The Mixing of Āyurveda and Allopathy: Holistic or Dangerous? – Part Two

Indian and Western philosophies differ significantly on numerous issues. As philosopher Chittaranjan Naik explains in his books, Consciousness (with a capital C)—also referred to as the Self, Puruṣa, or Cognizer—underpins the entire ontology and epistemology of Indian traditions and sciences and is considered primary. In contrast, it is viewed as secondary to matter in Western traditions. The concepts of the Self and mind-matter are categorically distinct; the former represents the sentient “cognizer”, while the latter embodies the insentient “cognized”. Mind and matter serve as the two modes through which objects of cognition manifest, revealing what can be understood as legitimate objective reality. In Western philosophy, consciousness emerges as a secondary outcome of matter, which begins with fundamental building blocks such as atoms, quarks, or strings.

In terms of ontology, the prevailing Western paradigm for perception involves light striking an object, reflecting onto the retina, and the resultant image being transmitted to the brain via neural impulses, followed by reconstruction of the image within the brain. This sequence applies uniformly across all senses. This “stimulus-response theory of perception” posits that perception is merely a response occurring within our brains, mediated by an intermediate causal chain. 

However, this framework raises challenges in elucidating how an internal image in the brain projects to the external world. Consequently, the perceived world is viewed merely as an internal representation of an external reality, rendering it an indirect form of reality. That which exists outside remains unknowable. This standard model of representation thus fails to adequately address the subject of ontology (reality), as the true nature of the world (noumenon) always eludes our comprehension. What we perceive consists solely of phenomena.

Conversely, Indian philosophy advocates for an active theory of perception in which the perceiver occupies a central role. The perceiver actively engages with the object in the world. This “contact theory of perception” posits that direct contact with an object provides the perceiver with genuine information about the world as it exists. As a result, the external world, whether seen or heard, is regarded as an actual reality rather than a mere construct. This perspective demonstrates the value of pratyakṣa, or direct perception, as a valid pramāṇa, or means of knowledge. This viewpoint stands in stark contrast to Western philosophy, which asserts that the external world can never be fully known; thus, perception is not considered a reliable source of knowledge in Western traditions.

When discussing epistemology—the method of acquiring knowledge—the conventional definition in Western philosophy is justified true belief (JTB). Edmund Gettier highlighted various problems with this framework of knowledge. In Indian traditions, knowledge is regarded as the supreme ideal. One of the attributes of Brahman, or the Self, which underpins the universe, is knowledge; thus, the pursuit of knowledge is viewed as the most divine endeavor within human pursuits.

Any knowledge must have a certain means of acquisition. Pramāṇa (proof or a valid ‘means of true knowledge’) plays a crucial role in Indian philosophical traditions. There are six pramāṇas, with the first three being the most significant: perception, inference, and testimony of reliable authorities, along with comparison and analogy, postulation, and non-perceptive negative proof. It is surprising that the West, which prides itself on numerous scientific and technological advancements, lacks a comprehensive theory of knowledge. The criteria for what constitutes scientific validity have undergone repeated revisions, too, as seen previously. In contrast, Indian science and traditions uphold verifiability as the criterion for acquiring knowledge.

Brahman, or the self, characterized by the primary attributes of knowledge (sat), truth (cit), and bliss (ānanda), serves as the foundation for both epistemology and ontology within Indian traditions. The ontology, or perception of reality, is an inside-out process that begins with the Self, which directly engages with the objects of perception. Knowledge of any object in the parā or aparā realm provides access to Brahman. Consequently, any activity in any domain can serve as a pathway, at least not an obstruction, to mokṣa in Indian knowledge traditions.

Yoga 

Yoga is a philosophical system comprising graded steps aimed at attaining knowledge of the immortal Self, which liberates individuals from the constraints of nature. Both orthodox (Nyāya, Vaiśeṣika, Yoga, Saṅkhya, Mīmāṃsā, Vedānta) and non-orthodox (Buddhist, Jain) Indian schools—excluding atheism—place significant emphasis on yoga and meditation within their frameworks. The initial five components of yoga serve as preparatory stages for higher states: yama, niyama, āsana, prāṇāyāma, and pratyāhāra. The first two—yama and niyama—focus on controlling desires and emotions, while the next two—āsana and prāṇāyāma—address disturbances originating from the physical body. Pratyāhāra involves detaching the sense organs from the mind, effectively severing the connection to the external world and its impressions.

