Vol VI, Issue 4 Date of Publication: October 11, 2021
DOI: https://doi.org/10.20529/IJME.2021.039

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Research, biomedicine and Ayurveda: From evidence-based medicine to evidence-informed healthcare

Sarika Chaturvedi
Nandini Kumar
Girish Tillu
Bhushan Patwardhan
Abstract:
As the search for effective treatment for Covid-19 intensifies, traditional medicine systems are receiving increasing attention from researchers as well as the public. While scientific rigour is non-negotiable, there remain fundamental issues to be addressed when bringing evidence from traditional systems. Here we examine some of these issues pertaining to Ayurveda and the underlying philosophical underpinnings, and suggest potential ways to move forward. We find an ability to emerge from the cage of “biomedicalism” and its foundational reductionism essential for appropriate research in Ayurveda. We caution against pursuing research in Ayurveda by just mimicking modern medicine and highlight the need for appropriate use of modern science tools and methods to understand Ayurveda and explore its potential for healthcare. We emphasise the need and potential for transdisciplinary research in Ayurveda. A balance between evidence-based medicine and evidence-informed healthcare is required.


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©Indian Journal of Medical Ethics 2021: Open Access and Distributed under the Creative Commons license ( CC BY-NC-ND 4.0),
which permits only non-commercial and non-modified sharing in any medium, provided the original author(s) and source are credited.

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  1. G L Krishna
    Ayurvedic physician and independent researcher, Bengaluru , India
    23 May 2021

    I was disappointed to read this article.

    The article makes the usual false presumption that ayurveda is holistic while modern medicine is reductionist. Why this presumption is untenable has been discussed in this essay published by Confluence, the web-forum of the Indian Academy of Sciences: http://confluence.ias.ac.in/the-holism-versus-reductionism-conundrum/

    The authors seek to establish an epistemological and ontological difference between ayurveda and modern medicine. They assert that “The basic premise of modern medicine is the existence of an objective reality reducible to uniform measurement in contrast to the Eastern philosophy of Ayurveda that emphasises conscious experience and subjective reality. The ontology of Ayurveda and BM are very different in their basic assumptions about nature, ways of gaining knowledge, and vocabulary.” They do not, however, explain this sweeping assertion. This makes the whole thing unintelligible and suspect to a discerning reader. Firstly, they don’t substantiate their premise by citing primary ayurvedic sources; secondly, even if their premise were right, they do not explain in what precise ways it has a bearing on COVID-19 research designs. High-sounding philosophical words are no substitute for clear explanation and intellectual accountability.

    Both ayurveda and modern medicine hold the simple-minded view that medicine should base itself on evidence-based reasoning. A major reason for ayurveda’s stagnation today is its academia’s lack of appreciation of Charaka’s emphasis upon yukti-vyapashraya (evidence-based reasoning). Consequently, their devotion to debunked and outdated theories seeks to sustain itself by resorting to unintelligible mumbo-jumbo. Sooner the ayurveda ecosystem rids itself of this truth-negating habit, the better it would be for the revitalisation of this valuable ancient medical system. This paper explains: https://wwwops.currentscience.ac.in/Volumes/117/01/0009.pdf

    • Affiliation: Ayurvedic physician and independent researcher, Bengaluru
    • Country: India
  2. K P Mohanan
    ThinQ (www.thinq.education) , India
    18 August 2021

    As an academic who has been engaged in research on
    (a) transdisciplinary ontology and its field specific manifestations, and
    (b) transdisciplinary epistemology and its field specific manifestations,
    I have some reservations on both the Chaturvedi article and Krishna’s “disappointment” with the article. I think a better way to go forward would be to
    1) identify the desirable features (and undesirable features) of not only the ontologies and epistemologies of ancient and modern Western and South Asian medical systems, but also the ontologies of epistemologies of Academic Knowledge as a whole, covering mathematics, the sciences (of the physical world, animate world, mental world, and social world), and the humanities (e.g., philosophy.)

    The claim that ‘western’ systems are reductionist cannot be critically evaluated unless we clarify what we mean by reductionism. Likewise, the claim that Ayurveda is holistic cannot be critically evaluated unless we clarify what we mean by holism.

