REFLECTIONS
Confessions of an Ayurveda professor
Kishor Patwardhan
Published online first on July 2, 2022. DOI:10.20529/IJME.2022.049Abstract
In this essay, I narrate my experiences of teaching Ayurveda physiology through an approach that involved laborious re-interpretation of ancient literature using the recent advances in the field of medical physiology. Though this approach made the ancient concepts and theories appear modern and relevant, it did not contribute much except for apparently reducing cognitive dissonance among students. I cite examples describing the processes of formation of shukra (semen) and rakta (blood) to show how we often overinterpret Ayurveda concepts to make them sound rational by proposing ad hoc conjectures. I illustrate why my previous writings were faulty by applying the falsification principle proposed by Karl Popper. I further explain how this approach made these concepts only verifiable but not refutable, and hence, non-falsifiable. I argue that instead of using such re-interpretation to prove obsolete concepts, they can be dropped altogether from the curricula of Ayurveda programmes. There is a need to develop a reliable method to identify such outdated content.
Keywords: Ayurveda physiology, falsification principle, tridosha, strained interpretation, pseudoscience
I am a teacher of Ayurveda physiology, and for the past twenty years or so, I have harboured a belief that advances in contemporary sciences must be used to interpret descriptions documented in ancient Ayurveda texts. This has been a central theme of most of my past writings. This belief originated in my training at postgraduate level, when we consulted the books of scholars such as C Dwarakanath, BG Ghanekar and Gananath Sen. These scholars ensured that modern anatomy, biochemistry, and physiology were abundantly used in their books to draw parallels between ancient and modern literature. Further, Banaras Hindu University offered me a unique opportunity to learn basic sciences like anatomy, physiology, pharmacology, biochemistry, microbiology, and pathology, and to look at Ayurveda literature through the current science lens. The background literature, especially by C Dwarakanath, VJ Thakar and VV Subrahmanya Sastri made me feel that my approach was legitimate and scientific. I even authored a book titled Human physiology in Ayurveda, which became quite popular among our students as it saw many reprint editions [1]. The book discusses how Ayurveda physiology and current physiology are not inherently distinct and how they can be merged effortlessly. The book contains chapters with titles such as “Cardiovascular System”, “Digestive System” and so on, a pattern followed in most of the modern textbooks on medical physiology. I consciously selected the most rational versions of ancient aphorisms to make them appear relevant. I thought I was continuing the tradition of writing commentaries, wherein commentators amended the literature to suit their contemporary times. “This is a tradition that has kept Ayurveda vibrant and relevant”, I always thought. I viewed all my writings as commentaries on ancient scriptures. I also felt that it was my duty to be loyal to my subject and to the acclaimed scholars in whose footsteps I was following.
What I did not realise was that my efforts at this stage were directed at seeking validation of what I was supposed to teach, which was otherwise mostly obsolete material. This urge for validation was possibly rooted in the frustration that I had developed when this subject was taught to me during my graduate studies. About thirty years ago, I had observed and even ridiculed the primitive and obsolete nature of physiology contained in our ancient textbooks. I wanted my students not to perceive the subject the same way as I had, and wanted them to read current physiology more seriously. Hence, I made every effort to legitimise ancient literature using a strategy of “strained interpretation” (drawing unintended but convenient meanings of certain words and phrases using cherry-picked references from commentaries) — which I called “rationalisation” — to make it sound modern and relevant. A few of my teachers who followed this strategy had had a profound influence on me as they made it possible for us to connect very well with the subject.
However, Covid-19-related restrictions offered me a chance to read a few interesting articles and books, and sufficient time to introspect on certain points, which probably wouldn’t have occurred to me otherwise. This reading and introspection changed my perspectives so dramatically that I decided to write about it knowing very well that this might put my entire career at risk. But the truth must be told — and the earlier the better.
Below, I trace how I changed my perspectives on the subject. The books and articles that have had immense influence on my new thinking have been listed in the reference section. I try analysing my own faults in my past writings and viewing these mistakes through the falsifiability principle.
The problem of shukra
Here, I discuss why my approach was wrong by taking the example of shukra (semen). This was the most disturbing concept that I had to deal with during my graduate studies. Though testicles have been identified as the roots of the channels that carry shukra, Ayurveda proposes the formation of the same in majja (bone marrow), for whatever reason [2]. Ancient scholars also felt that shukra existed in the entire body [3]. Since I found it difficult to make it sound scientific, I took some references from commentaries and argued that the term “majja” need not exclusively denote bone marrow, but could stand for all tissues that filled bony cavities. One reference from a commentary on Sushruta Samhita referring to the brain as “Majja present in the cranial cavity” offered relief [4]. Hence, majja became two substances to me — brain and bone marrow. I argued that translating terms such as majja needed to be done more cautiously as this could restrict the original broader meaning. Then, I took another reference from a commentary stating that two types of shukra may be identified — one indicative of semen and the other indicative of a substance that was present in the entire body [5]. Now, my knowledge of modern physiology made me relate GnRH and other hormones in the hypothalamic-pituitary-gonadal axis with the substance that circulated all over the body. Since one of my teachers had also suggested this interpretation, I found it convincing. Thus, I thought, we had solved the problem by bringing in clarity. While I knew that the existence of hormones had only been discovered in the recent past, it did not matter to me as my enthusiasm to prove ancient Ayurveda literature relevant was boundless. On the basis of my postgraduate training, I argued that such interpretations were valid. Though the ancient scholars did not know what hormones were, the concepts were amenable to re-interpretation. If such an interpretation could reduce cognitive dissonance (the holding of conflicting beliefs simultaneously) among our students, I thought, “why not?”. Though I never suggested that the ancient scholars knew it all, I certainly made their writings sound relevant. “This is what all commentators have done”, was my justification.
Formation of the blood
This is another example which shows that the ancient scholars did not know in which organ the blood was formed, because they did not know what blood-cells were. Their observations were limited by the tools and other means to which they had access. Using some indirect references and laborious re-interpretation, one can argue that bone marrow was considered as one of the places of blood cell formation; but clearly it is not the case. They thought that the liver and spleen were the organs that imparted the red colour to blood [6]. Vagbhata added amashaya(stomach) to this list [7]. Incorporating the knowledge from physiology that describes the role of the liver and spleen in erythropoiesis in early life, one could argue that these too are very important organs in the formation of blood. One could also argue that this was known to the ancient scholars. Considering the role of the stomach in absorption of vitamin B12, Vagbhata’s proposition too can be justified. However, other than making our students feel that “physiology” is similar in both the systems, it does not serve any useful purpose. At the same time, in the name of re-interpretation, we do a disservice to our ancient scriptures. I must admit I have committed this error in my previous writings.
Even in my paper on the physiology of blood circulation, I have tried re-interpreting some principles of blood circulation that rest heavily on the writings of scholars such as VJ Thakar. My paper proposed that the description of three vascular segments such as arteries, veins and capillaries could possibly be traced back to Ayurveda literature. Similarly, by translating rasa as blood using some references from a commentary [8], it became easy for me to suggest that the scheme of blood circulation could be traced back to these ancient textbooks [9].
It is the same in other topics such as the role of kidneys in urine formation. Though there is no clear evidence to suggest that ancient scholars knew the physiology of urine formation, it can be argued otherwise through strained re-interpretation and can be made to sound as if they had this knowledge.
Now I realise that simply because the verses are amenable to interpretation, it is not in the true scientific spirit to superimpose modern science over classical references.
Rescuing tridosha theory
As tridosha theory lays the foundation for all aspects of Ayurveda, making it sound relevant was very essential for me. Ayurveda makes use of the concept of three doshas, viz, vata, pitta and kapha, to describe one’s constitution, to explain physiology, to plan diet and lifestyle, to explain the pharmaceutical effects of herbs, to explain the pathogenesis of different diseases, to explain various symptoms and to plan therapeutic interventions. It is the fundamental theory that all Ayurveda students deal with during their entire educational programme. One of my teachers had already convinced me that this was a mere theory and did not represent any material entities in the human body — which, I thought, solved most of the problems. I went on to elaborate how different entities in the human body at different levels of organisation could fit in well within this framework. I also included the most recent advances in neuro-endocrine immunology to justify this theory. All these efforts made tridosha theory look very practical, modern, relevant, and attractive.
Where is the problem?
Though such interpretations could apparently reduce cognitive dissonance among our students, as shown in our research on teaching methods [10], the key question remains: “What additional contribution do they make to Ayurveda?” The fact is that many of these topics are no longer relevant, and need not be in the curriculum in the first place. Why should obsolete physiology be taught to our students at all? I realised that all my efforts were directed at making the prescribed curricular framework look relevant and rational. That such laboured misinterpretation could lead to clinical misapplication and misjudgement is something we tend to forget. Such an approach could also smother innovation [11].
The curriculum of the recently notified National Commission for Indian System of Medicine demonstrates some of these fundamental errors. It prescribes stringent instructional methods such as Objective Structured Practical Examination (OSPI) and Case Based Discussion (CBD), to teach clinical skills in assessing many Ayurveda parameters in physiology such as dhatu-sara (form of clinical examination to assess the structural and functional health status of different tissues in the body); whereas, in reality, the practical utility of this concept is yet to be determined and there exists huge inter-rater variability in its assessment. This means that, when two or more physicians independently assess dhatu-sara of the same set of individuals, the chances of obtaining a significant level of agreement among these physicians are not high.
Applying the falsifiability principle
I must admit that I stopped at this point, and did not ask difficult questions that could possibly have made my existence in the system irrelevant. “If I argue that most of the theories and concepts of Ayurveda physiology are irrelevant, why should I be part of the system? How can I even say that the subject which I was appointed to teach is mostly obsolete? Will it not be an injustice to my subject and to my institution?”, and many such apprehensions kept me constrained within the prescribed curricular framework. However, change is not possible without introspection, and some disruption is required to trigger it.
Falsifiability is a principle that is used to distinguish between a scientifically sound theory and one that is scientifically weak. The concept of “null hypothesis” and “alternative hypothesis” proposed in our postgraduate research proposals has its origins in this principle. Karl Popper, the proponent of this principle, argues that “verifiability” is a weak proof to judge the validity of a theory. He takes examples from Freud’s psychoanalysis, Adler’s individual psychology and Karl Marx’s theory of history to show how all these theories can easily be verified. He goes on to demonstrate how each one of these theories can be rescued by proposing ad hoc conjectures or assumptions or re-interpretations. In short, he suggests that theories that cannot be refuted (at least in principle) cannot be called scientific [12].
What I realised was that, all these years, we have been attempting to rescue our theories using re-interpretation by introducing ad hoc conjectures. For example, instead of a straightforward translation of majja and shukra as bone marrow and semen respectively, by adapting the strategy of laboured interpretation, I had brought in ad hoc conjecture to propose “two forms of majja” and “two forms of shukra”. This makes our theories look even more unscientific — which is what I did not realise.
Let us take up a hypothetical example to understand this more clearly. Suppose we plan a study to record resting blood pressures among adults of different prakriti groups. Let our hypothesis be that the individuals with kapha prakriti could be more prone to hypertension as they tend to gain weight easily and are likely to be leading a sedentary lifestyle because of the “heavy” (guru) and “slow” (manda) nature of kapha. Kapha could also be leading to plaque formation in the arteries because of its “oily” (snigdha) nature. However, let us assume that the results of our study suggest something very different: “individuals with pitta prakriti tend to develop hypertension more frequently than those of kapha individuals”. Now we can argue that “pitta prakriti individuals tend to be more aggressive because of ‘hot’ (ushna) and ‘sharp’ (tikshna) properties of pitta, and hence, their overactive sympathetic nervous system might lead to hypertension”. Thus, every result can be justified, irrespective of what our actual hypothesis was. In this example, though the original assumption stands falsified, we rescue the theory by proposing an ad hoc conjecture and re-interpretation. This way, our theories will never be “disprovable” or “refutable”. Even in Charaka Samhita, similar ad hoc conjectures that were proposed to rescue the theory of tridosha have been observed by GL Krishna in one of his essays [13].
The way ahead
Alan Sokal, a reputed physicist, in an essay on pseudoscience has identified two categories of experts who advocate Ayurveda [14]. One of these groups refuses to accept the credentials of modern science by calling it “western ethno-science” and wants to retain Ayurveda as it is, whereas the other tries to portray Ayurveda as already containing the knowledge of all cutting-edge current research. This second group makes use of modern science to validate Ayurveda. Both these approaches are faulty and do not promote Ayurveda being subjected to rigorous scientific inquiry, he argues. Steven Engler has shown with examples that most Ayurveda literature does not fit into the current definition of “science” in its present form, though empiricism clearly exists therein [15]. When I read the book, The Intelligence Trap by David Robson, I could immediately relate it to many intellectuals who advocate Ayurveda, even though they may not have undergone any formal training in Ayurveda. This book delves into an emerging field called “evidence-based wisdom” [16].
Ayurveda clinicians have always been arguing that Ayurveda is a holistic science and the prescriptions they write are highly individualised. That they generally make this an excuse to evade scientific scrutiny, is what I have gathered. This escapist attitude serves neither science nor humanity. The current trends in Ayurveda research do not call for a re-examination of basic Ayurveda theories. For instance, the inter-rater variability of the assessment of prakriti is very high. But we have not asked the questions — “Does the tridosha theory need modifications?” or, “Can prakriti assessment be made more reliable by removing those markers / traits that lead to maximum divergence?”. We assume that our texts are ever-relevant and irrefutable. Most of our research starts with the premise that these theories are true and are unquestionable [17, 18, 19, 20, 21].
In science, nothing should take precedence over finding the truth [22]. We must not hesitate to put our practices through scientific scrutiny. The scientific attitude is universal, and it cannot change from one stream to another. The immediate need is to evolve a rigorous method to identify such content in the present curricula of Ayurveda programmes that can safely be dropped. The logical next step is to subject our theories and principles to scientific scrutiny. Instead of teaching obsolete concepts in Ayurveda anatomy and physiology, the Ayurveda system deserves that our students be taught in-depth contemporary anatomy and contemporary physiology, since understanding the biological basis of a disease is essential for any physician, irrespective of the stream.
Acknowledgements: I thank Dr GL Krishna and Dr Narendra Khairnar for suggesting some vital reading material. I also thank Dr GL Krishna for triggering this process of introspection.
