Ayurveda, India’s traditional medicine, has historically been open-minded and inclusive. In the ancient and medieval times, it collaborated actively with the traditions of alchemy and Unani to incorporate into its knowledge-base whatever appeared true and useful. The Charaka-Samhita, a 2000-year old classic on which Ayurveda is based, expressly upheld humility and openness in the matter of acquiring knowledge. It said, “The singular criterion for a thing to qualify as medicine is its proven ability to heal. With this understanding, the physician must remain open-minded and learn from sages as well as shepherds. To the wise, the whole world is a teacher.”
As such, integration with other useful medical traditions has been natural to Ayurveda. However, integration has historically occurred without compromising Ayurveda’s guiding philosophy. Assisting, and not bulldozing, the body’s innate mechanisms in their course towards recovery has been the cornerstone of Ayurveda’s gentle therapeutics. Whenever newer and more potent drugs got incorporated into the Ayurvedic pharmacopeia, this primacy of self-healing was not lost sight of. Newer incorporations were assigned appropriate places with a view to make their use consonant with Ayurveda’s gentleness and holism.
For instance, the classical Ayurvedic protocol for managing common fevers has always been non-pharmacologic and supportive, primarily involving the triad of caloric restriction (langhanam), warm fluids (swedanam), and watchful waiting (kaala). When newer alchemical compounds for fever management were incorporated into the Ayurvedic pharmacopeia around the tenth century CE, they were assigned a secondary role to the classical triad. In this way, progress in Ayurveda was characterized by a consistent emphasis on medical minimalism, gentleness, and self-healing. Care was taken to tread the middle path between medical inertia and medical aggression.
Enthusiasts in current times who seek to integrate Ayurveda and modern medicine must bear these vital facts in mind. Otherwise, what would result from a melange of medical systems is a loss of Ayurveda’s uniqueness and epistemic autonomy. As an editorial in JAMA cautioned, “If there is a single strength of alternative medicine that risks being lost in its integration with conventional care, it is an emphasis on self-healing as the lead approach for improving wellness and for the treatment of disease.”
The Union Government’s plan
There have been news reports about the Union Government’s plan to integrate Ayurveda and modern medicine under one academic curriculum. A new integrated MBBS-BAMS1 course is expected to be launched at a premier medical institute in Puducherry.
The proposal raises serious questions: Is the time ripe for a large-scale integration of Ayurveda and modern medicine? Is it a good idea to start an integrated bachelor’s course in Ayurveda and modern medicine? And, should the place that experiments with such an integrative course be an institution of modern medicine?
Ayurveda must first put its house in order
Despite its immense potential to serve as a holistic system of primary care in India, the fact is that Ayurveda as a medical system has remained intellectually stagnant in modern times. Its texts have not undergone timely revisions. As a consequence, what is taught in Ayurvedic colleges today is an incongruous mixture of truths and untruths.
The ancient Ayurvedic classics document valuable information on health-promotion and illness management, a significant portion of which retains relevance even for today’s healthcare. But the same texts also contain a formidable mass of physiological and pathological conjectures. The official approach to Ayurveda is characterised by a woeful ignorance of the need to sift what is relevant from what is obsolete. Philosophical misunderstandings that treat revisable texts as dogmatic scriptures underlie this flawed approach.
Unless Ayurveda renews itself by jettisoning its obsolete portions, it will remain dissonant with evidence-based approaches. Far from being able to integrate with other evidence-based approaches, it will not even be able to function to its full capacity safely and effectively. More fundamentally, such a renewal is mandated by the spirit of yukti-vyapashraya (reason-dependence) that birthed Ayurveda over two millennia ago.
Once Ayurveda undergoes the long-overdue revisions and reforms, the way of a prudent integration with modern medicine, particularly in primary care, will get automatically unraveled. The system will acquire a better understanding of its strengths and limitations. This enhanced self-awareness will then enable Ayurveda to collaborate meaningfully with allied disciplines. Doctors of modern medicine who appreciate the healthcare needs of the community will also find this approach more agreeable.
In the interest of conserving the system’s strengths and uniqueness, the intellectual and practical endeavours for such an integration must take place in spaces that are permeated by Ayurvedic thoughts and practices. An institution of modern medicine would therefore not be suitable for it.
What needs to be done
The most serious problem facing Ayurveda is the sheer lack of a vibrant intellectual resource that can question and correct the academia’s deep-seated philosophical misconceptions. Ayurveda, being a non-global field, does not arouse much interest amongst academics and researchers outside India. Even within India, it does not attract the best talent for its bachelor’s and master’s courses.
Instead of focusing its energies on ventures like a joint MBBS-BAMS program, the government must devise ways to equip Ayurveda with a good intellectual resource. Ayurvedic scholar-physicians, biologists, allopathic doctors, and even humanities experts who have a genuine interest in traditional knowledge systems must be pooled together to work on the grand project of renewing Ayurveda along evidence-informed lines. Integration will come thereafter.
Policymaking must be guided by knowledge, scholarship, and a sense of what is truly benevolent for people’s health. Wishful thinking based on ideologies would not serve the purpose well.
1MBBS: Bachelor of Medicine, Bachelor of Surgery; BAMS: Bachelor of Ayurvedic Medicine and Surgery
Author: G L Krishna is an ayurvedic physician. He is also a research scholar at the National Centre for Biological Sciences – Tata Institute of Fundamental Research, Bengaluru, India. Views are personal. Email: krishnagl@ncbs.res.in
Competing interest: None
Handling Editor: Neha Faruqui