Following this preparatory phase, the last three aṅgas (or limbs) are dhāraṇa, dhyāna, and samādhi. Dhāraṇa entails concentrating the mind within a limited mental space; dhyāna represents an uninterrupted flow or contemplation directed towards an object of meditation; and the final state, samādhi, is characterized by a consciousness solely of the object of meditation, devoid of any awareness of the mind. In this state, the mind merges into the ultimate experience of samādhi.

Do these states yield knowledge of the mundane world? The Yogic perspective affirms this, as elucidated by Ramakrishna Puligundla in his seminal work, Fundamentals of Indian Philosophy. Samādhi encompasses progressive stages known as savitarka and nirvitarka, according to Patañjali. In the savitarka state, knowledge manifests at three levels: śabda (knowledge based on words), jñāna (knowledge derived from perception and reasoning), and artha (intuitive knowledge of the object in its essence). In the final nirvitarka state, the yogī achieves unity with the Supreme Consciousness. The savitarka state, particularly its jñāna component, allows for the formation of conceptual knowledge. As articulated by Patañjali, the highest state does not facilitate knowledge of individual objects; however, the yogī can, should they choose, access corresponding states of consciousness and attain worldly knowledge. 

Dean Ornish, in his book Dr. Dean Ornish's Program for Reversing Heart Disease, presents compelling evidence-based arguments for his program, which integrates Indian yogic exercises, breathing techniques, meditation, and dietary practices to reverse heart disease. Most conventional interventions, such as aspirin, medications, stents, and surgery, at best, halt disease progression; they rarely accomplish reversal, as Ornish demonstrates in his work. He strongly advocates for these yogic methods in addressing heart issues. Nonetheless, to gain Western funding approvals, he had to rebrand the techniques with more secular-sounding terms, such as "alternate nostril breathing," "forced breathing," and "visualization" techniques.

The ongoing debate about whether yoga is an Indian tradition or a universal practice akin to the law of gravity has drawn attention from prominent figures on both sides. The confusion largely stems from the widespread applicability of āsanas and prāṇāyāma in promoting physical health. Viewed through this narrow lens of physicality, yoga can indeed be considered universal and beneficial for all individuals. However, when understood as a holistic philosophy, yoga is unequivocally Indian, with its ultimate aim being mokṣa, or liberation.

Western interpretations often selectively highlight certain aspects of the practice while overlooking the broader metaphysical context. Consequently, terms like “cardiac coherence breathing” are used to secularize these breathing and physical exercises. Such usage represents a form of appropriation without proper acknowledgement. Therefore, when discussing its origins, it is clear that yoga is fundamentally Indian, and drawing parallels to concepts like gravity is misleading. There is no ambiguity within the realm of modern Western science regarding Newton’s role in the discovery of gravity.

The concept of immortality, too, presents different perspectives within Western scientific materialism and Indian philosophy. In the former, which adheres to a single-life metaphysics, immortality is perceived as one continuous, deathless existence. Contemporary science and medicine strive towards this goal. While the duration of life is certainly increasing, its quality has yet to improve correspondingly. It is conceivable that, in a distant future, humans—provided they do not annihilate themselves—may attain a state of permanent youth with death being a choice rather than an inevitability. It would naturally follow that humans would need to seek extraterrestrial planets or moons to alleviate the strain on the resources of a single Earth.  

Āyurveda, in contrast, aligning with Indian darśanas, has multiple-lives metaphysics along with ideas like karma prevailing across many lives. The concept of immortality refers to a state of complete and everlasting happiness in which the striving jīva does not experience any further rebirth. Such ideals are in better harmony with nature and ecology, as well.  Modern medicine is perhaps a long way from achieving its goals. It is just possible that Āyurveda perfected its system thousands of years ago to serve human life. 

Surgery and Anesthesia: Challenging Questions 

From ancient times, India was renowned for performing a range of routine and complex surgeries, including plastic surgical procedures such as the use of rotational flaps from the forehead for reconstructing amputated noses. Ancient practitioners demonstrated considerable expertise in employing various wines and intoxicants for anesthetic purposes. However, at a certain point, modern medicine began to overshadow the natural evolution of surgery rooted in Āyurvedic principles, effectively stating, “Thank you, but we will take it from here.”

