Kishor's Blog

Mahatma Gandhi's thoughts on Ayurveda

2022-01-30T07:20:00.004-08:00

Mahatma Gandhi has spoken and written a lot about Ayurveda as a science and also about the way how it is practiced. Most of what he expressed still holds relevant - is something that speaks about his keen observation and analysis of the situation.

Following articles, letters and news reports have been copied from different volumes of Mahatma Gandhi's compiled works. There may be some inadvertent errors even though these have been curated carefully. I have added emphasis (bold fonts) to highlight some crucial points he made. In some instances, I have deleted some stanzas that were not related to the context to keep the entire narration focused.

Though this can be developed as a detailed article, I am posting the material here in its original form purposefully so that those who might be interested can delve deeper into this.

KUMARA PARK, BANGALORE,

June 5, 1927

DEAR FRIEND,

You were good enough to send me a copy of your letter to Dr. Gananath Sen regarding his rendering of certain Ayurvedic terms. I wonder if Dr. Sen ever sent you any reply. As you seem to be a close student of Ayurveda, could you please tell me,

(a) in what way Ayurvedic treatment is superior to the Allopathic treatment?

(b) Is there any progressive research work being done either in Ayurvedic materia medica or in any other branch of medicine or surgery in terms of Ayurveda?

(c) Have you or any other Ayurvedic physician investigated the meaning of or tested the prescriptions contained in hridroga shweta kushta-nashan sukta—kushta-nashan sukta—suktas reproduced in the current number of the Vaidika Dharma edited by Pandit Satavalekar of Oundh? If you have not the magazine, I shall be glad to send it to you.

Yours sincerely,

DR. GANGADHAR SHASTRI JOSHI

TILAK MAHAVIDYALAYA

POONA

KUMARA PARK, BANGALORE,

July 19, 1927

DEAR FRIEND,

I thank you for your letter and the pains you have taken to answer my questions. Do you claim cheapness, simplicity and efficacy for Ayurvedic medicine as we find it at present? After my own fashion, I have been interested in its success ever since 1891, and have even spent what little I was capable of and induced friends to spend on behalf of Ayurvedic physicians. But so far, I have found it to be neither cheap nor simple nor efficacious. Some of the prescriptions are most complicated. Ayurvedic physicians have been known to charge as much as men with medical degrees. I know Ayurvedic physicians who charge today even as much as Rs. 1,000 per day. The best of them are beyond the reach of the poor. And what I have also unfortunately found is that a very large number of patients have gone to the physicians with Western degrees after having found Ayurvedic treatment to be inefficacious. I am aware of the converse also having happened. But the scales seem to me to weigh in favour of Allopathy. My own desire has been and is now also to find Ayurveda practice successful, if only because I am probably fanatically vegetarian and because I have a horror of Allopathy for many reasons I need not go into. Even for simple home treatment, having studied something of both Ayurvedic and Allopathic drugs, I have been obliged to use Allopathic drugs instead of Ayurvedic. For instance, I have found nothing so efficacious as quinine for malaria or iodine for simple pains or Condy’s fluid as a disinfectant. I must not, however, worry you with my own experience. If it is not troublesome, will you kindly illustrate in what way Ayurveda aims at purifying the whole system rather than affording only temporary relief? As time permits me, I shall go through the pamphlets you have kindly sent me. I shall also await the views from the friends to whom you have shown my letter. You will please write to me if you do not receive the relevant texts from Pandit Satavalekar.

Yours sincerely,

SJT. GANGADHAR SHASTRI JOSHIJI

9/2, SADASHIV PETH

POONA CITY

WHY DOCTORS?

Q. Why do you go to the doctors for examination and diagnosis and not to the vaidyas?

A. The vaidyas do not possess the knowledge of the human body as the doctors do. The basis of diagnosis in Ayurveda is the theory of tridosh. They have not got to the bottom even of that. The doctors are ever carrying on research and making new discoveries. One either goes forward or backward. Nothing remains static in the world. Those who become static, become lifeless. God alone is static, but amazing as it may sound, He is described both as motionless and full of motion. Moreover, doctors and vaidyas are my friends. The doctors have clung to me. One of them has become more than my own daughter. One’s own daughter can leave her father; how can one who has chosen to become a daughter? The vaidyas themselves use, though indifferently, the methods of diagnosis used by the doctors or else they advise the patient to go to the doctors for it. The viadyas possess the knowledge of certain drugs which they use effectively. But the doctors, vaidyas and hakims all slave for money. They do not take to the profession purely from a spirit of service. That some of them have that spirit does not contradict my statement. Nature cure is the only thing which has come into existence purely from the point of view of selfless service. Today even that has become a means of making money. Thus money has taken the place of God. The doctors examine me, but I depend on none but God. He is the Master of every breath I take. If He wills it, He will keep me up to 125 years. If not, He might carry me off any moment, leaving the medical friends staring as helpless spectators.

NEW DELHI, May 2611946

BHAI GANESH SHASTRI,

There is too much of cholera around Sevagram. What does Ayurveda have to say? People are succumbing to the disease every day; how can we then promptly cremate the bodies? Where to find all the firewood ? How quickly and in what manner should the body be removed? If they are to be buried, how should it be done and by whom? Please think over the problem. Send a reply or meet Dr. Sushila and discuss the matter with her. Be prompt.

Blessings from

BAPU

POST ANDHERI,

April 5, 1924

My unfortunate position is that I have faith in the Ayurvedic drugs, but very little in the diagnosis of the physicians. I therefore never feel sure about a patient under an Ayurvedic physician if his diagnosis is not checked by a trustworthy practitioner under the Western system.

DR. G. B. TALWALKAR

AHMEDABAD

19. SPEECH AT AYURVEDIC PHARMACY, MADRAS 2

March 24, 1925

Mahatamaji said that perhaps those responsible for the function did not realize that he seemed to be entirely out of tune there. They did not know that he made these remarks even when he performed the opening ceremony of a medical college with which his esteemed friend Hakim Ajmal Khan, was connected. From his chair on that occasion he had to dissociate himself from much that went under the name of Unani, Ayurvedic or European medicine. He was opposed to indiscriminate use of drugs. It did not give any pleasure to him to hear that Dr. Sri Ramacharlu was able to distribute his medicines amongst two lakhs of people or twenty lakhs of people. He could not congratulate the doctor on his successful advertisement of makaradhwaja. What was wanted among their physicians was a real touch of humility. It was a matter of good fortune to him to have friends among both allopathic doctors and Ayurvedic and Unani physicians; but they all knew his mind thoroughly that he could not possibly endorse their activities in the distribution of drugs.

He wished the physicians of the modern day took the role of the physicians of old, when they gave their lifetime to make researches and distribute relief among the people without taking a single farthing. That was unfortunately not the case today. What he noticed at present was that the Ayurvedic physicians were trying to live on the past glories of Ayurveda. The system of diagnosis was still in the primitive stage and it could not be in any measure compared with that prevailing under the Western system. Whatever might be said of the Western system—he had said a great deal on that subject—one thing must be said in its favour, that it had got humility and it had got research; and there were physicians and surgeons who gave their whole time to this work, the world not knowing them. He wished that spirit would fire the Ayurvedic physicians. But unfortunately what he noticed today was hunger for wealth and renown and hunger for coming to the top. That was not the way in which they would be able to serve Ayurveda. He knew there were most potent and efficacious drugs in Ayurveda. But today because they had forgotten the art, they had really lost the use of that. He had discussed these things with many physicians and they had nodded assent to all that he had been saying.

You would not call me a dear friend of yours, when you have purposely invited me to come here, if I do not utter this truth that is lying deeply rooted in me. And it is a result not of a day’s thought or a hurried thought; but it is the result of nearly 40 years of observation and also experiments in hygiene and sanitation. As a result of these things, I have come to the deliberate conclusion that the best physician is one who administers the least number of drugs. The surgeon who performed the operation on the late King Edward and so successfully performed it, has said that in his pharmacopoeia their were but two or three drugs that he used. Otherwise he left nature to do its own work. I trust that our physicians understand the secret that nature is the sweetest, the quickest and the best restorer of health, whereas what I find is that all kinds of experiments are being made, arousing the basest passions of humanity. The advertisements that I see of medicines made me sick. I feel that physicians are rendering no service to humanity whatsoever but the greatest disservice by claiming every medicine as the panacea for all ills of life. I plead for humility, simplicity and truth.

The Hindu, 24-3-1925

167. SPEECH AT ASHTANGA AYURVEDA VIDYALAYA

CALCUTTA,

May 6, 1925

FRIENDS,

It was not without greatest hesitation that I accepted the invitation to lay the foundation-stone of this great institution. You know that some years ago I performed the opening ceremony of the Tibbia College1 whose presiding deity was my esteemed friend and brother, Hakim Ajmal Khan . Even then it was not without hesitation that I performed the ceremony. I could not resist the invitation that was given to me by a bosom friend and little could I resist a similar invitation coming again from a bosom friend. But I would be untrue to myself and untrue to those assembled if I did not express my deepest thoughts about medicine and particularly about Ayurvedic and Unani medicines and the profession in general. It was in 19083 that, for the first time, I reduced to writing my views about medicines and the medical profession, and I am not able, looking at it after so many years, to alter a single word of what I have said there. No doubt what I wrote in 1908 was compressed, it was a passing reference to a subject which was included among so many others which I had to deal within a mere booklet. Since then I have expanded the same thought, but I have not diminished the strength of the thought that I expressed in 1908. Every time I approach medical men and their medicines, I do so in fear and trembling, and it takes nothing away from my fear that I submitted to the living knife of a surgeon whom I only knew perfunctorily in the Yeravda jail. I had the fullest confidence in Col. Maddock2 as a man and as a friend but I had not the fullest confidence in his ways and in the medicines that he prescribed. If you were to go to him today, he will issue a double certificate—one in my favour and the other against me. He will certify to you that to a certain extent I was a willing, obedient and a loyal patient, a more loyal patient he could not wish for. But he will also say and certify that I was one of the most difficult patients he had to deal with. He had to deal with my prohibitions. I will take this and I will not take that and my negations were far more than my ayes. And, therefore, he always came to me in des-pair whenever he felt that he wanted me to put a little more weight. It was with the greatest difficulty that he could persuade me to take so many of the medicines that he thought I should take and that I thought I ought not to take. (Laughter.) Well, there it is. I have merely given you a skeleton of my views about the profession, but perhaps you will better understand my views when I tell you that I belong to that noble, growing, but the still small school of thought which believes more in prevention than in cure, which believes in Nature doing things for herself even for suffering humanity if we would but let Nature take her course. I believe in that school of thought which considers that the less interference there is on the part of doctors, on the part of physicians and surgeons, the better it is for humanity and its morals. I belong to that school of thought among medical men who are fast coming to the conclusion that it is not their duty merely to subserve the needs of the body, but it is their bounden religious duty to consider the resident within that body, which is after all imperishable. And I belong to that school of thought among medical men who consider that they will do nothing in connection with that body if whatever they do is going to impair, in the slightest degree, the soul, the spirit within. And it grieves me so often when I find some of my best medical friends—and you will accept my word—but I assure you that it grieves me when they discuss with me the question whether there is such a thing as soul and when they tell me that, if there was a soul, it would not escape their deadly knife. Little do they know that the soul survives the knife and that the soul is not to be found by any probing of knife, however deep it may be. (Laughter). Therefore, it was with the greatest hesitation that I have approached this function. I wonder whether it is a real sign of civilization when the number of hospitals in a particular place is larger than in another place. I wonder whether it is really a test of growth to find in the catalogues and in the directories of medical men that every year their sales are increasing by leaps and bounds and that the inmates in the hospitals and dispensaries are increasing. I really wonder whether it is a sign of real progress. However, I know that there is the other side of it. I don't want to labour only on one side of this question. But, in all humility I have placed [these] for consideration of those who are put in charge of the management of this great institution. I have hitherto confined my remarks to medicine and surgery in general, but when I come to the Ayurvedic and the Unani system, I am filled with greater doubts. You may not know that, even from my boyhood. I have come in contact with many physicians, some of them known to be distinguished in their own localities. There was a time when I used to swear by the Ayurvedic medicine and used to commend it to all my friends, who went in for Western medicine, to go to these Ayurvedic physicians. But I feel sorry to have to own to you that I was undeceived and I found that our Ayurvedic and Unani physician lack sanity. They lack the humility. Instead of that I found in them an arrogance that they knew everything (Laughter), that there was no disease which they could not cure. (Renewed laughter.) I found that they believed that the mere feeling of the pulse could enable them to understand whether the patient was suffering from appendicitis or same such other disease. When I found that their diagnosis was false, that it was incomplete in most cases, I felt that it was nothing short of humbug. When I turned to the advertisements of medicines—I shall not say from Kavirajas—but Unani Hakims and Vaidyarajas, I felt humiliated I felt a sense of shame coming over me—these advertisements which pander to the basest passion of humanity, disfigure our newspapers and magazines. I have handled magazines devoted to the education of ladies. I have seen magazines devoted to the education and information of young men, and I have found these advertisements alluring, no doubt, profitable, no doubt, to those who advertise these nauseating things. I felt that they are cutting deep into the vitals of the suffering humanity. Therefore, whilst I am going to perform this ceremony of laying the foundation stone of this noble institution and whilst I do so with a prayerful heart and wish it all success, I want the organizers to note my limitations, to understand the note of warning that I have uttered to those who are called upon to devote their wealth to this institution. I utter an all humility this note of warning. May this institution be of use to the real suffers. May this institution take care not merely of the need of the body but of the imperishable soul that resides in that body. May it never be said of this institution that it panders to the basest taste of humanity, that it panders to the basest taste of the youths of Bengal—and I know the youths of Bengal. I know how their fair life is being sapped by the medicines that are poured down their throats by physicians who, in the words of the Lord Justice Stephen, “introduce drugs of which they know little into the bodies of which they know less”. And so I plead, as I pleaded in Madras at a similar function, for sanity, for humility, for truthfulness, for fear of God among those who are the present organizers of the institution and those who follow. With these words I shall have much pleasure as soon as you give me room to go to the place where I have to lay the foundation and I shall have equal pleasure in praying for the success of this institution.

Amrita Bazar Patrika, 8-5-1925

287. AYURVEDIC SYSTEM

Kaviraj Gananath Sen writes :

I take this opportunity of drawing your attention to the fact that the speech you delivered when laying the foundation stone of the Ashtanga Ayurveda Vidyalaya has been greatly misconstrued both by the public and by the Ayurvedic physicians of Calcutta. May I suggest that you will kindly explain that you did not mean to condemn Ayurveda itself or its conscientious votaries but only a certain section of them who lived by fraud? To me such an explanation appears to be urgently required in view of the fact that almost all Bengali papers are misinterpreting your speech and condemning us for not contradicting it.

