Reflections on Ayurveda

JOHN DEWEY, perhaps the most influential American philosopher of the 20th Century, said at one time "some people have criticised me for repeating myself through several books. I take it as a compliment to my consistency over the years! Some others have criticised me for contradicting myself in different books. I take it as a compliment that my thinking process has not stagnated for over 40 years of writing!"

My involvement in the science of Ayurveda, and personal association with Ayurvedic research began some 25 years ago. The idea of quoting John Dewey is not to equate myself with the big man, but to say that it is but natural that over a period of 25 years some thoughts remain constant while others change with new information, other inputs, and changes in the national environment. I choose to trace my pilgrim's progress of thoughts through my occasional articles published in The Hindu.

In 1986, I had said "As every aspect of traditional culture, arts and crafts suffered during the two centuries of colonial exploitation, the Indian systems of medicine such as Ayurveda and Siddha suffered a terrible blow. Western medicine had to its credit a contemporary scientific approach as well as economic and political patronage{hellip} Despite the revival of interest in Indian arts and Indian cultural environment, unfortunately, there has not been adequate revival of interest in Indian medicine -- an important branch of Indian culture. The glamour attached to the modern medical profession takes away the best of students to learn allopathic system of medicine, not attracting the best of talents to learn traditional Ayurvedic systems of medicine" (The Hindu -- December 14, 1986).

Later in 1997, commenting on the status of research in Ayurveda, I wrote: "What is important is that the Indian pharmaceutical industry, the practitioners of Indian medicine and the scientists associated with indigenous medicine should ensure that such vibrant developments take place within India, to capitalise on and be proud of our heritage. If we lose this initiative to foreign scientific organisations and pharmaceutical companies, we cannot obviously blame them" (The Hindu -- January 26, 1997).

Unfortunately in India, we have a tendency to have seasons of very extreme views. Unlike Astrology (which is currently in the centre of a debate whether it is a science or not), Ayurveda is, without dispute, a science, which should not be treated as a mere faith. With very blurred dividing lines between traditional culture and traditional science, mythology and history, the Indian psyche creates an amorphous amalgam of attitudes. Ayurveda and Siddha systems of medicine have to be treated as science and not bracketed with faith healing.

As much as I felt that the precious science of Ayurveda was ignored two decades ago, I am even more bothered about the packaging and publicity for Ayurvedic drugs as a fashion statement today. Sadly, the Marketing and Public Relations Industry tends to sell images of Arundathi Roy, Aishwarya Roy and Ayurveda with the same mindset. Ayurveda neither deserves the ignominious rejection by the "modern" minds, nor does it deserve to be made equally irrelevant by snobbish elevation to the status of being "cool" as the "in-thing".

Personalised system

The more we come to grips with this ancient system of medicine, the more we understand that this is a highly personalised system which can hardly support proliferation of "over the counter" drugs. The Ayurvedic physician is expected to understand each individual patient as a unique human being, and prescribe what is tailor-made for him. In fact, most formulations are to be specially made by the physicians and supplied to the patient, as per the classical manner of practising this system. While it is true that changing lifestyles, tension and speed in modern life call for easy accessibility, modern packaging and delivery systems, the ultimate success of the system will be directly proportionate to the success rate in its effort to be a cure for specified ailments.

It is absurd to generalise, as is often done that: (a) there are usually no side-effects for Ayurvedic drugs because they are natural; (b) because of their natural sources, they are not toxic; (c) they can be taken on the basis of "self prescription". These and such other beliefs are myths and do not stand scientific scrutiny. The Ayurvedic pharmacopoeia is extremely complex and it is a pity that several drugs are brought into the market with the label of Ayurvedic drugs since they escape the stringent provisions of the Drug Control Regime. Perhaps it is important to classify Ayurvedic formulations also into "prescription drugs" and "over the counter drugs", in the manner in which modern medicine is classified.

In the absence of such classifications, there is a danger of commercial interests promoting all these drugs as "wonder drugs over the counter". Such a callous attitude can result in short- term profits for the pharmaceutical industry, and long-term disillusionment with the science of Ayurveda itself.

After my visit to the People's Republic of China in 1984, I was deeply impressed by their approach to the Chinese traditional medicine. I also strongly believed that an integrated system of medicine combining Ayurveda with modern medicine should be evolved and perhaps included in the syllabus of all medical students. Over a period of years, and after my association with the College of Ayurveda of Chandrasekharendra Viswa Maha Vidyalaya as a consultant, I gradually changed my opinion to think that such integration will only confuse a student and may not serve a constructive purpose. It may be still useful for medical students of both the branches to understand the elementary principles of the other, but perhaps the integration should stop there.