References
- Patwardhan K. Human Physiology in Ayurveda. Series No. 134. Varanasi, India: Jaikrishnadas: Chaukhambha Orientalia; 2005.
- Sharma RK, Dash B, eds. Charaka Samhita, Chikitsa Sthana, Vol 4, Chap 15, (30-35). Second Edition. Varanasi: Chowkhambha Sanskrit Series Office; 2000; p 19-21.
- Sharma RK, Dash B, eds. Charaka Samhita, Chikitsa Sthana, Vol 3 Chap 2, (46-49). Third Edition. Varanasi: Chowkhambha Sanskrit Series Office; 1998; p 103
- Dalhana. Nibandha Sangraha, Commentary on Sushruta Samhita, Sutra Sthana, Chap 23: 9(12). National Institute of Indian Medical Heritage. eBook [Cited 2022 Jun 29]. Available from: https://niimh.nic.in/ebooks/esushruta/
- Paradkar HS, ed. Hemadri in Ayurveda Rasayana commentary on Ashtanga Hridaya, Sutra Sthana. Vol 1, Chap 11, (37). Eighth Edition, Varanasi. Chaukhabha Orientalia. 1998; p 189
- Murthy KRS, ed. Sushruta Samhita, Sutra Sthana. Vol 1, Chapter 14, (4). Second Edition, Varanasi. Chaukhambha Orientalia. 2004; p 87
- Paradkar HS, ed. Asthanga Hridaya, Sutra Sthana. Vol 1, Chapter 12, (13). Eight Edition, Varanasi. Chaukhambha Orientalia. 1998; p 194
- Sharma RK, Dash B, eds. Chakrapani Datta in Ayurveda Dipika commentary on Charaka Samhita, Chikitsa Sthana, Vol 4, Chapter 15, (36-38). Second Edition, Varanasi. Chowkhambha Sanskrit Series Office. 2000; p 22
- Patwardhan K. The history of the discovery of blood circulation: Unrecognized contributions of Ayurveda masters. Adv Physiol Educ. 2012;36:77–82. https://doi.org/10.1152/advan.00123.2011
- 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.
- Krishna GL. Ayurveda’s bane. The Hindu. April 15, 2018. [Cited on 2022 Jun 20]. Available at: https://www.thehindu.com/opinion/open-page/ayurvedas-bane/article23540373.ece
- Popper K. Science as Falsification. Originally published in: Conjectures and Refutations. 1963. [Cited on 2022 Jun 20]. Available from: https://staff.washington.edu/lynnhank/Popper-1.pdf
- Krishna GL. The Ayurvedic Dosha Theory: A Deconstruction. Confluence. July 11, 2019 [Cited on 2022 Jun 20]. Available at: http://confluence.ias.ac.in/the-ayurvedic-dosha-theory-a-deconstruction/
- Sokal AD. Pseudoscience and Postmodernism: Antagonists or fellow travelers? In: How pseudoarchaeology misrepresents the past and misleads the public. Editor: Garrett Fagan. 2004. [Cited 2022 Jun 20]. Available at: https://physics.nyu.edu/sokal/pseudoscience_rev.pdf
- Engler S. “Science” vs. “Religion” in Classical Ayurveda. Numen, Vol. 50, No. 4 (2003), pp. 416-463.
- Robson D. The Intelligence Trap – Why Smart People Make Dumb Mistakes. Publisher W. W. Norton. Digital Version. ISBN 0393651436. (2019).
- Krishna GL. The Need to Recast the Dosha Theory as a Heuristic. The Indian Practitioner, Vol.75 No.1 January 2022. [Cited 2022 Jun 20]. Available from: https://journals.indexcopernicus.com/api/file/viewByFileId/1453815.pdf
- Krishna GL. Ayurveda awaits a new dawn. Indian J Med Ethics. 2022 Jan-Mar;7(1)NS:16-21. https://doi.org/10.20529/IJME.2021.093
- Krishna GL. Ayurveda Needs an Intellectual Reinvention. The Sciences. November 24, 2020. [Cited on 2022 Jun 20]. Available at: https://science.thewire.in/the-sciences/ayurveda-needs-an-intellectual-reinvention/
- Krishna GL. The History of a Superstition. BMJ Blogs. May 21, 2019. [Cited on 2022 Jun 20]. Available at: https://blogs.bmj.com/medical-humanities/2019/05/21/the-history-of-a-superstition/
- Lakhotia SC. Need to Demystify Ayurveda. The Indian Practitioner,2022; 75(2):10-11
- Singh S, Ernst E. Trick or Treatment? Alternative Medicine on Trial. Bantam Press, 2008.
Better late than never!
I extend my warm congratulations to Prof Kishor Patwardhan. He needn’t feel diminished. The greatest glory of a man is not in never falling, but in rising every time he falls.
Instead of hounding Prof Patwardhan for his changed stance, I hope ayurveda academics take a leaf out of his book and become a bit conscientious. Things will begin to look up if just a dozen of them become as intellectually honest. Fundamentally, academics getting fat salaries from government-run institutes need to see how sinful it is to hand over an unprocessed proto-science to gullible youngsters and then mislead them into believing that it is a super-sophisticated advanced science.
As a medical system, Ayurveda is valuable immensely for its observations, only marginally for its theories, and not at all for its speculations. As long as the academia stays intellectually inept to grasp this basic truth and modify its approach accordingly, it will continue to be a madhouse. With better funding, it’ll only be a better-funded madhouse.
The praxis and solution of this catch 22 situation can only be obtained when ayurveda is first studied in an non prejudiced manner. i.e understand the concepts in an non judgemental approach. For this the main requisite is
1.An through knowledge of the language of samskrit for five years which lays the foundation for understanding the core concepts in its pristine form
2.Application of these concepts on an clinical level and appreciate the soundness of its infallible accuracy
3.Application of research methodology as explained by our acharyas in tantra yukti and vimana sthana of Charaka and an interpolation of those principles should be sought out from persons proficient in vedanta and Nyaya/Samkhya shastras (Indic Philosophy).
When these things becomes enshrined in our whole being we reach an stage of appreciating the comparitive analysis to allopathic system and it’s research methods.
We get an prejudiced teaching right from our Undergraduate days by trying to understand both systems simultaneously which catapults us to an false air of superiority and trying to do “analysis by paralysis”. Modern allopathic people make fun of ayurvedic system because of these reasons.
Falsifications principle of Karl, refutation principle are everything enshrined in tantra yuktis which we never apply. There are many more principles over there which is still unknown to the realms of modern sciences research methodology.
Such article can only be written by theoretical persons and not by the one who is capable enough to apply the principles of Ayurveda in practice. One can not reach at any conclusion by mere sitting in a room with a pen and a paper and some reference articles and books. Ayurveda is more of subjective and Importance is given to functional aspects. Many of things can neither be translated nor be interpreted in terms of western science. Author has no right to come to the conclusion to call the concepts of Ayurveda as obsolute. His very statement i..e Tridosha is a theory itself is wrong. Tridosha is a theorem and we are able to practice based on the tridosha theorem and cure several patients. Such ignorant papers might mislead the young generation. Ridiculous article. I pray sincerely that such articles dont come up in the future and may this person be cornered and not entertained.
Dr. Patwardhan must be applauded for his forthright assessment of the teaching of physiology to Ayurvedic students today.
His final paragraph is an excellent summation of the logic behind his arguments.
May I suggest that a similar approach be used in teaching every subject in Ayurvedic medicine? Whilst gold must be retained, dross must be discarded ruthlessly without allowing disabling sentiment to interfere.
Our Ayurvedic students deserve access to the latest scientific advances and knowledge just as much as do students in other branches of medicine.
This is what happens when you separate a healing system from its base. This was done when the British doctors found that the people of India did not turn to their superior science and preferred to stick to ayurveda. A commission was set up. The commission decided that ayurveda was a mixture of religious texts and herbal practices. Worse these herbalists were also dead against the small pox vaccine program and attempted to deal with the vaccine toxins in their own way. The recommendation was that ayurveda should be divorced from its philosophy and the ayurvedic colleges instructed to pursue the scientific method. This created a horde of graduates who were neither here nor there. Taught by the gora sahebs these physicians thought it better to endear themselves to their new found teachers.
The anatomy and physiology of ayurveda depends upon the Samkhya philosophy. The basic building blocks are space, air, fire, water, and earth based on which we have constitutions like vata, pitta and kapha. There are three states of mana, buddhi and ahankar (mind, intellect, ego). And there are mental states of sattva, rajas and tamas (purity, passion, and inertia). There is also the energy body with 6 invisible energy vertices in the spinal region and 72,000 channels that are within and without forming the aura. The vitality that drives all processes is termed the prana shakti. All of this was considered superstition.
The same thing happened with homeopathy. In India the course curriculum is designed the mainstream way. Homeopathic philosophy and holism is paid scant respect and students are taught pathology based medicine. They are also told in no uncertain terms that they must bow down to the dominant concept. The emerging physicians thus have no qualms about suggesting antibiotics and falling at the feet of vaccination. The discerning ones study the real science after they pass out.
We are much taken up by anatomy, physiology and pathology. We dream of hijacking every cell of the body, reaching into the mitochondria and DNA to come out with miraculous cures. But disease proliferates and patients suffer all their life.
To heal one needs to understand how the whole system works driven by vitality. Symptoms are guiding forces. Delving into the mind and emotions offer solutions. Instead of cutting open everything the full system is to be used for a cure.
Thank you for this honest and introspective article on Ayurveda physiology education. The need is long overdue for the application of a rigorous scientific and evidence-based approach to how Ayurveda is taught and practiced. The treatments that work should be tested prospectively in RCTs and the ones that fail to improve outcomes should be discarded.
Respected Sir,
This introspection and the bold decision to accept it openly is really commendable.
I think you have opened Pandora’s Box (if others in ‘power’ do not close it forcefully).
A person like you, who has gone far deeper in so-called ‘scientific evidence’ and realized that something is going wrong, will be the real torch bearer for the future generation.
If i may, i will humbly suggest you that human anatomy and physiology is much beyond the perception of scientific evidence. A simple example: I think we can rely completely on western science has understood the human mechanics only if it can demonstrate, in vitro, ‘meal’ being digested and converted into Rasa, Rakta etc body tissues…. till then, lets not undermine the wisdom of Rishis…..
Nicely presented sir..
Nobody present there mistakes in understanding..
As you said there should be some standards made for many of Ayurveda examination methods like sara ,prakriti etc..
Kishor Pawardhan has exposed the hollowness of the anatomical and physiological underpinnings of the Ayurvedic curriculum. Himself a widely published researcher and an accomplished teacher of Ayurvedic physiology he confesses that he too interpreted the Ayurvedic texts in the quest for “validation of what I was supposed to teach, which was otherwise mostly obsolete material…(my) enthusiasm to prove ancient Ayurveda literature (as)relevant was boundless…. though I never suggested that the ancient scholars knew it all, I certainly made their writings sound relevant” he writes in a frank, four page personal essay. His justification for his having followed the beaten track is ironically “that all commentators had done it” and he wanted “ to make the writings of ancient scholars sound relevant.” Having himself subscribed to this subterfuge he laments that “simply because the verses were amenable to interpretation, to superimpose modern science over classical references was unscientific.” He warns that “Such laboured misinterpretation could lead to clinical misapplication and misjudgement” and could also “smother innovation”.
For this Mea culpa to come from one of the most published and respected Ayurvedic teachers and researchers would have taken enormous courage -more so as he continues to be a serving member of the Faculty of Ayurveda at BHU. By doing this, Dr Patwardhan has raised issues which the NCISM must confront with an open mind and academic integrity.
While castigating the analogies used in interpreting Ayurvedic physiology, based on compelling rationale, I wish Dr Patwardhan had also highlighted where Ayurveda actually scores in contemporary times and how it provides a scholastic basis for most health traditions, tribal and folk medicine and countless home remedies which Indian families continue to use throughout the country. Lakhs of formulations included in the Traditional Knowledge Digital Library are accessible to 13 patent offices worldwide and India’s approach has been recognised by the World Intellectual Property Organisation. The formulations have been painstakingly listed after relying on the actual stanzas in the ancient texts. This endorsement of the utility of ancient knowledge validates Ayurveda is matchless.
This seminal work of TKDL has helped foil hundreds of patents filed before international patent examiners who have rejected the so- called inventions and discoveries based on the documentation in the ancient texts available in digital format. If patent examiners across the globe have given credence to this traditional wisdom why cannot the NCISM include this in the curriculum of Ayurveda and other traditional medical systems in India ? Similarly, Ayurvedic herbal and other formulations along with Panchakarma procedures have become popular and are being utilised by a significant population for various health issues.
NCISM needs to encourage the study of these based on published therapeutic and observational studies. Students of Ayurveda also need to be convinced how far the observance of the Ayurvedic daily and seasonal regimen contribute to healthy life-styles , increased longevity and fostering mental peace and a happy disposition.These too are integral teachings of Ayurveda.
If instructed properly the students on becoming practitioners could teach people to invest in their own health the natural way. The practitioner, the educationist and the researcher if equipped to deal with real health and life-style situations, before there is a need for hospitalisation is felt, could answer a real need . Instead of regurgitating Sanskrit stanzas propped up by shaky interpretations as Dr Patwardhan has illustrated, millions of Indians could receive direct benefit from contemporary approaches . NCISM needs to focus on a curriculum which teaches students to give people what they are seeking; to prepare future practitioners to take on the mantle of family doctors with a grounding in anatomy, physiology, pharmacology but also a knowledge of the properties of plants and their application which is the real strength of Ayurveda. If this is done by addressing the needs of the population from birth, childhood, adolescence , middle into old age, Ayurveda could still become the answer the world is seeking.
Kishor Patwardhan has been forthright and what he has said must be examined and acted upon by NCISM. I wish he had also clarified that Ayurveda continues to have enormous relevance provided the claims are based on published, peer- reviewed research not on didactic claims and rhetoric ! Were NCISM to teach students why peer reviewed published work is essential and were to provide access to practical knowledge and skills, Ayurveda could yet reinvent itself !Until then start by listening to Dr Patwardhan !
It is commendable that Prof. Patwardhan has commenced a bold step towards retracting from the justification of the injustifiable. But that does not validate the need effectively to learn subjects of basic modern medical science, to update the knowledge of the aspiring. It would be wise if the student of Ayurveda sticks to the principles and practice of Aurveda according to the traditional system and leave the modern medical science to the others who are aspirants for that science..