I gladly comply with the request, the more so as it enables me to express my views about Ayurvedic medicine. I must say at the outset that I was reluctant to perform the ceremony referred to as I was reluctant even to perform the ceremony of opening the Tibbia College by reason of the views I hold on Medicine in general as expressed in my booklet Indian Home Rule. Seventeen years’ observation has made no material change in them. If I rewrote the book, it is just possible that I should state the views in a different language. But I could no more resist the organizers of my tour than I could a bosom friend like Hakim Saheb. But I told them that my speech might prove embarrassing. Had I been absolutely hostile to the movement, I should, of course, have declined the honour at any cost. But I could reconcile myself to the performance subject to the conditions I named at the meeting. I hope that the college of which I laid the foundation and to which I understand the founder, himself a Kaviraj, had devoted a princely sum, will contribute to the alleviation of real suffering and make discoveries and researches in Ayurveda that will enable the poorest in the land to know and use the simple indigenous drugs and teach people to learn the laws of preventing disease rather than curing them. My quarrel with the medical profession in general is that it ignores the soul altogether and strains at nothing in seeking merely to repair such a fragile instrument as the body. Thus ignoring the soul, the profession puts men at its mercy and contributes to the diminution of human dignity and self-control. I note with thankfulness that in the West a school of thought is rising slowly but surely which takes count of the soul in trying to repair a diseased body and which, therefore, relies less on drugs and more on nature as a powerful healing agent. My quarrel with the professors of Ayurvedic system is that many of them, if not indeed a vast majority of them, are mere quacks pretending to know much more than they actually do, arrogating to themselves an infallibility and ability to cure all diseases. These gentlemen have no humility in them. They will not study the Ayurvedic system and wrest from it the secrets which appear at present to be completely hidden from the world. They impute to Ayurveda an omnipotence which it does not possess, and in so doing they have made it a stagnant system instead of a gloriously progressive science. I know of not a single discovery or invention of any importance on the part of Ayurvedic physicians as against a brilliant array of discoveries and inventions which Western physicians and surgeons boast. In fact, Ayurvedic physicians’ diagnosis, as a rule, consists in feeling the pulse which, I have known many to claim, enables them to know even whether the patient is suffering from appendicitis. Whether the science of the pulse ever enabled ancient physicians to diagnose every known disease no one can tell. But it is certain that the claim cannot be sustained at the present moment. The only thing Ayurvedic physicians can safely claim is a knowledge of some vegetable and metallic drugs of great potency which some of them succeed in administering for disease they only guess and, therefore, often with much harm to their poor patients. The advertisements of medicine that excite animal passions add immorality to incapacity and make those who resort to these practices a real danger to society. I know of no association of Ayurvedic physicians that protests against or endeavours to check this ceaseless flow of immorality which is sapping Indian manhood and making of many old men monsters living merely to satisfy their lust. Indeed, I have known such physicians enjoying a status of respectability in medical society. Whenever, therefore, I get an opportunity I seize it to drive the truth home to the physicians Ayurvedic and Unani and plead for truth, humility and patient research. I am a lover of all that is ancient and noble. I believe that there was a time when Ayurvedic and Unani medicine served a noble purpose and was progressive. There was a time when I actively helped these physicians and believed in them. But experience has undeceived me. I have been grieved to find arrogance and ignorance among many such physicians. It hurts me to find a noble profession being prostituted for making money. I have written this not to condemn individuals. I have merely reduced to writing the impression that has been left on my mind by a long course of observation of the practice of Ayurvedic physicians. It is no answer to say, as has been said, that Ayurvedic physicians have copied the evils I have named from their Western brethren. A wise man copies not what is bad but that which is good. Let our Kavirajas, Vaidyas and Hakims apply to their calling a scientific spirit that Western physicians show, let them copy the latter’s humility, let them reduce themselves to poverty in investigating the indigenous drugs and let them frankly acknowledge and assimilate that part of Western medicine which they at present do not possess. Let them shun the irreligion of the Western scientists, which, in order to heal the body and in the name of science, subjects the lower animal kingdom to the hideous tortures which pass muster under the name of vivisection. Some will retort that there is warrant for vivisection in Ayurveda. If there is, I am sorry. No warrant even in the four Vedas can sanctify sacrilege.

Young India, 11-6-1925

461. ANSWERS TO QUESTIONS

October 14, 1946

Q. Wouldn’t it be better to set up a public institution at Bordi for conducting research in the Ayurvedic system of medicine?

A. It would be good to make Bordi a public institution.

Q. The Government Ayurvedic Colleges teach seventy per cent allopathy. Ayurveda should be taught as a separate science. When this question was first discussed you had said that you would arrange for me to meet Dr. Gilder.

A. The Ayurvedic education is something I have been long interested in. The work can certainly be pursued if there are vaidyas you know who think like you and who are selfless. Only then would it be useful for you to go to Dr. Gilder.

Q. It is difficult to find vaidyas who fully share my views. There are some who are too orthodox to allow any changes or innovations in the Ayurvedic system while others want to turn it into allopathy. In fact Ayurveda is based on theory of tridosha and its cure is based on five basic substances.

A. What do you think of Joshi of Poona? If there is no one else, what can you do by yourself? Many doctors have told me that the treatment based on tridosha is a fraud. It is for you to prove that it is not so. It is also for you to train vaidyas like you. What Dr. Gilder has passed has also been prepared by vaidyas. Bhadkamkar, Lagu, Gananath Sen and Vishwanath are from among you, are they not?

Q. The doctors do not know anything about the treatment based on tridosha . Bhadkamkar and other vaidyas are more of doctors than vaidyas, and that is why they have approved the scheme.

A. I can arrange a meeting with Dr. Gilder. But I would advise you to see Bhadkamkar and Joshi. Have a little talk with Sushila Nayyar, with Satis Babu, too. He is here at present.

Q. I have gone through the book Prakritik Chikitsa which you gave me. It is full of tall talk and is not based on the author’s personal experience. He has described properties of medicines without citing authority.

A. I have noted the tall talk in it. Only you can write authoritatively on medicines.

Q. I will prepare the students. But it is obvious that my syllabus will be different from that prescribed by the Government Board. So what shall we do about its registration?

A. Prepare something. Do not worry about registration. First of all train the volunteers. It is not necessary for them to have degrees. If they are good I will accommodate them. I do not care for degrees.

32. DR. MEHTA’S INSTITUTION

I have received several questions about Dr. Dinshaw Mehta’s institution. Two of them are worth noticing. They are given below:

In order to make the institutions more scientific, more modern and more useful for the public, is it not desirable that some capable enthusiastic nature cure man or men should be sent abroad for higher studies in nature cure? Would not such experts on their return evolve a system of nature cure suitable for our country and enable it to become popular and stand on its own feet?

You want a simple and cheap method of nature cure for our village. Can the methods described by Kuhne, Just and Kneip, etc., serve that purpose? Can these methods be useful and suitable for village work? The clinic at Poona could not serve the purpose of village nature cure in the opinion of the Trustees. Therefore, it was closed down and an experiment in village nature cure started at Uruli Kanchan. There the work is going on satisfactorily, though on a small scale. There is nothing there worth seeing as yet. Even the land has not been bought and no buildings have been built. Now let us take the main question. The tendency of looking to the West in order to make progress in whatever we do, should be checked. If we have to go the West to learn nature cure, it cannot be of much use to India. Nature cure is a thing which anyone can practise in the home. The advice of nature-cure experts should not be necessary for all time. It is such a simple thing that everyone can learn it. If we have to go to Europe to learn to recite Ramanama, it simply will not do. Ramanama is the very foundation of nature cure of my conception. Nor should it be necessary to go across the seas in order to learn the use of earth, water, ether, sun and air. This is self-evident. Whatever other knowledge is required in this direction can be had in our villages. For instance, if herbs are used, they must be village herbs. Ayurveda teachers know all about them. If some Ayurvedic physicians are scoundrels, they cannot become good men and servants of the people by going abroad. The knowledge of anatomy and physiology has come from the West. It is very useful and necessary for all physicians. But there are plenty of means of learning it in our own country. In short, whatever useful contribution to knowledge has been made by the West, it has reached everywhere and can be learnt everywhere. I might add here that the knowledge of anatomy and physiology is not essential for learning nature cure. The writing of Kuhne, Just and Father Kneip are simple, popular and useful for all. It is our duty to read them. Practically every nature cure physician knows something about them. Nature cure has not taken to the villages so far. We have not thought deeply and no one has thought of it in terms of the millions. This is just the beginning. No one can say where we shall stand in the end. As in all great and good enterprises, sacrifice and dedication are required to make this successful. Instead of looking up to the West, we should turn the searchlight inwards.

NEW DELHI, May 24, 1946

Harijan, 2-6-1946

I am unable to subscribe to the condemnation of the State for not providing institutions for research. I have always blamed the vaids’ apathy in the matter of real research. The top ones are busy making money. The others are too ignorant to do so or are easily satisfied with what they find in the orthodox Ayurvedic books. I am sorry for this view. I come to it, in spite of my great regard for the Ayurvedic system and the Yunani which are suited to the soil.

URULI KANCHAN, August 4, 1946

Harijan, 11-8-1946

465. AYURVEDA AND NATURE CURE

Vaidya Vallabhram, Professor of Ayurveda and Vanaspati Shastra writes :

Cure through Ayurveda is based on the five elements. . . . Pathya (diet cure) is a scientific term of the greatest importance in Ayurveda. Its real meaning is that freedom from disease depends on a proper observance of the laws of nature. I have no doubt whatsoever that the repetition of Ramanama and pure living are the best and the cheapest preventives of disease. The tragedy is that doctors, hakims and vaidyas do not make use of Ramanama as the sovereign of cures. There is no place given to it in current Ayurvedic literature except in the shape of a charm which will drive people further into the well of superstition. Ramanama has in fact no connection with superstition. It is nature’s supreme law. Whoever observes it is free from disease and vice versa. The same law which keeps one free from disease applies also to its cure. An apt question is as to why a man who recites Ramanama regularly and leads a pure life should ever fall ill. Man is by nature imperfect. A thoughtful man strives after perfection, but seldom attains it, for he stumbles on the way, though unwittingly. The whole of God’s law is embodies in a pure life. The first thing is to realize one’s limitations. It should be obvious that the moment one transgresses those limits one falls ill. Thus a balanced diet eaten in accordance with needs gives one freedom from disease. How is one to know what is the proper diet for one? Many such problems can be imagined. The purport of all this is that everyone should be his own doctor and find out his limitations. The man who does so will surely live up to the age of 125. Vaidya Vallabhram asks whether well-known home drugs and condiments can be included in nature cure. Doctor friends claim that they do nothing more than investigate the laws and act accordingly and that therefore they are the best nature-cure men. Everything can be explained away in this manner. All I want to say is that anything more than Ramanama is really contrary to true nature cure. The more one recedes from this central principle the farther away one goes from nature cure. Following this line of thought I limit nature cure to the use of the five elements. But a vaidya who goes beyond this and uses such herbs as grow or can be grown in his neighbourhood purely for service of the sick and not for money may claim to be a nature-cure man. But where are such vaidyas to be found? Today most of them are engaged in making money. They do no research work and it is because of their greed and mental laziness that the science of Ayurveda is at a low ebb. Instead of admitting their own weakness they throw the blame on Government and public men. Government is powerless to help those who through their own fault become helpless and thereby drag the name of Ayurveda in the mud.

SIMLA, May 9, 1946

Harijan, 19-5-1946

79. RAMANAMA, THE INFALLIBLE REMEDY

Shri Ganesh Shastri Joshi, vaidya, tells me after reading my article on nature cure in Harijan of 3rd March, 1946, that in Ayurveda too there is ample testimony to the efficacy of Ramanama as a cure for all diseases. Nature cure occupies the place of honour and in it Ramanama is the most important. When Charaka, Vagbhata and other giants of medicine in ancient India wrote, the popular name for God was not Rama but Vishnu. I myself have been a devotee of Tulsidas from my childhood and have, therefore, always, worshipped God as Rama. But I know that if, beginning with Omkara one goes through the entire gamut of God’s names current in all climes, all countries and all languages, the result is the same. He and His Laws are one. To observe His Law is, there-fore, the best form of worship. A man who becomes one with the Law does not stand in need of vocal recitation of the name. In other words an individual with whom contemplation of God has become as natural as breathing, is so filled with God’s spirit that knowledge of obser-vance of the Law becomes second nature as it were with him. Such a one needs no other treatment. The question then arises as to why, in spite of having this prince of remedies at hand, we know so little about it, and why even those who know do not remember Him or remember Him only by lipservice, not from the heart. Parrot-like repetition of God’s name signifies failure to recognize Him as the panacea for all ills. How can they? This sovereign is not administered by doctors, vaidyas, hakims, or any other medical practitioners. These have no faith in it. If they were to admit that the spring of the Holy Ganges could be found in every home, their very occupation or means of livelihood would go. Therefore they must perforce rely on their powders and potions as infallible remedies. Not only do these provide bread for the doctor, but the patient too seems to feel immediate relief. If a medical practitioner can get a few persons to say ‘So and so gave me a powder and I was cured’, his business is estabished. Nor, it must be borne in mind, would it really be of any use for doctors to prescribe God’s name to patients unless they themselves were conscious of its miraculous powers. Ramanama is no copy-book maxim. It is something that has to be realized through experience. One who has had personal experience alone can prescribe it, not any other. The Vaidyaraj has copied out for me four verses. Out of these Charaka’s is the simplest and most apt. It means that if one were to obtain mastery over even one out of the thousand names of Vishnu, all ailments would vanish :

POONA, March 10, 1946

Harijan, 24-3-1946

Charaka Chikitsa, m, 311

Several physicians are taking an interest in my experiment. They send me texts from Ayurvedic writings for or against the articles I have been using. Two or three have sent me the identical text against taking honey mixed with hot water and pronouncing dire results. When I ask them whether they have verified the text from their own experience they are silent. My own experience of taking honey mixed with hot water extends to more than four years. I have experienced no ill effect whatsoever.

……...

Another physician quotes a text against the use of sprouted pulses but he too lacks actual experience for supporting his text. And this has been my complaint against many Ayurvedic physicians. I have no doubt that there is abundant ancient wisdom buried in the Sanskrit medical works. Our physicians appear to be too lazy to unearth that wisdom in the real sense of the term. They are satisfied with merely repeating the printed formula. Even as a layman I know many virtues are claimed for several Ayurvedic preparations. But where is their use, if they cannot be demonstrated today? I plead, for the sake of this ancient science, for a spirit of genuine search among our Ayurvedic physicians. I am as anxious as the tallest among them can be to free ourselves from the tyranny of Western medicines which are ruinously expensive and the preparation of which takes no count of the higher humanities.

Young India, 8-8-1929

128. LETTER TO MATHURADAS PURUSHOTTAM

July 6, 1932

……

For instance, if anybody translated Charaka1, the work would not be of any use today since we cannot find many of the herbs and plants described by him and, with regard to those which we do find, cannot prove the properties attributed to them.

