventilation, with open courts and huge windows and open verandas. In keeping with the system that the healing is both for the mind and the body an image house was built at the centre of the buildings for easy access to the patients and the hospital staff. When we walk around the ruins of these ancient hospitals we can see how calm and soothing the surroundings would have been.
Toilets and bath facilities were attached to the rooms or positioned nearby. This shows that the bath and toilet in one unit was not something we had got from the Europeans, because it is said that the English learnt to bathe daily only after they came to our part of the world, and that was the reason for women to get married in June, after their annual bath in May when the water was warm enough to bathe. Even then, by June she would begin to smell of stale sweat and that was the origin of carrying a bouquet of fragrant flowers.
It is again so unfortunate that limited space and funds have deprived the patients today of such facilities in our hospitals, like when 3000 beds are crammed into a space of a 30 acre block of land.
Today we think vaccination is the only solution to prevent viral infections, and that vaccination was a great achievement of the west. But it was known in the east many thousands of years ago, probably around 200 B.C. In the old days, children developed their own immunity against measles, mumps or chickenpox from a mild infection, in their childhood. It was considered as a part of growing up. Children didn't die of such infections. Today there are vaccines for even such minor infections, and now there is a growing panic in the west that all these vaccines are causing other far more serious problems in children. Many parents in the west are refusing to vaccinate their children for fear that the vaccines cause autism in children. In our country there were several unfortunate deaths claimed to be due to the rubella vaccine. (Our young school girls are not promiscuous as the girls in the west and there need not be such fear about teenage pregnancy, so why can't we wait till the girls reach marriageable age and give them the choice, instead of forcing them to take the vaccine so early in life?)
Today too, the WHO is in a mighty hurry to vaccinate everyone against swine flu. Normally a vaccine goes through a period of tests and trials for several years before WHO approves it for use, but in this case it was approved and used without any such precautions, and several hospitals in the States are carrying out trials with children, human guinea pigs. This is at a time when there are several cases filed against drug barons for releasing this virus in the first place.
When man has to depend on a machine to go to sleep, it just shows the pathetic situation we are all in. We have the latest fad of the sleep labs in our hospitals. Sleeplessness is an age old problem, and our ancient healers did not resort to sleep labs or CPAP (Continuous Positive Airways Pressure) machines to solve the problem. The CPAP machine will only keep the airways open when the muscles relax and the airflow is interrupted. In the past the physicians would have gone into the patients condition and history and identified the cause for sleeplessness and then treated him accordingly, by eradicating the cause, either mental or physical.
Today in our country we find euthanasia practised in the leading hospitals, where a ventilator could be switched off when the family decides the patient is beyond recovery or has suffered long enough, or the hospital bill is running too high. I don't know the legal and ethical aspects of this, but according to our Deshiya Chikitsa this could never be condoned. Those who are in favour of euthanasia refer to the stories of the Buddhist monks, Channa, Vakkali and Godhika during the time of the Buddha. They had taken their own lives when they realized they were terminally ill and there was no cure. These three monks were at the end of their cycle of birth and re-birth. But for an ordinary lay person, seeking death will not let him escape his suffering, because he has to face his kamma, and face the same suffering may be in the next birth too, and taking his own life would add to the prolongation of his suffering in the future lives.
In our literature we find many references to healthcare which display the awareness among the people of common treatment methods. A few examples - Sadharmaratmavaliya mentions first – Avasta piliyam first aid . – Meha aththavunta thel anubhava karannata kiyanna se, probably because oil was not considered good for diabetics,Semata uka sakuru kannata kiyannase, and cane jaggery bad for phlem. Paya barabayata pitikara behet badinna se, Filaria was known and there would have been treatment for it. Vadimata akamethi nisa vanda behet kanna se. This could mean we had contraceptive drugs in ancient times, in addition to the use of other contraceptive methods. Then there could have been treatment for barrenness too. Women had also prayed for children. A woman would go up to a Bo tree early morning, in her wet clothes, immediately after a bath, and walked around the tree with the rays of the early morning sun falling on the tree and bouncing back on the woman as she prayed for a child. Today a childless couple would spend thousands, month after month at fertility centres.
Even for Leprosy our indigenous medicine had a treatment. Leprosy had been first described in the 'Susruth Samhita' and treatment with 'Choulmoogra oil' was known at that time. Hydnocarpus kurzii, Chaulmoogra contains strongly antibacterial chemicals, two of which, hydnocarpic and chaulmoogric acids, are responsible for destroying the bacterium, Mycobacterium leprae, that causes leprosy.
King Bimbisara who suffered from hemorrhoids had been treated and healed by Jivaka.