In contemporary times, envisioning how Āyurveda could re-establish its presence in the field of surgery appears challenging. Modern medicine has pursued a path of specialization to such an extent that it is often joked that there are now separate specialists for the right and left hands. The training, apprenticeship, accreditation, and advancements in areas such as antimicrobials, diagnostics, imaging, and anesthesia have reached extraordinary levels of complexity. From abscess drainages to organ transplantations, modern surgery in an operation theater provides a snapshot of the significant progress of human medicine over the centuries. The operation theater is the place where medicine and instrumentation engineering have the greatest interface.  

Such complexity raises questions about whether Āyurveda could gain access to these resources or if practitioners would be denied even basic tools like oxygen for treatment purposes. Moreover, it is noteworthy that, on numerous occasions, non-qualified personnel in the operating theater can perform remarkably well—sometimes even surpassing qualified surgeons—in both open and minimally invasive techniques.

An adage states, "Good surgeons know how to operate; better surgeons know when to operate; and the best surgeons know when not to operate." The "how", or technical aspect of surgery, ultimately hinges on practical skills honed through repeated practice, akin to any sport or skilled trade. Some of the best technical surgeons are, in fact, non-qualified people working under the supervision of qualified surgeons. In fact, there is a burgeoning international movement advocating for the official accreditation of technically proficient laparoscopic assistants.

Should this trend continue, it may not be far-fetched to envisage Āyurvedic doctors re-entering the surgical field at a more significant level. The “how” of surgery (broadly, trauma-related, extractive, excisional, reconstructive, or replacive) may be within the reach of Āyurvedic doctors because it is essentially a technical job. However, it would take a lot of work to see how paradigmatic differences could play in the "when" and "when not" of surgery. However, it requires extreme caution and thoughtful consideration to make such ideas a viable reality. Certainly, an outright condemnation is not required if Āyurveda practitioners want to gain surgical skills on a bigger scale. The Āyurveda department at the Banaras Hindu University in Varanasi does offer postgraduate courses in surgery. However, very few patients would approach an Āyurvedic surgeon today for their operative needs. 

Integration, Symbiosis, Assimilation, or Absorption: How do the Twain Meet? 

How can we integrate the two forms of medicine for both preventive and therapeutic aspects concerning individuals and the community? P. L. T. Girija, T. M Mukundan, and M. D Srinivas, in their work, Ayurveda for Revitalising Healthcare in India, propose several strategies. They argue that a careful study is essential for leveraging the strengths of both systems without fostering antagonism between them.

As a first step, they suggest that government expenditure on health should be increased from the current low level of 1% of GDP to at least 3% over the next eight years. Also, funding support for Āyurveda, which currently stands at 1.5%, should rise to at least 30% of the health budget. This is warranted, as the Āyurvedic system comprises over one-third of registered medical practitioners and one-fifth of undergraduate medical students and serves more than two-thirds of the population. The level of state support must be proportional to its significance and user base.

Rather than encouraging antagonism, the curricula of both Bachelor of Ayurvedic Medicine and Surgery (BAMS) and Bachelor of Medicine, Bachelor of Surgery (MBBS) should be designed to foster a more profound understanding of each system, promoting healthy interactions between them. Enhanced understanding would enable physicians to refer patients to a system more adept at addressing specific diseases, without worrying about the fundamental paradigms of the two systems. 

Āyurveda has a well-defined role in managing respiratory infections, viral fevers (such as chikungunya and dengue), and diarrhoeal diseases, which significantly contribute to morbidity and mortality in children. Furthermore, Āyurvedic treatments for autoimmune diseases and wound healing present additional opportunities for collaboration. Surgeons extensively use the Āyurvedic thread for treating anal fistulae.

The authors suggest integrating traditional bone-setters and midwives (dais) into the public health system. Allopathic doctors would highly debate the former, however. Āyurvedic nutritional strategies, refined over millennia, play a crucial role in addressing the needs of malnourished and anemic children and in managing lifestyle disorders. Consequently, they write that government hospitals and primary health care centers should ideally incorporate all branches of Āyurveda alongside their counterparts in modern western medicine (MWM). In 2003, Tamil Nadu successfully included Āyurveda and Siddha medicines in its Reproductive and Child Health Program, training 10,000 nurses to manage a medicine kit comprising 50 treatments for pregnancy and post-delivery care, as well as various diseases.