……

453. LETTER TO NARAYAN KULKARNI

October 20, 1932

BHAI NARAYAN KULKARNI,

I have your letter. I regret my inability to write in Marathi. I hope that you will find no difficulty in following my Hindi. Several vaidya friends of mine had informed me three or four years ago that honey should not be taken in warm water. My other friends, the allopathic doctors have no objection to it. But I am not influenced by their opinion as they have not made a close study of the effects of articles of food. In their system they do not observe much1 distinction between what may be eaten and what eschewed. But I am writing of my personal experience. I have found no harm but rather benefit by taking honey with warm water. I started taking honey on a doctor’s advice which came about in this way. Owing to a lack of

carbohydrates in my system sugar was needed. The best sugar in his opinion was obtained from honey. I have taken honey since then and he never objected to my taking it in warm water. My complaint against our vaidyas is that they hold on to whatever is expounded in the ancient texts even if it be contrary to experience as they consider them the last word. I am sure in the Ayurvedic system there is need for further research. It should be revised in the light of experience. Does honey lose its property by being poured into hot water? Have you made a chemical analysis of honey? Obesity and leanness are relative terms. For which kind of leanness is warm honey undesirable and why so? To conclude, have you proved by experience what you write? Vaidyas do not follow this method but are content with quoting shlokas from the old texts. I beg you to give up this irrational attitude and test by trial whatever is written in the ancient works.

442. LETTER TO D. B. KALELKAR AND B. D. KALELKAR

February 19, 1933

I can find no plant or herb which can equal milk in food value. There is certainly some truth in the belief that milk is a wholesome food even for yogis. It is the only substitute for meat. Only our vaids could have discovered a vegetable substitute for milk, but, lacking zeal for dharma, they made no such attempt. I have failed in my search and given it up. We do not know if anybody else will take it up and succeed. Perhaps in the West they may succeed. Among us there is no one who possesses the necessary medicinal knowledge to make such a discovery. We do not regard it as our dharma to acquire such knowledge and to make experiments with that aim. Anybody who wishes to undertake the task should be inspired with zeal for the welfare of the cow. He should be convinced that no milk other than the mother’s milk can be the proper food of a human being. Such a person should then study medicine. We do not have at present men with such a spirit. If India is destined to discover such a substitute, God will send among us a person with the necessary gifts. Till then, let us sing praises of milk and do the duty which lies before us.

78. LETTER TO VALLABHBHAI PATEL

August 31, 1941

BHAI VALLABHBHAI,

I have your letter. I do not expect any letter from you at present. If you can politely get yourself released from the doctors and come here, I should like it. I believe that your intestines can be soothed by remedies like mud-packs and changes in diet. I have not much faith in ayurveda. The vaids do not master their subject. Some of the remedies are effective, but I have not observed what the vaids know, how they work and so on. This is only my guess-work. Do what satisfies you. I have only expressed my personal view. Anyhow you must get well. I would not let you spend a whole hour in the lavatory.

Blessings from

BAPU

259. LETTER TO KRISHNADAS SHAH

April 17, 1942

BHAI KRISHNADAS,

I have your letter. I do have faith in Ayurveda but what can I do if the vaidyas lack competence? All the same I keep in touch with them and take what I can out of them. It is precious little, however.

7. LETTER TO VALLABHRAM VAIDYA

SEVAGRAM,

June 81, 1942

At present it is allopathy that commands enterprise, industry and knowledge. It is a developing science. It has many defects. Its pharmacopoeia is vast and yet very restricted. But it is systematic and so can draw upon whatever is special in Ayurveda. However, it is worth reflecting upon that if Ayurveda were to take what is special in allopathy the latter would be left with nothing but a few drugs.

Blessings from

BAPU

LETTER TO VALLABHRAM VAIDYA

June 28, 1942

BHAI VALLABHRAM,

I have already told you that Ayurveda cannot be saved either by money or by State help. Would the State be able to revive Ayurveda even if it gave thousands of rupees every month to the purveyers of indigenous tonics? Hundreds of people have laid down their lives to spread allopathy. Allopathy by itself is not expensive but the doctors and the chemists have made it so. You have not seen their books giving the formula and cost of each important medicine. The cost price of Bayer’s Sarsaparilla is one and a half pice but its market price today is ten rupees. The same is true of the doctors’ fees. Ayurvedacharya Gananath Sen charges one thousand rupees for a day when he goes out of station. Without yajna there can be no achievement. Yajna implies ceaseless intelligent labour to the extent that it makes a person sweat and all that, again, dedicated to the Lord. Ayurveda has not yet become a science. In a science there is always scope for progress. Where is any progress here? Come when you feel like it.

My reflections on Ayurveda Education, Practice and Research

2021-11-06T01:10:00.010-07:00

Recently I completed twenty years of my academic career as an Ayurveda teacher and that makes me record my reflections on some crucial aspects of Ayurveda education, practice, and research in this post. The content is India-centric, obviously.

How did we deal with the Covid-19 situation?

1. Promoting unscrupulous self-medication

Let me begin with how Ayurveda fraternity has dealt with Covid-19. Having an introspection on this topic might give us some idea as to how should we proceed further. Ayurveda sector saw a great opportunity in this pandemic and the way how this opportunity was exploited needs to be analyzed. To me, personally, the performance of Ayurveda sector looks disappointing because we somehow encouraged self-medication among the public by advocating preparations like Ayush Kadha and by distributing some spices and herbs for free. We failed to send across the message that unscrupulous use of any medicines could be harmful. Several case reports have emerged suggesting the gastrointestinal and other adverse events possibly associated with Ayurveda herbal interventions.

People often argue that they have been using many herbs and spices in kitchen on a daily basis and hence, what is wrong if they consume them to prevent Covid-19? Well, basically what we often don’t understand is that ‘using spices in kitchen’ is different from consuming them in the form of concentrated decoctions. Spices used in small quantities are particularly safer, but the same cannot be said if they are used in larger quantities and in higher concentrations, too frequently for months together. Hence, we need to know that unsupervised use of even familiar herbs can be harmful as has been suggested in many studies.

Another point is that we have not educated the general public in the matters concerned with the identification of the correct herb, though we encouraged their consumption. Guduchi also known as Giloy and Cinnamon, commonly called Dalchini, could be taken as two examples where a correct identification of the herb matters a lot. Tinospora cordifolia is the actual Giloy which is generally safe whereas Tinospora crispa is reported to possess toxic effects on liver and kidneys. The point to be noted is that lay public cannot possibly distinguish between the two species because both look very very similar.

Cinnamon is another spice that is extensively used. But many of us don’t know that it comes in two varieties: Cinnamon xylanicum and Cassia cinnamon. Both look similar but the former is the safer variety. Often Cassia cinnamon is used as an adulterant, which contains a molecule called coumarin in large concentrations, which is known to possess toxic effects on kidneys. Hence, self-medication of any herb for a long duration needs to be actively discouraged.

2. Poor documentation of Covid-19 cases treated with Ayurveda interventions

Almost every Ayurveda physician came up with his/her own formulations as a purported cure for Covid-19. Many lab reports suggesting clinical improvement because of Ayurveda interventions were shared on different social media platforms, but most of them did not make into good case reports or case series. Thousands of Covid-19 cases being treated by Ayurveda physicians could have made a good data that would have allowed for further evaluation. Even though the Ministry of Ayush came up with an online case registry, the cases registered on the portal are not sufficient for anyone to interpret the results.

3. Poor standards of clinical trials

Many clinical trials came up for Covid-19, and a few even got published. However, most of these trials lacked good study designs. For instance, to prove the efficacy of a new intervention in mild to moderate cases of Covid-19, where the spontaneous recovery itself is more than 95%, one needs a large sample size and a robust study design. In most of these trials the Ayush interventions were either given as add-on therapy along with conventional protocol, or, when given as independent intervention, they were administered in mild to moderate cases only. The clinical outcomes observed too varied widely which make the actual interpretation of the results, a difficult task. Even the Governmental agencies widely publicized a few formulations unnecessarily that were tested either in small samples with not so good study designs, or were tested in mild to moderate disease which normally does not require any specific intervention at all, and drew flak from the scientific community for doing so.

4. Immune Boosting: A futile approach

Scientifically speaking, “immune boosting” is a vague and potentially misleading term. During the pandemic every other pharmacy came up with its own patent and proprietary formulation that supposedly boosted immunity.

On many platforms, experts were heard saying that Ayush sector is contributing to economy by promoting the exports of certain herbs and by citing an increased market share of some of the Ayush formulations. Common public definitely was made to believe that Ayush interventions were safer, of much preventive value and were effective in treating the disease. In fact, the preventive role of Ayush interventions is very difficult to prove, that too with small samples. Prevention studies need log-term follow up, however, no good study from Ayush stream could convince the scientific community for its preventive role. Even the purported efficacy of certain medicinal plants and formulations in preventing the disease were studied in comparison with hydroxychloroquine or similar drugs that have been now removed from most of the preventive protocols.

How differently this could have been handled?

After delving with this, “How differently we could have approached the Covid-19 situation?” is the question that naturally comes up. Ayush sector could have been visualized as a crucial healthcare-related workforce. Instead of making them (especially PG students) engage with online classes and tons of webinars, they could have been roped-in to manage various tasks such as telephonic triaging, tele-consultations, monitoring of home-quarantined patients and referral services. Though some Ayush hospitals were converted into Covid-Care Centers, most of these facilities looked after only mild to moderate cases, which even without any specific interventions, would have been resolved without complications. Those who developed complications were promptly referred to higher centers, thus making the data look like Covid-19 cases in Ayush hospitals had good clinical outcome. “Not a single death” was actually achieved in many Ayush hospitals this way. This is where a collaboration was required, in fact, between Ayush and conventional healthcare professionals. In most of the situations, this coordination was lacking, one of the reasons being a lack of connectedness between Ayush and ICMR protocols. The two protocols did not establish a dialogue by prompting “at which stage a case can be managed by Ayush professionals and at what stage it needs referral”.

Moreover, the Ayush workforce could have been used to address the needs of Non-Covid patients. During the periods of restrictions, the non-Covid patients suffered the most because of various factors including a lack of transportation facilities, conversion of many hospitals into Covid-Care Centers and limited functioning of many hospitals and clinics. Ayush sector could have used this opportunity to the fullest extent and could have contributed in taking care of Non-Covid patients. Succumbing to pressure of Covid-19 and an imaginary expectation to showcase our strength in Covid-19 exposed the sector to public scrutiny.

Engaging with the voices that call all Ayush systems ‘Pseudoscience’

During the pandemic, due to some greedy pharma companies that started making tall claims about their poorly tested formulations, and because of the involvement of Yoga Guru Baba Ramdev, a huge debate on the contribution of Ayush sector started amidst the pandemic. Ayush Vs Evidence Based Medicine (popularly but incorrectly known also as Allopathy) became a hot topic for debate on many television channels, bringing the issue literally into every drawing room of TV-viewing Indian households. It went on to become a chosen topic of discussion on social media too. Amidst all this, a few hard-core scientists with background in different branches of biomedical sciences started a social media campaign calling all Ayush systems to be pseudoscience. Most of these experts are doing this in a mission mode with an attitude of activism. In my view, what this small group of rationalists is propagating will soon assume the shape of a social movement influencing the huge chunk of common people who use social media. Dr. Cyriac Abby Philips, a hepatologist by profession is one of the popular names who is leading this movement.

These anti-pseudo-science activists mainly carry out a few very interesting activities.

1. They conduct chemical analysis of many Ayush formulations and demonstrate that many of these products contain high doses of unwarranted constituents such as antibiotics, corticosteroids, heavy metals etc.

2. They publicize the unscientific and outdated content present in the textbooks of Ayush graduate programs.

3. They propagate the various clinical case reports where adverse events are reported after exposure to Ayush interventions. Often these cases are of liver failure, kidney failure etc.

4. They keep publishing such case reports in scholarly biomedical journals

5. Exposing the poor quality of clinical trials and other published literature also is another activity this group is engaged with.

They do this most of the time with evidence such as lab reports and other investigation reports. This movement is aimed at sensitizing the public about evidence-based medicine and publicizing how Ayush interventions lack good evidence.

The activities of this mostly unorganized group have received severe criticism from Ayush sector: from practitioners, pharma industry, teachers and also from the policymakers. Many representations have been made before different government officials against the group’s activities and they have been targeted personally on many social media platforms.

This activity in my opinion is very crucial and needs support from at least those who believe in rational Ayurveda. This would make Ayush academicians and policymakers think seriously about the current education system. How much of irrelevant and impractical content is taught in Ayush curricula is a matter of serious concern and needs serious deliberation. Such a deliberation does not happen when only Ayush experts sit together for carrying out curricular reforms but will happen when there is external criticism by biomedical experts who call Ayush streams “Pseudoscience”. Present academia has made Ayurveda a pseudo-science by teaching the young minds that “whatever is written in ancient texts is the ultimate truth and can’t be challenged or changed”. This assumption makes Ayurveda non falsifiable and hence a non-science. “Is there any point in teaching a vibrant science in a manner how artforms are taught?”- is a question that needs thoughtful consideration.

Evidence Generation: Do or Die situation

One cannot deny the fact that thousands of patients throng on a daily basis in many Ayush hospitals. Obviously many get benefited of these interventions. However, this popularity has not yet been translated into documented and publishable evidence. There are no good published systematic reviews and meta-analyses on Ayush modalities. These are known as the highest form of evidence where results of a number of independent clinical trials are synthesized and analyzed. Even the individual clinical trials published are mostly weak in their designs, either with small sample sizes or lack meaningful and implementable results. Let us admit this fact: there is no reliable (highest level of) evidence whatsoever to show that Ayurveda interventions work independently and to show that they are either equally or more efficacious than conventional medicine or conventional surgeries. This makes one think as to why should anyone consider Ayurveda given the uncertainty of the outcome, possible development of adverse events and uncertainty about cost-effectiveness. Procedures such as Panchakarma are often beyond the reach of common man in certain settings.

This situation coupled with mass media and social media trials are going to take Ayurveda away from educated and rationalist, scientifically thinking class in the coming years – is what I can foresee. Often irresponsible and hyperbolic statements by so-called stakeholders of Ayurveda especially the ones from the pharma industry and also sometimes by politicians are going to damage the sector. The rationalist movement calling out Ayurveda as Pseudoscience is likely to have a major role in forming public opinion against Ayurveda.

The one and only way to make Ayurveda a real science, is to present evidence before the scientific community that Ayurveda works beyond any doubt. To do this we need to plan accordingly. Absence of uniform protocols either for diagnosis or for intervention make Ayurveda practice too subjective. An objective evaluation of this is very difficult in the standard format of double blind randomized controlled trials. Studies have shown that the inter-rater variability among physicians while diagnosing different Ayurveda clinical parameters is huge. Even the preliminary parameters such as Prakriti, Agni, Ama, Oja etc have not yet seen their universally acceptable standard formats. Most of the tools that have been shown to be promising to assess these parameters are still not there in the public domain. This makes the evidence-building evidence a Herculean task.