The importance of taking good care of ones health is seen well in the precautions taken during pregnancy. They had refrained from taking certain food which were considered bad for the mother or the baby. They would avoid overeating. All these precautions came under gaba pirimesima or gaba raksana. There were also ceremonies carried out for garbharaksana. Perhaps all these precautions could have helped the mother to deliver the baby at home, with only the assistance of a midwife or an elderly lady, and Caesarean surgery was not resorted to. After the childbirth too, the mother's diet was controlled, special food was given to yield sufficient milk for the baby and to keep the mother and baby in good health. Our people had survived in Sri Lanka for several thousand years without feeding their babies with infant formula. If the mother's milk was not sufficient, they found a suitable healthy lactating mother to feed the baby. The personal touch is seen here as they called her 'kiri amma', which is not the same as calling her a 'wet nurse'. The Butsarana mentions that a mother would take medicine herself when her baby was sick.
Panchakarma must have come from Indian Aurveda and it is for cleansing and rejuvenation of the body by removing ama or toxins. I don't believe that true panchakarma is offered at most of our so-called ayurvedic resorts or if the foreign patients who come in search of this treatment would have the time or the patience to undergo the complete treatment, after the individuals constitution and dosa has been properly studied. Today even Deepak Chopra offers Panchakarma to his Hollywood clients.
Panchakarma would begin with the purvakarma, to prepare the body to get rid of the toxins. Then the Pradhanakarma to be followed by paschatkarma. The main therapy will depend on the dosha conditions and the individual. Vamana (therapeutic emesis) and Nasya (nasal administration of medicated oils and herbal preparations); Virecana (therapeutic purgation) and Rakta mokshana (therapeutic withdrawal of blood) , and Bhasti is the introduction of herbal medicaments into the colon to be retained and absorbed into the body. We use suppositories today.
Raktamokshana, bloodletting is done in different ways for different conditions. For vata conditions a horn of a bull is used. For pita it is leeches and for khapa it is an instrument made from a dried bottlegourd. Pilindavachcha thero who complained of body aches was cured by Raktamokshana or lohitan mochetun, as mentioned in the Mahavaggapali.
Even today in our hospitals bloodletting is done, in cases of Polycythemia Rubra Vera. Even though it would be done in a most hygeinic manner and under medical supervision, it would be done in the same manner for all patients, not considering for a moment that the patients constitution would vary from one individual to another. Had we been able to use some of our ancient knowledge, perhaps these patients would have better chances of recovery.
Probably one reason for the success of our ancient healthcare system was that our physicians never went against nature. Our Deshiya chikitsa would have been based on Ahimsa, loving kindness, not only for human beings but for all living creatures, unlike today, when animals are used to experiment on, and then for clinical trials to test new drugs before use in humans. Animals are infected and then killed to make vaccines, like the vaccine for Japanese Encephalitis, where rats are infected, killed and the inactivated vaccine developed from their brain tissue.
In Deshiya Chikitsa they had very successful treatment for snake bites. Today we use snake venom anti serum, made by injecting the snake venom into horses, and then collecting the serum from their blood for the anti-venom. The horse gets snake venom injections many times during its life, suffer the poison, and then his blood is circulated through a plasmpheresis machine to collect the serum. To save human lives, horses have to suffer and die in the end.
Ancients believed that gazing at the moon was considered very good for keeping the eyes healthy.
There are many references of the treatment of eye ailments, including Glaucoma. It is unfortunate that with all the advancements in medical science, we have consultants who could not diagnose a case of juvenile glaucoma, when our ancient healers could diagnose and treat 76 different ailments of the eye.
Among the Jataka stories the Sivi Jataka is of interest when we talk about eye surgery. A king by the name of Sivi, had decided to donate his eyes to a blind Brahman and summoned a physician, by the name of Sivaka. Sivaka had not wanted to use any surgical instruments to operate on the king. Sivaka had prepared three types of medicinal paste, applied one of them on a blue lotus and had stroked the king’s eye with the flower, then the second paste was used, and then the third. The eye had loosened from the socket and come out to hang by the nerves. It was removed and handed to the king who had offered it to the Brahmin. The detached eye was then placed in the Brahmin’s eye socket and he had been able to see with the king’s eye. Such a story would not have been included among the Jataka stories unless there were physicians who could perform such miracles.