They also highlight that many individuals who are genuinely interested in and better prepared for the study of Āyurveda, such as students of Saṃskṛta, are denied admission to Āyurvedic courses. Given that Āyurvedic science is based on principles distinct from those of modern medicine, the existing admission criteria are flawed and require revision. The authors are concerned that the current syllabus for the bachelor’s degree in Āyurveda places greater emphasis on modern medicine than on Āyurveda itself. Consequently, many graduates possess incomplete knowledge of Āyurveda, undermining the integrity of Āyurvedic education and legitimizing 'mixed practice'.

A significant shortcoming of the current curriculum is its conflation of both systems within the same paper, resulting in the potential for individuals to pass all examinations without adequately learning the Āyurvedic components. The BAMS course suffers from glaring deficiencies in Āyurvedic content, which poses a serious threat to the practice of Āyurveda in its own native land. Furthermore, the study of Saṃskṛta has been nearly rendered obsolete; yet, Saṃskṛta serves as the technical language of Āyurveda, with Nyāya-Vaiśeṣika providing its foundational logic. Rather than engaging in selective reading, there is a pressing need for undergraduate students to study the three principal canonical texts—namely, Caraka Saṃhitā, Suśruta Saṃhitā, and Aṣṭāṅgahṛdayam—in their entirety.

The National Health Policy of 2017 scarcely acknowledges Āyurveda. While it advocates for the optimal use of existing infrastructure, it appears oblivious to the significant manpower and resources within the Āyurvedic system that cater to the health needs of the majority of the population, despite receiving less than 1.5% of the government's health budget. 

The authors encapsulate their position by asserting that Āyurveda constitutes a distinct medical science, possessing a valid yet fundamentally different understanding of health and disease. It does not employ the modern medical paradigm to comprehend ailments, nor does it rely on contemporary Western medicines for treatment. Consequently, the guidelines for accrediting AYUSH hospitals for insurance coverage should be developed in alignment with the principles of Āyurvedic science, aiming to genuinely promote Indian Systems of Medicine.

 Concluding Remarks

A medical college dean's suspension for permitting his students to recite the “Caraka Śapathā" reflects a profound colonial mindset. The oath is as relevant to India in its comprehensive reiteration of ethical principles as the Hippocratic Oath of contemporary medicine. Both oaths are non-binding and inadequate for today's complex medical field, which has seen major scientific, economic, political, and social changes. Nevertheless, what accounts for the greater acceptance of the Hippocratic Oath compared to the perception of the Charak Oath as superstitious and unscientific?

A claim that Indians were aware of vaccination prior to Jenner is likely to provoke either disbelief or a condescending smile, suggesting an embellishment of the Indian historical narrative. A mentality shaped by colonial influences creates a formidable barrier. While Jenner may have independently discovered a method for vaccinating against smallpox, it is implausible to believe he was ignorant of the Indian inoculation practices in use, especially since the English were already documenting Indian advancements in their writings. Individuals like Holwell acknowledged the Indian contributions to vaccination, as highlighted by Dharampal (see Part 1). Regrettably, this Western validation seems to be the only way to persuade certain Indian sceptics.

As philosopher Chittaranjan Naik notes: 

Western culture, as it has evolved in modern times, attempts to answer the question ‘why’ solely from material causes, and this has resulted in the rise of both science and atheism in such cultures.  The colonizers, entrenched in a Western worldview, adopted a "scientific" perspective that engendered a profound disdain for Indian traditions, including their medicinal practices, despite their significant advancements. Unfortunately, thinkers in the post-independence era have perpetuated this negative perception of traditional India. The narrative portrays the past as primitive, the future as golden, and the present as merely a transitional phase, reflecting a linear historical interpretation inherited from the West.

Āyurveda ought not to be evaluated through the lens of modern medicine, nor does it require validation from Western sources. We possess a medical system in which we can justifiably take pride. A constructive interaction between these two medicinal approaches holds considerable potential for enhancing the health and happiness of individuals and communities alike. Despite the potential conflict between fundamental paradigms, a proper understanding of both systems can lead to a beneficial interaction. In the realm of preventive medicine, a sātvika diet, breathing exercises, āsanas, and meditation provide results unattainable by modern medicine. Challenges persist within both systems. Engaging in healthy debate is always preferable to launching antagonistic critiques against one another.

The current BAMS curriculum requires significant improvements; however, the proposal to merge BAMS and MBBS into a single program is untenable and would result in considerable injustice to both fields. There is an urgent need to bring together genuinely concerned experts in Indian philosophy, Āyurveda, and modern medicine to forge a better path forward. National pride about Indian heritage without understanding the philosophical foundations of Indian civilization is certainly not the solution. 

References And Further Readings