Observational Studies: Possibilities

What one can do practically is to go for longitudinal observational studies in multiple centers. It is wrong to assume that observational studies should by default be inferior to randomized clinical trials. When assessing the effectiveness of multi-component interventions, observational studies would be the ideal ones to carry out. This needs meticulous planning. Each patient needs to be diagnosed properly based both on modern medical parameters as well as on Ayurveda parameters. Physicians/ surgeons looking at these patients too must be from both sides, i.e., Ayurveda and conventional medicine streams. Initially around twenty different clinical conditions involving different organ systems can be identified where physicians feel Ayurveda has definite role as a potential treatment option. A large sample with long term follow up in a multi-centric design will go a long way in establishing the usefulness of Ayurveda. I visualize a period of at least 10 years for such a study to come up with conclusive results. It maybe pertinent to mention that the causal relationship between smoking and lung cancer was revealed through a huge observational study that lasted for about 40 years!

The conflict between Education and Practice:

We never teach our graduates the patent and proprietary formulations. However, as they set up their clinical practice, they start prescribing these formulations. Most of these are not backed up by good trials and even pre-clinical and toxicity studies. Thousands of pharmacies have developed their own formulations and the companies that manufacture primarily classical formulations has reduced to bare minimum. This speaks in volumes about how the sector is being commercialized.

The standards of education are really poor in most of the institutions because the curricula still contain a lot of material that is outdated. Students spend their precious time in memorizing this stuff and in preparing for PG eligibility test. This could be a best example to show how human resources can be wasted massively.

An increase in the number of new Ayurveda colleges is continuing indiscriminately and students studying in many of the poorly equipped colleges end up being individuals with no clinical expertise but with an Ayurveda degree. Lack of good teaching staff, lack of good patient input, lack of good infrastructure etc are the lacunae known to exist in these colleges. Maintaining and approving only a manageable number of colleges is very essential to ensure all students get good clinical exposure.

Introducing basic sciences in Ayurveda curricula would be the single most important intervention that I would suggest. This suggestion is based on my experiences in Banaras Hindu University. In BHU, Ayurveda Post Graduate students are formally trained in basic sciences such as Physiology, Biochemistry, Pathology, Pharmacology and Microbiology by the experts in these respective fields. These papers are officially the parts of their PG training, irrespective of one’s specialty. This happens nowhere else. This basic-science training makes them develop critical thinking and analytical skills. Instead of simply learning the Rasa, Guna, Virya and Vipaka of a medicinal plant, they also know their chemical composition and the biological basis of their effects in the body. This makes them alert and vigilant vaidyas.

Of course, the present Ayurveda curricula contain some information pertaining to basic sciences. However, in most of the colleges, there are no experts who can teach these subjects in such a depth which is required. Introducing more subjects such as molecular biology and genetics would add further value to Ayurveda programs.

Ps.: An abridged version of this post has been published as an Op-Ed in "The Hindu" available at: https://www.thehindu.com/opinion/op-ed/making-ayurveda-a-real-science/article37614617.ece

Research Orientation in Ayurveda Educational Institutions

2018-07-31T03:57:00.000-07:00

There has been a mushroom growth in the number of Ayurveda colleges in the last 2-3 decades which has led to a dilution in the standards of education and research. Pursuing postgraduation has become a fad among the students though they do not get exposure to the basics of research. Recently, CCIM has introduced the Research Methods and Biostatistics subjects in both the graduate and postgraduate levels of Ayurveda curricula. However, the required level of expertise to teach these subjects is not available among the teachers in most of the Ayurveda educational institutions. Therefore, the research is still at a stage of infancy in most of these institutions, though research forms an 'essential' part of the degrees these institutions award. In the following paragraphs, I have tried summarizing the major facets of this problem.

Compulsion-driven Research

Currently, in most of the Ayurveda colleges, research is performed as a ritual for acquiring the degrees. The teachers get involved with research activities out of compulsion to guide the students and not out of curiosity. This leads to monotonous and template-based research that thwarts innovative ideas. Often the PG/PhD theses in such cases contain meaningless data that are not worthy of getting published anywhere. For instance, though the database of the Ayurveda theses and dissertations maintained by Girish KJ and Baghel MS contains more than 20,000 titles, however, as the entire PubMed database contains only 5000 articles on Ayurveda, the futility of these works becomes evident.

Lack of research-literacy and scientific pursuit

The research atmosphere in Ayurveda colleges and Universities is dampening. The ethical aspects of conducting and reporting the research are often overlooked in these institutions. Plagiarism and publishing with predatory journals are well-known problems in the sector. Unfortunately, many teachers from these institutions are themselves associated with many of the sub-standard journals, and hence the question of educating them is a challenge. The most striking problem is that there are no well-informed expert teachers who can train the students in research methods, biostatistics, scientific writing, research ethics etc. Many colleges are so ill-equipped that they thrive only because of the widespread corruption that prevails in the system. The fake data of patients they manufacture every day systematically save their recognition and serve as the basis of the dissertations and theses as well. The menace of ‘ghost faculty’ is another problem that adds to the gravity of the situation. The fabrication of data is so rampant in these institutions that it is better if it remains unpublished!

The absence of Ayurveda-principles-driven clinical research

The current clinical research in Ayurveda colleges revolves around the one drug-one disease model (or one intervention-one disease model) of clinical research method, which is most of the times not suitable for Ayurveda. Practice-based research must be the ideal mode of research in most of the circumstances, however, the fossilized mindset and lack of motivation to learn new methods have made the clinical studies stagnant. To most of the teachers in Ayurveda colleges, ‘whole system trials’ is still a new phrase. They do not venture into newer domains of research not only because of lack of experience but also because of lack of orientation.

The absence of basic-science research

Every department in Ayurveda colleges is unfortunately inclined at carrying out some or the other clinical trials on one or the other pretext. This has been a major setback to the basic research such as teaching methods, assessment methods, development of standard tools to assess clinical health parameters such as Agni, Ama, Koshtha etc. Students who fail to get admission in any clinical branch while pursuing postgraduation, try doing clinical work while being in a non-clinical branch which is not the ideal situation to be in. This way they neither become good clinicians nor do they gain expertise in basic science research.

Lateral entry of teachers from allied disciplines

A postgraduate degree holder in the subject Ayurveda Samhita and Siddhanta and one who has taught Charaka Samhita for ten years, for instance, can be inducted directly as a professor in Kriya Sharir as per the latest CCIM guidelines. This renders the seriousness, knowledge and skills required in the subject totally a non-issue. There are many more subjects with a similar provision of lateral entry. This especially is injurious to basic science subjects such as Kriya Sharir which require dedicated study of the subject.

Questioning: An Attitudinal Problem

A widespread perception that prevails among Ayurveda teachers is that there is no need for carrying out any research in Ayurveda because whatever has been written in ancient classical textbooks is the ultimate truth and has been written only after sound research. However, they fail to recognize that in classical textbooks too, it has been clearly stated that accepting any theory without repeatedly examining it is not a sign of a rationally minded physician. Further, the descriptions that were documented hundreds of years ago need not necessarily match with the present-day situation. There might have also been a loss of information during its transfer from one version of the textbook to the next. Therefore, there is a need for inculcating the habit of questioning among Ayurveda teachers and students, and only then, good research questions will emerge.

New Institutions in Isolation: Good or Bad for Ayurveda?

Of late, we have been witnessing a trend of establishing standalone Ayurveda universities and institutions/colleges both by Central and State governments. This strategy won’t serve the purpose of setting the right trend in education and research. I like to believe that this inclination stems out of a subconscious sense of diffidence that prevails among Ayurveda professionals. They often feel more secure when in isolation. In fact, we forget that a conducive atmosphere for research cannot be created on an isolated campus and students need enough exposure to multiple interrelated disciplines to be able to produce meaningful research output.

The following tables illustrate the differences in research output in different types of educational institutions. These institutions have been chosen randomly and for the purpose of illustration only. The years of establishment of these institutions have been provided so that a reasonable comparison can be drawn. The data is based on Scopus, and of course, there might be some unintentional omissions. However, the trend becomes very clear from the tables: the smaller and more isolated is the institution, the smaller and insignificant is the research output. A university such as BHU stands out so differently because of the multiple disciplines it hosts in the campus apart from Ayurveda which vary from physics, botany, zoology to molecular biology.

Therefore, the future step must be not to start new Ayurveda educational institutions in isolation, but to move the existing isolated Ayurveda educational institutions into the campuses of various State/ Central universities/ IITs/ /AIIMS/ other medical colleges and other premier institutes. Such an effort would probably be able to replicate the BHU model throughout the country and would improve the quality of research.

Note:

Following is the brief talk (first 8 minutes of the clip) on "Research Orientation in Ayurveda Educational Institutions" that I gave during the panel discussion on the occasion of National Symposium on Creating Conducive Environment for Ayurveda Research Organised by AYUSH Center of Excellence, Savitribai Phule Pune University, Pune.

What is wrong with public-funded Indian Universities?

2018-07-10T01:10:00.002-07:00

The higher education sector in India has been largely a failure story- is what most of the analysts believe. Except for the few institutions such as IITs, AIIMSs, and Indian Institute of Science, most of the public funded Universities have shown their inabilities to keep themselves geared up to embrace the contemporary challenges with respect to quality of research, relevance of curricular contents and to the relevance of instructional methods. This write-up tries to enlist a few vital challenges that most of the Central and State-owned Indian universities have failed to recognize and address. These are based entirely on the perception and experience of the author’s working with a central university as a faculty member for about fifteen years. Some of the experiences mentioned in the article need not be from author’s direct experiences but may be anecdotal.

1. Illogical and bizarre Teachers’ Recruitment Process

Over the years, this author has realized that often the best candidates are not shortlisted and the worst among the shortlisted candidates are selected during the interviews as teachers. One of the reasons for this aberration is a ‘purely mathematical shortlisting strategy’ where only numbers matter and not quality. For instance, the shortlisting committee members themselves often are not sure of the quality of the journals where the candidate has published his/her research. They do not know if the impact factor claimed by the journal is true or fake one. Similarly, there is no criterion to ascertain if a certificate showing the participation of a candidate in an international conference is genuine one or is it of one of those with a single speaker from Nepal or Sri Lanka. What matters most is the certificate and the papers: the more the papers, the more are the points.

The second reason behind the selection of undeserving candidates is a poorly structured interviewing procedure. Most of the times the experts do not know the difference between a viva-voce examination and an interview. They mostly do not ask the candidate about his/her plans to improve the work output of the university or his/her ideas about the administration of academically active departments. They mostly end up asking questions that assess recall or, at the most, comprehension of their own subjects of expertise. They fail most of the times to evaluate one’s research skills and higher order thinking skills.

Another major problem that deals with the recruitment process is ‘canvassing’. Though most of the universities in their advertisements state that canvassing in any form would be a disqualification, practically there exists no such mechanism to disqualify the candidature. Most of the influential candidates use this method to gain access to recruiting authorities and ensure their selection. This author is yet to see a University that has taken up some tangible measures to curb such practices.

Suggested Measures:

A. Measures to improve the shortlisting mechanism:

It may be a good idea to include at least three domains of evaluation while shortlisting the candidates, especially where the number of applicants for a teaching post is more than that can be invited for an interview. Though this may not be applicable for all diverse disciplines, this idea is definitely implementable in science and other applied disciplines.

a) Writing Skills:

A written test be held where all the applicants are invited to write an examination. This test can be held online to save time and resources. This will test their expertise in the knowledge domain along with their writing skills. Written communication happens to be one of the weakest dimensions of skillsets among many university teachers- is what this writer has observed. This examination must include questions on higher order thinking skills such as analytical skills along with language skills. 1/3rd of the weightage may be given to this test based on the marks obtained.

b) Teaching Skills:

All candidates who score well (maybe those who score above the 75th percentile rank) in the test can be invited to give lectures to the UG and PG students. The evaluation may be done by students on a structured questionnaire that should include the assessment of communication skills, language skills, subject knowledge, presentation skills etc., and the average marks obtained may be given a weightage of another 1/3rd. This will test their teaching skills.

c) Research Skills and Aptitude:

University teachers must clearly know that research is expected out of them apart from their routine teaching. Hence, the remaining 1/3rd of the weightage may be given to the research aptitude. This could be calculated based on the quality of publications in terms of originality and general understanding of research and publication process. An objective rating scale may be evolved to evaluate each publication based on the number of citations received, quality of the published journal, indexing database, originality, extent of the contribution of the individual author etc.

After this exercise, the shortlisted candidates may be asked to appear for an interview. This list is likely to represent the candidates with a good combination of knowledge, skills, and attitude required for a teacher and a researcher. This method would avoid giving unnecessary and undue weightage to the number of conferences attended, the number of papers presented, the number of courses attended etc.

B. Measures to improve the interviewing process

The basic need is to train the experts to test one’s higher order thinking skills. Along with the invitation, a booklet on interviewing skills must also be sent to the experts and it must be ensured that they ask the questions to evaluate research aptitude, application skills and analytical skills of the candidates.

C. Measures to curb canvassing

Every university needs to come up with guidelines and measures to curb the practice of canvassing by announcing specific indicators of canvassing and the kind of evidence permitted as a proof of canvassing including the specific actions that are likely to be initiated against such candidates. During the interview, all the selection committee members may be asked to fill out a form to declare that they have not received any phone calls from influential people/ Politicians/ others in favor of any candidate, or, that any candidate has not visited their home pleading for his/her selection or has not offered any bribe etc. There must be some provision to report the cases of canvassing with evidence such as recorded phone calls, CCTV footages etc. There must be a form along with a list of admissible evidence which must be made available on the university websites so that the prospective candidates will not gather the courage to involve themselves in canvassing.

2. The absence of any publication guidelines

In the recent years, the quality of research publications from developing countries has been attracting criticism world over. For a country such as India, this situation is being proven to be damaging because it creates a bad reputation worldwide. University Grants Commission (UGC)’s guidelines mandating certain number of publications for promotions has fueled the mushrooming of substandard and questionable research journals that thrive on author-pays model and misuse the situation. Though some universities have started prescribing guidelines for their staff and students about the research publications, (for instance, Savitribai Phule University of Pune is one such university that has issued its own guidelines for publications), however, this has not yet become a norm.

Suggested Measures:

Instead of coming up with a whitelist of journals, UGC must state that journals indexed with more than one credible database such as Scopus, PubMed and Science Citation Index will be considered for promotion/ recruitment. UGC must come up with a warning to the university teachers about the consequences of publishing with predatory journals. Teachers publishing with such journals aiming at a promotion must be made answerable and a provision for imposing some disincentives must be introduced. Universities must release strict guidelines regarding the publications and the kinds of journals that are required to be avoided.

3. Poor intramural research funding arrangements

Though many new entry-level teachers get some seed money in many universities, there is no consistent funding arrangement for intramural research projects. Applying for extramural funding is always cumbersome and usually encounters a lot of hindrances at multiple levels. This often makes the senior teachers lose interest in research once they attain the highest level of promotion.