The manner in which Ayurveda analyses the functioning of the human body is fundamentally different from the parameters of learning modern anatomy and physiology. Thriguna (vatha, pitha, kapha) classification in Ayurveda is so dominantly important in understanding human physiology as per this system that entire treatment and methods are related to these classifications, which find no parallel in western medicine. Like nodal points of acupuncture in the Chinese systems which cannot at all be explained from the perspectives of modern anatomy, this too has to be recognised as yet another form in which ancient India has understood the functioning mechanism of the physical body. Each of these forms of different medicine is successful in its own way.

Cross prescriptions

This brings us to the problem of "cross prescriptions". It is now commonplace for some Ayurvedic physicians to prescribe certain allopathic drugs. It is increasingly becoming a practice for certain allopathic practitioners to prescribe Ayurvedic drugs. I think it is very important that the practice of "cross- prescriptions" is strictly disallowed. These practitioners do not have the background to prescribe medicines from another system. Unknowingly, this may result in complications for the patient, which can sometimes be serious. Once, when I was interviewing candidates for admission to specialise in Ayurvedic gynaecology, I asked a candidate what action she would take to prevent abortion, in case of an emergency. Spontaneously, she replied that she would use hormones. Asked how does she qualify to administer hormones, she replied that a maternity home practising modern medicine may be too far away for the patient, and in case of an emergency, the Ayurvedic doctor will have no option but to save the patient by using hormones, even if she had not studied the allopathic system of medicine.

Those of us from a paramedical background (my doctoral and post- doctoral work being in biochemistry), who understand the serious implications of administering hormones, consider that even some of the allopathic medical practitioners, except the specialists, lack complete knowledge of consequences to administer hormones. Many of us feel that the syllabus in pure science should be strengthened for practising doctors of modern medicine, in such areas. It is even more imperative that an Ayurvedic physician should be thoroughly prohibited from utilising any of the drugs from allopathic formulations. Similarly allopathic doctors are not qualified to judge the patient from the parameters of Ayurveda and prescribe medicines from that system. "Cross prescriptions" are often born out of ignorance of, and lack of respect for, alternative systems of medicine. No doubt, the pharmaceutical industry has a vested interest in encouraging "cross prescriptions", even as they have a vested interest in promoting more and more drugs under the OTC stream. Some Ayurvedic physicians feel "proud" that doctors practising modern medicine have also started prescribing Ayurvedic drugs, considering it as a sign of recognition for their system of medicine.

Control mechanism

A number of examples can be quoted for the premature untested introduction of a so-called Ayurvedic product in the market, and its failure. Some years ago, for instance, a wooden "tumbler'' was introduced as a cure for diabetes, if the patient used the tumbler to drink water. Obviously, it failed in the market, and you do not hear about it anymore. This kind of unscientific and untested introductions in the market tend to give an image of quackery to Ayurveda.

Instead of allowing all and sundry products to be introduced in the market under the label of Ayurvedic drugs, a better drug control mechanism needs to be introduced to regulate or permit the manufacture and sale of Ayurvedic products. Either the existing rules, or their implementation seem inadequate.

It is equally important to improve the quality of education of the Ayurvedic practitioner and ensure that qualified medical professionals of this science practise family medicine with personal rapport with their patients. The idea of an Ayurvedic physician as a family doctor needs to be pursued and promoted to realise the true validity of this science. The high profile branding of Ayurvedic formulations, on the contrary, may be counter productive by being opposed to the very principles of Ayurveda.

Adherence to diet

An Ayurvedic prescription is related to prakriti -- the uniqueness of each individual. It is related to the mental attitude and state of evolution of every individual patient. There is a significant element of trying to achieve mental equilibrium in the patient, through counselling and meditation exercises, which are an integral part of treatment. Ayurveda also means very strict adherence to diet prescribed by the physician. Classical texts of Ayurveda prescribe the state of mind of those who cook the food, and who serve the food to a patient. Even if it means that with changing times, it is not practical to strictly follow all this, Ayurveda minus this holistic approach, and adopting merely one uprooted part of it, is grossly wrong. Without understanding the subtleties of this science, mere propagation of OTC drugs will result in a fragmented imbalance and will be against the basic grain, and against the very conceptual foundation of the science of Ayurveda.

Neither human physiology nor the fundamental nature of man has changed over the centuries. And so the principles and foundation of Ayurveda remain relevant and valid even if some of these concepts may sound old-fashioned in the era of tele-medicine.

Dr. MOHANA KRISHNASWAMY

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