The author wrote this open letter as part of a recent assignment. The letter summarises and adds to his earlier essays on related topics. The assignment was to “Imagine that the Prime Minister has sought your advice for institutionalising Ayurveda in India and abroad. He wants you to tell him the current challenges and solutions to overcome them.” – Editors
Dear Prime Minister,
After decades of concerted efforts aimed at throwing overboard our race experience, it gladdens my heart unspeakably to see your noble intentions to revitalise our rich civilisational inheritance. Many thanks for the opportunity to do my bit in this sacred nation building endeavour.
Ayurveda is a veritable treasure trove of priceless and employable medical wisdom. Its optimum use would serve the purpose of meeting the healthcare needs of the common man in a way that is economically affordable, ecologically sustainable and culturally appropriate. Most important of all, it is the system with the highest potential to fulfil the need for holistic healthcare in the Indian context. Institutionalising its study, research and practice is therefore, needless to add, in the best national interest.
I have identified four major challenges that require to be addressed if we are to mainstream Ayurveda in our country; these relate to the areas concerning -
- The scientific soundness of Ayurveda’s theory and practice
- The quality of Ayurvedic medicinal products and services
- The false propaganda aimed at denting Ayurveda’s image
- The intellectual slavery that we, as a nation, suffer
Let’s look at these issues one by one.
The Scientific Soundness of Ayurveda’s Theory and Practice
I would like to remind your Excellency of an important point you had raised in your speech at the sixth World Ayurveda Congress. You had said, “The biggest challenge to Ayurveda comes from its practitioners themselves; (even) they don’t seem to trust it fully!” Your observation is true; it is important that we, first of all, understand the reason for the trust-deficit an Ayurvedic doctor has in the very science he is trained in.
The average Ayurvedic doctor is frankly out of sync with the intellectual climate of his time. His scientific world-view is narrow and its expression, archaic. The narrowness of his scientific world-view may be traced to the way Ayurveda is being approached and taught in our universities. Deriving usable patient care information from centuries old medical treatises first requires a dispassionate sifting of their contents. This sifting, guided by the great scientific tradition of classical Ayurveda, should aim at removing the obviously discernible pseudoscientific vestiges on the one hand and at enhancing the scientific compatibility of its theory and practice on the other. The current approach of the academia to the study and teaching of the Ayurvedic classics is characterised by a woeful ignorance of this obvious need.
The Ayurvedic academia hold, seldom declaring it expressly, that the ancient Ayurvedic texts, being ‘divined’ by sages, are perfected products relevant almost in their entirety. This gross superstition is often presented pretentiously as the “epistemological distinction” and the “trans-scientific” nature of Ayurveda. These high-sounding words, when probed, are simply a cover for pseudoscience of the most ludicrous sort. The consequence of institutionalising this worldview is the sad spectacle of science students getting schooled at the university level in the weirdest of pseudoscientific fantasies. The Ayurvedic intern thus ends up finding his theory ununderstandable and its practice, often fruitless. The problem gets amplified when seen in the backdrop of the sad reality that the Ayurveda course does not attract the most meritorious of science students.
It is pertinent here to briefly discuss the evolution of the scientific worldview in the Ayurvedic tradition. The switch from the predominantly faith-based (daiva-vyapashraya) therapeutics of the Atharvana Veda to the predominantly evidence-based (yukti-vyapashraya) form of the Ayurvedic classics did not happen as a single disruptive event. It happened over a period of time as a gradual process. A change resulting from such a process, though not unremarkable for the path-breaking turns it takes towards scientific advancement, should still be expected to retain ideological vestiges. That the daiva-vyapashraya practice is merely vestigial becomes clear even from a cursory reading of the classical texts. Charaka’s repeated emphasis upon reason (yukti) is unmistakable throughout his text. He says rather sweepingly in one place: “Vina tarkena ya siddhih yadrichchasiddhireva saa.” Vagbhata most memorably finalises the idea when, characterising all of Ayurveda as “Nirmantra,” he declares, “Ayurveda does not derive its authority by the fact of its being divined by Brahma; its merit comes simply from the verifiable truths it contains.”
An inadequate grasp of this yukti-vyapashraya spirit that guided the origin and evolution of classical Ayurveda is the central bane that’s marring Ayurvedic education today. Outdated medical facts are held current and imperfect hypotheses, eulogised as perfect laws. This process is aided by laboured misinterpretations of ancient aphorisms to suit contemporary scientific findings. Add to this the extremely crass New Age fancy of ‘discovering’ the ideas of Quantum Physics in Indian philosophical literature, the Procrustean bed of laboured misinterpretations achieves its lethal completeness. This dangerously flawed approach leads to imperfect clinical applications on the one side and to a complete smothering of the innovative spirit on the other.