Suggested Measures:

Some competitive mechanism may be put in place so that a specific number of teachers may be declared eligible for receiving intramural funding based on their past performance/ project proposals.

4. Dogma of Seniority

Universities still consider that being senior in age and hierarchy equals to being wiser than all juniors: that is why many key positions such as Head, Dean, Principal etc are by default occupied by the “senior most” people irrespective of their academic, administrative and other capabilities. Sometimes these people are appointed on a rotational basis, but also based on seniority. On one hand, this makes uninterested people occupy key positions and on the other, it may make undeserving people misuse their positions.

Suggested Measures:

The appointments to the key positions such as Head, Dean, Director etc must all be made through inviting applications and only interested and capable people should get opportunities to occupy these positions. While to some extent the experience accompanied by seniority is required, it does not mean that all mid-career teachers are useless. Rather, mostly they are the ones who have the zeal to change the system in all possible positive ways and they should get opportunities to execute their dreams.

5. Compromised research and publication Ethics

While plagiarism and publication with poor quality journals are two well-known challenges, non-adherence with the ethical aspects of research and publication is another major problem the Universities have not yet been able to handle. There is no stringent mechanism to periodically screen for possible fabricated data, falsified data etc. While students want their degrees on a timely basis, often supervisors too want their list of “PhDs supervised” to grow quickly to be able to get more points for promotion. This often leads to compromised research ethics and publication ethics. Practices such as distortion of data, simultaneous submissions to more than one journal etc are very common in universities.

Suggested Measures:

There needs to be a mechanism to fix responsibility in cases of any fabrication or falsification of data. Dis-incentivization in the form of cutting down the increments will be helpful in proven cases of fraud. There must be a provision for sudden and surprise visits from external expert members to screen the progress of research work and to verify the raw data. Further, the cases of retractions and editorial queries/complaints must be taken up seriously by the authorities of the universities.

While these are a few steps that are possible to take, it depends entirely on the Syndicates and Executive Councils of the Universities whether they have the willingness to tackle these issues or not.

Note:

An edited version of this article has been published in University World News and is available at:
How can we fix what is wrong with Indian universities?

'Duality in Expectations' is the Problem with Ayurveda Curriculum

2018-04-25T22:50:00.000-07:00

I have been teaching Ayurveda at postgraduate level for more than a decade, and as a teacher I have faced the dilemmas of understanding and teaching it the right way. What I have concluded is that, possibly, there exists no single way that is right as well as acceptable to all!

In my experience, the fundamental problem lies with the dual perception of Ayurveda as an ‘Art form’ and also as ‘Science’ - both at the same time! The students who join Ayurveda courses are from the science background, but we expect them to practice Ayurveda in its classical form, which is perceived to be the original and uncontaminated one. This notion unfortunately considers classical Ayurveda to be more like an ‘Art form’ and not like Science.

These students are trained to think rationally because of their science education and hence perceive this as 'Science' which, in all probabilities, might contain some information which is outdated. One of our studies has also shown that the students and teachers often perceive many topics in the classical textbooks to be irrelevant. Teachers too, mostly teach Ayurveda as Science. For example, the very translation of the term Ayurveda that is taught in Ayurveda colleges is “The Science of Life”. Therefore, these students perceive Ayurveda to be a science like any other scientific discipline.

But then, the educated and 'elite' section of society (where Ayurveda is more popular), treats Ayurveda as an ‘Art form’ (somewhat similar to Bharatanatyam, to make things clear) and likes it to be prescribed in the classical way without introducing any modifications to it. This is because ‘Art forms’ do not undergo perceivable changes over the course of time and are expected to retain their essence in the original form. On the contrary, Science keeps changing because of its progressive and self-correcting character.

Well, this is where the actual problem begins because there is duality. What we conveniently forget is that, Ayurveda too, in its classical form, has been open for corrections and inclusions: and that is what makes it different from Bharatanatyam. Therefore, without including the recent advances achieved in biomedical sciences, even Ayurveda remains incomplete! When one tries bridging the ancient and modern sciences, some loss and corrections are obviously inevitable. Even many Sanskrit commentators of Ayurveda textbooks have done the same: to re-interpret Ayurveda in terms of contemporary knowledge of their times!

The problem with the present Ayurveda curriculum is that it spells out nothing clearly as to what is expected of an Ayurveda physician after graduating from a college. If he/she is expected to take up the responsibility of primary health care delivery, how can it be done only through classical Ayurveda, without incorporating the recent advances? The limitations of Ayurveda in tackling serious infectious conditions and other acute clinical conditions that require mostly Allopathic interventions are not acknowledged in the curriculum at present. A rationalist student would obviously want to incorporate these advances in his/her practice if at all he/she is to deliver primary healthcare. It is irresponsible and irrational to expect an Ayurveda physician to either completely miss the diagnosis of early stages of some serious cancers, or not to refer a patient with dissecting aneurysm to a tertiary care hospital and instead to administer enema and purgations. This is what will happen if contemporary sciences are not introduced in Ayurveda curriculum!

Similarly, on one hand, Ayurveda teachers face the pressure to preserve Ayurveda in its original form, and on the other, they also face the challenge of proving it to be a Science! If at all it is to be preserved 'at any cost' in its original form, what is the need of validating it and what is the need of pursuing research? These are two mutually contradictory expectations!

The solution to this puzzle is to clearly spell out what is expected out of Ayurveda physicians once they graduate. This is difficult to do because the needs of the different sections of the society have yet not been properly identified and analyzed. For example, the Kerala model of Ayurveda cannot be practiced in Uttar Pradesh and Bihar considering the differences in literacy levels, socioeconomic patterns, population density, awareness and many more such aspects. A “policy research institute for medical education” if established, may be through NMC Bill, periodical surveys such as those conducted by NCERT can be conducted and tailormade policies can be crafted.

Designing the right kind of Clinical Trial protocols in Ayurveda: A proposal

2017-08-13T10:56:00.002-07:00

Need for good clinical trials in Ayurveda:

Double-blind randomized placebo-controlled trials have been long regarded as the gold standards that provide evidence regarding the efficacy of any intervention, and hence, one cannot afford to ignore this trend. When there are sufficient numbers of such double-blind trials, there will be room for meta-analyses and systematic reviews which will form the best possible evidence. However, when one considers Ayurveda interventions, it becomes obvious that there are no good meta-analyses in the literature because of a paucity of good clinical trials. On PubMed search, for instance, we get roughly 130 clinical trials when the search term ‘Ayurveda’ is entered. Therefore, there cannot be an argument against the need for good clinical trials in Ayurveda.

Why conducting good clinical trials in Ayurveda is difficult?

Ayurveda is a complex system that considers multiple clinical and other parameters while deciding a specific line of treatment. These parameters include individual constitution (Prakriti), digestive strength (Agnibala), nature of bowel evacuation (Koshtha), Saama-Niraama state (metabolically immature and mature state) and many more. Further, the diagnosis of a disease in Ayurveda too is complex one. For example, different individuals suffering from the same clinical condition, noninfective gastroenteritis for example, may be diagnosed by different names such as Visuchika, Atisara, Grahani, Ajirna, Adhoga Amlapitta, Shula etc. Further, there could be external factors such as seasons (Ritu) and Desha (place of residence) that might differ in each of these individuals. This in fact leads to many possible permutations and combinations in interventions. In a nutshell, different patients suffering from same disease may receive different interventions according to Ayurveda.

This situation poses a challenge in designing a good clinical trial because the generally accepted method of conducting clinical trial involves comparing the efficacy of one intervention against either placebo or another intervention. Mostly, a linear cause-effect relationship is assumed in such trials. For example, it may be one antibacterial agent vs another antibacterial agent in case of infective conditions, and one analgesic versus another analgesic in conditions that are associated with pain. This model may be sufficient to guide biomedical clinical practice because this is how biomedicine is practiced. However, this model of clinical trials is not suitable in the context of Ayurveda because multiple algorithms are involved in decision-making by Ayurveda practitioners. This is the reason why available literature on Ayurveda clinical trials is grossly insufficient: these protocols are blind copies of the clinical trials involving biomedical interventions. Therefore, there is a huge gap between how Ayurveda is practiced and how it is researched!

Recent attempts:

It is important to note that during the past few years there have been a few sincere attempts at designing right kind of Ayurveda clinical trials in a manner that is true to the principles of Ayurveda. In one of these trials on rheumatoid arthritis, the autonomy of a physician in the form of individualizing the complex interventions was preserved. Because this study was published in one of the leading journals of rheumatology, it was expected that many such studies would be attempted at. However, it is strange to see that researchers have not yet considered this as the right template for building up evidence in favor of Ayurveda interventions. One of the reasons for this is that Ayurveda academia does not take up serious kind of research in general. Another factor may be that most of the Ayurveda teachers are ignorant of these attempts and hence, this model has not yet probably percolated into Ayurveda colleges and research institutions.

Suggested algorithm:

I suggest that the complexity involved in deciding interventions must be considered at an early stage while designing a good clinical trial. All possible permutations and combinations of parameters and diagnoses must be enumerated in the beginning itself and the individualization methods must be made clear. It is a good idea to include a panel of clinically successful Ayurveda practitioners to deliberate and finalize this. Such a trial would prove fruitful in testing the “whole system” against either standard of care or a placebo, as the case may be. A good protocol for Ayurveda clinical trial must at the beginning itself have clear-cut flowcharts designed and individualization methods finalized. A flowchart involving the following factors must be prepared and each intervention at every possibility must be pre-decided:

The factors related to the individual could be Prakriti, Agnibala, Koshtha, Dhatu Sarata, occupation of the individual, lifestyle, dietary habits, etc
The factors related to the disease could be Saama-Niraama stage, Nava-Purana State, Stage of the disease (Kriyakala), the diagnosis of the condition, accompanying conditions such as obesity, hypertension etc.
The factors related to environment: Ritu, Desha etc.

While reporting, though conventional biomedical diagnosis must also go in the title, I suggest that a detailed algorithm followed while deciding the intervention may also be provided.

Limitations of this approach and available alternatives:

Yes, this approach may be too complex and it may be difficult to enumerate all possible permutations and combinations beforehand. Conducting such complex studies with the limited available resources may be another problem. This is especially true because as the number of permutations and combinations increase, the number of formulations and other interventions too would increase. Standardization of raw materials, standardization of pharmaceutical processes etc would consume lot of time and resources. In such cases, I suggest that a study can be limited to one set of possibilities. For example, a study could be framed something like "Effectiveness of Ayurveda intervention in the young-adult population of Pitta Prakriti with acid-peptic disease presenting as Vidagdhajirna in Sharad Ritu". Though such an alternative would require excluding many cases of the same disease, still would prove to be practical.

Science versus non-science dilemma:

Most of the hardcore science lovers have a bias against alternative therapies and often call such methods ‘pseudo-medicine’ or ‘pseudoscience’. It is high time that Ayurveda researchers come up with right kind of clinical trial protocols and start publishing the results. This would in a long run help everyone of us to understand what Ayurveda actually is. Till that time Ayurveda will continue to be perceived by scientists based on the trials that are poorly designed and that ignore core principles.

References:

1. Manohar PR. Consideration of Ayurvedic diagnostics in design of clinical trials. Ancient Science of Life. 2013;33(1):1-3. doi:10.4103/0257-7941.134553.

2. Witt CM, Michalsen A, Roll S, et al. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee – study protocol for a randomized controlled trial. Trials. 2013;14:149. doi:10.1186/1745-6215-14-149.

3. Furst DE, Venkatraman MM, Krishna Swamy BG, McGann M, Booth-Laforce C, Ram Manohar P, Sarin R, Mahapatra A, Krishna Kumar PR. Well controlled, double-blind, placebo-controlled trials of classical Ayurvedic treatment are possible in rheumatoid arthritis. Ann Rheum Dis. 2011 Feb;70(2):392-3. doi:10.1136/ard.2010.136226. Epub 2010 Aug 24. PubMed PMID: 20736391.

4. Furst DE, Venkatraman MM, McGann M, Manohar PR, Booth-LaForce C, Sarin R, Sekar PG, Raveendran KG, Mahapatra A, Gopinath J, Kumar PR. Double-blind, randomized, controlled, pilot study comparing classic ayurvedic medicine, methotrexate, and their combination in rheumatoid arthritis. J Clin Rheumatol. 2011 Jun;17(4):185-92. doi: 10.1097/RHU.0b013e31821c0310. Erratum in: J Clin Rheumatol. 2011 Oct;27(7):407. PubMed PMID: 21617554.

Educational Policy Research: Ayurveda context

2016-12-13T03:08:00.001-08:00

A robust education system is a prerequisite for any stream of applied science to ensure its relevance with respect to the changing societal needs. It is expected that the education system must keep evolving itself into more efficient one on the basis of new advances in the knowledge, changing value systems and needs of the society, technological advances, and, changing connotations of learner-teacher relationship. Education scenario in Ayurveda, however, is lagging behind in many of these aspects and there appears to be a general consensus in favor of improving the situation so that the strengths of Ayurveda can be utilized to the fullest extent.

The major problems that Ayurveda education sector currently faces are: lack of required exposure to basic clinical skills during graduate level of education, inadequate training in research domain, too much of reliance on textual references than on practical utility, non-availability of standard resource material that addresses current healthcare needs of the society etc.

Gurukula system of education:

The traditional learning method of Ayurveda was that of Gurukula, where a student used to stay with his Guru for several years to be trained. The Guru used to have a small group of students at his place that used to discuss, observe and help him in carrying out various activities such as collecting herbs, preparing the medicines and performing different clinical procedures. Because this was a small group, learning was possibly natural, spontaneous and informal. Possibly it was also based on competency than mere theoretical knowledge. As this system got transformed into universities, learner-teacher interaction became minimal. This system has made ‘commercial success’ the most important motivating factor for a student, instead of 'compassion'. Further, the competitive stress has become an inherent part of the learning process.

Most of the medical educationists have realized the drawbacks of the process of ‘institutionalization’, and have started exploring alternative methods of teaching and learning. The proposals such as small-group discussions, competency based curriculum, parallel and vertical integrative strategies of teaching etc. are the results of such realization. Surprisingly, most of these newer methods mimic the ancient method of education that was followed in Gurukula.

‘Traditional Science Vs Modern Science’ dilemma:

There have been two prominent streams of thought when it comes to the question “How should Ayurveda be taught and practiced?” While one school proposes that Ayurveda must be taught strictly along the lines of Ayurveda logic and epistemology, the other proposes an integrative approach that incorporates the inputs from various streams of sciences. The first school is of the opinion that Ayurveda is complete by itself and does not need interpretation and research on contemporary science-based parameters, whereas the second school proposes that integrating recent scientific advances into Ayurveda is absolutely in congruence with the spirit of Ayurveda and therefore, Ayurveda practices must be put under the lens of the recent advances in biological sciences.

