This article is a response to "Integrative Medicine: The Confusion Compounded" by Rajiv ji who authored a rebuttal to my earlier piece titled, "The Mixing of Āyurveda and Allopathy: Holistic or Dangerous?"

I must thank Śrī Rajiv Vasudevan ji for initiating a debate on the issue of mixing Āyurveda and allopathy at the undergraduate level. Rajiv ji is doing phenomenal work in integrative medicine, and I hope to be a part of his efforts to bring the two systems together for the benefit of the individual and society. There is every reason today to bring the different systems of medicine to the table, and a healthy discussion should be the way forward.

However, I have a few problems with his rebuttal, Integrative Medicine: The Confusion Compounded,  to my initial article, The Mixing of Āyurveda and Allopathy: Holistic or Dangerous? He begins by saying that ab initio, he does not support the mixing of the two at the undergraduate level. Later in the article, he suggests combining the two systems at the postgraduate level. The primary and sole focus of my article was to reject and refute the government's proposal to combine the two systems at the undergraduate level. There is an attempt to show how the paradigms differ while studying Āyurveda and allopathy. If he agrees with this position, the rest of his article reduces to a significant misunderstanding.

A true rebuttal to my article would take the form of approving the merging of the two curricula (BAMS and MBBS) into a single course and asserting that such combined courses would face no issues in gaining acceptance at any level. Such a contention is not presented in the rebuttal. The author appears to have followed a different train of thought and then argues against unfamiliar sights.

Epistemology and ontology are important in any knowledge domain. Ignoring them for the sake of practical integration in addressing health problems may be acceptable, but disregarding them when attempting to combine curricula is not only risky but unacceptable. It is quite surprising that Rajiv ji claims that these, along with metaphysics, are not very relevant to the discussion. Ignoring the basic principles of any knowledge domain is a serious matter. This presents a significant risk of prematurely abandoning any further debate. However, in light of the misunderstanding of the basic position, I will assume that he believes I am arguing against the integration of any kind. This is certainly not my position. Perhaps Rajivji feels that I am undermining his work when I have nothing but genuine respect for what he is doing.

Āyurveda is a metaphysical science based on the Vedas, and its methods and applications will have different standards from allopathic medicine. It is either a facet of colonial consciousness or plain ignorance to try to apply the modern scientific paradigms that are changing all the time to evaluate Āyurveda. When the basic frameworks of understanding the subject are different, it is absolutely necessary to keep them separate at all levels: undergraduate, postgraduate, and doctoral. These are two different systems for the benefit of the individual and society. 

Of course, both systems individually are inadequate for providing a permanently healthy and immortal life. However, they can and should meet as equals once the individuals involved have acquired the necessary training, expertise, and efficiency in their respective fields. Each system stands independently, and there should be a recognition of the strengths and limitations of its respective systems. The meeting should happen with humility, of course, and a sincere passion to learn.

Nyāya is the crux of Āyurveda, as I understand. Yukti stands as an important pramāṇa in Nyāya and especially Āyurveda, as Rajiv ji rightly points out. Based on my limited knowledge of Nyāya, Yukti serves as a pramāṇa that integrates other pramāṇas into a cohesive and logical whole. In classical Nyāya, it is neither a pramāṇa by itself nor does it independently generate knowledge. In Āyurveda, Yukti is elevated to a greater role in diagnosing and treating conditions based on variable factors. Regardless of its role, Yukti is ultimately closely attached to the classical pramāṇas.

Rajiv ji takes refuge in the Yukti of Āyurveda as a grand idea that aligns with modern sciences. The traditional sacred sciences have a different epistemology that no modern sciences concede or acknowledge. Rajiv ji, in his detailed exposition, explains beautifully how Yukti works in Āyurveda but does nothing to reconcile the differing paradigms of modern profane sciences and the traditional sacred sciences. There is nothing for or against the argument of not combining the two systems into a single curriculum. 

Finally, the importance of epistemological methods in Āyurveda is unknown to almost all allopathic practitioners and most BAMS doctors I have interacted with. Modern sciences disregard the epistemological methods of Nyāya, including the all-important "universals" and "essences" in the study of objects. The two systems study health and disease using two different paradigms. The incommensurability of paradigms is the single most important reason not to combine the two into a single curriculum.

However, this does not prevent combining them at the practical level of achieving health or treating disease in an individual. The two systems can function in parallel, sequentially, complementarily, or as alternatives, depending on what is most suitable. However, such integration requires a respectful dialogue among experts in their respective fields, rather than simply merging the two into a single curriculum. One can study and acquire competency in both systems in a sequence to do a comparative and integrative exercise, but that would be extremely impractical and difficult. The ideal scenario is one that would involve unbiased institutes encouraging conversations between the interested and competent practitioners to achieve the best possible outcomes. We must appreciate Rajiv ji for carrying out this type of work.

