Special issue with the Sunday Magazine
From the publishers of THE HINDU

Indian health traditions: October 08, 2000

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Scientific basis of Indian systems of medicine

Dr. A. V. Balasubramanian

The question of "scientific" examination and assessment of traditional medicine has been with us for well over a century. There have been extensive debates and scholarly discussions but for the purpose of this article, we will just focus on the following:

*Are there any general criteria based on which we can call a knowledge system as being scientific and if so can traditional medicine be called scientific based on these criteria?

*Most of us who are brought up on a diet of modern western scientific theory and ways of thinking notice that there are a number of factors in traditional medicine different from what we can expect a scientifc system to be. How do we come to terms with this?

Is Ayurveda a science? Let us take the example of Ayurveda as an illustration of traditional medical systems. What are the criteria based on which we can consider Ayurveda as scientific? There can be three types of criteria namely:

Methodological Criteria - It should be based on a sufficiently large body of observational data, and have a comprehensive and rigorous theoretical framework and the basis of legitimisation of all theory should be observation.

Epistemological Criteria - This presupposes that the above method is a legitimate method to acquire knowledge about the subject and the knowledge acquired is always limited and subject to modification in the light of new data.

Sociological Criteria - Society must have a professional community with practitioners of knowledge in the above sense.

Let us have a brief overview to examine Ayurveda based on the above criteria.

The Ayurvedic texts mention of a large number of plants and plant products. The three major texts of Ayurveda list about 700 plants and 1,900 formulations. They discuss animal products from 165 species and a large number of mineral preparations are also mentioned. Quite often we find specific properties given for different parts of plants such as roots, fruits, oils etc. Animal products also encompass a range of animal parts including milk, flesh, urine etc. In fact the Ayurvedic classic Ashtanga Hrdaya states that - "There is nothing in this universe which is not medicinal ..."

Ayurveda has developed its own theoretical framework to understand the structure and properties of all material things based on the theory of Pancha Mahabhutas (the five primordial elements) which analyses all the constituents of the universe based on the sensory organs that are employed to detect them. They have a theoretical framework based on the three doshas namely Vatha, Pitta, and Kapha to understand health and disease. The Ayurvedic Materia Medica lists the properties of literally thousands of plants as well as hundreds of animals and mineral products based on Ayurvedic concepts.

Ayurvedic literature contains adequate recognition and explicit statements on the limitations of the knowledge systems and its domain of applicability. Ayurvedic texts give indication that this knowledge system is the product of an active community of physicians that has well established norms to govern itself. There are rules regarding discourses between physicians, admission of students into the fold, ethics of practitioners and manners of settling disagreements and disputes. In fact it is interesting to see that much of the treatise of Charaka Samhita is in the form of a symposium wherein groups of Ayurvedic scholars take up a series of topics for discussion.

Thus there is every indication that Ayurveda is indeed a scientifc knowledge system by all the above criteria.

However, to the modern trained mind there are a lot of questions and doubts since the manner of discourse and presentation of knowledge in Ayurveda is vastly different from modern sciences. Some of these pertain to issues such as - can we examine Ayurvedic tenets by modern scientifc systems and validate them, what kind of experiments do people make in Ayurveda, how do they measure and quantify things and above all are traditional medical theories changing and evolving to meet the changing situation in the manner of modern medical theories. We shall try to answer some of these questions.

Is it possible or necessary to test and verify the truth of Ayurvedic prescriptions based on modern medical research. A classic example is the study of the root Sarpagandhi (Rauwolfia serpentina) by modern chemical methods. This research succeeded in isolating an alkaloid which was named as Reserpine. Observations have shown that Reserpine has several side effects which are not observed with the Ayurvedic preparation using the root. Simultaneously, the use of huge amounts of this root for extracting Reserpine on a commercial scale has rendered this plant scarce and has put it outside the reach of the ordinary village Vaidya and Ayurvedic practitioners. Hence the use of - modern research techniques must be taken up with due caution.

Experimental method

The essence of the modern laboratory method is to isolate any problem from its environment, to eliminate the interlinkages that it has with diverse other factors in nature and to reduce it to the minimum possible number of "controllable" parameters. After this, the parameters are varied (generally one at a time) and its effect on the system is studied.

In contrast, the traditional approach attempts to solve problems by taking them in their entirety with all their interlinkages and their complexity. This method of solving problems in their natural setting seems to be efficient in providing balanced solutions. The traditional Indian sciences seem to adopt this holistic method of looking at the world in its integrity. It appears that they seek to systematise commonsense and to make it rigorous rather than destroying its essential unity and its multifacetedness. Thus, according to Charaka, science is dependent upon "Yukthi" - a quality of the intellect that enables it to perceive phenomena brought into existence by a multiplicity of causes.

Again it means, using Yukthi to bring together appropriate actions and material at the appropriate time and place. Thus the traditional system even in its theoretical formulation, seeks to find ways of living in good health rather than to dissect it or change it in any major manner. Hence it appears that while traditional sciences are indeed built upon a stupendous amount of detailed and minute observations, experiment (in the modern laboratory sense of the word) perhaps does not have a clear counterpart in Ayurvedic tradition.