The status of educational research:

The answers to the dilemmas such as the one posed above will emerge only when rigorous educational research is introduced in Ayurveda system of education. It is disappointing to note that this area has been one of the most neglected in the field of Ayurveda. For instance, a PubMed search for the terms ‘Ayurveda’ and ‘Education’, entered with a rider that both these terms must occur either in the title or in the abstract, gives less than 50 results.

Teaching and learning process in Ayurveda colleges has not changed much in spite of the availability of technological tools in the education sector. Standard e-contents such as standard e-textbooks, good videos to demonstrate diagnostic and therapeutic procedures etc., are still not available. This has led to a lot of subjectivity in teaching. There is often a great deal of difference between different interpretations of the core concepts of Ayurveda from one expert to another. Examinations and assessments in Ayurveda too have largely remained recall-based with least emphasis on evaluating the higher order thinking skills. During their postgraduate education too, the students are not introduced to the effective teaching and learning techniques. Educational research has not been considered as an attractive option by most of the researchers.

As a result, different stakeholders take advantage of the situation to push their own agenda. For instance, during past decade, the Central Council of Indian Medicine (CCIM) has introduced many changes in curricula and syllabi repeatedly without having a truly meaningful intellectual debate and evidence-base to support these revisions. Similarly, a delegation from Kerala (composed of many pharmaceutical firms) has recently requested the Government of India for reduction of modern science-based topics from the BAMS syllabus. Such experiments and requests are highly opinionistic and lack research-generated data to support.

Need for a cross-talk:

India still follows a parallel kind of approach while China, Vietnam and a few more countries follow integrative policy model in traditional medicine education and practice. This parallel policy model has probably prevented Ayurveda students in acquiring required skills and knowledge related to the contemporary needs of the society. Since the cross-talk between the different streams of physicians has been negligible, a state of cognitive dissonance sets in among the students leading to patchy knowledge and skills - both in Ayurveda and contemporary biomedical sciences - with an inability to connect the two. To promote a crosstalk between different streams of medical professionals, we need to encourage the incorporation of some introductory material related to Ayurveda in the curriculum of graduate level of conventional medical programs. Presently, medical graduates do not know to what AYUSH interventions their patients might have been subjected. They also do not know when to refer their patients to AYUSH practitioners. They are neither introduced to AYUSH modalities that can complement and enhance the clinical outcome. We have proposed that a small Ayurveda module be introduced in graduate level curriculum of MBBS. This would sensitize these students towards Ayurveda, which will, in future, certainly help in promoting an attitude of inquiry, thus promoting much needed collaborative research in various fields of health sciences.

Policies on Medical Education

Bringing a paradigm shift in the education strategies, though, can happen through right kind of policies, it is difficult to expect such dramatic changes happening overnight. This shift can happen only through a continuous and sustained research on educational policies. It is to be noted that, currently, all the education-related policies are being framed based on the opinions of certain expert groups and not on the basis of research. Therefore, there is a need for creating a ‘research-base’ to support policies of AYUSH education. This would help the policy makers to consider positive corrections in education system.

Proposed model and important Questions:

We propose setting up of an “Institute for AYUSH Education Policy Research”, or, even better, an “Institute for Medical Education Policy Research”. Many top Universities and Governments world over, already have such centers and institutes for “health education policy research”. Though there are some groups and institutions engaged in ‘health policy research’ and public health research in India, ‘AYUSH education’ has received minimal attention in their debates and deliberations so far.

If such an ‘AYUSH education policy research institute’ is setup, it needs to take up certain important questions, and must be asked to come up with evidence-base to enable us to have answers to these questions:

1. Is a single model of AYUSH education and practice sufficient to cater to the healthcare needs of the public in all regions / states / of all socioeconomic strata? (e.g., Applicability of Kerala model of Ayurveda Education and Research in UP/Bihar).

2. Are the kinds of health conditions being treated by differently trained physicians in different regions/ set-ups similar or different?

3. Which kind of Ayurveda education gives maximum health benefits to the society (e.g., integrative model of BHU or classical model of Kottakkal)?

4. Are the kinds of patient populations being served in different regions by Ayurveda physicians (based on education/ socioeconomic status etc.) similar or different? If they are different, what determines these different practices?

5. Can India shift from its present parallel policy model of medical education to integrative policy model? If yes, how?

In a span of, say 5 years from now, such an institution with handful of skilled personnel is likely to come up with answers to these and many more questions. These questions must be addressed through proper research methods and tools such as surveys and interviews. Workforce that already exists in health sector in different States can be utilized to generate data to support decision making. These answers should guide the future policies that we will have, not the opinions of certain expert groups.

References:

1. Patwardhan B, Joglekar V, Pathak N. Vaidya-scientists: Catalysing Ayurveda renaissance. Curr Sci. 2011;100:476–83

2. Kligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, Lee R, Remen RN; Education Working Group, Consortium of Academic Health Centers for Integrative Medicine. Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med. 2004 Jun;79(6):521-31.

3. Telang-Chaudhari S, Baxi GD, Bhalerao S. Competency based education in Ayurveda: Need of the hour? Ancient Science of Life. 2014;34(2):119-120. doi:10.4103/0257-7941.153484.

4. Gruppen LD, Mangrulkar RS, Kolars JC. The promise of competency-based education in the health professions for improving global health. Hum Resour Health. 2012;10:43. doi:10.1186/1478-4491-10-43.

5. Report submitted by Udupa KN. Committee on Ayurveda Research Evaluation. 1958. Available from: https://nrhm-mis.nic.in/ui/who/PDF/Udupa%20K.N.%20Committee%20on%20Ayurvedic%20Research%20and%20Evaluation%201958.pdf Accessed July 31, 2016.

6. Bala P. Medical revivalism and the national movement in British India. Anc Sci Life. 1990;10(1):1-5.

7. Rastogi S. Building bridges between Ayurveda and Modern Science. International Journal of Ayurveda Research. 2010;1(1):41-46. doi:10.4103/0974-7788.59943.

8. Joshi H, Singh G, Patwardhan K. Ayurveda education: Evaluating the integrative approaches of teaching Kriya Sharira (Ayurveda physiology). J Ayurveda Integr Med. 2013;4(3):138-146. doi:10.4103/0975-9476.118683.

9. Patwardhan K, Gehlot S, Singh G, Rathore HC. Graduate level Ayurveda education: Relevance of curriculum and teaching methodology. J Ayurveda. 2009;3:74–82.

10. Patwardhan K, Gehlot S, Singh G, Rathore HCS. Global challenges of graduate level Ayurvedic education: A survey. Int J Ayurveda Res. 2010;1(1):49-54. doi:10.4103/0974-7788.59945.

11. Patwardhan K, Gehlot S, Singh G, Rathore HCS. The Ayurveda Education in India: How Well are the Graduates Exposed to Basic Clinical Skills? Evid Based Complement Alternat Med. 2011;2011(Ccim):1-7. doi:10.1093/ecam/nep113.

12. Patwardhan K. How practical are the “teaching reforms” without “curricular reforms”? J Ayurveda Integr Med. 2010;1(3):174-176. doi:10.4103/0975-9476.72612.

13. Bodeker G. Lessons on integration from the developing world’s experience Commentary: Challenges in using traditional systems of medicine. Bmj. 2001;322(7279):164-167. doi:10.1136/bmj.322.7279.164.

14. Patwardhan B, Warude D, Pushpangadan P, Bhatt N. Ayurveda and traditional Chinese medicine: A comparative overview. Evidence-based Complement Altern Med. 2005;2(4):465-473. doi:10.1093/ecam/neh140.

15. Patwardhan K. Medical education in India: Time to encourage cross-talk between different streams. J Ayurveda Integr Med. 2013;4(1):52-55. doi:10.4103/0975-9476.109556.

16. Roy V. Time to sensitize medical graduates to the Indian Systems of Medicine and Homeopathy. Indian J Pharmacol. 2015;47(1):1-3. doi:10.4103/0253-7613.150301.

Medical education in India: Time to encourage cross-talk between different streams

2012-09-09T02:57:00.002-07:00

India is a country where medical pluralism is officially recognized and encouraged. Currently India recognizes six different healthcare systems along with the conventional medicine (Allopathy or Biomedicine). India follows a ‘parallel’ kind of policy model where the conventional medicine and other indigenous systems of medicine (referred collectively as ASU- Ayurveda, Siddha and Unani or, ISM-Indian Systems of Medicine), are placed ‘parallel to each other’. Because of such a policy, however, there is no official provision for cross-talk between the professionals belonging to these different streams during medical education, research and practice. This has in fact given rise to mutual misgivings among these healthcare professionals regarding the strengths and weaknesses of each other.

In this write-up, I argue that it is the right time to encourage some kind of cross-talk among the professionals of different streams of healthcare systems in the Indian context to enable our country to take care of its varied healthcare needs effectively. I further suggest that introducing an ASU module in the current MBBS curriculum would be one such concrete step that would help in building an atmosphere of mutual trust and mutual respect among the healthcare professionals of various streams, which would improve the healthcare delivery system of the country. Encouraging ASU institutions to hire biomedicine experts to give instructions in the areas of their expertise is another suggestion that will be discussed.

The current scenario of ASU education in India:

According to a recent report, there are currently more than 300 undergraduate colleges and more than 50 postgraduate colleges that produce graduates in ASU streams of medicine in India. The syllabi of these programs contain a huge number of topics related to conventional biomedicine. However, the number of ASU institutions asking the biomedicine experts to teach these topics to their students is extremely low. The governing body CCIM too doesn’t make it compulsory for such topics to be taught by the experts in the relevant fields. Therefore, the teachers teaching some ASU subjects also teach the relevant biomedical subjects such as anatomy, biochemistry, pathology, physiology, surgery. Therefore, it can be assumed that the quality of instruction in these topics that ASU students receive is possibly inferior.

The scenario is different in the medical colleges, because, the governing council, MCI does not think it necessary to include even the essentials of ASU related topics in the undergraduate or post graduate curricula. Therefore, there exists a perceivable gap between ASU and conventional healthcare professionals when it comes to ‘awareness about the domain knowledge of each other’.

Problems with the existing system of medical education and practice:

1. MBBS graduates don’t know what interventions their patients might have been subjected to

It is estimated that about 60-70% of the population in India resorts to one or the other ASU modalities of interventions for their healthcare needs. ASU systems employ various kinds of interventions like Panchakarma, dietetics, herbal preparations, herbo-mineral preparations and so on. Graduates in conventional medicine, however, are not aware of these interventions. They are neither exposed to the theoretical constructs of ASU systems, nor to their possible health benefits. They are not even exposed to their possible adverse effects. There is increasingly available literature on herb-drug interactions, food-drug interaction and drug-drug interactions, and therefore, in all possibilities, these are being overlooked by the medical practitioners currently. This not only creates hindrances in the anticipated outcome, but also puts patients at increased health risks.

2. MBBS graduates don’t know when to refer their patients to ASU practitioners

While there are several reports highlighting the positive outcome associated with ASU interventions in several health conditions, especially those related with chronic non infectious diseases, graduates in conventional medicine don’t know what kind of cases can be referred to ASU hospitals. Conditions like fistula in ano, for example, are better treated with Ksharasutra therapy than with many other conventional methods. However, the referral taking place even in such cases is only marginal. Similarly, several studies on the effect of Ayurveda interventions in conditions like rheumatoid arthritis have been published, to which, conventional medical graduates are not introduced.

3. MBBS graduates are not introduced to ASU modalities that can complement and enhance the clinical outcome

There are several studies indicating the possible beneficial role of ASU interventions when administered as ‘adjuvant’ or ‘complementary’ to the conventional therapies. Dietary interventions, Panchakarma and lifestyle modifications as per ASU modalities, for instance, can at least be supplemented along with many biomedicine interventions to enhance the clinical outcome.

4. MBBS graduates are not introduced to the recent advances that are taking place in ASU systems.

Several interesting research findings related to ASU interventions are being reported widely in recent years in peer-reviewed scholarly journals. Graduates in conventional medicine need to know some of these key advances so as to help their patients.

5. MBBS graduates are not introduced to the medical heritage of their own country

ASU systems are historically integrated into social and cultural domains of commoner’s life in India. Certain terms such as ‘heat’, and ‘gas’ that are commonly expressed by patients, have got their roots situated in such cultural connections. Similarly, Sushruta’s practice of rhinoplasty was a milestone in the evolution of surgical practices. Therefore, having some knowledge in the history and heritage of one’s own country definitely adds value to the medical practice.

6. ASU graduates don’t receive instructions from qualified experts in the topics related to conventional medicine

In one of our earlier studies, we have noticed that Ayurveda students are not trained well in the essentials of physiology, pathology and clinical diagnosis in general, and this possibly holds true for Siddha and Unani students as well. The reason for this situation in all probability is that ASU students don’t receive these instructions from the experts in these fields.

7. Inadequate involvement of Biomedicine experts in ASU research

An ideal research protocol for ASU streams needs the involvement of biomedicine experts, however, only a few biomedicine experts are currently interested and involved in pursuing research related to ASU systems. This is because they are not routinely exposed to these systems during their formal education. It is to be noted that ASU systems can still guide many areas of current sciences because they provide a larger fundamental conceptual framework that is in alignment with ‘systems thinking’.

Suggested solutions:

1. Introduce ASU module in MBBS curriculum

Introducing an ASU module in MBBS curriculum that contains the essential introduction to these systems would help in solving most of these problems. This module ideally must cover the following components:

a. Fundamental principles and theories on the basis of which ASU systems are practiced

b. Historical evolution of ASU systems in India and the important contributions of these systems to the current sciences

c. Introduction to the essentials of commonly practiced ASU interventions like Panchakarma

d. Essentials of ASU pharmaceutics: common methods of preparation of ASU formulations, their key ingredients

e. Recent advances (fundamental and clinical) that have taken place in ASU streams

f. Essential information regarding herb-drug / food-drug/ drug-drug interactions related to commonly used herbs/drugs/dietary compounds.

g. Pharmaco-vigilance program of ASU and the major centers coordinating it

2. Encourage instructions by bio-medicine experts to ASU students in the relevant topics

Institutions like Banaras Hindu University have since long introduced such a practice. During their postgraduate years of study, Ayurveda students receive instructions by experts in Anatomy, Physiology, Pharmacology, Pathology, Microbiology, Biochemistry and Medicinal Chemistry. However, such a practice needs to be encouraged everywhere so that ASU students receive standard instructions.

Suggested Road-map:

a. The government of India may identify a few institutions where ASU module could be introduced on an experimental basis. These institutions should preferably have a medical college and an A/S/U college under the same management, preferably in the same campus. Institutions such as Banaras Hindu University, where three faculties (Medicine, Ayurveda and Dental sciences) work under the same umbrella of IMS (Institute of Medical Sciences) are ideal for such a venture to begin with. A few other institutions with a similar set up could be identified.

b. A group of experts may be asked to frame a module. This group should consist of experts from ASU, pharmacology, clinical research and sociology. This group may be asked to come up with a course module containing the essential information in the form of an e-book. This should also include the links and addresses of important organizations and institutions that can facilitate the acquisition of the required information on the issues addressed.

c. This module may be introduced either during final MBBS or during the internship period. Initially, fifty hours of contact lectures may be allotted and feedback from the instructors and students can be obtained. Alternatively, during every semester of MBBS ten hours of contact lectures can be introduced to lessen the burden.

d. Governing bodies like CCIM should come up with norms making it essential for biomedicine experts to be recruited in ASU colleges to give instructions in their area of expertise.

e. As a long-term measure, a 10-year integrated MBBS/MD/PhD ‘triple degree program’ in integrative medicine might be introduced, wherein the essentials of all major streams of healthcare systems can be incorporated along with a research project. This would certainly encourage more researchers to involve themselves with ASU systems.

