« στις: Ιανουαρίου 29, 2012, 16:25:48 »
Μία σύγχρονη έρευνα που συνδέει τον Ιπποκράτη και την σύγχρονη τάση προς την ολιστική προσέγγιση στη θεραπευτική.
http://www.vickipitman.com/phdi/p1.nsf/supppages/1771?opendocument&part=5
Hippocrates Now! A resource for recovering our links with the wellsprings of Western Herbal and Naturopathic Medicine
Here are some essays based on my research into holism in ancient Greek / Hippocratic medicine.
Article 1: Sources of Holism in the Hippocratic Corpus
A comparative approach using the Caraka Samhita of Ayurveda
Vicki Pitman MPhil, URHP IFA, AoR
Introduction
This paper reports the results of an investigation into sources of holism in the ancient Greek medical theory and practice as found in the Hippocratic Corpus. The Corpus is the surviving record of the ideas and practices of physicians of the 5th and 4th centuries B.C. which deeply influenced Galen and became the foundation for western medical tradition. The research was prompted partly by a perceived gap in understanding and a lack of awareness on the part of contemporary practitioners in western disciplines of any substantial body of ancient or traditional precept and practice for their field. Many have heard of Hippocrates and one or two famous sayings are attributed to him, but few know anything more than this. This lack of connection among complementary medicine practitioners in western disciplines with any historical tradition is in contrast with practitioners of Chinese or Indian traditional medical systems.
The aim was also assess the some of the record of holistic precept and practice, collate it under certain headings and to make it more accessible to colleagues in the field of complementary medicine. Extensive quotations of Hippocratic writers were included in order that they could be allowed to speak for themselves as far as possible. To enhance the investigation a comparative method was used using a classic text of Ayurveda. Ayurveda is a holistic system both historically contemporary with that of Hippocrates and extant today. The comparative text used was Caraka Samhita. Due to restraints of time and space, this report will concentrate on the findings in the Greek record
“ Perhaps you … have heard what good doctors say when a patient comes to them with sore eyes… They say … that to think that one could ever treat the head by itself without the whole body is quite foolish. On that principle then, they apply their regimens to the entire body and attempt to treat and heal the part in conjunction with the whole.” Plato: Charmides, 156b,c.
Plato’s fifth century B.C. report on ancient medical practice is striking in its similarity to the approach of modern practitioners of complementary holistic medicine. Indeed, so striking is it that it prompted questions such as
1. Is it possible that the origins for the contemporary holistic approach are to be found in "that principle" on which these ancient Greek physicians based their work?
2. What else is there in their work which is still either germane to, or reflected in contemporary practice?
The answer to the questions is important for several reasons.
1. Many practitioners of CAM are attracted to the study of non-European traditional medical systems because they are seen to offer a mind-body-spirit approach within a philosophy such as taoism, or samkhya. Thus they are perceived to be historically holistic in contrast to western scientific medicine and, since they have survived into the modern era, to be both ancient and modern. Among the general public too there is more familiarity with the terms and concepts such as qi, yin and yang, and prana and tridosa than with that what may be termed traditional western medicine, for example pneuma and humours. Not only practitioners but the general public are unaware of a western medical tradition of any validity going back 2,500 years or more. The reasons for this situation are complex and not the topic of this paper.
2. Western disciplines of complementary medicine, such as osteopathy, naturopathy, herbal medicine, chiropractice and massage can seem from the outside to be discrete, lacking in any common principles . (Integrated Health Care 1997) Compared to practitioners of acupuncture or Ayurvedic medicine, practitioners are not educated in any detail about a historical tradition of precept and practice.
3. Apart from other considerations, is the reason for this lack of connection to the ancient traditions due to an absence in ancient medicine of a substantial body of precept and practice which is valid for today’s practitioners or to an absence of a western model holism of sufficient substance to be of use?
What to call contemporary non-medical health care is itself fraught with difficulties. Historically terms which describe what is practised today have been taken into the scientific medical model, e.g. originally a physician was one who studied nature, phusis, and based his practice on what was readily available in the natural world a practice that originated in ancient Greece. The designates “complementary” and “alternative” are used but are objectionable as they define it only in relationship to the culturally dominant scientific medicine. Previously it has been called “natural” medicine by its adherents to emphasise a more simple less technological hence more safe medicine of herbs, diet and manipulative techniques. This seems to have now been largely discontinued partly on the grounds, that just because something is natural doesn’t mean it is safe. However, the epithet is not without merit in the light of the Hippocratic approach as we shall see. “Traditional medicine” is perhaps more helpful, but in a western context this is associated more with exotic systems those of native to western culture. “Integrated” is another term which is currently in use more implying an integration of the alternative/complementary approach – whatever it is to be called - into mainstream health care. I prefer the epithet holistic because the practices we find among adherents are premised on the idea of a mind-body-spirit whole.