Science that is not clear enough is often simply science that is not science enough. Richard Feynman, the Nobel Physicist was once asked by a Caltech faculty member to explain a rather complex physics concept to young students. He gauged his audience and said, “I’ll prepare a freshman lecture on it.” But a few days later he returned and said, “You know, I couldn’t do it. I couldn’t reduce it to the freshman level. That means we really don’t understand it.”
The Ayurvedic academia, from university professors to journal editors, lack such plainness in accepting the fogginess that surrounds core Ayurvedic theories. As a consequence, their student becomes the sad victim of being schooled in a foggy and ununderstandable theoretical framework! When the quality of science thus suffers, trust-deficit in it naturally follows.
I would therefore urge your Excellency to first set up a scientific committee to clarify and update the Ayurvedic classics. Although this updation requires experimental research, a lot of it may be accomplished by simply adhering to scientific straight-thinking. Employable medical information contained in the classics are to be sifted from outdated theories and ideological vestiges. The committee may be mandated, after this exercise, to produce an updated Ayurvedic samhita within a span of three years. The new samhita should be reflective of the philosophical imperatives for Ayurveda’s progress namely, an enhancement of its Sankhya with Vedanta, of its Nyaya with mathematical reasoning and of its Vaisheshika with physiology and chemistry. This samhita, while being strictly faithful to the guiding philosophy of Ayurveda, shall also aim at reducing the chasm between Ayurveda and Western Medicine. The potential of this singular endeavour in revitalising the great scientific traditions of classical Ayurveda ought not to be under estimated.
Sir, my writings on Ayurvedic experimental research have consistently emphasised upon a singularly important fact: While the classics of Ayurveda contain trustworthy and employable clinical observations, their speculations about the physiology and chemistry underlying them are understandably outdated. Researching the underlying physiology and chemistry of these observations would profoundly enrich both Ayurveda and biology.
I shall explain this with two examples. Last year’s Nobel Medicine was awarded to the discovery of the biological mechanism underlying autophagy. The efficacy of Upavasa (therapeutic fasting) in certain well-defined diseased states is a plausible clinical implication of the phenomenon of autophagy. It is worth noting that this clinical employability of upavasa was carefully studied and documented in the Ayurvedic classics; the biological mechanism underlying it was of course waiting to be deciphered.
Similar is the case with this year’s Nobel winning discovery of molecular mechanisms underlying the circadian rhythm. One important clinical implication related to this discovery is the recognition “that chronic misalignment between our lifestyle and the rhythm dictated by our inner timekeeper is associated with increased risk for various diseases.” This again has been documented clearly in the classics, most memorably in the chapters relating to ‘Dinacharya’ and ‘Ritucharya’. A simple health sustaining message that was codified by Vagbhata more than fifteen hundred years ago is illustrative of the point: “Regular night-time sleep is the ‘chief nourisher in life’s feast.’ Erratic daytime sleep habits, on the other hand, can destroy happiness and convert life into a frightful encounter with the goddess of Death!” Ayurvedic observations have been so meticulous that disorders that can arise from untimely sleep habits have also been pinpointed.
Several such important clinical observations worth researching have been receiving no attention at all. We have a treasure of sound medical observations waiting to get their biology unravelled. This unravelling, as I pointed out earlier, would enhance both Ayurveda and biology.
Allied to the matter of experimental research is the question concerning clinical trials on Ayurvedic interventions. It is not adequately well understood that Ayurveda has been traditionally strict about medical therapies being evidence-based. The classic of Charaka, in fact, marks the switch from faith-based therapeutics to its evidence-based variant. Medical anecdotes graduating into evidence after careful deliberations by experts is the cornerstone of clinical medicine in Ayurveda. At least half-a-dozen such conferences of experts have been recorded in the Charaka Samhita. For reasons that are obvious, this evidence cannot be called “hard” by contemporary standards. What policymakers need to look at is to harden this evidence-base through carefully conducted trials. Newer trial designs that can rigorously assess the value of Ayurvedic therapies without in any way diluting its holistic and personalised approach must be expeditiously explored.
The Quality of Ayurvedic Medicinal Products and Services
With increasing demand for Ayurvedic herbal products, their adulteration with cheap substitutes has become alarmingly rampant. A recent report, for instance, suggested that almost 80% products claiming to contain the drug Ashoka do not have even traces of it. While penalising the manufacturers of such adulterated products can be a short term quick fix, it has be understood that this problem can have a sustainable solution only when the supply of medicinal herbs keeps pace with the rapidly increasing demand. This can be accomplished only by an informed collaboration with agricultural scientists and farmers. Here is an opportunity for a visionary like you to think big - we need ‘Green Revolution 2.0’, this time aimed at meeting the huge demand for medicinal herbs.