Coming back to king Buddhadasa, 337 – 365 AD and quoting from Culavamsa, he was a mine of virtues creating happiness for the inhabitants of the island. He had seen a snake writhing in pain when he was on his way to the Tissa vewa to bathe, he had got down from his elephant and with the knife he wore at his side, had split open the belly of the snake and removed the diseased parts, applied an excellent remedy and at once cured the reptile. Whether he treated a real snake or a man of the Naga tribe what matters to us is that he could perform surgery with his knife, in the open air by the roadside, first diagnosing the problem without any aid of CT or MRI scans, and as he would not be carrying any medicine with him, prepared the remedy from any herbs available around him, and with the confidence that there would not be any post op. infections or complications. It is also not mentioned if he carried the knife for such emergency surgeries, or as a weapon, because if it was for surgery, it should have been “sharp enough to split a hair in two”.
A monk came to him ailing from drinking milk with worms in it. A horse had also been brought for bloodletting. After the king had bled the horse, he had given a dark liquid for the monk to drink, and after he had drunk it, told him that it was the blood from the horse. In revulsion the monk had vomited out not only what he drank, but all the worms along with it. If this is not a true healer in action!
Buddhadasa had also been able to streighten out the back of a bhikku who had been bent in half, though culavamsa does not mention if it was done by surgery or medication. Jesus too had miraculously cured a woman who had suffered for 18 years from a bent back.
Buddhadasa had saved a chandala woman the fruit of whose womb had taken a wrong position seven times with child. For the woman to miscarry seven times, means she either was not able to receive proper treatment because Buddhist monks did not touch her because she was a woman and the lay physicians did nto touch her because she was a chandala. It could not be that our Deshiya chikitsa did not have any treatment for such a condition.
According to the Culavamsa, Parakramabahu I was another great physician. He had not only built hospitals, but also visited them on Poya days. “with an eye that charmed by goodness he gazed at the sick. And as the Ruler of men was himself versed in medical lore, he the all wise summoned the physicians appointed there, tested in everyway their healing activities, and if their medical treatment had been wrongly carried out he met them with the right method, pointed it out to them as the best of teachers and showed them the proper use of the instruments by skillfully treating several people with his own hand”. Culawamsa also claims that he treated a crow “suffering from an ulcer that had formed in her cheek”. Once again it is a matter of argument if 'Kaka' meant a crow or a resident of the crow island in the north.
Dr. John Atygalle states in his book that he has personally known of cases where limbs which would have been subjected to immediate amputation by Western surgeons , has been not infrequently restored whole under the treatment of these much despised 'native surgeons'.
In vedic India initially there would have been several obstacles in the development of healthcare. Any person treating the sick would have been considered impure and a Brahmin who worked as a physician sometimes may not have been allowed to perform Vedic rituals.
Long before the time of the Buddha, the early physicians would have been mostly wondering ascetics. They treated people wherever they went, and also met and exchanged their knowledge and experience, getting into discussions and debates and thus went on accumulating all the medical lore into a huge store of medical information.
When the Brahmins realized the influence of the medical system, they would have decided to take charge of Ayurveda. They would have manipulated the Hinduization of this heterodox knowledge. and claimed that the healing process was passed down by Brahma, through Prajapati, the Lord of beings, to Indra who taught it to Danavantari. It was then written in to the Susruta Samhita by Susruta. Probably the Susruta Samhita is a collection of all the knowledge that was accumulated by the wondering ascetics, and not the work of just one person. The Brahmins incorporated the medical practices with their rituals and vedic practices, convincing people that the rituals have to go hand in hand with medical treatment for effective cures. To improve the efficacy of the healing plants, they created a plant goddess, Arundati.
Susruta samhita may not be the oldest book on medicine so far discovered.
The oldest could be the Edwin Smith Papyri, accepted to have been written in the 17th cent. B.C. recording techniques of brain surgery used in ancient Egypt from around 3000 B.C.
Charak Samhita was written about 100 A.D. Astanga Hridaya Samhitha, attributed to Vagbatha around 11th cent. contains medical knowledge from Tibet and India. Hridaya Samhita deals with heart ailments. Bark of the Kumbuk. Terminalia arjuna, had been used even in the treatment of Cadiomyopathy.
Without such restrictions of the concept of purity and cast issues, and with the belief that treating and nursing a sick person was a most meritorious act, the Buddhist monks would have begun to learn and practice medicine in earnest. As healing became a part of Buddhism, all the medical knowledge began to be collected in early monasteries, so it became institutionalized, then developed into infirmaries attached to the monasteries and grew into hospitals.
In the past a patient would go to the physician with the confidence that the treatment will cure his ailment. The physician would treat the patient with the sole intention of healing him, without any financial or other benefits expected. The physician will also spend time to learn all about the patients body, his mind, his environment and his habits, before he would prescribe any treatment. He also does it in good faith. The people who would prepare the medication also do it with the intention of seeing the patient recover from the illness, and would not be doing it for any financial gain. The person who serves the medication to the patient also gives it wishing that it would be effective.