I am not a medical professional. I teach and research in management and business admin. The problem is one of seeking only objectivity as truth. If the subjective experiences and the decisions that emerge from them give superior results, then why not accept the role of the “subject” as a “variant” agency. Outliers in many instances are more interesting and research as a vocation has to accommodate for outlying subjects too. If the above is acceptable, as teachers and researchers more of our time will be spent in cleaning up ourselves rather than in pursuing truth out there, outside.
When such a view of “subjectivism” is adopted, then we will be training people to be wiser, more peaceful, and compassionate from inside. When that happens the practitioner will automatically carry truth, his or observations will be more tuned to deeper truths, and through processes not understood through science, healing would simply happen.
Firstly let me congratulate you for this. It’s a self introspection. I too have gone through the same stage during my early days. But seeing the stalwarts like Sri P. K. Warrior Sri Raghavan Thirumulpadu Sri Rajagopal and of course my father who (all of them ) were not only academicians but also roaring practitioners I thought what I learned and comprehended was not upto the mark
But today I after I have put not leas than 36 years of practice and also 15 years of academics I think we need to re evaluate our principles. I can also imagine so many eyebrows going up. But I feel some one should say that the king is nude. Let this article be a reason for this.
Respected Kishor Patwardhan Sir,
I am an Ayurveda Scholar and have recently completed my MD from AIIA and am currently pursuing PhD from IIT Delhi. Your each and every word serves the raw opinions and I too accept the insights you have stated. I am certain that the education system of Ayurveda needs to be invigorated and transformed. I trust that there is a furthermost necessity of remodeling the assemblies which holds the whole Ayurveda citadel. Rather than generating fixed distorted limited unquestioned cerebral understanding there should be a space to actually develop a learning. During my course work at IIT Delhi I realized what all we are actually missing and that gap has been clearly addressed in your article. It addresses how important it is for us to foster a learning culture for continuous improvement in our propagation. Ayurveda is a science of Human lives which is entirely conceptual and its thoughtfulness cannot be constructed on cramming methods. Cognitive learning is based on information which needs to be essentially felt by our senses, which somehow, we are lacking behind. It is also based on memory but it does not advocate cramming information. It focuses on creating an environment of mastering the concept, which helps learners relate to their sensory experience. Instead of memorizing concepts, a practical approach is now the prerequisite. We on the one hand infuse the narrative of reproducibility and on another hand the conceptual understandings and intellectual reasoning diverges within an institution. This has resulted in an atmosphere of limited approaches. This undiluted form of science and its education methodology leaves students with confusion, misperception, self-doubt and imprudent with cramming mnemonics or dissatisfied with the enlightenment we receive. This is a major setback in our course of study which in the future is going to be a major challenge. We all are now on the edge of being answerable to the people, and now we are actually ready for this revolution. Revolution is done best when it’s considered most difficult, impossible but yet inevitable.
These are my emotions as a learner who is seeking knowledge but could not quench my thirst, failed to find space for my individuality like many other students and also refuse to thrive on survival techniques. who all were meritorious till senior secondary and in Ayurveda are still struggling with the dilemma unlike few others who have conditioned their survivals.
Still based on personal experience i have seen ayurvedic and homeopathic medicine work better, for my allergy modern medicine was nothing but a complete waste of money, but homeopathy cured my allergy. So I feel your article is full of bs
The author has made an reference to blood pressure,and tried to evaluate it in the field of ayurveda.It means that it’s accepted and a given that the principles of blood pressure is true. Now let’s apply falsification of Karl here. 1.Eucledian mathematics can only be applied to linear objects,whereas heart and vessels are non linear
2 According to Fluid mechanics cosine 90 is zero i.e fluid moving in an tubular structure can’t apply pressure laterally
So in this what is really blood pressure. Please go through Dr B.M. Hegde’s speeches on this.
Also please do refer the book “Death by prescription”and see the nature of allopathic models.
Dear Dr. Suresh Kumar,
In fact, teachers like me, who teach non-clinical subjects, have always been made to feel that all the principles and theories that we teach are useful and applicable in clinical practice. It is primarily the physicians who propagate such impressions. It took me years to realize that it is mostly not the case. If a few more physicians gather the courage to say what you have said can truly change the system.
Thanks a lot for your comment!
Dear Dr. Kavita,
Thanks for your comment. Good to see our students speaking up their minds. I wrote this essay primarily to address the problems our students face. Teaching obsolete concepts could have been still justified if they were taught as “historically important concepts”. But no! Students are expected to cram hundreds of such Sanskrit verses so that they can correctly answer all MCQs in their postgraduate entrance examinations! We have shown in our research that more than 90% of MCQs in such examinations assess only the “Recall” component. Questions assessing higher-order thinking skills do not find a place in these question papers. The fact you draw our attention to that “interpretation and explanation of the same theory varies a lot within one institution” simply means that these theories are not fully refined.
Thanks for your comment.
Dear Ms. Shailaja Chandra Madam,
Thanks a lot for your remarks!
My essay, as you can make out, is focused only on Ayurveda Physiology. Within the given word limit, this is what I could write. You have closely observed the Ayush sector for many decades and your impressions are of immense value. I do not undermine the positive aspects of Ayurveda. Medicinal plants, different formulations, and therapeutics – are the areas that truly deserve our attention.
However, there is no sufficient evidence to suggest that our theories typically guide our physicians in their clinical decision-making except as heuristic models. One of the established Vaidyas too has accepted this fact here in his comment. What I am arguing here is that if these theories are not guiding decision-making, then there is a need for these theories to be tested/ modified/ discarded. Our students spend a lot of time cramming hundreds of shlokas describing these theories which they are unlikely to put into clinical use.
We need to make Ayurveda a dynamic inquiry-based science instead of projecting it as a faith-based tradition is what I am trying to suggest here.
Thanks again for your thoughtful remarks!
Dear Dr. GL Krishna,
Your scholarly work in demystifying Ayurveda as it is taught, practiced, and researched today is of immense value.
I sincerely hope that all stakeholders give due attention to your publications. In fact, your work deserves much more attention than what it has received so far.
Thanks for triggering all this introspection!
Dear Dr. Naveenchandar,
Thanks for your comment. However, I would like to point out here a myth that we have been carrying along. This myth is that basic sciences such as anatomy and physiology exclusively “belong” to current biomedical sciences, or, so-called “modern” medicine. Don’t you think this attitude of “owning” an entire branch of science is detrimental to the growth of science itself?
Very interesting and relevant introspection at this important juncture. Will this revisit lead to a new way of looking into Ayurveda?
I being a student can understand the power of Ayurveda but you being a teacher that too for many years in a renowned college don’t know what you are saying that too at a public platform. I’d rather suggest you to read samhitas and try and start practicing Ayurveda because it’s never too late for anything.
I really wish you get to rectify your mistakes before it’s too late and plz listen to real renowned vaidyas on you tube it may work as an eye opener to you and you may get to unfold beautiful principles of Ayurveda. And still if you feel that we need to obsolete the text written in our samhitas then I guess you should resign because we don’t need teachers like you… You’ve earned in the name of Ayurveda and now you are demeaning it, you should feel shameful… This is not acceptable…
This is a comment made by a person who fully believes in the Western system of medicine, and has never used Ayurveda.
1. It is going to be nearly impossible to rationalize Ayurveda on the terms of modern medical practice because the criteria of scientificity are fully tilted towards the jealous and exclusive rationality of modern medicine.
2. Popper’s criterion of Falsification, while a good one to design experiments, cannot lead to the success or failure of sciences. Thomas Kuhn has critically addressed this criterion and suggested that instead, what constitutes scientific knowledge is a dominant paradigm. The dominant paradigm today is that of Western medicine — and this paradigm is woven deeply with that of modern scientificity.
3. If one wants to make a dent, it would be to address the criterion of falsification to modern medicine and show where it fails where Ayurveda succeeds. It is not at the level of theoretical formation, but at the level of practical application, the definition of medical cure and the healing of the patient that the attack is to be made. One has to demonstrate the failings of the modern paradigm and show how Ayurveda can, if at all, prove better.
4. This will require moving into the domain of individualized cures rather than RCTs and EBM in the traditional Western model.
5. There is a somewhat curious (though) common misunderstanding in the paper. The null and alternate hypothesis concept is not a Popperian innovation. It was introduced by J Neyman and E Pearson who wrote a paper on this in 1933, a full year before Popper’s Logic der Forschung (the German original of what became famous as The Logic of Scientific Discovery).
Congratulations and best wishes to the author for initiating this difficult direction of thinking!
Dear Ms. Kirti Sharma,
This is an academic debate and as soon as you start a personal attack, the debate loses its meaning.
Please tell us which statement in the essay is wrong and why. Do you still think that the blood cells are formed in the stomach? Do you still think the role of kidneys in urine formation has been explained in Ayurveda classics? If yes, please share the details. And please read one of the interesting comments shared by an established Vaidya on this page.
Thanks for your interest.
Being a teacher for years your concepts and basics about the science and not clear and you are here to defame ayurveda out of your ignorance
Not at all acceptable
Thank you, Dr. Srivvatsan,
Your comment has been really helpful. I agree with the points you have raised and I am convinced that we need to keep these facts in mind while framing further strategies.
Thanks for your interest!
“What ails the current approach to Ayurveda” – My recent essay in The Hindu might help put things in perspective.
https://www.thehindu.com/opinion/op-ed/what-ails-the-current-approach-to-ayurveda/article65624019.ece?homepage=true
I am an Ayurvedic Vaidya, practising for the last 26 years in Kerala, attending all types of cases despite a post-graduation in Salakyatanthra. I was teaching in Ayurveda colleges and was a principal of an Ayurveda college for 5 years. Parallel to formal education, I have had the opportunity of learning Ayurveda traditionally under Vaidyabhushanam K. Raghavan Thirumulpad for 21 years. With this background, reading Dr Kishor’s confessional essay was an interesting exercise.
To confess is not a bad art especially when you feel guilty about some of your past actions about which you feel ashamed or embarrassed. Your action might have affected the lives of many, but still, that cannot be considered illegal under a court of trial, and the victims of your crime have no opportunity to ask for legal and deserving reparation. Confessions of an individual are the results of deep introspection. They are also the doors (or windows) for many others outside to introspect and confess. That way, Dr Kishor’s confessions are important and praiseworthy. I congratulate him on that.
Dr Kishor narrates his own experiences of teaching Ayurveda physiology through an approach that involved a laborious reinterpretation of ancient literature using the recent advances in the field of medical physiology. Now he is convinced that his earlier writings were faulty. And he argues that instead of using such reinterpretation to prove obsolete concepts, they can be dropped altogether from the curricula of Ayurveda programmes.
He puts his ideas to move forward in three statements: 1, the immediate need is to evolve a rigorous method to identify such content in the present curricula of Ayurveda programmes that can safely be dropped, 2, the logical next step is to subject our theories and principles to scientific scrutiny and 3, instead of teaching obsolete concepts in Ayurveda anatomy and physiology, the Ayurveda system deserves that our students be taught in-depth contemporary anatomy and contemporary physiology.
This is not a new demand. There were uproars and outcries to revoke obsolete Ayurvedic theories (especially related to Sareera) in the past also. I remember, in Kerala, there were many scholars like Dr C. R. Agnives, Dr N. V. K. Varier and many others of the same feather who had this opinion years back. They had very strong feelings that the topics should undergo rigorous validation. If I remembered it right, Dr N. V. K. Varier, a hard-core Marxist, had gone to the level of opining that the tridosha theory cannot be accepted unless and until it is validated using the methodology of dialectical materialism. (Of course, they might have changed it later). It was there in the air of the Ayurveda campuses as one among the students’ union demands in the 1980s (or even earlier) to drop all obsolete sections from the curriculum. Students’ unions believed that the syllabus shall be subject-specific and not text-specific. They also observed that the Sanskrit language was a big obstacle as far as the proper articulation of the topic in the classrooms is concerned.
This is not a matter to be commented upon by emotional compulsions. We should look into this matter seriously.
It shall be accepted that Ayurveda academy (not only in BHU, but all across the country) is not working on Ayurvedic premises. This is the most important point that one should understand about Ayurvedic education in India today. It is an amorphous mix of Ayurvedic literature and allopathic explanations and a predominantly allopathic practising style. All literature in Ayurveda – commentaries on classics, textbooks, guides, or popular stuff – written in the last 100 years (or more) shows the same tendency in varying degrees, to explain Ayurvedic principles and practices in terms of modern science. This was considered a big ‘scientific act’ that keeps on revitalizing Ayurveda. Dr Kishor correctly identifies this in his confession.
As all the academy is uniform that way, and as all the teachers are academically trained, all the students of Ayurveda in the last 75 years (at least) were influenced by this way of revitalized and ‘scientificised’ Ayurveda in their formative years and that continues.
There are many states in India where Ayurveda doctors practising allopathy is permitted: in some places it is legitimate, but in some others, it is tolerated. There is a big change in this trend towards the south. Here, Ayurvedic doctors practise Ayurveda and otherwise it is considered quackery. In Kerala, my home state, Ayurveda enjoys a high degree of social patronage and the public never prefers their Ayurvedic doctors practising allopathy. It is not legitimate as well. But from Central India to the entire North and East, it is not so. Only a handful of graduates stick on to Ayurvedic practice. Even the academies make no exception in this regard. This is not a new development but continues to be so for decades. There is every reason to think that this influential group of vaidya-turned-allopaths contributed heavily to designing the Ayurvedic curricula from time to time. This is one important factor, among many others, behind the ever-increasing allopathic load of the Ayurveda syllabus and the allopathic interpretations of Ayurvedic literature.
Similarly, the farrowing of books and guides by some ‘professional’ writers as dictated by monopolised publishers and the listing of such worthless comparative literature in the syllabus as text or reference, have also contributed significantly to the trend of making Ayurveda more and more ‘scientific’. (There are many other factors, which include social and political, behind this. But I am not going to elaborate on them in this piece).
Dr Kishor is trying to see everything in the light of modern science. Meantime, there are issues in his observations. Putting Popper’s falsifiability principle to evaluate the scientificity of Ayurveda is the first one among them. The falsification principle deals with modern science and not Ayurveda. Ayurveda operates as per its methodology which is different from that of modern science. Even in the case of modern science falsifiability is not an unchallenged approach. Many authors have highlighted their discontent in this regard.