    For instance, is ‘reductionism’ an ontological assumption or an epistemological assumption? If reductionism is an ontological assumption that says that
    “The parts of a whole and their relations/interactions determine the properties of the whole”
    or an epistemic assumption that says
    “If we understand the parts of a whole and their relations/interactions then we can predict everything about the whole.”
    reductionism is clearly untenable. Taken to its logical conclusion, for instance, the strong version of epistemic reductionism asserts that if we understand the properties of fundamental particles and their interactions, we can predict the phenomena in astronomy, relativity theory, solid state physics, chemistry, biology, cognitive science, social science, and history can be reduced to quantum mechanics, and we can predict historical events from quantum mechanics. I don’t think any scientist worth his/her salt would assert this. If so, what exactly does the word ‘reductionism’ mean?

    I would suggest a weak version of reductionism can be understood as a methodological strategy ( =epistemic strategy) understanding as many properties of the whole on the basis of an understanding of the whole. To understand the cell, for instance, it is useful to understand molecules, but cellular biology cannot be reduced to ( = completely predictable from) molecular biology, because the higher level of organisation exhibits EMERGENT properties. Without an understanding of self organisation and emergentism on modern science, I think we will be lost in endless and unproductive battles on Ayurveda vs modern medicine.

    Likewise, if ‘ the term holism’ denotes the strategy of integrating and unifying diverse knowledges into a single system, Newton’s theory is holistic because it integrates and unifies our understanding of terrestrial motion and celestial motion of inanimate bodies. So is the theory of electromagnetism because it integrates and unifies electricity, magnetism, and optics.

    The way these words are currently used, I see words like reductionism and holism as divisive words. And I personally think, like Krishna, that the current state of Ayurveda research and education has much to be desired. However, I also think, like the authors of this article, that the ontology of Classical Ayurveda has much to contribute to both biology and medicine. And if we liberate ourselves from ill understood dichotomies, and figure out how the ontologies of Classical Ayurveda and Modern Biology and Medicine can be integrated and unified into a single system, we can make progress. I would therefore recommend both Krishna and the authors of this article to cease their antagonistic stances, and look for ways of collaborating with one another.
    K P Mohanan, Retd Univ Prof

    • Affiliation: ThinQ (www.thinq.education)
    • Country: India
  3. K P Mohanan
    ThinQ (www.thinq.education) , India
    18 August 2021

    One sentence seems to be missing in my comment. After recommendation (1), there should have been recommendation (2). Here is the correct version:
    I think a better way to go forward would be to
    1) identify the desirable features (and undesirable features) of not only the ontologies and epistemologies of ancient and modern Western and South Asian medical systems, but also the ontologies of epistemologies of Academic Knowledge as a whole, covering mathematics, the sciences (of the physical world, animate world, mental world, and social world), and the humanities (e.g., philosophy.)
    and
    2) put together the desirable features of all into a single system.

    • Affiliation: ThinQ (www.thinq.education)
    • Country: India
  4. G L Krishna
    Ayurvedic physician and independent researcher , India
    26 August 2021

    While thanking Prof. Mohanan for his comments, I sought from him the following clarification.

    “Can you please explain this line in your comment:

    However, I also think, like the authors of this article, that the ontology of Classical Ayurveda has much to contribute to both biology and medicine.

    1. What is the ontology of ayurveda in your understanding?
    2. How’s it different from that of biology and medicine?
    3. In what specific ways can it contribute to biology and medicine?”

    The professor was kind enough to mail a detailed reply. His reply follows:

    “1. What is the ontology of ayurveda in your understanding?”

    PART 1: What is ontology?

    One way of unearthing the ontology of a ‘discipline’ is to
    identify the theories in the discipline as presented in well reputed textbooks, (step 1)
    identify the inventory of the technical vocabulary used in that theory. (step 2), and
    define or clarify the concept denoted by each item in that inventory, such that we can deduce the logical consequences of the propositions containing thosed concepts (step 3) .

