India is watching the tussle between the Indian Medical Association (IMA) and Mr. Ramdev of Patanjali. Tall stories are being told about Ayurveda’s ability to cure diseases. I am an Ayurveda graduate, and I do have complete faith in the system. There is no doubt that there are shortfalls in the allopathic approach to treating diseases. Even World Health Organization (WHO) has recognized traditional, complementary, and integrative medicines across the globe. Ayurveda, which is knowingly or unknowingly integrated into the daily lives of every Indian, has much more to offer to the world. However, when mythology intermingles with scientific temperament, it prevents Ayurveda from coming forward as a strong alternative. Also, there is something more systemic that has halted its growth for so many years. The monopoly by certain groups over the traditional knowledge, considering the Ayurvedic texts as sacred, and linking it to religion are the biggest hurdles in front of this practice. In the following text, I sift through Ayurveda’s history, the causes of its stagnant growth, and what we can learn from other parts of the world.
The Ayurveda connection
To me, the only connection visible between ancient Indian philosophy with modern science is Ayurveda. Developed on deep-rooted thinking, vision, and direct observations by the different schools of thought, many ayurvedic medicines prove their value in curing many ailments today. Unlike allopathy, the philosophical underpinnings of Ayurveda are solid and diverse! It covers various approaches of treatments, including Panchbhautic Chikitsa (treatment using natural elements), Srotas System (inner transport system), Tri-dosha Kalpana (body humors), and much more. Once famously doing plastic surgeries and rhinoplasties (as claimed), the Indian medicine system couldn’t progress after a certain period. Despite the visible limitations of this practice now, it is vehemently revered by right-wing Hindus as the best and correct system for treating humans and animals.
The spread of Buddhism was blamed for the demise of surgical practices in Ayurveda. A few history writers claim that infiltrating texts with horrifying details of surgeries without anesthesia were inserted in Ayurvedic scriptures to refrain anyone from doing it. The science of anesthesia was lost somehow in this period, as the history textbooks claim. This very Buddhism, however, was praised as many monks advanced and practiced internal medicine and pediatrics. Many researchers believe Charaka, who gave “Charaksamhita” – an original text on internal medicine in Ayurveda – was the name of the stream of Buddhist monks who developed the system over the period. However, the recent textbooks on the history of Ayurveda, written mainly by prejudiced Vaidyas, refute this claim.
Blaming other religions by predominantly Hindu writers is obvious. However, it should make us think that if the appropriation of medical texts is possible when Buddhist philosophy was proliferating, then why is it not possible before and after it? Isn’t it possible that some Brahmin Vaidya might have appropriated the books to undermine Buddhism? As we all know, Takshashila and Nalanda, the world’s most ancient universities, were flourishing under Buddhist dynasties, and Ayurveda was prominently studied and furthered during the period. I am not a historian, but this is a critical inquiry we need to make.
Later, Britishers were blamed for imposing western medicine and not giving Rajashraya (royal patronage) to Ayurveda. Now, right-wing politicians and thinkers blame Congress’s long-time rule and ignorance for halting the progress of the indigenous medicinal system.
Decline of Ayurveda
In my opinion, the decline of Ayurveda is attributable to its two main features. First, the Ayurvedic medicine practice was and is very discriminatory. Second, the Ayurvedic system did not sufficiently test against the modern research norms.
Let’s look at the first proposition—almost every Indian household practices traditional medicine in one form or another. Thus, Ayurveda is ingrained in our daily lives. However, the systematic practice of Ayurveda was and is highly discriminatory towards the lower caste and tribal communities, especially the untouchables. It remained a monopoly of those who can read Sanskrit—the language of God. Since upper castes knew Sanskrit, they had total control over the system. They wrote, modified, and practised Ayurveda and developed the “Gharana system,” where knowledge of medicine was kept within the family and passed surreptitiously along with the generations. The traditional medicinal and plant knowledge of tribes and lower caste communities was appropriated in these ayurvedic texts without any recognition or attribution.
I have not come across any single example of a famous Vaidya (physician) who belonged to a lower caste untouchable community mentioned in the history books. Until recently, these communities never had access to the medicinal information written in Sanskrit texts. Towards the end of the British Raj, many ayurvedic colleges were opened and Ayurvedic knowledge became more accessible to lower caste communities for the first time. However, the Gharana system prevails in Ayurvedic practice even today.
If someone wants to acquire better knowledge of Ayurveda, then he or she has to spend months at a famous Ayurvedic doctor’s practice. Take the example of Maharashtra: many Ayurvedic graduates flock to Pune after finishing their bachelor’s degree just to work under these famous Vaidyas without getting paid most of the time. Many of these famous names, with a few exceptions, are from the upper castes and practise the knowledge of Ayurveda as a family tradition. Thus, the Ayurvedic system never became the practice of the masses, leaving less opportunity for research and modifications.
Now, let’s look at the second reason. During my training as an Ayurvedic physician, we read the history of Ayurveda, its philosophical underpinnings, and human physiology and anatomy in the first year. The emergence of Ayurveda is tied to the Hindu gods giving sanctity to the system. The philosophical discussions and understanding from ancient India form the basis of Ayurveda.
