The Challenges Facing Ayurveda
Dr. Sunil Deepak, 17 May 2019
Ayurveda is an ancient system of medicine that is still used by millions of persons in the Indian subcontinent. The Ayurvedic understanding of the body physiology and diseases has concepts which are different from those of the modern medicine (known as “Allopathy” in India).
In this post I want to reflect on some basic ideas of Ayurvedic medicine and the challenges it faces, especially from the dominance of Allopathic medicine.
Personal background and my encounters with Ayurveda
I am a doctor with training in modern medicine (Allopathy), with a long experience in community health programmes. Since childhood, though I knew about Ayurvedic medicine, and I had seen family and friends taking Ayurvedic treatment, I had limited knowledge about it.
I used to think that Ayurveda meant curing persons with the help of herbs and medicinal plants, but I didn’t know that it has its own way of understanding disease and wellness.
My encounter with Ayurveda happened a few years ago, when I was having severe and disabling knee pains. Different visits to orthopaedic specialists and different treatments had not helped me. A friend suggested that I try Ayurveda, so I visited an Ayurvedic hospital in Kerala (India). That treatment finally gave me a relief from the knee pain.
Though after that first treatment, my knee pains have almost gone, since then I have been going back to that Ayurvedic hospital for a one-week course of treatment every year. At the same time, I have been reading about Ayurveda. Earlier this year, I also visited an Ayurvedic medical college in India and spoke to some of the teachers and students. I won’t pretend to be an expert on Ayurveda, but I have learned somethings about it. Thus, this post should be seen as that of an outsider, of someone from Allopathic system, who is trying to look objectively at Ayurvedic medicine.
Biases and Misconceptions about Ayurveda
Our way of thinking places Allopathy or the Western Medicine at a higher level by using words like modern, advanced, and scientific. On the other hand, for Ayurveda we use words that make it seem inferior, such as – traditional, alternate and anti-conventional. Some persons equate Ayurveda with superstitions or quackery.
I must confess my own patronizing attitude towards Ayurveda and Ayurvedic doctors. I had not realised that they also study medicine for 5 years like I had done. They study subjects like anatomy (including doing dissections), physiology, pharmacology, etc. though with a different approach. At the same time, they also study additional subjects like Sanskrit and Indian systems of Darshana.
Their rationale about causation of diseases is different from that of Allopathy – instead of concepts like cellular microbiology and pathology, they are looking at the concepts of 3 body humours (Vata, Pitta, Kaffa, roughly translated as air, bile and phlegm).
The modern medicine analyses body parts at micro, molecular and genetic levels and looks at the biochemistry of body functions. Ayurveda looks at an understanding of those same body parts and functions, through an understanding based on ancient texts.
The Pressure on Ayurveda
The education system in India is dominated by Western approach to logic and science. Persons growing with this education system understand the world in ways that are very different from the ancient Sanskrit texts that guide the Ayurvedic learnings. Thus, when they talk to Ayurvedic doctors, and ask questions about a health condition, they expect to hear answers in terms of Allopathy, because that is what today most of us understand. When they do not get answers that they can understand, they may feel that Ayurveda is illogical. For example, they may ask about fever due to malaria or flu, while these terms are not used in Ayurvedic medicine texts, which have a different approach to understanding and treating Jvars (fevers).
Persons also expect quick results from Ayurveda in ways they can get relief from the use of Allopathic pain-killers or anti-inflammatory drugs or antibiotics.
I think that this puts pressure on Ayurvedic medical practitioners by forcing them to use the logic of Allopathy. It may also force them into using medicines in way they are used in allopathy such as giving tablets, or using injections and IV drips.
There have accusations against Ayurvedic and Unani (another traditional medicine system) practitioners of using indiscriminately potentially harmful Allopathic medicines such as steroids and antibiotics. Studies in India have shown that roughly one third of all medical practitioners have training in modern medicine (MBBS degree), another one third has formal Ayurveda or Unani medicine training while the remaining one third has no formal medical training. Thus, I am not sure if such accusations actually are based on works of Ayurvedic doctors or depend mainly on practices of untrained medical practitioners.