Testing for heavy metals and other contaminants in Ayurvedic herbal products is already a part of Good Manufacturing Practices notified in 2003. These practices should be strictly enforced and brazen transgressions, penalised.
There is a long felt need in the Ayurvedic sector for properly trained masseurs and therapists. This is akin to a modern hospital requiring trained physiotherapists and nurses. Although there are a few institutes offering certificate courses in Panchakarma therapy, the trend is yet to pick up. Ayurvedic healthcare centres often suffer from an acute lack of such skilled therapists. Focussing on this area would better Ayurvedic healthcare facilities in addition, of course, to generating newer job opportunities.
False Propaganda aimed at Denting Ayurveda’s Image
Your Excellency might be aware of the malicious attack that vested interests, both foreign and indigenous, often launch against Indic knowledge systems. The sad case of the Journal of the American Medical Association (JAMA) publishing a highly biased article entitled, “Heavy Metals in Ayurvedic Medicines,” is too fresh in our memory to be forgotten. The Indian Government responded by producing evidence from CSIR labs to show that the paper is “seriously flawed and strongly biased.” However, the popular press in India was over zealous in propagating the views of JAMA. It seemed to pay little attention to the well reasoned rebuttal by Indian scientists. Social media needs to be intelligently employed to counter such spread of misinformation . The Department of AYUSH should have scholar-scientists in its social media wing who can ably respond to malicious propaganda. You would appreciate the importance of this better than anyone else!
The idea of setting up chairs for Ayurvedic studies in prestigious medical institutes of the West can also work towards countering malicious propaganda. The possibility of having such chairs in Harvard Medical School, Mayo Clinic, and Oxford University must be earnestly explored. Best Ayurvedic minds who can function as Ayurveda’s ambassadors should be appointed at these chairs.
Another major source of false propaganda against Ayurveda, it might surprise you, is the hostile indifference of Indian doctors trained in Western Medicine (Allopathy) towards their own indigenous medical system. That the Indian doctor, trained in western medicine, cares not to even familiarise himself with the rich medical traditions of his long-lived civilisation, speaks ill of him both as a medical scientist and as a cultural inheritor. Indifference to a three thousand year-old living medical tradition can only characterise a mind that pursues science for its baser rewards. This brazen close-mindedness, after all, is scientific incompetence by another name.
The priceless realisation that comes with a sincere study of science is that of its universality. Medicine, as science, is singular and universal. Medicine, as practice, can be dichotomous and varied. This vital understanding would make the allopath fairer and more open-minded in his assessment of Ayurveda. It would propel him towards researching Ayurveda for the great medical wealth it contains. There is the heart-warming example of Prof. M S Valiathan before us, whose important work on the genotypical variations underlying the Ayurvedic body-types, has been recently reported in the journal Nature. It is not out of place to mention that the latest Nobel prize for Medicine has been awarded to a researcher in Traditional Chinese Medicine. Such an open-minded examination will go a long way in correcting the image of Ayurveda, not only in the minds of doctors, but also in the mind of the patient community at large. A course to promote such open-mindedness with respect to traditional systems might be introduced in the MBBS curriculum.
The Problem of Intellectual Slavery
The problem of intellectual slavery that we, as a nation, suffer is too momentous an issue to have easy solutions. Who better than Vivekananda to articulate this problem? Addressing his countrymen, he said, “You are more dead than alive. You are in a hypnotised state. For the last thousand years or more, you are told that you are weak, you are nobodies, you are good for nothing and so on, and you have come to believe yourselves such.” All things Indian, from Vedanta to Ayurveda, have been victimised by this abhorable mentality. That our school textbooks of science do not even allude to the great wealth of clinical medicine contained in the classics of Ayurveda is an eloquent testimony to this mentality. That best science students do not opt for Ayurvedic education is yet another proof of the same. Extricating ourselves from this dehumanising psychological state along with a vigorous self-assertion is the key to solve this serious problem. Once this is properly tackled, the other issues would simply melt away. A more enlightened State, with a strong scientific orientation and an equally strong rootedness in the great cultural inheritance of this ancient land, is the best bet against this sad state of affairs.
I end my letter with these solemn lines from Gitanjali –
Where the mind is without fear and the head is held high
Where knowledge is free
Where words come out from the depth of truth
Where the clear stream of reason has not lost its way
Into the dreary desert sand of dead habit
Where the mind is led forward by thee
Into ever-widening thought and action
Into that heaven of freedom, my Father, let my country awake.
May your leadership, Mr. Prime Minister, work towards providing us with that ‘heaven of freedom’!
Yours sincerely,
Krishna
December 20, 2017
Bengaluru
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