Literature
The primary ancient text used for the study was the translation of the Hippocratic Corpus made by W.H.S. Jones for the Loeb Classical Library (Heinemann, 1972, 1979, 1982) and recently enlarged by translations of Potter and Smith (Heinemann 1988, 1994, 1995). The Medical Writings of Anonymous Londinensis (Jones 1947), and the writings of ancient philosophers were also used (Kirk, Raven, Schofield 1983, Watt, 1987, Hamilton 1951). The Hippocratic Corpus was compared to the Caraka Samhita, a work of the 1st century AD, whose roots are thought to lie in earlier 6th century medical practice (Zysk, 1991). A samhita is a compendium and while Caraka includes different views on medicine, these are ultimately harmonised under one authoritative voice. Caraka exhibits a concern with a rational as opposed to a religious approach and is influenced by philosophical schools derived from the Upanishads: primarily that of Samkhya philosophy.
Knowledge about ancient Greek medicine is almost exclusively gathered and transmitted by Classics scholars and archeologists, with more recently sometimes insights gained from medical anthropology. For the past one hundred fifty years these scholars have tended to be influenced by the predominance of the scientific medical model as they assessed ancient medicine. For this reason, the value of ancient practice as coherent and efficacious has been largely dismissed. (Jones1981, Lloyd, 1978, 1987.Longrigg 1993). A change came with the publication of Dioscorides on Pharmacy and Medicine, Riddle 1985). The sympathetic journalist Barbara Griggs (1997) provided a useful modern history of herbal medicine and included some information on ancient practice. Also a few practitioners western herbal medicine have begun to research historical practice of traditional European medicine in order to recover its insights for contemporary practice (Holmes 1993, Mills 1991, Tobyn 1997). While very welcome, these have not produced a detailed account of the most ancient source material.
Holism is a relatively new term in modern parlance. Pietroni (1990 16-27) traces the first use of holism among writers and thinkers in modern times to J.C. Smutts’ Holism and Evolution and through Lovelock’s Gaia Hypothesis and Weiss and Bertanfly’s General Systems Theory). To an extent what is now call holism can viewed as a revival of the 19th century idea of vitalism. (Mills, 1991, refers to the 19th century debate between vitalistic mechanistic paradigms, and prefers the “organicism” of Leibniz and Whitehead.) The term itself comes from the Greek holos, a whole. There is a close linguistic association between wholeness and wellness. Our words health and heal come from the Germanic hael, whole. The relationship between parts and wholes and health and healing are important to writers in the Corpus. (Regimen I)
Methodology
The method adopted was to identify concepts about holism common to contemporary holistic/ complementary medical practice and then investigate, or “interrogate” the Hippocratic Corpus for evidence of these. Similarly, concepts representing holism in Caraka were investigated and the two compared.
The research was supervised by scholars in the fields of Classics and Ayurvedic medicine. By these three means the study sought to avoid projecting back onto the past, modern ideas and to ground any discussion of the tradition in sound scholarship.
The investigation was informed by research on ancient medicine and philosophy by Classics scholars. It was also informed by my professional knowledge about current practice in herbal medicine and naturopathy and the point of view of a complementary medicine practitioner. In this respect it is analogous to the development in Classical scholarship of re-examining sources to discover more about the role of women in the ancient world and bringing to light knowledge which had previously been ignored or obscured.
Additionally, to test if ancient practices hold validity in today’s context they were compared with practices in Ayurveda as represented in the Caraka Samhita and practiced today. Observations and interviews were carried out in Ayurvedic clinics in the U.K. and in India.
Due to restraints of time and space, this report will concentrate on the findings in the Greek record.
Holistic concepts of contemporary complementary medicine were identified as:
1. The Vital Force
2. The wisdom of the body
3. The mind, body spirit connection
4. The relationship between health and disease
5. Treatment to support healing processes and balance the body.
6. Treat the individual not the disease
7. The participatory role of the patient; the patient-practitioner partnership.
Featherstone and Forsyth, (1997, 24-27) have sought to outline the distinctions in approach between the bio-medical and holistic models. The authors distinguish holistic medicine by the following criteria:
•
Responding to the person as a whole (body, mind and spirit) within the context of their environment (family, culture, and ecology)...
•
A willingness to use a wide range of interventions, from drugs and surgery to meditation and diet...
•
An emphasis on a more participatory relationship between doctor and patient and awareness of the impact of the 'health' of the practitioner on the patient. (Physician heal thyself.)