Whatever the ailment was, one of the major ingredients always found in our medicine was 'Loving Kindness', which probably was the so called 'guru mushti', which some students could not grasp.
When the physician holds the patients hand to check his pulse beat, he becomes one with the patient, both in body and mind. It is not only the pulse beat, but the texture and the warmth of the skin, the look in the patient's eyes, his breath, would tell the physician a lot about his mental and physical condition. Then the physician would treat the patient as an individual, and he would never just treat the illness in isolation. That is why we could say in ancient healthcare, the medicine would only be about 1/4th of the cure. The rest would be the confidence the patient has on the treatment and the physician, the good intentions of the physician and the strength of the patients own system.
A well learned ayurvedic physician could diagnose almost any ailment, without resorting to the modern day investigation methods. But his diagnosis was always accurate, because it was personal first hand investigation. There is no possibility of any human errors by a lab technician, or a software bug in the instrument, or the wrong sample being tested, the wrong report being sent to the patient. Diagnosis was never outsourced, probably nothing in the healthcare system was outsourced.
Diagnosis would have been very accurate and must have been always non-invasive. Treatment would not cost very much, often done at no cost, and there are no records of surgical misadventures, harmful side effects of the medicine used or of exploitation of the patients by the physicians.
In the North of the country, till about the 10th century Deshiya Chiktsa would have been practised in healthcare as most of the migrants from South India till then would have been Buddhists. Later on with the advent of more and more Hindus, there would have been a parallel practice of Siddha. This system of medicine, sometimes called Siddhayurveda, is said to have been more suitable for the climate and the people in the North. The physician in Ancient Jaffna had known the art of preparing drugs especially those with iron and mercury. He was claimed to be an expert in the purification, calcinations, and oxidation of minerals, knew the use of alkalise and also a master in treating poisoned conditions as snake-bite. The physician was able to dispense medicine free of charge. His methods were cheap, natural, and simple. With the herbs he collected in the district, and with simple drugs he gave rural population good medical aid. There is a story that Crown Prince Paranirupasinghan once went to Kandy and successfully treated a long standing ailment of the Queen.
The Kings of Jaffna had encouraged the practice of medicine by getting new books on the subject written by able physicians, and caused them to be revised from time to time by a body of physicians. "Pararajasekaran", "Segarajasekaran" and “Sarpasastram” are some of the books. There had been a herbarium at Kalliyankadu where some rare herbs were preserved.
Today Ayurveda is the term most commonly used for the ancient healthcare systems of the Indian subcontinent, and includes Ayurveda, Siddha, Unani and what is termed Deshiya Chikitsa found in Sri Lanka. It also has come to mean a way to earn a quick buck from the western tourists, where the term Ayurveda is abused, making a mockery of our ancient healthcare system.
Today unfortunately ayurveda too is getting commercialized, which is more harmful than the Western treatment, because ayurveda treatment can get away without proper research, clinical trials and scientific studies on their long term effects. Unscrupulous businessmen could hide behind the fact that ayurvedic drugs do not need any clinical trials, because they have been tried and tested and found hundred percent satisfactory over several millennia. However most of the drugs now reaching the west, in the name of Ayurveda are far from the true formulae used by the ancient sages.
Multinational drug makers are getting into the act, like a marketing campaign in rural India, calling it Arogya Parivar, to push their western drugs on the poor people in the villages, I believe they are abusing the very concept of Arogya.
Then we have herbal drugs, trying to mislead people into thinking that they are based on ancient formulae. But a true indigenous or Ayurvedic drug could never be manufactured on a large scale. To manufacture in such large quantities the herbs have to be cultivated as monoculture crops, and to obtain high yields agrochemical poisons have to be added. Then the herbs have to be harvested frequently to meet the demand of the factory. When they needed a medicinal plant, our ancient physicians were careful about the place where they found it. They would never pick a herb from near a cemetery or by the road side. They would know the time of the month and the time of day to pick the herb. These plants were found in their natural habitat, as a part of a stable and healthy ecosystem. The contents of the plant and the micro-nutrients and metals found in it would be so different from a plant grown on a mass scale with synthetic fertilizer. The part of the plant used for the medicine too would be very important.
A very good example from the present day is the making of tea. We do not pluck just any leaf from the tree, but only the two leaves and a bud. The planter and the tea maker knows what would happen to the quality of tea if the third leaf is added. And the Japanese have realized the effect of poison added to the plants in the name of agrochemicals and that is why they are so strict about the contamination levels in the tea we export to them.
The next problem with the commercial herbal preparations is that it is one common product for everyone and would not work in the same manner with different individuals. It is only very recently that western medical professionals have begun to realize the same drug may not be havi