He points out that there is a tendency among Ayurveda scholars to rescue their theories by proposing ad hoc conjectures and reinterpretations whenever they are refuted. But interestingly, this allegation is equally applicable to falsifiability as well. For example, in one of his interesting articles, Adam Becker, a writer and astrophysicist, observes that “falsifiability doesn’t work as a blanket restriction in science for the simple reason that there are no genuinely falsifiable scientific theories. I can come up with a theory that makes a prediction that looks falsifiable, but when the data tell me it’s wrong, I can conjure some fresh ideas to plug the hole and save the theory” (https://aeon.co/essays/a-fetish-for-falsification-and-observation-holds-back-science).
The biggest difference between modern science and Ayurveda is that the former is very reluctant to accept the existence of a principle called consciousness whereas the latter cannot be construed at all without the principle of consciousness. This is an important point that is to be identified while criticising Ayurveda from the viewpoint of modern science. It may be interesting at this point to recollect Galileo Galilee’s famous observation that “consciousness exists completely outside the physical realm” and hence it is not within the framework of science. Ayurvedic theory and practice spin around a living body which is more qualitative than quantitative. And modern science finds it very difficult to accommodate something qualitative.
Let us forget all these debates. After all, I always wonder what is wrong with Ayurveda being considered and continuing as a non-science. Science is one method of inquiry, but not the ultimate one. There can be many other methods. And the methods of science need not be as innocent and unbiased as highlighted by its followers. There are many scholars, not Ayurvedic, across the world who criticise the methods of science for many valid reasons. So, even if one admits Ayurveda is a non-science, it is not a matter to be ashamed of. Still, it can be a valid tool of enquiry.
There is always this question in the air regarding all systems of Medicine: Is medicine a science or art? Philosophers of medicine always appreciated the art in it. Ayurveda is always more about philosophy and art than about the science in it. What is derogatory about it?
Dr Kishor tries to focus primarily on his domain i.e., Kriyasareera. With some examples, he highlights the idea that the principles of kriyasareera are not scientific. They are obsolete pieces that should not be taught to any modern student. When you have a notion in your mind that it should be ‘scientific’, then you become judgemental about everything and start scrutinising. Unfortunately, it is scrutiny using the concepts of modern scientific physiology which you have accepted as the base. In this scrutiny, when you validate one Ayurvedic principle and accept it as scientific or otherwise, it shall not be forgotten that the tool with which you evaluated the principle itself need not be valid tomorrow. Because they are ‘scientific’ and they are on an intensive falsification drive throughout and may be refuted tomorrow. Then what will you do? This is the fate of all tools of scrutiny that you are going to employ to validate Ayurveda.
The branches of Moulika sidhantha, Kriyasareera, Roganidana, and Kayachikitsa in Ayurveda should work in sync in the academy. There should be creative dialogues between them. Projecting the Maulika Sidhantha to a living body is what is called Kriyasareera. Proper understanding of these two is essential for proceeding to learn and practice Nidanasasthra. Chikitsa is the prayoga of what the learner has gathered through the proper understanding of the earlier three. Maulika Sidhantha represents all the theoretical foundations of the sasthra. It has in it many inputs from different philosophical schools called darsanas like Sankhya, Nyaya, Vaiseshika and Advaitha. Ayurveda darsana tries to accommodate the essential components of all these schools that are beneficial in its context, i.e., understanding the living body. Many basic principles of Ayurveda are adaptations, modifications or improvisations of the approaches that one sees in darsanas. Understanding and explaining the living body based on the Maulika sidhanthas is called Kriyasareera. The learner needs to understand the functioning method of the body in the Ayurvedic way. It is this training which prepares him for the understanding of Nidanasasthra. Only with the background of Kriyasareera and Nidanasasthra, the learner succeeds in understanding the methods of chikitsa properly. The application of sidhanthas varies with changes in place and time. Earlier explanations may not be sufficient to explain a new experience. This may initiate new discussions about the validity of existing sidhanthas in that regard. Accordingly, new insights about the body may emerge. These insights may contribute to modifying the existing sidhanthas or proposing new ones. It is the regular exercise of giving and taking between the four quarters that makes the Ayurvedic body of wisdom vibrant and new. All the contemporary understanding of the body and its diseases shall be incorporated into these exercises. This shall be a regular event in all academies. The departments shall not be water-tight compartments. And the clinical-nonclinical divide, which is not original to Ayurveda, shall not grow beyond the purpose of administrative convenience.
The above exercise is not going to be beneficial to the sasthra, its students or society if it is not carried out on Ayurvedic premises. It is neither just an accumulation of data nor validation of the principles using some tool that is not meant for the job. It is an organic procedure to connect the theory and practice uninterruptedly happening within the system. Practice shall be the real testing ground for theory. In Ayurveda, the real practitioners are outside the campus. The teachers shall reach out to them and see how they put the theory into practice. This is not happening at present. There they think that Ayurveda is all about the Samhithas, their interpretation, reinterpretation and ‘scientific’ manipulation. This has caused great damage to the methodological integrity of Ayurveda. This is to be regained and put back in place.
Dr Kishor makes a statement towards the end: “Instead of teaching obsolete concepts in Ayurveda anatomy and physiology, the Ayurveda system deserves that our students be taught in-depth contemporary anatomy and contemporary physiology, since understanding the biological basis of a disease is essential for any physician, irrespective of the stream”. This statement shows that though confessional, Dr Kishor is nowhere near to suggesting a real solution. Concepts of Ayurvedic anatomy and physiology are not obsolete. They are to be understood and taught on Ayurvedic premises. Regaining the original premises of Ayurveda in teaching and practice is the only solution here. He thinks that the biological basis of diseases is universal sans boundaries of different systems. That is not true. Each system has its way of understanding the biological basis of diseases. And that is its originality and that is why we have different systems. You cannot expect to practice Ayurveda with a biological understanding of the disease in terms of modern medicine. A Vaidya should have an understanding of a disease based on Ayurvedic kriyasareera to treat it in the Ayurvedic way. For example, we treat diseases diagnosed by modern medicine by different names like chronic kidney disease, epilepsy, Ulcerative Colitis, Autoimmune Thyroiditis etc. This is done using the principles of Ayurveda Kriyasareera and not the biological basis of those diseases as explained in modern medicine. Meantime, the Vaidyas need not keep their eyes and ears closed when it comes to the contemporary understanding of these diseases. All those information is complementary to the Ayurvedic understanding when you are trained to foot firmly on your Ayurvedic platform.
Dr Kishor thinks that Ayurvedic theories are not tested and the scholars always think of them as irrefutable. This is not true. Ayurvedic principles are repeatedly tested. Unfortunately, Dr Kishor is not getting any idea of this, I am afraid. The real testing of theories is continuously happening in clinical practice wherever it is done in an Ayurvedic way. Vaidyas do not think the textual propositions as irrefutable. For example, nagaradi kashayam (the famous amruthotharam kashayam) is indicated in the text for treating jwaras of all dosha predominance. Vaidyas put this indication under repeated trial. As a result, they understand the qualities of the combination well. They do not prescribe this kashayam in jwaras of all dosha predominance. It is prescribed only when the jwara is kapha-pitha predominant and specifically when there is amam. Indeed, the text is not revised accordingly. It is because the Vaidyas do not enjoy the privilege of such exercises. They are also the least bothered about getting their work published in peer-reviewed journals or getting recognised for the same. They have no priorities of departmental promotions or increments in their perks. They focus on patient care. Instead, the academy could have done this exercise based on the information from the practising vaidyas.
A culture of rigorous interactions between the departments of Maulika Sidhantha, Kriyasareera, Roganidana and Chikitsa shall exist in the academy. This will pave way for the systematic review of the literature and revision of the same, wherever it is required, properly and pragmatically. I can give any number of examples to show this sort of real testing being done on Ayurvedic theory and practice in the field. Dr Kishor may identify that it is because of these exercises of the Vaidyas that Ayurveda is still a living system in the country, and not because of the ‘strained’ interpretations that the academy made (unwittingly or otherwise) all these years.
A worthy trial that I would recommend to the NCISM would be to keep all the topics of modern medicine alien to the freshly enrolled students of Ayurveda for not less than 2 years. This will help in connecting them with the Maulika Sidhantha and Kriyasareera properly and will train them to perceive a living human body in the Ayurvedic way.
The best reply which I saw which I vouch for wholeheartedly and I congratulate you from the core for your infallible faith in ayurveda
Dear Dr. Prasad Sir,
Thanks for sparing your time on this. In the following paragraphs, I quote your statements and present my responses sequentially.
Prasad:
“Ayurveda operates as per its methodology which is different from that of modern science.”
Kishor:
Scholars have argued that the principles of research in both the streams are not incompatible with each other. [1] This argument is based on Ayurveda literature as well as Nyaya-Vaisheshika principles. However, ancient scholars did not have suitable tools to explore physiology and hence their speculations were faulty.
Prasad:
“The biggest difference between modern science and Ayurveda is that the former is very reluctant to accept the existence of a principle called consciousness whereas the latter cannot be construed at all without the principle of consciousness.”
Kishor:
An enormous amount of work has gone into consciousness research in contemporary science, neurophysiology and anaesthesiology being two such notable branches. In June 2022, International Anaesthesia Research Society has carried an article titled “Consciousness” in its official journal. The article delves into multiple aspects of consciousness.[2]
Prasad:
“After all, I always wonder what is wrong with Ayurveda being considered and continuing as a non-science. Ayurveda is always more about philosophy and art than about the science in it. What is derogatory about it?”
Kishor:
There is nothing wrong, if in its ‘artform’ it can treat patients successfully using its own physiology. But it can’t do that, is the truth. Ayurveda physicians today must depend on laboratory tests to understand pathology. If Ayurveda physiology was complete, many tests described in ancient texts would suffice. (Rakta-Shuddha and Ashuddha Rakta, Purisha- Jale nmajjana/ Mutra- Pipilika parisarpana, Tailabindu etc). Curious to know how would you explain this, considering your argument that Ayurveda practitioners are the only true saviours of Ayurveda, as you suggest towards the end? Do you see this as laborious interpretation, or as total dismissal of Ayurveda principles, or as a natural assimilation that follows Nyaya-Vaisheshika principles? If it is the last one, would you please explain with one example of, say, serum creatinine, the Nyaya-Vaisheshika principles that lead to the understanding the kidney functions?
Prasad:
“Dr Kishor tries to focus primarily on his domain i.e., Kriyasareera. With some examples, he highlights the idea that the principles of kriyasareera are not scientific. They are obsolete pieces that should not be taught to any modern student. Unfortunately, it is scrutiny using the concepts of modern scientific physiology which you have accepted as the base.”
Kishor:
It is the truth that has been accepted as the base of this scrutiny, not the modern science. Semen is not formed in bone marrow is truth. There are no ducts that connect intestines and urinary bladder is the truth. Blood cells are formed in bone marrow is the truth. It is not scientism but, it is the truth that forms the basis of this argument. Whatever method that leads to truth is acceptable.
Prasad:
“Understanding and explaining the living body based on the Maulika sidhanthas is called Kriyasareera. The learner needs to understand the functioning method of the body in the Ayurvedic way.”
Kishor:
Your own Guru, Vaidyabhushanam K. Raghavan Thirumulpad in his book ‘Ayurveda Parichaya’ writes categorically: “Ayurveda is indeed a physical science. Such explanations presented in Sankhya concerning with cosmogony as Mula Prakriti producing Mahat, Mahat producing Ahamkara, Ahamkara producing Tanmatra, Tanmatra producing Bhuta etc. have got little relevance in the study of Ayurveda. Only those aspects that are perceivable through the sense organs are to be called Vyakta and that is also how Bhuta is defined in Ayurveda. Therefore, all entities prior to the manifestation of Bhuta can be collectively called ‘Avyakta’. Akasha is perceivable through Shabda, Vayu is perceivable through Sparsha, Agni is perceivable through Rupa, and so on.” What you are suggesting looks contrary to this. It would be nice if you could explain the physiology of urine formation using the Samkhya and Nyaya-Vaisheshika siddhanta.
Prasad:
“The application of sidhanthas varies with changes in place and time. Earlier explanations may not be sufficient to explain a new experience. This may initiate new discussions about the validity of existing sidhanthas in that regard. Accordingly, new insights about the body may emerge. These insights may contribute to modifying the existing sidhanthas or proposing new ones.”
Kishor:
Academia has been doing the same by incorporating new insights into the curricula. But you have a problem there. Hence, an example to show how modern physiology of formation of blood cells in the bone marrow can be incorporated into Ayurveda using Nyaya-Vaisheshika principles would be a wonderful insight that will benefit all readers. I take it as a learning opportunity.
Prasad:
“Concepts of Ayurvedic anatomy and physiology are not obsolete. They are to be understood and taught on Ayurvedic premises.”
Kishor:
I again ask a similar question: to kindly explain the process of formation semen inside the bone marrow along with the process of oozing out of the semen through small pores in the bones, on the Ayurvedic premises. Again, this would be a learning opportunity for me.
Prasad:
“A Vaidya should have an understanding of a disease based on Ayurvedic kriyasareera to treat it in the Ayurvedic way.”
Kishor:
A sixty year old male presents with fatigue as the chief symptom. He is otherwise well and not on any medication. There is no history of reduced appetite/fever/weight loss. On examination, no abnormality is found except for mild pallor.
How does one approach a case like this using the ayurveda (tridosha) framework? If it is plainly diagnosed as a case of panduroga and treated along ayurvedic lines, diagnoses with grave prognosis (such as renal cell carcinoma, for example) would be missed. If you propose that such cases require the aid of modern investigations, you are simply endorsing the view that the classical ayurveda framework is incomplete and therefore unsafe if applied without crucial inputs from current pathology. (This is not an imaginary example. It is taken from a real-world clinical incident in which a renal cell carcinoma patient had to pay the price of delayed diagnosis for about 6-7 months.)
Prasad:
“Indeed, the text is not revised accordingly. It is because the Vaidyas do not enjoy the privilege of such exercises. They are also the least bothered about getting their work published in peer-reviewed journals or getting recognised for the same. They have no priorities of departmental promotions or increments in their perks. They focus on patient care.”