(I thank Dr.Madan Thangavelu from Cambridge, for his suggestion to include a 10-year integrated triple degree program under the list of "suggested road-map".)

Reforms required in Reorientation and Training Program (RoTP) for Ayurveda teachers

2011-04-01T02:27:00.000-07:00

What I have concluded from twenty years of my experience in Ayurveda education, as a student and as a teacher, is that there is an urgent need to train the teachers of Ayurveda in some essential areas of education. I have explained in my earlier writings that teachers’ training needs to start at the level of postgraduate education itself; however, the question as to who should train these future teachers remains to be answered. This question is very important because the teachers currently involved in postgraduate teaching may not be suitable for this task in general. I receive several dissertations every year from various universities for evaluation and when I go through them, in most of the cases, I am left deeply disappointed. I find most of these dissertations not worthy of the paper on which they are printed, and, this is the reason why significant research publications are not emerging out of these studies. I find insufficiency in these dissertations at every level: the writing style, the study design, literature review, methods, statistical analysis and interpretation. I know; the supervisor alone cannot be held responsible for these discrepancies, rather, in most of the cases, it is the weakness of the entire postgraduate training program that is responsible for this kind of a poor outcome.

Possible solution:

Whenever I think of a possible solution for this problem, I am reminded of teachers’ reorientation and training programs (RoTP) that are regularly conducted all over the country by Rashtriya Ayurveda Vidyapeeth. Though this initiative is highly admirable, the way in which these RoTPs are conducted is far from satisfactory. Since last three to four years, I have participated in a few RoTPs as an expert, and, except in a few cases, my experience has not been good. When I take feedback from the participants, on most of the occasions, I get to hear that the experts keep talking on the very same topics that are taught at graduate level. In fact, the experts often forget that the participants in these RoTPs are teachers who have been teaching these topics for many years, and what they need is not just repetition, rather, it is re-orientation.

I suggest that a few specific topics be included in every RoTP irrespective of the subject specialty, so that the real purpose of RoTP is fulfilled. Of course, apart from these topics, the specific topics relevant to the subject specialty may be included as per the need. If appropriate experts from Ayurveda are not available to deliver these contents, experts from other relevant fields such as Bioinformatics, Library sciences, Education, Mass communication, Epidemiology and Biostatistics may be requested to extend their help in this task. Following is the list of topics that I suggest, which includes possible contents to be incorporated:

Privileges and duties of a teacher

1. Privileges and duties of a teacher, teaching profession- a pious profession

2. Historical perspective of teaching profession with a few examples of great teachers

3. Transmission of the latest knowledge (teaching) along with generation of new knowledge (research): Two primary duties of a teacher

4. How can a teacher pursue research activities with limited resources?

5. Role of a teacher in career guidance: How to motivate students in their pursuit of Ayurveda as their career?

6. Keeping pace with the recent developments in the field: teacher as a life-long-learner

Different modes of acquisition of information

1. Differences between the Internet Vs traditional library

2. Introduction to different web-based resources and scholarly journals related to the subject

3. How to weed-out the junk information on the web?

4. Introduction to some important web-based biomedical databases like PubMed, Cochrane library, NLM databases etc

5. Hands-on training in accessing some relevant information related to the subject

Different teaching methods and good teaching practices

1. Importance of developing essential communication skills in teaching

2. Traditional classroom lectures: strengths and limitations

3. Interactive sessions

4. Learning in small groups

5. Problem-based learning

6. Early introduction of clinical cases

7. Promoting self learning among students

8. Importance of life-long learning

Using the information technology in day-to-day teaching

1. Preparing impressive presentations / lectures

2. Blogging

3. Using multimedia technology in teaching (audio-visual)

4. Using the Internet based groups/ forums for interactions/discussions

Good examination practices

1. Good practices of question paper setting

2. Good practices of preparing multiple choice questions

3. Good practices of conducting viva voce examination

4. Good practices of conducting practical examination

5. Difference between memory-based, understanding-based and analysis-based question patterns

Planning a research project and guiding MD(AY)/PhD students

1. Identification of research question

2. Preparing a research protocol

3. Various study designs applicable for the research in the subject

4. Information about various funding agencies relevant to the field and method of submitting a project to procure resources

5. Basics of biostatistics

6. Basics of operating a statistical software like EPI-INFO

7. Introduction to various guidelines to carry out different kinds of research

Publishing the research

1. Relevant journals for Ayurveda

2. Importance of publishing one’s research findings

3. Converting a MD(Ay)/PhD thesis into scholarly publications

4. Possible types of publications: Reviews, hypothesis, original articles, letters to the editor etc.

5. Importance and features of Peer review process

6. Types of publications relevant for the subject

Is biomedicine on its way to becoming Ayurveda?

2011-02-10T04:27:00.001-08:00

Ancient Ayurveda theories are receiving a phenomenal reinforcement in the recent years like never before in the form of advances in science. For instance, the emerging trends in personalised medicine, newer insights in neuro-endocrine-immune interactions, advances in chronobiology, role of gut microbiota in health and disease, and, the current stem-cell related research findings are a few areas that show a perfect congruence with Ayurveda principles.

Over the last few years, the studies related to genomes and their derivatives have so advanced that genomic research can now serve as the basis for many medical decisions in the form of ‘individualised medicine’. Precise prediction and treatment of certain diseases has now become possible because of the various genomic tools ^[1]. Though the concept of individualization of medicine is a recent trend in biomedicine, this has received enormous emphasis in the form of Prakriti (constitution) of an individual in Ayurveda ^[2]. Ayurveda proposes that ‘Prakriti’ of an individual is one of the important factors to be considered while planning the treatment in any clinical condition. Furthermore, there have been a few studies suggesting that pharmacogenomics may be a useful tool in verifying this ancient Ayurveda concept ^[2,3,4,5]. It has been also suggested that the theory of Prakriti can guide some serious research into genetic susceptibility of an individual to certain clinical conditions ^[6].

The recent trend of recognising the interactions between neuro-endocrine and immune mechanisms to be vital in the regulation of homeostasis is another important understanding that supports the basic theory of Ayurveda, known as Tridosha. In fact, the theory of Tridosha represents the basic ‘homeostatic mechanisms’ as perceived in biomedicine. At a gross level, the three Doshas —Vata, Pitta and Kapha—can be paralleled with the nervous, endocrine, and immune mechanisms respectively as Vata governs all the sensory and motor functions, Pitta controls metabolism, and Kappha confers immunity ^[7,8]. Biomedicine has in recent years started taking note of some of the important interactions that take place between these neuro-endocrine-immune mechanisms and has proposed the role of some potential regulatory feedback loops between these three major integrative bodily systems in maintaining homeostasis. For example, it is now known that the nervous system influences the immune system through hypothalamo-pituitary-adrenal axis; immune cells produce several endocrine hormones, neurotransmitters, and neuropeptides; and, the endocrine and nervous systems express receptors for a variety of immunologically derived substances ^[9,10,11].

Another area that is currently attracting the scientists is chronobiology, where circadian and other biorhythms are being assigned an important role in determining certain physiological responses and also in determining specific outcomes of pharmacological interventions^[12]. It has been proposed that this approach is likely to be highly beneficial in the management of major chronotherapeutic conditions such as asthma, allergic rhinitis, cardiovascular disorders, rheumatoid arthritis and cancer ^[13]. This kind of an understanding merely re-affirms the Dosha biorhythms explained in Ayurveda. Ayurveda recognises that Doshas show rhythmic variations in relation to day-night cycle, seasonal cycle, stages of digestion, and stages of aging ^[7]and further recommends that medicines be prescribed only after considering these Dosha biorhythms.

The role of gut microbiota in health and disease has been another neglected area that is receiving attention in recent times. It is now known that the microbiota in the gut, apart from contributing to digestion, also play important roles in various mechanisms including the development of human immune system. A healthy human state is now recognized as a homeostasis between the microbiota and the host. Diet, anti-biotics and several other factors can have enormous effects on the composition of microbiota.^[14] In this context, it is interesting to note that most of the important therapeutic procedures (such as Vamana, Virechana and Basti) in Ayurveda are administered through gut and at least one possible mode of action of these therapies could be an intentional manipulation in the composition of gut microbiota.

The very idea that cells from one tissue can be transformed into the cells of a different kind was unconceivable till the stem cell research proved this possibility in the recent past. This understanding has resulted into most important therapeutic applications like regenerative medicine and tissue engineering. Tissue-engineered skin replacement grafts, chondrocyte repair of joint cartilage, and bone regeneration with skeletal stem cell implantation have been already proven to be clinically useful^[15]. These developments are quite supportive of the theory of ‘Tissue transformation’, also known as ‘Dhatu Parinama’ explained in Ayurveda. Ayurveda proposes that one tissue is converted into another during the developmental phase of an individual, and, also that one can regenerate a lost tissue by replacing it with a similar tissue.

On the basis of these observations, it is logical to presume that Ayurveda can provide many more leads to the development of science. These may include certain unique areas such as Dhatu-Upadhatu-Dhatumala, Ojas, Agni and certain therapeutic procedures like Panchakarma.

References:
1. Hong KW, Oh B. Overview of personalized medicine in the disease genomic era. BMB Rep. 2010 Oct;43(10):643-8.
2. Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, Purohit SG, Sengupta S, Khanna S, Mohammad F, Garg G, Brahmachari SK; Indian Genome Variation Consortium, Mukerji M. Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurveda. J Transl Med. 2008 Sep 9;6:48.
3. Patwardhan B, Bodeker G. Ayurvedic genomics: establishing a genetic basis for mind-body typologies. J Altern Complement Med. 2008 Jun;14(5):571-6. Review. PubMed PMID: 18564959.
4. Bhushan P, Kalpana J, Arvind C. Classification of human population based on HLA gene polymorphism and the concept of Prakriti in Ayurveda. J Altern Complement Med. 2005 Apr;11(2):349-53.
5. Ghodke Y, Joshi K, Patwardhan B. Traditional Medicine to Modern Pharmacogenomics: Ayurveda Prakriti Type and CYP2C19 Gene Polymorphism Associated with the Metabolic Variability. Evid Based Complement Alternat Med. 2009 Dec 16. [Epub ahead of print]
6. Aggarwal S, Negi S, Jha P, Singh PK, Stobdan T, Pasha MA, Ghosh S, Agrawal A; Indian Genome Variation Consortium, Prasher B, Mukerji M. EGLN1 involvement in high-altitude adaptation revealed through genetic analysis of extreme constitution types defined in Ayurveda. Proc Natl Acad Sci U S A. 2010 Nov 2;107(44):18961-6. Epub 2010 Oct 18.
7. K. Patwardhan, Human Physiology in Ayurveda, Jiakrishnadas Series No.134, Chaukhambha Orientalia, Varanasi, India, 2008.
8. Tripathi PK, Patwardhan K, Singh G. The basic cardiovascular responses to postural changes, exercise, and cold pressor test: do they vary in accordance with the dual constitutional types of ayurveda? Evid Based Complement Alternat Med. 2011;2011. pii: 251850.
9. Marchetti B, Morale MC, Gallo F, Batticane N, Farinella Z, Cioni M. Neuroendocrineimmunology (NEI) at the turn of the century: towards a molecular understanding of basic mechanisms and implications for reproductive physiopathology. Endocrine. 1995 Dec;3(12):845-61.
10. Licinio J, Frost P. The neuroimmune-endocrine axis: pathophysiological implications for the central nervous system cytokines and hypothalamus-pituitary-adrenal hormone dynamics. Braz J Med Biol Res. 2000 Oct;33(10):1141-8.
11. Turrin NP, Rivest S. Unraveling the molecular details involved in the intimate link between the immune and neuroendocrine systems. Exp Biol Med (Maywood). 2004 Nov;229(10):996-1006
12. Sewlall S, Pillay V, Danckwerts MP, Choonara YE, Ndesendo VM, du Toit LC. A timely review of state-of-the-art chronopharmaceuticals synchronized with biological rhythms. Curr Drug Deliv. 2010 Dec;7(5):370-88.
13. Ohdo S. Chronopharmaceutics: pharmaceutics focused on biological rhythm. Biol Pharm Bull. 2010 Feb;33(2):159-67
14. Shen D, Liu C, Xu R, Zhang F. Human gut microbiota: dysbiosis and manipulation. Frontiers in Cellular and Infection Microbiology. 2012 September; Vol 2, Article 123. doi: 10.3389/fcimb.2012.00123.
15. Humes HD. Stem cells: the next therapeutic frontier. Trans Am Clin Climatol Assoc. 2005;116:167-83; discussion 183-4.
16. Bianco P, Robey PG. Stem cells in tissue engineering. Nature. 2001 Nov 1;414(6859):118-21

Some Physiological Issues related to ‘Medo Dhatu’ with special reference to Obesity

2008-02-16T04:19:00.000-08:00

‘Medas’ is the fourth ‘Dhatu’ in the sequence of tissue synthesis and nourishment. There is little doubt that the term ‘Medas’ indicates ‘fat’ in general and Adipose tissue in particular. But the description of ‘Abaddha’ Medas (1) compel one to understand this ‘Dhatu’ in two forms- one, ‘bound’ or ‘stored’ (Baddha) and the other, ‘free’ (Abaddha). This free form of ‘Medas’ should therefore include the circulating lipids like those in the form of lipoproteins or those in the form of free fatty acids(2).
Adipose tissue is a specialized connective tissue that functions as the major storage site for fat in the form of triglycerides. This is of two forms- white and brown. White adipose tissue serves several functions: heat insulation, mechanical cushion, and most importantly, a source of energy. Subcutaneous adipose tissue is an especially important heat insulator in the body, because it conducts heat only one third as readily as other tissues. As the major form of energy storage, fat provides a buffer for energy imbalances when energy intake is not equal to energy output. It is an efficient way to store excess energy, because it is stored with very little water.
Lipid in brown adipose tissue, instead of serving as a substrate, releases energy directly as heat and is, therefore used in heat production for non-shivering thermogenesis. The mechanism of heat generation is related to the metabolism of the mitochondria. Mitochondria from brown adipose tissue have a specific carrier called uncoupling protein that transfers protons from outside to inside without subsequent production of ATP.
But recent studies show that the adipose tissue is a complex organ with functions far beyond the mere storage of energy(3). Indeed, it has been shown that fat tissue secretes a number of adipokines including Leptin, adiponectin and visfatin, as well as cytokines, such as Resistin, Interleukin-6 and Tumor-necrosis factor-α.