The section on Āyurveda was primarily meant for the allopathic practitioners fascinated by recent advances to make them aware of the strengths of traditional Indian Vidyas. Modern doctors hold such antipathy toward Āyurveda that I cannot see any meaningful integration occurring in the years to come. Getting the subjects at the curriculum level would make matters even more confusing. The initial part of my article was simply acknowledging this contribution when I looked at the historical developments of Āyurveda in India. It was simply a statement of facts rather than a judgment of any sort. 

However, saying "Āyurveda is better than allopathy for treating anorectal and urological disorders, non-healing wounds, pain management, and more" shows an ignorance or misunderstanding of the advancements in gastroenterology, coloproctology, urology, or nephrology. Making such broad claims is misleading and potentially harmful. There are certainly specific instances where Āyurveda may have a role. To say it “scores over” is a factually wrong statement. The major problem today is that each system focuses on the issues and shortcomings of the other in order to evaluate it.

Again, there is a presupposition that the objection against polypharmacy due to a singular lack of studies in this field has been constructed as a summary rejection of integrative medicine. I would invite Rajiv ji to go through the article again and perhaps revise the tone of his stand. Integrative medicine is always accepted. Polypharmacy is a real and scary issue in modern medicine, where the number of medications goes up as the age of the patient or the complexity of the disease increases. Many of the drug interactions are complex and have been the focus of lifetime studies by many experts in pharmacology. Incorporating Āyurvedic medicines, whether as a supplement or a replacement, offers a fresh perspective that has not yet been explored, necessitating researchers to begin from scratch. I cannot see how Rajiv ji finds a problem when this issue is raised in the article. 

The meeting of the two cannot be possible when one assumes the role of being subordinate to the other. Sadly, the present Āyurveda colleges and systems do not instill a pride that is so much vital. I work in a place where an Āyurvedic college has existed for many decades. I have been seeing the graduates for 25 years, and I have been closely associated with them. We can discuss their attitudes and knowledge regarding their field of expertise. Very few decide to become Vaidyas. Most seek employment in allopathic hospitals as duty doctors or assistants to surgeons. Some attempt to establish nursing homes by employing allopathic doctors. I know that they have learned Saṃskṛta and are familiar with Darśana.

My assistant of 25 years is an Āyurvedic doctor, and when asked about Nyāya, he said that they had a paper of 60 marks in the subject. Apart from that, he has no clue about the relevance of Nyāya. He had learned Saṃskṛta too, but he hardly thinks of furthering its use. That is the painful state of Āyurvedic teaching in our country. Allopathy teaching and training are also deeply problematic, but that is a matter for another day. One could argue that I come from a different world, and my perspective on the subject is an outlier. I do not then have any answers.

With my limited understanding of Indian Darśanas, knowledge is inherent in the soul (or the Self or Consciousness), and the external world is revealed when the obstruction to the knowledge is cleared. Modern sciences take a divergent opinion of consciousness that places it secondary to matter, an epiphenomenon. I would be happy to be convinced about how two knowledge domains having two absolutely different frames of reference for acquiring knowledge can be combined at the curriculum level without giving a mental breakdown to the students. Rajiv ji informs me that I would be pleased to know that Nyāya is taught along with many other subjects in Āyurveda. I am certainly aware of the subjects taught in BAMS courses, and it would be nice to revisit Girija et al.’s document, where it is shown that one can actually pass the exams without knowing much about Āyurveda. Such is the unfortunate design of the curriculum. 

The whole point of the article was to sensitize the allopathic practitioners to the strength of Āyurveda, to articulate my attempt to understand how Āyurveda differs from allopathy, and to make a case for the incommensurability of paradigms to mix the two into a single curriculum at the undergraduate level. However, this does not mean that combining and integrating at the practical level is impossible. Each system can potentially compensate for the shortcomings of the other.

The two great systems must meet as equals, without either system rejecting the other as inferior or accepting the other as inherently superior. This situation is a practical and widespread reality, highlighting the shortcomings of both the Indian medical teaching and education systems. The allopathic medical teaching is plummeting to seriously low levels, and the Āyurvedic teaching is faring no better. Unless the government thinks that two negatives can make one positive, the mixing of the two systems into a single curriculum defies logic.

There is eagerness on my part to learn how Āyurveda can integrate with allopathy, and I hope to be a part of such endeavours in the future. However, rebuttals of this kind, along with the tone and tenor that misunderstand the basic statements of the article, risk alienating the allopathic practitioners who hope to come closer. In my view, Rajiv ji has misunderstood the purpose of the article and is responding based on a flawed interpretation. I would be pleased to have more conversations. But my stand that the two cannot be combined into a single curriculum is non-negotiable. 