Kishor:
Is it not the duty of a Vaidya to publish the new clinical results, for the betterment of the humankind, if not for his/her career? Focusing on patient care should also mean sharing their experiences with academia. We have been trying to gather how Vaidyas use Ayurveda principles in diagnosing and treating different clinical conditions. However, the response we are receiving has been very poor. [3]
Prasad:
“A worthy trial that I would recommend to the NCISM would be to keep all the topics of modern medicine alien to the freshly enrolled students of Ayurveda for not less than 2 years. This will help in connecting them with the Maulika Sidhantha and Kriyasareera properly and will train them to perceive a living human body in the Ayurvedic way.”
Kishor:
Every school going kid is introduced to basic human physiology during high school and intermediate level science education. Hence, are you suggesting that all formally school-educated students must be declared unqualified to study Ayurveda? Will not their prior exposure to biology create problems in studying Ayurveda?
References:
1. Vinodkumar MV, Anoop AK. Review on comparability of ‘classical’ and ‘contemporary’ research methods in the context of Ayurveda. Journal of Ayurveda and Integrative Medicine. 2020 Oct-Dec;11(4):539-546. DOI: 10.1016/j.jaim.2019.02.005. PMID: 31387787; PMCID: PMC7772492.
2. Mashour GA. Consciousness. Anesth Analg. 2022 Jun 1;134(6):1118-1125. doi: 10.1213/ANE.0000000000005983. Epub 2022 May 10. PMID: 35595688; PMCID: PMC9093729.
3. https://docs.google.com/forms/d/e/1FAIpQLSfoZjhriFLhbpPatSSRFpjtTgRD2foJ4utcHJChpCGCVAGASA/viewform
Sir,
Do you believe that “space, air, fire, water, and earth” are the basic building blocks?
Just asking as a curiosity.
Regards
Namaskar!
Similar dilemma and hurdles aroused when I was trying to understand classics while doing MD (Rasashastra) at Jaipur.
Classics tell Rasa(parada) as Shiva veerya and one of the potent elements on earth to heal, rejuvenate as well as make our body everlasting (dehavad).
If I try to analyse this principle based on modern chemistry ,Mercury is such toxic metal that don’t dare to touch it , or stay in the room where it gets spilled. So it is total nonsense to think about its medicinal value.Leave it and change your path.And how could a metallic liquid be the sperm of Shiva, it is nonsense story.
There I many such instances where I supported my science on one hand and criticised it on other way.But support was always one step ahead than criticism due to the teachings of great gurus who taught to understand the things written between the lines and who taught to believe in things yet to be proven.
Thank you!
It does take honesty of the utmost kind to declare publicly that one had been wrong throughout one’s academic life, especially when one is a professor at one of the finest universities in the country. Prof. Kishor definitely did let down a lot of people but he surely felt that the worse choice would letting down the truth. Nevertheless, there are certain things overlooked in this article. I shall try my best below to jot down a few that I quickly noticed.
Karl Popper was a philosopher, not a scientist. Nowhere in his 545 pages long “Logic of Scientific Discovery”, we could find any scientific notion behind the formation of “principle of falsification” (POF). POF is NOT a scientific theory or principle. Popper “proved” POF only based on a couple of thought exercises, not by testing it rigorously and repeatedly in real situations. Also, there is no record of anyone ever testing POF and proving it true or scientific.
POF postulates that all scientific principles must be falsifiable, not just verifiable. So by its own definition, POF becomes “scientific” only when a theory that can never be falsifiable exits. But the existence of such a theory proves POF incorrect and requiring “falsifiability” for science concludes that POF itself is pseudoscience. In short, POF cannot even say whether it itself is scientific or correct. One doesn’t need to be a scientist to see that, only use a little common sense.
So whether Dr. Kishor’s academic contributions should be discarded or not is secondary. The primary fact is that he could not see whether something that fails before the scrutiny of common sense was a suitable choice to judge the work of his lifetime. One can only imagine the weight of the cognitive dissonance that burdened him.
Given that Sanskrit has the most complex sets of grammatical rules that are capable of spinning different meanings from the same set of words and phrases, at least a working knowledge of the rules of Sandhi, Samasa, Vibhakti and Tantrayukti are essential to understand any Ayurvedic text. My experience is that the vast majority of BAMS doctors fail even to read Sanskrit fluently.
Panchami vibhakti, which is used in all contexts that this article cited examples from (dhatu parinama – “transformation of tissues”), is used to state the distinction between two things. “X is born from Y” is only one of 13 common scenarios where Panchami is used. So without considering the other scenarios, it would be unwise to conclude that “majjaat shukram” means “semen is born from bone marrow”. This is neither my idea nor something new. Commentaries describe dhatu parinama in two different ways which clarify that semen is NOT born from bone marrow.
Then the most likely reason for the grouping of organs/tissues in dhatu parinama, like semen and bone marrow, could be that each set of them is targeted by the same medicine. Because it is here prabhava (target specific action, one of the five fundamental properties of medicines in Ayurveda) is explained. Hence Dhatu parinama appears more likely as a model, which, by explaining how quickly drugs are transported across body and which organs behave similarly under target-specific actions, lets the physician easily decide which drugs are needed in a disease. I don’t think this can be understood as some kind of physiology.
Therefore, at least for me, the acid test of “semen is born from bone marrow” would be testing whether medicines that target bone and bone marrow (vaatahara drugs in general) also affect the quality of reproductive tissues. This has already been tested by Ayurveda as it is clear from the fact that many medicines mentioned in vatavyadhi & vatarakta are excellent medicines of infertility as well. These medicines are still widely in use.
I can go on like this about the “obsolete” concepts in Ayurveda, but the space here is very limited and the point seems clear. The aim of the medicine is not describing anatomy or physiology. That is the aim of biology. Medicine’s aim is to build working models of disease and health based on available data, test them and use them as needed. As long as these models deliver their promised outcomes, they are not outdated. In my experience, the models that Ayurveda developed 2600+ years are still working fine. Thouse who are doubtful may kindly read the texts thoroughly and broaden their clinical experience.
I support dropping any useless part of the BAMS syllabus. But it will take a lot more than this article’s logic to convince me that Ayurveda principles are “obsolete”.
Dr. VG Sharma,
I have the following points to make regarding your comments.
1. What Karl Popper has suggested is not a scientific theory to test! It is all common sense and perfectly applicable in the context in which I have cited it. It is a tool that one can use to test other theories and by itself is not a theory. Falsification is a principle that we use whenever we propose a hypothesis. If the hypothesis can be stated in falsifiable language, it means that it is testable. Otherwise, it would only be an untestable assertion. So, calling the principle of falsifiability “pseudoscientific” would be a gross error.
2. You have raised a question pertaining to Sanskrit grammar. If you contend that the explanation of “formation of semen from the bone marrow” is wrong, you should also be able to state “what is the correct meaning of the verse” that proposes the formation of semen in the bone marrow. Charaka Samhita describes this process as follows: (Chikitsa Sthana, 15th Chapter, 32-35)
“The sneha (fatty) portion of majja (marrow) produces shukra (semen). The porosity in the asthi (bones) is produced because of the factors such as vata and akasha. Shukra comes out of asthi through these pores just as the water coming out of a new earthen vessel. Through the channels known as shukravaha srotamsi, this shukra spreads all over the body. Shukra is thus collected in the urinary bladder and is then discharged.”
Without explaining this using the right kind of Sanskrit grammar, your objection to my view becomes unfounded.
3. The mere existence of three different explanations (Nyaya) of “Dhatu Parinama and Dhatu Poshana” indicates that the theory itself is unsettled. Had there been clarity, only one explanation would have been sufficient, which is characteristic of settled facts.
4. “The proposition that each set of tissues/organs grouped under this conjecture could be based on drug action” is not based on any evidence. When you say “Dhatu parinama appears more likely as a model, which, by explaining how quickly drugs are transported across body and which organs behave similarly under target-specific action” you are bringing in pharmacokinetics and pharmacodynamics and still you say that this cannot be called physiology. Without physiology how can pharmacokinetics and pharmacodynamics be even explained? The concept of “Prabhava” itself shows that the existing rules of Rasa-Guna-Virya-Vipaka are often insufficient to explain the drug actions.
5. “Therapeutics that are useful in Vata Rakta and Vata Vyadhi are also useful in treating diseases of reproductive tract” is something that you state but is not mentioned in textbooks. Further, there are no published studies to support this.
6. You state that “Medicine’s aim is to build working models of disease and health based on available data, test them and use them as needed. As long as these models deliver their promised outcomes, they are not outdated. In my experience, the models that Ayurveda developed 2600+ years are still working fine.”
The problem precisely is that these models do not deliver their promised outcomes. Agnivesha himself points to this in the Charaka Samhita. Vide the paper by GL Krishna referenced in my article. If it is your view that the Ayurveda models are robust, just prove it. A Nobel will be yours!
I also ask, had these models been precise and adequate, why do Ayurveda clinicians use modern laboratory investigations to diagnose diseases? Dosha model should have been sufficient to diagnose any condition, in that case, using Vriddhi-Kshaya features.
REFUTING THE STATEMENTS OF AYURVEDA PROFESSIONALS TERMING CONCEPTS OF AYURVEDA INCORRECT AND OBSOLETE
Prof.Dr.Sandhya Patel1,
Prof.Dr.S.N.Gupta2 and
Prof.Dr.V.V.Prasad3
1 Swami Vivekanand Charitable Hospital, Dharmawala, Dist.Dehradun, Uttarakhand
2 Vice Chancellor, Maganbhai Adenwala Mahagujarat University, Nadiad, Gujarat
3 Swami Vivekanand Charitable Hospital, Dharmawala, Dist.Dehradun, Uttarakhand
Reference – Patwardhan K. Confessions of an Ayurveda professor. Indian J Med
Ethics. Published online first on July 2, 2022.DOI: 10.20529/IJME.2022.049
In view of the above said article terming certain ayurvedic concepts obsolete, and the author advising to delete them from the syllabus, we urge the Ministry of AYUSH to consider the scientificity of the terms of ayurveda before taking a decision whether those are obsolete during present times. That article may send a wrong signal among public particularly new generation, which is fondly attracted to ayurveda, and also to the world population, which has strong trust in ayurveda and vedic knowledge system. Additionally, this is not important that some professor is unable to understand the depth of knowledge of ayurveda; this is important that thousands of persons realize the utility of these concepts and able to save lives. Nevertheless, the points raised in the above article are important Ayurvedic concepts; hence, the possible clarification is attempted.
Basic concepts of ayurvedic science and modern medicine are different in many aspects. Physiological and pathological details of Ayurveda are independent of modern medicine, and treatments are done accordingly. The problems arise when the ayurvedic concepts are seen through modern lens, which is not warranted. Some practitioners do not try to evolve suitably, but like to see ayurveda as allopathy.
We would like to make it clear that we have no intention to target, insult or humiliate anyone, but we are making an attempt to protect the interests of Ayurveda and request the policy makers in the Ministry of AYUSH, Govt. of India to maintain the balance while deciding the syllabus. It is also not our intention to claim that Ayurveda is a complete science. In fact, no science can be called complete. Whenever newer understandings and newer discoveries are made those that are accepted by majority get incorporated in the related science.
Einstein first predicted the existence of black holes (the term was coined much later in 1967), but could not explain. One year later in 1916, Karl Schwarzschild laid the foundation by giving exact solution to Einstein’s equation of general relativity to prove the existence of black hole. However, the first image of invisible black hole (about 27,000 light years away from earth) was captured after in 2019. Does this mean that Albert Einstein and Karl Schwarzschild were wrong in proposing the existence of some unexplainable cosmic entity or does it mean that the black holes never existed before their discovery?
Ayurveda is never against learning of any knowledge system. So modern anatomy, physiology, pathology, pharmacology, medicine and all other subjects should be taught to students of any healing system; but this is not true that the
Ayurvedic concepts may dilute any knowledge. Ayurvedic concepts will rather enrich their understanding for modern subjects and vice a versa.
This kind of teaching would help in many ways. For example,
This is required for applying during research work, CMEs, etc. because the fields of research are controlled and guided by the modern sciences including modern medical science.
To explain ayurvedic points to the professionals from other modern sciences in a possible best language that they can understand.
To clear the doubts from the minds of novices in Ayurveda.
To understand the concepts well and explain them to the ultimate beneficiaries such as students, patients, general public, etc.
Let us analyse the points discussed in the article that are considered obsolete.
It may not be proper to believe that ancient ayurvedic samhitas were the works of any single individual and that the commentator/s amended the literature to suit to their contemporary times. In fact, the commentaries reveal a good insight into many of the difficult points. Ancient commentators have really worked hard to put their logical and scientific explanation, invention or a counterargument to a theory, which was considered completely established at that time. For example, very popular theories of kshiradadhi-nyaya, kedarakulya-nyaya and khalekapota-nyaya were not in original texts. They came in to practice through commentaries. Theory of ashayaprakarsha was coined by Vijayarakshita in his commentary on Madhavanidana.
There was evolution of the knowledge in ancient time also and that is reflected in Ashtanga Samgraha and Ashtanga Hriday, where Vagbhat boldly selected the points that he was convinced with, and also put forth his own views, which differed from earlier scholars’ views. For example, he has accepted and quoted of the others about ovulation in the absence of menstruation (A.S.Sha.1/38), which is not found in Charaka samhita and Sushruta samhita (predating Vagbhat). Similarly, he has quoted (A.S.Sha.2/25) basic pathophysiology as subnormal level of oja that results in secondary apnea and death of fetus born in 8th month of pregnancy (could be premature, LBW or VLBW).
One has to remember that a patient remains the same for all the medical systems. The practitioners of different medical systems know or call the same medical conditions with different terms. For example, elevated body temperature (beyond normal) is called pyrexia or fever in modern medical science while it is called jvara in Ayurveda. Take more complex example of a disorder of sexual development, called 5-alpha-reductase 2 enzyme deficiency, which is known as shandhaa or narishandha (female pseudohermaphrodite) in Ayurveda, who can father a child (Dalhana’s commentary on Su. Sha. 2/43).
There are polysemantic words that exist in Ayurveda also. Most of the time the authors or commentators of samhitas have explained the meaning of the terms in relation to that particular context.