Process of Successive Tissue Synthesis – ‘Kshira- Dadhi Nyaya’:

The process of nourishment and synthesis of tissues has been explained through various theories in Ayurvedic textbooks. One of them is ‘Kshira Dadhi Nyaya’. As per this theory, one tissue is transformed into the next in a particular sequence. Cakrapani has explained it as follows (4,5):

अत्राहाररसाद् रक्तादिपोषणमेवं केचित् ब्रुवते यत्, रसो रक्तरूपतया परिणमति, रक्तं च मांसरूपतया । एवं मांसादयॊऽप्युत्तरोत्तरधातुरूपतया परिणमन्ति । अत्रापि च पक्षे केचिद् ब्रुवते – क्षीराद् यथा सर्वात्मना दधि भवति, तथा कृत्स्नो रसो रक्तं भवति; एवं रक्तादयोऽपि मांसादिरूपा भवन्ति ॥

अत्र च रसाद्रक्ताद्युत्पादने केचिदिदं वदन्ति यत्, रसोऽग्निपच्यमानः रक्ततां याति, रक्तं च मांसतामित्यादि पूर्वपूर्वधातुपरिणामादेव उत्तरोत्तरधातूत्पादः । यथा क्षीराद् दधि भवति, दध्नो नवनीतं, नवनीताद् घृतमित्येकः पक्षः ।

In Caraka Samhita, the following description is found regarding the process of transformation of one ‘Dhatu’ into another(6).
तेजो रसानां सर्वेषां मनुजानां यदुच्यते । पित्तोष्माणः स रागेण रसो रक्तत्वमृच्छति ॥
शोणितं स्वाग्निना पक्वं वायुना च घनीकृतम् । तदेव मांसं जानीयात् स्थिरं भवति देहिनाम् ॥
वाय्वम्बुतेजसा रक्तमूष्मणा चाभिसंयुतम् । स्थिरतां प्राप्य मांसं स्याद् स्वोष्मणा पक्वमेव तत् ।
स्वतेजोऽम्बुगुणस्निग्धोद्रिक्तं मेदोऽभिजायते । पृथिव्यग्न्यनिलादीनां संघातः स्वोष्मणा कृतः ।
खरत्वं प्रकरोत्यस्य जायतेऽस्थि ततो नृणाम् । करोति तत्र सौषिर्यं अस्थ्नां मध्ये समीरणः ॥
मेदसस्तानि पूर्यन्ते स्नेहो मज्जा ततः स्मृतः । तस्मान्मज्ज्ञस्तु यः स्नेहः शुक्रं संजायते ततः ॥
वाय्वाकाशादिभिर्भावैः सौषिर्यं जायतेऽस्थिषु । तेन स्रवति तच्छ्रुक्रं नवात् कुम्भादिवोदकम् ॥
स्रोतोभिः स्यन्दते देहात्समन्ताच्छुक्रवाहिभिः । हर्षेणोदीरितं वेगात् संकल्पाच्च मनोभवात् ॥
विलीनं घृतवद् व्यायामोष्मणा स्थानविच्युतम् । बस्तौ सम्भृत्य निर्याति स्थलान्निम्नादिवोदकम् ॥

The above description has always attracted criticism by the modern Ayurvedic scholars. Even Cakrapani, on one instance, has disapproved this theory. Most of the scholars believed that the process of transformation of one tissue into another is not possible except in embryonic stem cells.

Recent Stem Cell Research:

Until recently, it was widely believed that the mature adult stem cells in the tissues can not be transformed into another tissue. But recent advances in the science have shown that the mature adult stem cells present in some tissues can form multiple tissue types. It is now known that fat is an excellent source for bone, cartilage, muscle, and maybe even blood cells because it is an excellent source of stem cells that can be prompted to develop into bone or muscle. In 2001, Hedrick, a plastic surgeon by profession, and his colleagues reported this research in ‘Tissue Engineering’(7). Afterwards, in 2005, researchers at Wake Forest University School of Medicine successfully isolated stem cells from human skin, expanded them in the laboratory and coaxed them into becoming fat, muscle and bone cells. The study, one of the first studies to show the ability of a single adult stem cell to become multiple tissue types, was reported in ‘Stem Cells and Development’ (2005)(8). More recently, scientists have successfully made immature sperm cells from human bone marrow samples (9). Therefore, formation of ‘Shukra’ from ‘Majja’ is no more an absurd description.

Vagbhata has comprehended the process of tissue transformation and nourishment as follows(10):
रसाद्रक्तं ततो मांसं मासान्मेदस्ततोऽस्थि च ।
अस्थ्नो मज्जा ततः शुक्रं शुक्राद्गर्भः प्रजायते ॥

Arunadatta has thrown light on this explanation in following lines, citing an example of obesity and initiating a debate on some related issues(11):
रसात् – धातुरसादाहाररसेन सहैकतामापन्नात् , रक्तं प्रजायते – स धातुरसस्तथा भूतो रक्ततया सम्पद्यते । तावद्यावत्स एव गर्व्हत्वेनेति योज्यम् । अत्र चोदयन्ति । ननु, यद्याहाररसो व्यानविक्षिप्तो रसधातुना सह एकतां परिणमन् क्रमेण रक्तादीन् भावान् गर्भावसानान् परिणमति । तर्हि कथमुक्तं “सारस्तु सप्तभिर्भूयो यथास्वं पच्यतेऽग्निभिः” इति? अत्रोच्यते । कार्ये कारणोपचारादेतदुक्तमित्यवेहि । सारकार्येषु रसरक्तादिषु सप्तभिर्धात्वग्निभिः पच्यमानेषु “सारस्तु सप्तभिर्भूयो यथास्वं पच्यतेऽग्निभिः” इत्युक्तम् । तस्माद्रसादिधातव एव साराख्यान्मूलकारणादुत्थिताः परमार्थेन पच्यन्त इति बोध्यम् । ननु, यदि क्रमेणाहाररसाद्रसो रसाद्रक्तं रक्तान्मांसमित्यादिक्रम आश्रीयते, तत्कथमुक्तं “व्यानेन रसधातुर्हि विक्षेपोचितकर्मणा” इति? अत्र हि युगपदिति च निर्दिश्यते । युगपत् – एककालं, व्यानेन रसो देहे विक्षिप्यते । विक्षिप्ताच्च रसात् सर्वधातूत्पत्तिरिति प्रत्यज्ञायि । इह च रसरक्तमांसादि क्रमेणाहाररसाद्धातुनिष्पत्तिरित्युच्यते । तदेतद् परस्परं विरुद्धमिव लक्ष्यते । ब्रूमः । युगपच्छ्ब्दोऽत्र शीघ्रक्रमार्थः । . . . रसधातुरित्येतद्कथमुक्तम् ? यतो रसाख्यो धातुस्तेन न विक्षिप्यते, किन्तर्हि ? आहाररसः । अत एव धातुशब्दोपादानं अनर्थकम् । ब्रूमः । धातुशब्द आधाराभिधेयत्वेनेहोपात्तो रसस्य देहधारणत्वं दर्शयितुम् । सर्वेषां हि धातूनां यद्देहधारणस्वभावत्वं तदाहाररसाप्यायितानामेषाम् , न त्वनाप्ययितानाम् । अतः स आहाररसो धातूनामाधारः उद्भवस्थानम् । यथा, लोले हेमादीनां य आधारः प्रतिनियतो विशिष्टा मृत् स धातुसंज्ञया भण्यते । इयं मृद्धेमधातुरियं रजतधातुरिति । एवमाहाररसो व्यानेन विक्षैप्यते, न रसाख्यो धातुः, इति स्थितमेतत् । किञ्च, आहाररसादेककालं सप्तसु धातुस्रोतःसु प्रवेशिताद्रसरक्तादयो धातव उत्पद्यन्ते, इति यद्येष एककालधातुपोषणपक्ष आश्रीयते, तदानीमिदं विरुध्यते – “पूर्वो धातुः परं कुर्याद्वृद्धः क्षीणश्च तद्विधम्” इति । यतः सर्वे धातव आहाररसेन युगपद्व्यानविक्षिप्तेन खे स्रोतस्यवतिष्ठमानाः स्वातन्त्र्येणाहाररसाप्यायिताः पुष्यन्ति, अनाप्यायिताः क्षयं यान्ति । तदेवं कथं पूर्वस्य धातोर्वृद्धो परस्य वृद्धिः पूर्वस्य धातोः क्षये परस्य क्षयः स्यात् ? न हि कदाचिद्घटते मेत्रे तृप्ते चैत्रः सुहितः स्यात्, अतृप्ते वाऽसुहितः स्यात् । तथा स्थूलस्य मेद एवोपचीयत इति दृष्टम् । न च समं कृत्वा सप्तसु धातुस्रोतःसु विनिक्षिप्ते रसे मेदसोऽधिका वृद्धिः कथञ्चिदुपपद्यते । क्रमपरिणामपक्षे तु स्थूलस्याहाररसो रसधातुतया परिणमति । रसधातु रक्ततया, रक्तधातुर्मांसतया, मांसधातुर्मेदस्तया परिणमति । मेदस आहारपूर्णस्य स आहाररसो मेदस्त्वं प्राप्तः पुनः प्रतिस्रोतोन्यायेन मांसस्य विशेषवतीं वृद्धिं करोति , अनन्तरं रक्तस्य, अनन्तरं रसस्य । पुनश्च रसधातुरतिपूर्णो रक्तस्य वृद्धिं विधत्ते, रक्तधातुर्मांसस्य, मांसधातुर्मेदसः, इत्येवं अतिस्थूलस्यमेदोवद्रसादयो मांसावसाना अप्युपचीयन्ते । अस्थ्यादयश्चास्थ्यादिस्रोतसां मेदसावृतत्वान्न तथोपचीयन्ते । तस्मादाहाररसेन मेदोभावेन परिणमता उदकपरिपूर्ण अभिनवमृत्कुम्भजललवस्यन्दनन्यायेन अस्थ्यादयो धातवः केवलमाप्याय्यन्ते, न तु तथोपचीयन्ते । तथा च मुनिः (च. सू. २१/४) – “स्थूलस्य मेद एवोपचीयते, न तथेतरे धातवः” इति । अस्य ह्ययमर्थः मेदसो येऽन्येऽस्थ्यादयः शुक्रावसानास्ते न तथोपचीयन्ते , न पुनः पूर्वे रसादयः धातवः स्थूलस्य नोपचीयन्त इति । अत एवाह मुनिः – (च. सू. २१/९) “मेदोमांसातिवृद्धत्वाच्चलस्फिगुदरस्तनः । अयथोपचयोत्साहो नरोऽतिस्थूल उच्यते । इति ।

Involvement of ‘Rasa’, ‘Rakta’ and ‘Mamsa’ in Obesity:

As described by Arunadatta, abnormal nourishment of ‘Rasa’, ‘Rakta’ and ‘Mamsa’ takes place along with ‘Meda’ in obesity. This explanation also seems to be true because dyslipidaemias and type- II diabetes mellitus (related to the abnormalities of ‘Rasa Dhatu’), hypertension (related to the abnormalities of ‘Rakta Dhatu’) and abnormally functioning muscle tissue (‘Mamsa Dhatu’) have been linked with obesity. Scientists have reported that severely obese people have three times as much of a fat-building enzyme called SCD-1 in their muscle cells than lean people indicating that simple dietary management may not be sufficient in the treatment of Obesity(12).

Kidney and Lipid Metabolism:

Also, in Ayurvedic literature, ‘Vrikka’ (Kidney) has been named as an organ associated with ‘Medovaha Srotas’. This description must have been based on some clinical observations. Recently there has been evidence that obesity increases tubular reabsorption in kidneys and this shifts pressure natriuresis towards higher BP. The increased tubular re-absorption is linked to the possible changes in intrarenal physical forces caused by medullary compression due to accumulation of adipose tissue around the kidney and increased extracellular matrix within the kidney. Because obesity is a primary cause of essential hypertension as well as type II diabetes, scientists believe that obesity may also be the most frequent cause of end-stage renal disease(13).
‘Medo Dhatu’ promotes the growth of ‘Asthi Dhatu’
One of the functions of ‘Meda Dhatu’ is to promote the growth of ‘Asthi Dhatu’. Recent advances in medical science have proposed that Adipose Tissue stimulates bone growth in children and young adults. After puberty, this effect is weakened. In a study reported in The Journal of Clinical Endocrinology and Metabolism, the fat mass in children was an independent predictor of bone mass and size(14).
‘Medo Dhatvagni’
Vagbhata has described that ‘Jatharagni’, has its fractions known as ‘Dhatvagnis’ situated at the level of tissues. If these fractions become over active, there will be 'Kshaya' (Catabolism) of 'Dhatu' and if they become depressed, there will be abnormal 'Vrddhi' of the 'Dhatu’. Several classical hemocrine hormones determine the metabolic state of a tissue. For example, 'Medodhatvagni' may include glucocorticoids, insulin, glucagon etc. If glucagon levels are excess, lipolysis occurs which is equivalent to 'Medokshaya'. Along with these hormones, all enzymes involved in lipid metabolism may also be regarded as ‘Medo Dhatvagnis’ (15).
Conclusion:

Various physiological and pathological descriptions available in Ayurvedic textbooks need to be looked at seriously with an open mind and concepts related to ‘Medo Dhatu’ are not exception for this.

REFERENCES:
1. Caraka Samhita, Nidana Sthana, 4/7
2. Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19
3. Tiziana Ronti; Graziana Lupattelli; Elmo Mannarino, ‘The Endocrine Function of Adipose Tissue: An Update’, Clinical Endocrinology. 2006;64(4):355-365.
4. Cakrapani on Ca. Su.28/4
5. Cakrapani on Sushruta Samhita, Sutra Sthana, 14/10
6. Caraka Samhita, Cikitsa Sthana, 15/28-35
7. http://www.webmd.com/news/20010410/turning-fat-into-muscle-bone-blood-cells accessed on 17/1/2008 10:20:33 PM
8. http://www.sciencedaily.com/releases/2005/06/050623000101.htm accessed on 9/2/2008 5:04:31 PM
9. http://news.bbc.co.uk/2/hi/health/6547675.stm accessed on 9/2/2008 4:53:11 PM
10. Ashtanga Hridaya, Sharira Sthana, 3/62
11. Arunadatta on Ashtanga Hridaya, Sharira Sthana, 3/62
12. http://www.medscape.com/viewarticle/514347 accessed on 14/2/2008 7:22:15 PM
13. John E. Hall, Michael W. Brands, Jeffrey R. Henegar, Eugene W. Shek (1998), ‘Abnormal kidney function as a cause and a consequence of obesity hypertension’, Clinical and Experimental Pharmacology and Physiology 25 (1), 58–64.
14. http://www.medscape.com/viewarticle/541500 accessed on 13/2/2008 11:44:25 PM
15. Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.48