    Step 1
    To unearth the ontology of physics, for instance, we begin with the theories in physics in well reputed textbooks. This would include Galileo’s theory of the pendulum, Galileo’s theory of the motion of inanimate objects (e.g., stones, cannon balls) on the earth , classical mechanics, relativity theory, optics, electricity, magnetism, heat, and so on.

    Step 2
    Take classical mechanics. This involves the concepts of gravity, force, momentum, mass, weight, acceleration, velocity, distance, time, and displacement as change of location along a straight line.

    Step 3
    The concept of force in classical mechanics is that of what causes a change in velocity. In contrast, the concept of force in Aristotle is that of what causes a change from state of rest to motion (Motion = change of location). The concept of force is replaced in relativity theory by the concept of energy and field. The logical consequences of the propositions containing these two concepts of force are quite different.

    To take another example, consider the theory of Euclidean geometry, built on the ontological framework of points, lines (straight or curved), triangles, squares, rectangles, circles, ellipses, vertices, angles, etc. The concept of point in Euclid is distinct from the concept of infinitesimal in calculus: points in Euclid have zero magnitude, their equivalent in calculus have magnitude greater than zero.

    Take Darwin’s theory of evolution. Its concepts include evolution, selection (natural and sexual), survival, fitness, mutation, parent-offspring, ancestor-descendant, species, …. I don’t think this theory is any more fleshed out than the theory of intelligent design, so in my opinion both are theory seeds, not theories yet.

    These are examples of ontology specific to a field field/ discipline/theory . To understand them from a general perspective and to transfer the concepts from one domain to another, we need a transdisciplinary ontology, with concepts like entity, property, relation, structure, function, change (= mutation), development, evolution, causation, and so on.

    PART 2: Ontology of Ayurveda

    I must confess that I have not read Charakasamhita (I intend to do so soon), but from what I have read about Charakasamhita in various papers and people talking about it, It has
    A) a ‘pure science’ theory of life ( what is called biology in IISERs, consisting of various subtheories, and
    B) an ‘applied science’ theory of medicine, consisting of various subtheories.

    Theory A includes a theory of bhoota (panchamahaabhoota) , a theory of guna, a theory of dosha, a theory of vaata, a theory of pitta, a theory of kapha, and so on.

    To critically evaluate any of these sub-theories, we may need to ‘reconstruct’ it: what we gather from an ancient text is hardly sufficient. [Footnote: This is the problem that I am facing when I study ancient Indian epistemologies and logics (Nyaya, Jainist, Buddhist) It took me more than twenty years to understand Nagarjuna’s concept of chatushkoti (tetralemma), and I am still not sure that I understand it, but I have my own reconstruction based on quantum logic.) ]

    Take the concept of bhoota. It is clear that bhoota should not be translated as the concept denoted by the English word ‘element’ in modern chemistry. I might be wrong about this, but it seems to me that bhootas are
    the properties of the universe that shape its evolution.
    Even if we do not understand the concepts of bhoomi, vaayu, etc. I think this idea is intriguing and valuable. If so, bhootas the properties of purusha that function as the causal factors (what biologists call mechanisms) that shape the evolution of the physical world, the biological evolution, biological development, ultimately forming the mechanisms of physical change, chemical change, biological change, cognitive change and social change.

    As I see it, the scope of concepts of gunas and doshas is restricted to the human species. Ignoring the particular gunas and doshas that the ancients have postulated, we can take the guna-dosha theory as a theory of the causal factors that shape the characteristics of a healthy human and a patient who has an ailment.

    “2. How’s it different from that of biology and medicine?”
    Both Classical Ayurveda and modern biology-medicine have ontologies at the level of organs, and organ systems. Classical Ayurveda does not have an ontology of molecules and cells. Modern biology is not grounded in a general theory of the evolution of the universe, and the causal mechanisms of change in the universe (bhoota).

    “3. In what specific ways can it contribute to biology and medicine?”
    I cannot say exactly how, but I hope that what I have sketched above can be taken as an outline of the conceptual foundations for a research program for Ayurveda, as well as the foundations for an integration and unification of the ontologies of the two knowledge systems, such that the resultant ontology can form the basis for theory construction in pure and applied sciences of life.

    Mo

    • Affiliation: Ayurvedic physician and independent researcher
    • Country: India
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