Discussion
The nature of ancient medical practice in both cultures is illuminated and set within respective historical and philosophical contexts. Both medical traditions were closely related to movements in philosophical thought. Caraka shows influence of the six classical schools emerging from the Upanishads, although samkhya philosophy is most in evidence, indeed the samkhya found in Caraka represents the earliest record of the ideas of this school. The Corpus shows the influence of the important ideas discovered about nature by the phusikoi, a divers group of thinkers who “invented the idea of the naturalness of nature” (Lloyd). It is especially important to emphasize this point in relation to the Corpus as, since the scientific revolution, a cultural bias has tended to play down medicine’s philosophical-spiritual side and highlight only the proto-scientific aspects.
For those not familiar with Hippocrates, as I was not, it is necessary to explain a little about this early source of ancient medicine. Although we know that there was a famous physician of the 5th c. B.C. called Hippocrates, today it is not certain if he is the author of any of the writings which are collectively called the Hippocratic Corpus. (Scholars have considered this “Hippocratic Question” for several decades without finding a solution) What is known is that the roughly sixty treatises which comprise the Corpus were by several authors in Ionian Greek over a period of about one hundred fifty years in the 5th – 4th centuries BC. The name Hippocrates is fundamental to western medicine. Various sayings such as “you are what you eat” are often attributed to him but seldom if ever are references given so that one can look it up and find out what else he might have said. Few today outside the realms of Classical scholarship appreciate the scope or detail of ancient medicine. Classical scholarship is of course necessary and very welcome; yet it has its limitations.
Most Classics scholars are for instance, embedded in the scientific culture of the modern west and this is reflected in how they interpret the evidence for ancient medical practice. Sometimes the ancient writings are examined by medical doctors, but they tend to concentrate on the ethical aspects and discount the efficacy of the actual medical practice. One scholar wrote that the 19th century physican and classicist M.P.E. Littre was “the last commentator for whom the Hippocrates was alive and meaningful in day to day medical practice.” (Smith, 1979, 31)
Different, sometimes completely contradictory voices and views are represented, which is not surprising given the time scale. Some treatises are considered to be polemical and rhetorical works defending a particular theory of medicine or persuading a lay audience of the value of the art and craft (techne) of medicine and of distinctiveness. These treatise attempt to persuade the reader that medicine is worthy of status and recognition . Others are case notes recording the progress of diseases in individuals. Some are thought to be lectures or information for the training of student physicians. They were produced in an era when writing was relatively new and itself undergoing dramatic change as ideas were beginning to be expressed in prose rather than poetic forms. There is no complete agreement among the various authors on either the causes or treatments of disease. However underlying all the arguing and diversity of opinion and practice, the treatises do convey a foundation of agreement about disease and wellness which is displayed in the most authoritative of the treatises. (Jones, 1972 xxix)
Background to Ancient Medicine
Jones (1972) characterises the Corpus as having: 1) a religious element, “generally discarded”; 2) a philosophic element still strong; and 3) a rational element relying on accurate observation and accumulated experience, which concluded that disease and health depended on environment and the constitution of the person.
Since the scientific and technological revolutions, scholarship has played down the value of the first two and concentrated on the third. Hippocratic writings have been investigated to see if the physicians practiced any kind of proto-scientific experimentation for example. My investigations convinced me that although conventional religion was not part of the ancient physician’s world, a philosophy about the divine nature of the natural world and the universe certainly was.
In the 6th century B.C., just before the writing of the Corpus, ancient philosophy, indeed philosophy itself, was just being invented. A paradigm shift was occurring in human thought from a magico-religious understanding to one based on rational thought. In Greece, thinkers were exploring and investigating the natural world in a new way. Nature and the cosmos constitute a macrocosm and man’s place in this is that of a microcosm of the divine whole.
In spite of the arguments and variety in the view points put forward, a general picture of a Greek Cosmic Scheme does emerge. (See Appendix)
Instead of finding an explanation of the universe and physical phenomenon with reference to non-human agencies such as anthropomorphized deities and super-natural demons, the thinkers sought to understand and explain phenomena through a study of natural forces. Hence the term they used for themselves and their activity was phusikon, the study of "phusis" or nature. Ionian thinkers such as Thales, Anaxagoras, Anaximander, Heraclitas, followed later by others from Western Greece (modern southern Italy ) such as Pythagoras, Empedocles and Alcmaeon gave very individual accounts within a core of agreement. Taken together they represent what has been called the spiritual discovery of the kosmos (Vlastos). As a corollary, human life could be viewed as free from magic and/or supernatural interventions. This philosophical and medical journey was part of man’s movement away from a magico-religious view to a rational one. But, importantly, to these ancient thinkers rational and reason were concepts which were not set in opposition to divinity or spirituality but part and parcel of the divine. Nature is divine. The Greek word for universe, kosmos, means both order and beauty and it was conceived of as a great sphere, and a holon or divine whole.
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