The texts on Ayurveda’s history are full of reviews on how the western theory of human evolution, the human body, and psyche is wrong and Indian philosophies have better explanations on these matters. Since claims and discussion in the ancient Ayurvedic Samhitas blend deep-rooted thinking (vision) and experience and less human body observations, a conflicting situation often arises when we compare it with the western medical system. For example, the Panchatatva concept, which says we are made up of five elements, namely earth, air, water, and space, sounds intriguing but fails to explain our bodily function. Moreover, the concept of body humor borrowed from the idea of Panchatatva was widespread in western medicine until the mid-sixteenth century when Andreas Vesalius demonstrated errors made in human anatomy based on imagination and not on direct observations. Ancient India had many Andreas Vesalius who wanted a more rational understanding of reality but they were systematically sidelined. This is why Charvak, Jain, and Buddhist philosophy find little space in India’s mainstream philosophical discourse and Ayurvedic texts.
There is no text available that explains Charvak’s philosophy in detail. After the dominance of Vaishnavism, the Shivaliks and Kapaliks who were inventing the method of converting lead into gold and were furthering the medicinal knowledge were isolated and had to live in mortuaries. Their practices were later termed as “Kala Jadoo” (black magic) and abandoned forever. Some Ayurvedic concepts are controversial as well. Take the example of the “Sattvik diet,” which classifies diet into different categories. This classification categorizes oil-cooked food and non-vegetarian diet as tamas and rajas, which causes more rage and anger. In contrast, clarified butter (ghee) and a vegetarian diet have been considered as increasing wisdom and calmness. One can imagine the implications of such an understanding of food as most lower caste communities cook their food in oil, and many eat non-veg. Thus, rationality in ancient India’s scientific inquiry was encouraged and favored only if it was suited to the dominant upper caste and communities’ narrative.
When we ridicule Indian philosophical understanding and applaud today’s western-based inquiry of science, we miss a basic fact of science. That is, establishing truth has always not been acceptable to the society of those times. Many thinkers and scientists, including Galileo, have paid the price for going against the norm. This is not to pass any claims without scrutiny but to evaluate every scientific proposition in an unbiased manner as much as we can. Having said that, if any ancient scientific claim stands on today’s scientific rigor and is proved with data and research, then it should be accepted. Following this, the ayurvedic medicines and treatment methods should undergo rigorous randomized control trials and demonstrate their effectiveness (slowly but steadily, it is happening now). There is only one option if we wish to thrive as a more rational and science-based society. We have to abandon mythological concepts and thoughts that do not make any sense or meet the agreed norms of testing scientific rigor. We further need to build new ideas based on the existing, proven scientific knowledge.
The China Example
Our neighboring country China provides us some lessons to learn. China has embraced modern scientific methods and research and is on the path of becoming a new global superpower. Even after breaking many ethical and scientific inquiry norms and playing dangerously with set western standards, Chinese scientists are taking giant steps in Artificial Intelligence (AI) and Genetic engineering. China successfully integrated its traditional medicinal system (TCM) into the modern system and is now leading research in drug discovery. The 2015 Nobel prize in medicine/physiology was won by a Chinese pharmacologist for the discovery of Artemisinin — a lifesaving antimalarial drug rooted in traditional Chinese herbal medicine.
While in India, we have focused more on glorifying ancient history instead of testing our concepts with modern scientific rigor. Very little funding is devoted to medical research in Ayurveda. As a result, no significant scientific advancements were made in this traditional medicine system. The knowledge and expertise provided in the five- and half-year ayurvedic bachelor’s curriculum is not sufficient to give the confidence to start an Ayurvedic practice. Just recently, the subject of clinical research was introduced in the Ayurvedic curriculum. If this is the situation, we can imagine how even the brightest ayurvedic physician will be motivated to acquire more research skills and conduct scientific experiments to test new drugs or therapy. The new national research institutes for Ayurveda are coming up, but still, there is a lot to achieve.
The western world is already moving towards comprehensive care where hospital and home-based treatments become integral to patient management. Instead of excessively focusing on allopathic tertiary care, this can be easily achieved in India’s pluralistic medicinal system. The Kerala health system has successfully done this to a great extent. Ayurveda has flourished in Kerala. However, I do not have first-hand knowledge of how inclusive Kerala’s Ayurvedic system is towards the Bahujan practitioners. Nevertheless, despite being controlled by upper castes, Ayurveda has evolved due to the contribution of all communities. And therefore, the Ayurvedic graduates, especially the Bahujans, should vouch for what is now open for them in modern India. Perhaps they can help develop a more inclusive Ayurveda blending our ancestral knowledge of medicines with modern science. Until it happens, the unproven claims flaunting Ayurveda’s glorious past makes our path to become a science-based and not mythology-based society challenging.
Dr. Preshit Ambade (BAMS, MHA, DrPH) is an independent writer and a health policy analyst.