Shukra production: The term ‘shukra’ is polysemantic and at most of the places it is self-explanatory. At some places commentators have elaborated the meaning. Everyone knows that shukra is the seventh dhatu and it is present in female also. There was a discussion in Sushruta samhita about the seventh dhatu. Majja is stated to differentiate in shukra during dhatu formation {(Su.Su.15/4(1)}. Dhatu formation explains several nyayas and each one is applicable in different physiological and pathological conditions starting from embryogenesis of various tissue formation, postnatal development and maturation of organ-system till adulthood and then till the end of one’s life. If talking about shukrotpatti (taking the meaning as semen) from majja (considering as bone marrow or even brain) then what happens to shukra dhatu in female? Do normal females (not talking about shandhaa or 5-alpha reductase 2 deficiency persons raised as females) have semen? This was discussed even in Sushruta Samhita. Sushruta has proposed that artava (female gametes) should be considered in females in place of shukra (semen, male gametes).
No where in any ancient text it is stated that semen forms from majja; instead shukra (the seventh dhatu) forms from majja, and is not an anatomical concept. This is therapeutic concept. For the knowledge of ignorants it is suggested to read about these research http://news.bbc.co.uk/1/hi/health/6547675.stm.
If the ayurvedic non-believers or scientists make such efforts they may find hidden truths of Ayurveda.
Vagbhat and Indu (A.S.Sha 1/6 and Indu commentary over it) have explained this concept of dhatu formation by giving the examples of how jaggery from sugarcane and ghrit from milk is produced. Can any one say that jaggery or ghrit appear directly and without procedures from their main source?
The functions of shukradhatu including libido, formation of gametes and garbha, transport and ejaculation of shukra (semen), etc are briefly mentioned in Ayurveda and they do not require the knowledge of modern endocrinology, especially hypothalamus-pituitary-gonadal (HPG) axis to understand that the functions of shukradhatu are controlled by HPG axis.
It is suggested that Ayurvedic students, practitioners or academicians may refer books (more than 20) released during the interactive workshops on various difficult topics conducted by Rashtriya Ayurveda Vidyapeeth, Ministry of AYUSH, New Delhi for some explanations by different ayurveda experts. At least the explanations (not interpretations) of late Prof. Dr. P.V. Tewari of BHU on shukradhatu, shukra and artava with all ayurvedic references and modern medical explanations can be referred.
The term ‘mastulunga’ has appeared while describing the prognosis of bhinna kapala (or fractured skull) (Su. Su. 23/12) and its treatment (Su. Chi. 3/46) where Dalhana commentary makes its meaning clear as CSF. In the reference of treatment of depression of anterior fontanelle, which occurs in neonates or infants (Su. Sha.10/42) for which Dalhana has used the term mastakamajja in the meaning of most probably CSF. Vagbhat in A.S. Sha. 5/33 has said that medodhara kala wraps the mastulunga/mastishka (brain) in cranium and majja in bones. Kalas are those membrane-like structures that separate dhatus and organs from other structures. Indu has further clarified that medas in cranium bones attains the characters of mastulunga and mastishka. Similarly while discussing a kind of headache (Cha. Si. 9/79) Chakrapani has commented mastishka as shirasthamajja. Many neurological conditions including facial palsy, hemiplegia, monoplegia, spasticity or rigidity, etc are mentioned as majjagata and asthigata disorders (Cha. Chi. 28/72-4). This clearly shows the terms used as mastulunga, mastishka, mastakmajja and shirasthamajja are in relation to brain. Sushruta being a surgeon he could not have missed such a gross structure as brain during injury or even during dissection. Moreover, while planning the treatment of brain and spine disorders purishavaha and majjavaha srotamsi are considered. Everyone agrees to this point. Basti treatment does produce reproducible results also (Cha.Chi.28/93). Concept of gut-brain axis is a recent development in modern medical science.
Rakta Formation: In relation to rakta, the principles cited in Ayurveda and other related medical sciences are to be considered. It is a fact that ultimately all different types of cells, tissues, organs and organ-systems are derived from genetic information stored in the zygote, which is single-celled. Dhatu utpatti and dhatu poshanakrama are two different physiologies, which need proper understanding. Each nyaya of dhatu-utpatti is correct in relation to morphogenesis of tissue, physiology and pathogenesis.
Rakta (or blood) formation involves origin, genesis and migration of first hemangioblasts, then hematopoietic stem cells (HSCs), their subsequent migration to different organs (that are going to develop fully at a later embryonic and fetal age) including liver (on 11 dpc)(dpc=days post conception) and spleen (on 15-16 dpc) and finally to bone marrow before birth.
Liver and spleen play a major role in formation and regulation of hemopoeisis after birth also under extreme circumstances e.g. severe hemorrhage when the body suddenly loses large amount of blood volume, in different pathological conditions related to different types of cells in the blood, etc. the liver and spleen remember their embryonic function of hematogenesis and revert back to production of blood cells. A micro-environment is specifically required for this function. This function of liver continues throughout the whole life of the individual, which is considered to be responsible for this reversal of function.
Post-natal erythropoiesis may be in marrow but essential substances for the process of blood formation are produced in liver. Science is gradually discovering such substances. Similarly, angioblasts (which again derive from hemangioblasts) give rise to genesis of circulatory system (irrespective of artery, vein or capillaries). One has to understand that ayurveda does not use the word ‘blood’ circulation. It uses word ‘rasa’-circulation. This is logical according to its own concept. This is the reality that rasa is being circulated. Blood cells are simply floating in the circulating rasa.
Urine Formation: It is agreed that physiology of urine formation according to Ayurveda is difficult to explain. However, on the basis of several references (A.S.Sha.56/44) [Dalhana commentary on Su.Su.15/4 (2)] of ancient ayurvedic texts many teachers and experts have opined the following. After the ingested food gets digested in gastrointestinal the final product gets separated as saara (essence) and mala-drava (waste products) in pakvashaya.
Solid mala is excreted as stools with some fluid part and much of the fluid part along with various water-soluble waste products [the starting states of urine (and sweat etc.)] get absorbed in large intestines. Most of it passes through various siras (channels) including kidneys (which act as filters) gathering other wastes and finally reaches bladder as urine and excreted out. Based on this principle that urine formation first starts from pakvashaya as explained in ancient texts, many ayurvedic physicians and pediatricians have been able to provide reduction in serum creatinine levels even in stage V of CKD patients through administration of drugs by rectocolonic route (basti), and these results are reproducible. (Please note that it is not our intention to confirmedly correlate this aspect of treatment to the concept of urine formation cited above).
There may be some points like this, which are inexplicable now according to the current knowledge of modern medical science, but that does not mean that they should be deleted. Such points are very few and one does not require much efforts to learn them for the examination purpose or for the successful clinical purposes.
Tridosha theory: There are several entities, which are non-material; but exist in universe and similarly in a living being. Is mind a material entity? Is energy a material entity? Is soul a material entity? No. Then doshas are also not material entities. These are subtle principles responsible for certain types of milieu in body’s atmosphere according to their guna (physiocophysiological properties and produce certain karma (functions) through them. To compare them with any biochemical entities is irrelevant. Biochemical or any other phenomenon is outcome of their functions. Kaarya-kaarana siddhanta (cause-and-effect principle) also explains functions of tridosha considering quantum physics.
Once there was a time when any practitioner writing “reduction in pain” was ridiculed calling it is a subjective criterion. Now, the pain score scale is in use for quite a long time, not only in sick neonates, infants and young children, but also in adults.
Prakriti determination: Basic fault lies in application of ayurvedic principle to considering blood pressure as a criterion for prakriti determination. It is to be understood that the prakriti is established at the time of conception and is unchangeable. The features mentioned for prakriti determination of an individual includes neither BP nor nadi (HR or pulse and its characteristics) because both are variable due to diurnal, nocturnal, psychic attitude, diet, illness and other factors. Person of any prakriti can develop hypertension. It is not restricted to one prakriti. Understanding kapha or pitta by finding a correlation of their propensity of developing hypertension in a few number of kapha- or pitta-prakriti individuals does not explain the guru, manda gunas of kapha or ushna and tikshna gunas of pitta. Why should this concept be considered unscientific for no fault of prakriti concept of Ayurveda? It is a convenient and biased selection of interpretation put forward by someone, and not majority of Ayurvedic fraternity accepts this view.
The exercise of refutation was already in practice in ancient time. Texts show a number of references with different views of scholars on several concepts including the basic ones. After discussion and consensus the final theory was established and such concepts and theories have been documented in texts. One can refute in modern time also but before that he has to raise the height of his intelligence to that intellectual level of sages.
As stated above, if interpretations or re-interpretations are attempted to show mismatch of principles of Ayurveda and modern medicine then problems arise. There will be no mismatching, if teachers are competent. Of course, we need competent teachers. Comparing Ayurveda concepts with modern concepts is a wrong practice which had pulled ayurveda in a wrong direction. For example, comparing agni with enzymes and doshas with neurotransmitters, and such similar attempts were futile. Otherwise management of diseases is possible with the basic concepts cited.
To understand Ayurveda one has to study the ancient texts and the commentaries thereon, rather than translations from Sanskrit to English or other regional languages, as translators mostly put their opinion (interpretations) and the readers are carried away with such opinions. Translations may help to some extent. Additionally, the teachers are also writing text books in competition at the instance of publishers, mostly, interpreting ayurvedic concepts with modern medicine. In these text books hardly we find the analysis of the subject matter taking into consideration what the commentators have clarified and to what extent modern science is required. Probably this led to the situation that many of present ayurveda doctors are in confusion what to practice. However, one has to understand that texts are not immortal. the knowledge system is immortal.
The inter-rater variability is always possible in any assessment including that of parameters taken to study physiology as well as pathology, irrespective of any system of medicine as the individuals (examiners) see them differently. The degree of variability may vary. Inter-rater variability is not due to fault in science, but due to persons’ ability (or inability) involved in the examination. This variability is also possible in clinical practice. Patient is same but doctors of same system may treat differently.
There is no need of validation of Ayurvedic principles and treatments. They were valid earlier and are at present also. Except some scribal errors, the texts are ever-relevant and irrefutable. During the corona period it has proven its all-time relevance. Development does not mean to destroy the things, if one is unable to understand and value them.
One has to remember that we are referring currently extant samhitas and other ancient texts that are available in India. These texts are not even a small part of the manuscripts available in ancient times, which have been lost for various reasons including time. Everybody agrees that Sushruta was the first to dissect and narrate human anatomy. Can we think that ureters connecting kidneys and bladder were not visible to Sushruta? Could Sushruta not visualize brain? Dhanvantari appeared before Punarvasu Atreya, so how come names of five pitta and kapha are not available in currently available Charaka Samhita while Bhela, who was the contemporary of Agnivesh (the guru of Charaka), has mentioned these. In fact, Bhela went on to state chakshurvaisheshik and buddhi-vaisheshik alochak pitta.
This mentality of Ayurvedist to validate every thing on science is inappropriate. Every knowledge system has its own parameters to evaluate and validate it. Indian ancient knowledge system is discovered not only by applying physical/ materialistic evidences (laukika pratyaksha) but also by non-materialistic/spiritual evidences (alaukika or yougika pratyaksha). The age of science is only 4-5 centuries, while Ayurveda and vedic sciences took several millennia to establish them. Modern science is still in the phase of evolution. Several new theories of modern science are gradually coming close to Ayurvedic concepts. Roots of stem cell therapy can be seen in the concept of dhatuparinama. Policy makers of India may be requested to start programs to develop spiritual evidences (alaukik pratyaksha) to enable these non-believers to believe in the subtle concepts of Ayurveda.
However, with an intention to bring uniform understanding among peoples of Ayurveda and others as well as for making ayurveda people-friendly the concepts are subjected to interpretations.
There can not be a uniform/standard approach in Ayurvedic treatment for all the patients suffering from same type of illness. Some may be the drugs of choice, which are usually used by majority of qualified ayurveda practitioners while for other drugs there is customization, some call it as individualization. Modern medical science also accepts this customization in some or other form. For example, if a patient is hypersensitive to a drug prescribed according to guidelines, a change is required. If there is any other comorbidity the drug of choice may be different. Genetic predisposition for some inherent metabolic disorder may also force for customization of treatment plan.
Some of the points of ancient texts, which once considered obsolete by translators of texts, have been proven scientific at a later period. The following are a few such examples.
Sushruta has stated terms shandhaa and anasthi garbha while modern medical science calls them a condition of 5-alpha reductase 2 enzyme deficiency and a kind of skeletal dysplasia, respectively. When we were studying our post graduation (from 1978 to 1981) this verse (Su. Sha 2/47) was literarily translated. That time as PG students we were frustrated and felt the same that such concept should be deleted. Not a single eminent faculty of those days explained that human reproduction is essentially heterosexual according to Ayurveda, nor any of them talked about Dalhana’s commentary on shandhaa and anasthi garbha. Imagine what would have happened had it been considered obsolete and deleted from the syllabus. Shandhaa is a condition of 5-alpha reductase 2 enzyme deficiency. The person suffering from this and usually raised as a female may revert to male sex at puberty, behave like a male and may even reproduce.
Similarly, in 1990s the revision of the nosology of skeletal dysplasia started in modern medical science. While Dalhana had clearly explained that anasthi is not boneless (as it was used to be translated by the ayurvedic experts or the teachers), but is a condition with less number of bones, which are also undermineralized. One may surf medical literature for this. In fact, we emphasize that Sushruta should be credited with the discovery of these two conditions, now being called as 5-alpha reductase 2 enzyme deficiency and skeletal dysplasia, and these be declared as Sushruta syndrome of narishandha and Sushruta syndrome of anasthi garbha.
Exclusive uniparental inheritance was described in Ayurveda and the credit of its invention should go to Punarvasu Atreya. Before 1990s and development of Haig hypothesis in 1991 and genomic imprinting, modern medical fraternity did not accept it and ridiculed this ayurvedic concept of uniparental inheritance. Now, one cannot discard the ayurvedic principle of matrija and pitrija bhavas by stating that the technology was not known in ancient time, and so how did they come to know about this uniparental inheritance? Ancient architecture, ancient metallurgy (Ashok stambh), ancient rocketry, genetics, etc still puzzle the current experts of the related fields about the knowledge of these without any modern tools, gadgets or equipment. Same is true for some of the principles of genetics in ayurveda.
Several new theories coming up in western medicine, which were not believed earlier are very close to Ayurvedic concepts. e.g. leaky gut, gut-brain axis, stem cell and so on. In recent years anatomists have accepted omentum as an organ, which was already considered in Ayurveda as koshthanga. These impatient and confused authors would have not accepted this as an organ some years back.