We perhaps have to ask questions like how modern diagnostics should be integrated into Āyurveda and whether they are required in the first place. We have to seek how Āyurvedic practitioners get integrated into surgical faculties without getting reduced to theatre assistants. How do advances in Āyurvedic medicine happen? Do modern evidence-based medicine principles apply to the traditional sciences? These are extremely difficult questions. The present state hardly encourages questions of this kind. Currently, both systems seem to rely solely on identifying and condemning each other's negatives or shortcomings. Bringing sanity into these conversations, which should build bridges instead of walls, would require a significant amount of care and effort. 

Anyway, I see it as a failure on my part to inadequately articulate that the two systems should meet as equals and that, at a curriculum level, they should be kept separate. It is unfortunate that Rajiv ji failed to appreciate this point despite standing on the same side and instead wrote a detailed rebuttal to a position I never took. In the meantime, there has been no further talk of our government combining the two into one single curriculum. I do hope the short-sighted and ill-conceived idea has been permanently shelved. If that is indeed the hopeful case, we can return to what Śrī Rajiv ji is doing with more participation, coordination, and dialogue from the relevant practitioners in each domain. 

ADDITIONAL NOTE: 

COMMENTS ON THE RECOMMENDATIONS FOR REFORMS IN AYURVEDIC UNDERGRADUATE STUDIES BY CENTRAL COUNCIL OF INDIAN MEDICINE, 2016 BY GIRIJA ET AL. (2025)  

The following is a reproduction of the section on Āyurvedic teaching in the book “Ayurveda for Revitalising Health care in India” by PLT Girija, TM Mukundan, and MD Srinivas that presents a very balanced view of the state of Āyurveda in the country and gives some solid recommendations: 

Current CCIM syllabus for Bachelor’s degree in Ayurveda should be reviewed. Presently, the syllabus has more emphasis on MWM than on Ayurveda; hence, many of those who acquire degrees have incomplete Ayurvedic knowledge, completely undermining Ayurvedic learning and practice. It also legitimises ‘mixed practice’ where ISM doctors prescribe both ISM and MWM medicines. 

The new Recommendations for Reforms in Graduate Ayurvedic Medical Education (Drishyam 2016) have diluted the content of Ayurveda in the BAMS Course to ridiculously low levels. It was expected that the Council would take serious note of the fact that the existing curriculum itself was very weak with the content of Ayurveda being less than 70% of the entire scheme of studies in the BAMS Course. On the other hand, the new Recommendations have diluted the content of Ayurveda further to 60% or thereabouts.

The following table roughly summarises the woefully inadequate coverage of Ayurveda in the existing and proposed curricula. 

The CCIM seems to have lost sight of the primary goal of BAMS course – to train students to be proficient practitioners of Ayurveda. The proposed syllabus can only produce incompetent physicians who have received inadequate training in both systems of medicine and are well versed in neither. What we should try to achieve is a healthy interaction and engagement between the two streams of medicine where there is professional dialogue and patients are referred to each other and not an integrated system of education that only legitimises quackery.

It is important to understand that students who have opted to seriously learn Ayurveda should not be forced to study modern Western medicine (MWM) as a significant part of the curriculum. Alternately, students may be provided a choice of optional courses (to the tune of 5 - 10% of the entire curriculum at most) providing introduction to the theory and practice of various systems of medicine in vogue in the country, issues of community health, health policy and so on. In this context, it is important to emphasise that it is also necessary to impart basic training in Ayurveda to the students of MWM by offering appropriate choices of introductory overview courses in the MBBS curriculum.

A view has been expressed in our country that we should train a set of physicians who are proficient in both Ayurveda and MWM. It would be foolish to think that such highly qualified professionals can be created from this BAMS course which teaches neither Ayurveda nor MWM with the required rigour and depth. 

In the proposed curriculum of CCIM, the study of Sanskrit is almost reduced to a nullity. Sanskrit is the technical language of Ayurveda. A sound grasp of the language is essential and it should be compulsorily taught throughout the duration of the course.

The new curriculum also proposes to restrict the study of Charaka Samhita to a set of random selections. Undergraduate students must study the three basic canonical texts, namely Charaka Samhita, Susruta Samhita and Ashtanga Hrdayam, in their entirety. 

The only welcome feature of the proposed scheme is that it advocates delinking of Ayurvedic subjects and those dealing with MWM. This removes a serious shortcoming of the existing curriculum which mixes up both these systems in the same paper, thereby giving rise to the possibility that one could successfully pass all these examinations without learning the Ayurvedic portion of the paper! 

The latest recommendations, therefore, further dilute the already woefully inadequate Ayurvedic content in the BAMS Course. This could sound the death knell for Ayurveda in its homeland. We call upon CCIM, in the interest of Ayurveda, to revamp the new recommendations and at the same time, initiate a process of review and consultation whereby the existing scheme of studies of BAMS is revised and strengthened along the lines suggested above.