Measurement and quantification

Measurement and quantification are indeed present in traditional sciences though they occur in a manner which is somewhat different from the modern notions on the matter. Most measurements made in traditional medicine use units which are normalised to a given individual. For example, while measuring the height of a person's body or the length of his limbs, it is expressed in units of Anguli - that is the dimension of a finger of the same person rather than an arbitrary standard external to the individual - like the standard international metre. Such normalised units exist for measurements of not only length but also volume and even for the measurement of time.

The "stagnation of theory" in traditional sciences

A feature of Ayurveda (or for that matter, many traditional scientific systems) that often puzzles anyone trained in modern science is the apparent constancy of the theories. It appears that in key areas nothing has changed for centuries or millennia. It is sometimes said that theories have been fossilised because no growth took place after some "dark ages." It has often escaped the observer that there may be a different approach to a scientific endeavour or a different way of organising science which may lead to a certain "constancy" of the fundamental theories.

The subject of Etiology provides us with a striking illustration of this characteristic feature of Indian thought. That causation of diseases can be by agencies outside of oneself is common ground between Etiology of both Ayurveda and Allopathy; but the analysis of such agencies by Ayurveda and Allopathy shows the characteristic features differentiating the two viewpoints. An analogy may perhaps serve a useful purpose in this context.

Suppose we wish to classify the various invasions of India; we may do it in two ways: in one we may classify the invasions as those by either land or sea or air; in the other we may classify them as those by the Greeks, the Muhammadans, the Europeans and so on.

The first classification is all-comprehensive and applicable for all time; because, all invasions must take place in one or other of these three modes - singly or combined; but, the second classification is applicable only to the present and the past and even that, only so far as it is known; and if there are new invasions in the future by others than those given above, the list will have to be added to, whereas, in the first case, all future invasions will naturally go under one of the three categories that have been laid down for all time as it were.

Invasions of India can be classified in two different ways.

In the medical context, Ayurveda classifies diseases as being those caused by Vata, Pitta and Kapha. Any disease can be understood in terms of how it affects the doshas singly or in combination. Such an approach is useful not only in disease of yore, but also new diseases of today or tomorrow.

There is a need to understand and respect the distinction and uniqueness of each scientific system. There is room for a dialogue between various systems and a need to avoid crude and quick equations or the judgment of one system by another. Various civilisations have evolved sciences, technologies and knowledge systems having their own individual characteristics and bearing the stamp of the world view and values of the society which gave rise to them.Ayurveda constitutes a body of scientific knowledge in the most rigorous sense of the term. An open minded study of traditional systems of knowledge is likely to provide us with a valuable starting point in a quest for a holistic approach not only to Life Science but also in various other areas of human endeavour.

Plastic Surgery Illustrations regarding the Indian method for plastic surgery for total nasal reconstruction, from an article in Gentleman's Magazine, London. Indian traditions were very advanced from early times and had a profound influence on the practice of the plastic surgery in various parts of the world. The first detailed description of surgical replacement of the nose is found in Sushrutha Samhitha. The two early methods practised in India namely the cheek-flap method and median forehead flap method are still used by modern surgeons. The method of total nasal reconstruction was practised by the caste of brick makers and potters. The use of the forehead flap method has been in vogue at least since the 15th century in Maharashtra. There are also families of Kangra who are skilled in this art and the last surviving member of this family Hakim Dinanath (who belongs to the potters caste) performed this operation during the 20th century. In the modern era, the Indian method (of total nasal reconstruction) was brought to notice by the publication of a report by the British observers in 1794 from where it aroused interest in the West.

The rise and fall of the baby's bottle Modern medical theories are said to be constantly changing and evolving - this is usually seen as a virtue. But in practice it may mean that the medical profession may also flip over time tested practices and one can never be sure if today's wisdom may be tomorrow's folly. Take the case of mother's milk. The superiority of breast milk is almost universally acknowledged today. However, this has not always been the case. When the bottle was introduced at the turn of this century it encouraged the development of the infant - formula business. By the time of World War II, cow's milk products were widely accepted as - "The proper, hygienic and civilized food for infants." After the war, bottle feeding was promoted as the "modern" (and therefore, better) way to nourish babies not only by the infant formula industry but also by hospitals, nurses, nutritionists and the popular press (A detailed account is given in the paper - "The rise and fall of the baby's bottle" by M. G. Schwab, Journal of Human Nutrition Volume - 33 (1979) pages 276-282. From the end of World War II till the early 1970s, formula feeding was replaced breast feeding throughout much of the industrialised world. Surveys during the period 1955 to 1971 showed a steady decline in the number of American women who breast-fed their babies. Although this decline first occurred in the industrialised Western countries evidence from developing countries also indicates a decline in breast feeding during this period. The trend away from breast feeding in the Western industrialised nations has been now reversed - the modern medical profession has travelled a full circle and come to the conclusion that breast milk is indeed the best for infants. Beginning with 1971 and continuing during the 1980s, the number of American women breast feeding their babies has increased steadily from about 25 per cent to 60 per cent. Ironically during this period there has been a decline in breast feeding in the developing countries. The net effect of the above cycle of events is that an entire generation ofour people has been "educated" to look down upon breast feeding, only to be now told how that it is the "latest thing."