There are umpteen number of examples where deletion would have resulted in disservice to this ancient health science. Somebody urging regulatory authorities to drop the so-called incorrect and obsolete concepts is similar to a child’s demand to destroy a toy with which he is unable to play. Had it been done in the past the world would have deprived of wonderful rhinoplasty method of Sushruta saṃhita.
Has anyone observed that after eight samskaras on shuddha Parad, which is already pure chemically, it does not develop scum on its surface when left open in the air?
All functional ayurvedic colleges, government and private ayurvedic pharmacies that are working on mercury regularly get exposed to mercury vapor. How many of the students, faculty, and employees have developed mercury toxicity and needed treatment or died (because mercurial vapor toxicity is considered highly lethal as its absorption is through respiratory system and exhibiting neurotoxicity and nephrotoxicity)?
Finally, it is to say that –
We need to progress and continuously evolve to develop our science of Ayurveda and not to blindly follow the modern medical sciences.
We do not oppose to differentiate the facts and myths. We request to fill the lacunae with our own principles, accept the researches that reproduce the results and other such positive changes. Consensus is difficult to achieve in the current times, but majority must prevail.
We also believe that changes are required in the syllabus and they are the need of the time because faculty, researchers, practitioners and students are forced to prove the theories or clinical aspects in the terms of modern medical science. So unless someone has basic knowledge of these sciences, it would be a futile effort to prove Ayurveda in modern medical terms.
Suggesting for deletion of certain concepts of Ayurveda on the basis of explanations given in translated books of samhitas without referring actual samhitas and their ancient commentaries is totally meaningless.
One can take the help of other sciences to enrich Ayurveda, but not to that extent to negate certain concepts as outdated or obsolete, without proper understanding and limited knowledge. Development does not mean to destroy the things, if one is unable to understand and value them.
Before considering concepts of Ayurvedic anatomy, physiology obsolete, please read this verse and try to understand it deeply and seriously –
na śakyaścakṣuṣā draṣṭuṃ dehe sūkṣmatamo vibhuḥ.
dṛṣyate jñānacakṣurbhistapaṣcakṣubhireva ca- (Su.Sha. 5/50)
Swami vivekananda was a science graduate and atheist before meeting Ramkrishna Paramahamsa, his enlightened preceptor. As soon as Paramhamsa led him to samadhi, he was able to visualize the ultimate truths related to existence, which were not possible through science.
We propose the following few points while deciding the UG and PG syllabus.
oRepetitions need to be excluded from the syllabus. Repetitions are found in the form of same points appearing in the different subjects (at UG levels) or the same points from the different ancient ayurvedic texts being taught or forced on students.
oPG syllabus should have related modern advanced subjects including the newly found medical conditions. There is no point in repeating those points which have already been taught during UG studies. Good numbers of ayurvedic practitioners, and consultants in hospitals and Ayurvedic colleges successfully deal with various types of illnesses. Include those difficult ones in syllabus, which were not considered in the scope of Ayurveda a few decades ago. It is also a myth that Ayurvedic treatment works only in chronic conditions.
oDo not delete those points when a minority of the professionals are unable to explain them to the students.
oExamination system should have separate sections for Ayurveda and modern medical parts and both the sections should carry the same numbers of marks; otherwise the efforts to improve the knowledge go in vain.
oAyurvedic faculty, researchers and practitioners should repeatedly undergo online examinations (practical and/or clinical oriented multiple choice) before their registration is renewed.
Thanks for your kind reply. I cannot write as much as should as the comment word limit is 800. Apologies for any perceived inability to express myself in that limit. I noticed that you misquoted me repeatedly. Keeping all that in mind, allow me to make a few points.
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Dr. Kishor: So, calling the principle of falsifiability “pseudoscientific” would be a gross error.
Me: “falsifiability” has been repeatedly rejected by leading scientists ever since its inception. Physicist Sean Carroll’s “What scientific theory is ready to retire” is a good starting point. When the status of falsifiability is shaky and is most likely to be abandoned, I don’t think it is wise to use it to judge anything related to Ayurveda. The popularity of falsifiability is easily attributed to two logical fallacies – The Appeal to Authority Fallacy and The Bandwagon Fallacy. The “principle” of falsification itself is an excellent example of two other logical fallacies – The False Dilemma Fallacy and The Hasty Generalisation Fallacy.
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Dr. Kishor: Without explaining this using the right kind of Sanskrit grammar, your objection to my view becomes unfounded.
Me: Besides this argument being “The Burden of Proof Fallacy”, I owe no explanation here more so because basic Sanskrit is taught in BAMS. You cannot expect others to make up for what you did not care to study.
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Dr. Kishor: The mere existence of three different explanations (Nyaya) of “Dhatu Parinama and Dhatu Poshana” indicates that the theory itself is unsettled. Had there been clarity, only one explanation would have been sufficient, which is characteristic of settled facts.
Me: Three nyayas of Dhatu Parinama were written by commentators who lived millennia after the original textbooks were written. That only proves that the commentators were confused, not that the textbook itself is confusing. After all, the commentators lived in a period when Sanskrit as a language was on decline. Dhatu parinama is already settled, as it is clear to anyone with adequate knowledge in Sanskrit.
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Dr. Kishor: Without physiology how can pharmacokinetics and pharmacodynamics be even explained?
Me: I am ever so sorry for being vague due to word limit. What I meant is– Ayurveda acharyas were able to vaguely identify the pharmacokinetics and pharmacodynamics of medicines they used but that was most likely to be from the observations they made while experimenting, and I don’t think we do need to attribute their ideas to correct or incorrect understanding in physiology.
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Dr. Kishor: “Therapeutics that are useful in Vata Rakta and Vata Vyadhi are also useful in treating diseases of reproductive tract” is something that you state but is not mentioned in textbooks.
Me: I clearly wrote “many medicines mentioned in vatavyadhi & vatarakta are excellent medicines of infertility as well”. What you quoted is your own reading. Read the formulations mentioned in vatavyadhi & vatarakta. My point is clear beyond doubt. Those medicines are still used in infertility. We study it in Charakasamhita, Kayachikitsa and Prasutitantra-streeroga. For example, bala-taila from vatarakta is “shukra-asrug-dosha-nashanam”. The complete lack of BAMS level knowledge in a BHU professor is terrifying.
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Dr. Kishor: If it is your view that the Ayurveda models are robust, just prove it.
Me: again “The Burden of Proof Fallacy”. Nevertheless, aren’t BAMS doctors proving it every single day? I don’t think you will get it because your publications reflect that you’ve zero clinical knowledge. But I agree with that we need to find some ways to document our clinical experiences though most clinicians don’t have the time and peace to do it.
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Dr. Kishor: why do Ayurveda clinicians use modern laboratory investigations to diagnose diseases?
Me: After BAMS, I went Kerala to study under one of the Ashtavaidyas who also introduced me to many BAMS doctors from traditional Vaidya families. I haven’t seen any of them using modern laboratory investigations in any stage for understanding the disease. Because they treat shotha, not hyperthyroidism, they treat vatarakta and amavata, not arthritis. Yet, their results were always centuries ahead of those who taught me in BAMS. If you are unknown to the existence of such doctors, I can only ask you to get to know them. I am not saying that Ayurveda cures everything but Ayurveda definitely delivers what it promises.
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Me: It is difficult to hold serious discussions on Ayurveda with someone of poor Sanskrit sknowledge, broken understanding of Samhita and alarmingly inadequate clinical experience (not forgetting the megalomaniac demeaning undertones). I am sorry that your teachers wronged you in irredeemably worst ways possible. Kindly stop weaponising it against the rest of us, respected Sir. Have great times ahead.
Dr. Sandhya Patel et al,
I have the following observations to record regarding your comments:
1. Your refutation assumes that ancient scholars knew everything, but we, because of our lack of intelligence, are unable to understand what they have written. The core basis of this argument is that “ancient Ayurveda scholars attained their knowledge not only through physical/materialistic evidence but also through non-materialistic / spiritual evidence”. This unfortunately is a thought process that can be categorized as superstition. The mere presence of diverse, sometimes even opposite views in ancient texts itself is sufficient to say that the assertions contained in these texts are not final, established facts. A reference to this has been already made in my article (Krishna GL. The History of a Superstition. BMJ Blogs. May 21, 2019).
2. Perceiving ancient scholars as “common people with empathy and curiosity” makes them truly great. Ascribing special powers to them diminishes their stature because there are many obvious errors in what they have written. With the kind of primitive tools that were available to them, they have put in tremendous efforts, and they deserve credit and respect for what they have done.
3. Projecting Sanskrit as an indispensable tool to understand Ayurveda is another error your comment makes. It could be true for creative writings such as poetry, but not for science. Good science is always translatable, and a language can / should never be a barrier to its understanding.
4. What I am suggesting is that much of the ancient Ayurveda theories have been rendered obsolete because of the advances in biomedical sciences. When I say this, I do not dismiss or discredit the entire Ayurveda. What I dismiss are many of those hypotheses and speculations. Observations documented in Ayurveda are valuable and are required to be studied seriously. Medicinal plants, preventive measures, clinical signs and symptoms, certain aspects of health promotion, and many aspects of therapeutics – are of high relevance and need our attention. However, most of the principles of physiology/pathology in Ayurveda are not based on direct observations but merely on speculations. Many of these speculations have already been disproven, hence I call them obsolete (for example, the pathophysiology of all infectious diseases).
5. You attempt at rationalising Ayurveda concepts using recent advances in contemporary science. This is precisely what I have done during the last 20 years of my career and I have found this exercise to be futile. However, while doing so, you also argue that comparison using modern science should not be attempted. This shows how desperate you are at refuting my position but are equally disinterested in seeking the truth. Your write-up shows your loyalty to the system, but not to the truth.
6. The explanations provided by you to justify the formation of blood make it sound that ancient scholars knew the complete process of erythropoiesis. While there is absolutely no evidence to suggest this, common sense is sufficient to tell us that blood cells can be identified only with the help of a microscope to which the ancient scholars did not have access. Similarly, all justifications given to explain the formation of Shukra from Majja use many of my own interpretations that I have cited in my essay and in my book. It is wrong to assume that I do not know anything that you are trying to convey. I have done all these exercises in the past and there are many of my own lectures and articles available in the public domain, that follow exactly a similar stream of thoughts.
7. Translating the terms such as Artava as “female gametes” is problematic. It is surprising that on one hand, you disapprove of erratic English translations and on the other, engage in the same exercise! Gamete means “a male or female cell that joins with a cell of the opposite sex to form a zygote”. How can we expect the explanation of a gamete in the texts written when there was no microscope?
8. You also use the term such as “ovulation” freely as though it has been mentioned in ancient textbooks. In Ayurveda literature where there is not even a clear mention of ovaries, how can one expect the mention of ovulation? In fact, what ancient scholars have proposed is that “a union of semen and menstrual blood produce embryo”. Possibly they arrived at this conclusion because menstruation is absent during pregnancy. However, they did not know about sperm and the ovum.
9. The descriptions available in the textbooks pertaining to the age of attainment of menarche and menopause, certain details pertaining to the menstrual cycle, description of the ideal phase of the menstrual cycle for successful fertilization, etc are important and are based on clinical observations. However, it is wrong to believe that these descriptions are based on an extensive understanding of the physiology of the reproductive system.
10. The presence of Shukra in females has been a long-held controversy in Ayurveda and we find diverse opinions in the classical textbooks and commentaries regarding this. This only means that this concept was an unsettled proposition, not an established fact. Otherwise, why would there be so many hypotheses in this context?
11. If one studies the Ayurveda literature even superficially, it becomes obvious that Doshas were considered to be material entities. That is why they have been ascribed with physical properties such as heavy, oily, light, swift etc. Even the channels/tubes that carry Doshas have been explained. However, a “safe academic approach” has always been to state that “Tridosha are non-material entities”. This is mostly done to evade further questioning and debate. I too have resorted to this clever way of explanation in the past!
12. You have completely misunderstood the example of Prakriti and Blood Pressure in my essay. It was clearly cited as an imaginary example. I never suggested that blood pressure can be used to identify one’s Prakriti. This example was in fact cited to show how ad hoc conjectures are used to rescue our theories.
13. When you cite ancient rocketry, ancient genetics, quantum physics etc., unfortunately, you are missing the point about what constitutes pseudoscience. These are precisely the points that prompt mainstream science proponents to call Ayurveda a Pseudoscience. Prof. Alan Sokal’s article that I have cited in the essay should provide a clear view on this issue.
Dear Dr. VG Sharma,
The kinds of ad-hominem attacks you have resorted to, speak a lot! Instead of arguing on the points being discussed, it is disappointing that you have resorted to personalised attacks.
Anyways, this kind of showing off does not offend me and I still have the following points to record:
1. Even if you keep the principle of falsifiability completely away, my arguments still stand valid by applying the principle called “common sense”. However, if we stop valuing the falsifiability principle, most of our research that depends on “hypothesis testing” would be rendered invalid! That poses an even greater threat not only to Ayurveda but to the entire research process in science itself!
2. A reading of Charaka Samhita, Chikitsa Sthana, 16th Chapter on Panduroga leads to a reference to Shilajatu Vataka, which has been indicated in Shukra Dosha as well. Following your line of argument (where you cite Bala Taila) would logically lead to an inference that Shukra would be the Dhatu to form immediately after Rakta Dhatu! This is because Rakta is the Dhatu that is directly involved in Pandu Roga. You are using cherry-picked references to prove your point, ignoring many other contradictory references. Further, Vatarakta is not even a disease that uniquely affects Majja.
3. Can I ask you what led you to believe that I do not know even the basics of Samskrita? The logic of Panchami vibhakti is a frequent argument that Ayurveda academia invokes to suggest that a certain reference in the text does not indicate the process of formation of one Dhatu from another. A straightforward reading is what is needed in science, even according to the rules of Shastra. Other figurative readings are applicable in artforms such as creative literature. (Please refer to the usage of Abhidha, Lakshana and Vyanjana in Samskrita Vyakarana). However, what is interesting is that even this logic fails in explaining the text that I have quoted from Charaka Samhita, Chikitsa Sthana, 15th Chapter. Well, in fact, the burden of proof lies with you in this case because you are the one who has invoked the logic of Panchami Vibhakti. I would call this attitude of yours “escapist” because you are not answering my query citing no reason whatsoever.
4. As I have explained in another reply, any knowledge that depends on a particular language for its existence cannot be called science. Science is always translatable and language cannot be a barrier to its understanding.