Strategies for dealing with the pressure on Ayurvedic Medicine
Persons trained in western medicine feel that their way of understanding human body is scientific while all other ancient understandings are illogical and superstitious. They put pressure on other medicine systems to prove themselves. Such critical examination of other medicine systems is usually done, based on the logic of western medicine, which ignores the different concepts of disease and wellness of the other systems.
For example, many western medicine doctors felt that the Chinese traditional medicine, which is based on ideas of body meridians and the balance between the body humours (yin and yang) was essentially quackery because there was no scientific proof about the meridians or specific acupuncture points. I think that China has managed to safeguard its traditional medicine by insisting on developing their own approach to its critical examination and research.
To deal with similar pressures and accusations on Ayurveda, where we risk diluting and contaminating its ancient knowledge system, I feel that some key strategies are needed. These key strategies can only come from wide discussions involving different stakeholders with expertise in Ayurveda.
Personally, I feel that the following strategies can be considered:
Specifying the role of ancient and new knowledge in Ayurveda: Ayurveda is based on ancient Sanskrit texts which go back to at least two thousand years. That ancient knowledge is a heritage and an invaluable treasure, which needs to be safeguarded. It has its own logic and system of understanding which are scientific but also include other ways of learning that are different from the scientific way. New knowledge and understandings using modern technology can be added to that ancient knowledge only after careful analysis and discussions.
Thus, experts may need to define the core ideas of Ayurveda, which must be respected and safeguarded.
Defining the fundamental logic of Ayurveda: Indian system of Darshana (such as Sankhya, Tarka, Yoga, etc.) include rational arguments and analysis similar to those which are used in the western scientific methods. However, they also include other ways of gaining knowledge and learnings that are different from the western scientific way. For example, Ayurveda has the idea of pre-existing knowledge that can be accessed by sages through deep Dhyana (meditation).
Negating the idea of pre-existing knowledge because it cannot be “proved” through current scientific methods would be foolish. Experts need to analyse and define the fundamental ideas of Ayurveda, about which we need to build our research base.
Identifying the key distinguishing ideas of Ayurvedic practice and specifying them: There are some differences in the way Ayurveda and western medicine understand and prescribe medicines. These specific ways of using Ayurvedic treatment should be defined and safeguarded and should not be diluted to conform to the needs of western medicine.
For example, Ayurveda draws and distils specific mixture of essences from the plants and uses these as medicines. On other hand, western medicine believes in isolating or manufacturing specific chemical molecules and use them for treating specific ailments. In fact, pharma companies want to know about medicinal plants used by traditional medical practitioners so that they can use them to identify new chemical molecules. Experts have to decide if there is need to safeguard the Ayurvedic understanding of preparation of medicines and not to start copying the preparation of tablets and injections.
Reflecting on the role of modern research in Ayurveda: “Scientific” medical research is based on specific ways of understanding the body. Probably, it cannot be applied uncritically to the whole Ayurvedic system. It has to be applied in ways that are respectful of the specific ways of understandings and learnings in Ayurveda. To do this, a mutually respectful collaboration between Aurvedic experts and modern researchers is needed.
In 2006, I was involved in the organisation of an Asian conference on traditional medicine in Bangalore. In one of the presentations of this conference, a biochemist from Mumbai had shared her research about a herb. She had explained that according to traditional healers, this herb should only be collected in a specific season and very early in the morning. Her research had shown that those plants collected during different seasons and different times of the day, had very different levels of certain chemicals and this quantity was maximum during the season and time recommended by the healers.
Thus, over the centuries, the healers had gained knowledge about that plant which was confirmed by modern research. However, most of us, think of traditional healers as basically uneducated persons, who are not real doctors, and who are often suspected of promoting superstitions. Many of us, often have a similar attitude towards Ayurvedic doctors.
I only have a superficial knowledge about Ayurveda. In fact, I had a lot of misconceptions about this ancient Indian system of medicine. A positive experience of resolution of my knee pain forced me to review my prejudices and to learn more about it, but I am in no way an expert on it.
My personal experience of benefiting from Ayurvedic medicine has helped me to shed some of my ignorance about it. As we go towards new technological advances, I feel that we need to safeguard the core knowledge of Ayurveda, so that its ideas and understandings can be studied and understood in ways that are respectful of its basic concepts.
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