5. What you say about commentaries is not logical. If the facts in the textbooks were completely settled, nobody should have had confusion about them. The application of “Samanya-Vishesha” theory is one such example. All understand it the same way and all agree to it. Nobody has any confusion because it is a valid theory.
6. If any physician practices and prescribes medicine in the 21st century without resorting to any diagnostic tools, it simply suggests that such physicians pose a threat to society. Please refer to the case of renal cell carcinoma that has been cited in another reply to understand what I mean.
Dr. Kishor,
Irrespective of the differences in our opinions, you are a teacher that I admire. And your life’s work is not as pointless as you tried to show in your confession. Perhaps your line of argument was incorrect. But that doesn’t make your position wrong. That is what my entire argument is essentially about. But you seemed to be in no mood to understand.
*****
It appears to me that you find it difficult to understand unless something is not said in plain words. So let me make this very clear. I never rejected your proposition of dropping outdated ideas from the syllabus. I only said that better arguments than the ones you provided are needed for me to be convinced. Because the ideas that are called “outdated” seem to signify something else. My earliest comment here had two main points which I will make clear again to avoid further confusion.
Firstly, you had no problem in rejecting something in Ayurveda because it didn’t appeal to common sense (which is as it should be) but you can’t do the same thing when it comes to allopathy. We don’t expect allopathic doctors to believe in Ayurveda just because it is written in our texts, do we? Then why should we blindly believe in their methodologies? Are not we supposed to look for the verification of their claims? If no, it is double-standards at best.
The focus of my second argument is dhatu parinama, not the formation of semen or blood or urine. I never said/supported that semen is born from bone marrow or blood is born from liver and spleen or anything of the like. We simply cannot drop “majjat shukram prajayate” because that will cancel entire dhatu parinama. Any step in such a direction is a big deal and it requires careful analysis. I understand dhatu parinama only as a model that groups tissues w.r.t their response to medicines. It has no other value in my understanding. I also don’t support micro-dissecting it into ‘origin of blood’ or whatever, whether it is done by you or Charaka. But that doesn’t reduce the usefulness of ‘dhatu parinama’. This is what I have been trying to say. I hope it is clear that you and I are focusing on different things here.
Now, to your responses.
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Dr. Kishor:- Even if you keep the principle of falsifiability completely away, my arguments still stand valid by applying the principle called “common sense”.
Me:- I totally agree. You picked the wrong argument to make your case. That is only what I meant.
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Dr. Kishor:- However, if we stop valuing the falsifiability principle, most of our research that depends on “hypothesis testing” would be rendered invalid!
Me:- So what? Publications of past 70 years have made it clear beyond doubt that the paradigms used in biomedical research are useless garbage. More recent articles explain how these faulty methodologies are causing “replication crisis” in medicine, psychology and everywhere else. It is all catalogued in PubMed. If Ayurveda researchers don’t read any of it, whose is responsible for that? We are supposed to know the limitations of the tools we use. There is always room for improvement.
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Dr. Kishor:- That poses an even greater threat not only to Ayurveda but to the entire research process in science itself!
Me:- Science has no universal research process useful equally for all of its branches. Statistics has no use in several branches of physics, most notably in particle physics. A lot of mathematics and other formal sciences are completely based on axiomatic theorems (theorems that are deemed self-evident, that cannot be proved or disproved). Many concepts in theoretical physics can never be tested because they are beyond human limits. Still they all provide practically useful information about the world we live. These lay outside the “research process in science” that you suggest as the mightiest yardstick of scientific truth. We cannot put something into a box and say this only is science or this only is the scientific research process. Science is problem-driven, not solution-driven, that is, problems define the solutions. You seem to suggest the opposite, that, something must pass XYZ test to be deemed science. A few days ago, James Webb telescope puzzled everyone by reporting the presence of a Schrodinger galaxy candidate (a galaxy that exists in two different timelines at the same time, in very very very simple terms). If true, that will redefine everything we know till date. Perhaps what we call science today will be no better than a lie tomorrow. And here you are feeling bad about rejecting a simple research paradigm in medical science that hundreds of scientists already rejected.
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Dr. Kishor:- You are using cherry-picked references to prove your point, ignoring many other contradictory references.
Me:- Late stage of Vatarakta specifically affects sandhi, asthi and majja (AH. Ni. 16/10, Cha. Chi. 29/22). So we cannot say medicines prescribed for that are not specifically targeting majja. Shilajatu vataka you quoted is famous as Kautaja Triphala in Kerala. My guru was very keen to use it in almost every disease because it is ‘sarvarogahara’ (‘cures all diseases’ in simple terms). Another version of the same yoga with more ingredients is found in Astanga Samgraha, called Shiva Gutika. Nevertheless, it neither proves nor disproves my point. I only wrote that many medicines useful in vataroga and vatarakta are also useful in infertility which only means that shukra, asthi and majja can be targeted by the same set of medicines. Where did I say that the formation of shukra has any connection with asthi or majja? At the best, shilajatu vataka says that it can target both rakta and shukra, nothing else. Besides bala taila, there are several yogas from vatavyadhi and vatarakta which support my point. They are too many to quote individually and explain. I didn’t cherry-pick there.
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Dr. Kishor:- A straightforward reading is what is needed in science, even according to the rules of Shastra.
Me:- If that is so, why tantrayukti are needed? Ayurveda texts made repeatedly clear that they were written keeping the unintelligent student in mind and others will find different meanings to the same text. How these both go together? Let the unintelligent understand straightforward meaning, let the others do as it appeals to their intelligence.
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Dr. Kishor:- However, what is interesting is that even this logic fails in explaining the text that I have quoted from Charaka Samhita, Chikitsa Sthana, 15th Chapter.
Me:- If you read the notes section of this particular text in original Samskrtam book of Charakasamhita with Chakrapani commentary edited by Yadavji Trikamji Acharya (bottom left of page 515 in my book), it is written under note number 3 that verses from 22 to 35 are possibly not part of the original text. The verse you quoted are 31-34. So we cannot take them seriously. This is further strengthened by the fact that Chakrapani makes his own comments and quotes several other opinions in different occasions of the same chapter to explain why it is impossible for “shukra to form from majja”. Kindly read all that. And this is fortified by the contexts of Panchami vibhakti other than ‘X is born from Y’. Stating blunders here is why I assumed that you don’t know Samskrtam.
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Dr. Kishor:- As I have explained in another reply, any knowledge that depends on a particular language for its existence cannot be called science.
Me:- I cannot agree anymore. But as you might have noticed above, not reading the original Charakasamhita made you quote a questionable text. It happened because translators skipped the warning in the original. I am okay with any translation that explains the text as it is intended. But how can we verify that the translator understood the text correctly unless we know Samskrtam? If we know Samskrtam, why depend on translations? My position is that knowledge must be learnt from the source, to avoid any confusion. That does not mean that I am against translations. I only intend to be as faultless in my understanding as possible.
*****
Dr. Kishor:- If any physician practices and prescribes medicine in the 21st century without resorting to any diagnostic tools, it simply suggests that such physicians pose a threat to society. Please refer to the case of renal cell carcinoma that has been cited in another reply to understand what I mean.
Me:- I am afraid you are reading beyond my words. I wrote “I haven’t seen any of them using modern laboratory investigations in any stage for understanding the disease”. What I meant is that they don’t use any lab test for their own understanding. They use lab tests for the sake of patients because that is what patients understand. They advise their patients to consult the relevant allopathy specialist before doing any test. Also they clearly explain their limitations to every patient. I have never seen them having any shame in doing so. I think that is an admirable quality. As for the renal cell carcinoma case you quoted, is not the change in prabha without any apparent cause or associated symptom a big deal of arishta lakshana? Any Ayurvedic doctor who misses that and doesn’t refer the patient to emergency care is really a threat to the society. I totally agree.
*****
I think I cannot myself clear anymore than this. You may respond if you thought your points are not clear on this platform. Thanks for finding time out of your busy schedule to reply.
REFUTING THE STATEMENTS OF AYURVEDA PROFESSIONALS ON THE BASIS OF PRACTICAL APPROACH
Reference – Patwardhan K. confessions of an Ayurveda professor. Indian J Med Ethics. Published online first on July 2, 2022.DOI: 10.20529/IJME.2022.049
In opinion of the above mentioned article terming certain Ayurvedic Principles are obsolete and author’s advice to remove from the syllabus.
On the basis of treatment of the patients of current scenario that we follow in our daily practice, it is my humble request to the author that without appropriate data, such statements against Ayurveda will create suspense of credibility. I want to ask from the author, did he applied the Basic Ayurveda Concepts of management in practice or not or has he discussed these principles with Ayurveda practitioners? If yes, then what is the basis to delete these Principles from the syllabus?
Irrational attitude and bias or prejudiced conceptions may lead to apprehension and mental aberration among Ayurveda students and fraternity.
For these basic Ayurvedic concepts criticized by Dr. K. Patwardhan (Author of above mentioned article), we use in our daily practice, If these are deleted from the syllabus, then how Ayurveda fraternity will treat mostly multisystem involved cases of current scenario.
There are various diseases and each disease can’t be named, so vaidya should not be ashamed and treat the patient according to the Dosha, Prakriti and Nidaan involvement.(CH. SU. 18/44)
So, if these Basic Principles are deleted no existence of Ayurveda will be there. Then what will happen, it is beyond our imagination.
Rather we consider that it is the need of hour to more and more strengthen these basic principles.
Ayurveda is such a Medical Science that is completely practical. If one’s intellect is unable to apply theoretical part with practical, it does not mean to drop from the curriculum of Ayurveda programmes.
Dr. K. Patwardhan’s notion is notional and not based on practical application. If Author uses his skill to treat the patients of current scenario on the basis of Holistic Ayurveda principles, there is no question that such conflict of thoughts and cognitive dissonance will arise among the students or Ayurveda fraternity.
It is our kind advice to the author that go to treat the ailing society of multiple diseases in a single body. Discuss diseases with Ayurveda fraternity and collect practical ideas, e.g. current diabetes is not only diabetes in majority of cases. Diabetes is presenting as metabolic syndrome and these cases responds very well to holistic Ayurveda basic principles. It seems to me that author of this article even is not aware about Vyadhi Sankar management. Vyadhi Sankar cases management in current scenario is only possible with Holistic Principles of Ayurveda. Without discussion practical aspect of Ayurveda, author’s suggestion is ridiculous to remove the basic principles from syllabus.
Basic Ayurveda principles can’t be translated to the modern science because original concepts are quite dissimilar of these two pathies.
Now the time has come to explain Nidan (Diagnosis) according Ayurveda concepts i.e. instead of telling cervical spondylitis, Ayurveda chikitsak should say, manya sandhigatavata, Hypertension should be interpreted as Vyan Vayu Vaishamya or Raktagatavata, likewise other Ayurveda terminology should be used in our daily practice.
Physiology is a subject of B.A.M.S. 1st year syllabus. It is Ayurveda teacher’s duty to explain Ayurveda physiology in clinical aspect according to the Holistic approach of management, because patient of current scenario are suffering from multiple diseases and system involvement. So patient of current scenario cannot be treated in pieces successfully. Ayurveda students need to explain according to patient sufferings, because you are aware that if you prepare a thorough history of a patient you will find multiple diseases in a patient, otherwise your efforts of teaching will go in vain.
Modern science is not dealing Holistically, instead we treat patient on the basis of basic principles of Ayurveda i.e. Tridosha, Aam – Niram, Anubandhya,Anubandha , Aavaranam, Ashayapkarsha etc. These basic principles are the backbone of our treating method.
We want to explain that we are getting marvellous results only on the basis of these basic principles. A patient of Takayasu’s Arteritis (pulse-less disease), the diseases have unknown cause in modern medicine Textbook. Now the treatment of this unknown cause Takayasu’s Arteritis is just symptomatic and not up to satisfactory result with bad prognosis. But when we see according to Ayurveda aspects, Pachan of Sukshma Aam Rasa and Shotha- har chikitsa gives relief and also pulse starts to be felt. This is discernible. How can modern science compare Sukshma Aam Rasa with modern concept? How can this chikitsa siddhanta justified?
We usually take help of modern technology to enhance the way of diagnosis in Ayurveda. It doesn’t mean that we have to compare and try to define Ayurveda according to modern views. If someone’s intellect does not understand the clinical application of authentic Ayurveda terms, it does not mean futile or obsolete. Each and every statement in Ayurveda text is completely practical and best suits to the multiple system involved patients of current scenario.
If any principle is dropped from syllabus of UG or PG Ayurveda, how the treatment of patients will be possible and a great havoc may arise in our health system.
I also become more confident about the basic principles, when I treat the cases and get amazing results. Our faith deepens in these principles.
It can also be added:
1. There is no need of modern conversion of every Ayurveda terminology.
2. Basic Principles of Ayurveda are quite different from modern medical science.
If we ask you for translation of modern terms into Ayurveda, can you solve the problem?
Likewise, why there is need of each Ayurveda term to be named according to modern science? It is not possible also, because basic approach of both these science is quite different. If one is not properly making efforts to understand Ayurveda, it doesn’t mean futile or obsolete. If someone thinks so, it may be a sign of imbecile or corrupt intellect.
Instead of words ‘obsolete’ or ‘futile’, one may legitimise that according to the multi-system suffering of patients, as we experience in our practice, Textbook of Kaya Chikitsa must be prepared accordingly. So that confusion of new doctors regarding management may be ended and they may treat patients more confidently. Because contemporary multisystem involved cases can easily be treated with Ayurveda Holistic management.
Whole Ayurveda literature is legitimate. There is no need to alter the terms used in textbooks or Samhitas. These terms used in the syllabus are basic foundations.
Without explaining theoretical aspect with clinical approach to the students, legitimisation is false and you can’t understand the Ayurvedic perspective of management. These concepts can’t be compared with modern science. If any effort made to illegitimise basic Ayurveda concepts, it will prove crisis of health.
Dr. Satyaprakash Gupta,
Thanks for your comment. I request you to kindly go through all the earlier discussions on this page.
I have already explained my views on all matters that you have pointed out.
Thanks!
Kishor
Sir ,
Gone through your essay and i can conclude one thing that ,we need introspection, on a higher scale just like a revolution .
Ayurveda fraternity here doesn’t need a mask to cover himself but ,it should stabilise it concepts providing scientific basis not hypotheesis.
We should accept that some more or less ,our concepts are obsolete and we must drip them.
And lastly ,
Respect for your courage and honesty .