Ayurveda Renaissance - Quo Vadis?
Table of Contents:
Ayurveda has been practiced in India and many Asian countries since time immemorial. The names of the celestial physicians, Asvinikumara (Dasra and Nasatya) appear in the documents excavated from Boghaz Koyi in Cappadocia region of present-day Turkey (Keswani 1974). Similarly, the discovery of the Ayurveda text Navamtakam in a ruined Buddhist monastery near Kuchar in Chinese Turkestan indicates the popularity of Ayurveda in that faraway land (Pandey and Pandey 1988). In India this medical system occupied a lofty position as a result of royal patronage. But a series of foreign invasions and the subsequent socio-economic problems caused grievous injury to it.
Western medicine was introduced into India by the Portuguese in the 16th century. The Portuguese commander Alfonso de Albuquerque conquered Goa in 1510 and founded Hospital Real (The Royal Hospital). It was later handed over to the Jesuits in 1591. The Jesuits managed this institution exceptionally well and introduced a rudimentary form of medical training, with Capriano Valadares as its chief. Hospital Real was converted in 1842 into School of Medicine and Surgery (Keswani 1974). Although it was the Portuguese who introduced Western medicine into India, it was largely the British who later established and consolidated both its practice and study in the subcontinent. Starting with small trading posts in the 17th century, the British ultimately occupied the entire Indian subcontinent. The history of Western medicine in India is almost exclusively that of the development of medicine during the British rule (1857-1947) (Chakravorty 2008).
Up to the 19th century, the impact of Western medicine on India was relatively small. It was mostly confined to the larger cities like Calcutta, Bombay and Madras, the enclaves of the white community and the army. Nevertheless, several factors, including advances in medical science and sanitary practice, growing Indian involvement and the rise of the women’s medical movement, enabled Western medicine to partly free itself from its old enclavism. By 1937 when the Indian National Congress first formed governments in the provinces, it was apparent that the traditional systems like Ayurveda and Unani would enjoy the modest benefits of a minority status while the lion’s share of state support went to Western-style public health and medical practice. The Bhore Committee (1943) headed by Sir Joseph William Bhore called for more doctors, nurses, midwives, dispensaries and hospitals, to bring India closer to the level of health care in the West. This Beveridge-style blueprint was put into practice in independent India. As a result Western medicine became the dominant medical system of the country (Arnold 1996).
Renewed Interest in Ayurveda
Interest in Ayurveda started growing all over the world in the late 1970s due to two reasons. Firstly, a major shift in global healthcare management policy was instrumental in renewing interest in all forms of herbal medicine, including Ayurveda. To encourage national and international efforts to develop and implement primary healthcare throughout the world, the World Health Organization (W.H.O.) convened the International Conference on Primary Health Care (6-12 September 1978) at Alma Ata, in the former Soviet republic of Kazakhstan (Hall and Taylor 2003). This conference adopted the famous Alma Ata Declaration, which called on member nations to formulate national policies, strategies and plans to launch and sustain primary healthcare. The member states were especially encouraged to mobilize their own national resources (Anonymous 1978a). The Western world was thus encouraged to study in depth the various traditional medical systems of the world. Ayurveda was an important one among them, having a sound theoretical basis.
The second reason for reviving interest in Ayurveda was the enthusiasm generated by several spiritual organizations such as the Chinmaya Mission, International Sivananda Yoga Vedanta Center, International Society for Krishna Consciousness (ISKCON), Isha Foundation, Maharishi Foundation, Osho Foundation and The Art of Living International Center. Imparting knowledge in Ayurveda is one of their major missions, and this has helped to popularize Ayurveda in the West (Kumar 2016). In Germany, Austria and Switzerland Ayurveda is one of the fastest-growing complementary and alternative medicine methods (Kessler et al. 2013).
Coinciding with burgeoning worldwide interest in Ayurveda, important decisions were taken in India. Aimed at improving the traditional Indian systems of medicine, Government of India established in 1995 the Department of Indian System of Medicine and Homeopathy (I.S.M. & H.). In November 2003 this department was renamed the Department of A.Y.U.S.H., to further the development of education and research in Ayurveda, yoga, naturopathy, Unani, Siddha medicine and homoeopathy. The Ministry of A.Y.U.S.H. was formed on 9 November 2014 for better integration of A.Y.U.S.H. systems into healthcare in the country (Anonymous 2017).
Theoretical Constructs of Ayurveda
There are many traditional medical systems in the world. While many of them are collections of empirical knowledge, very few of them are based on a firm theoretical foundation. Ayurveda is the foremost among them and the only other medical system that can stand at par with it is Chinese medicine. Ayurvedic theory and practice are exclusively based on the doctrine of tridosa derived from the six schools of Indian philosophy, namely, nyaya, vaisisika, sdmkhya, yoga, mimamsa and vidanta. These schools include an atheistic and generally materialistic tradition, centrally concerned with questions of logic. However, this tradition has generally committed itself to the view that the aim of philosophy is moksa or liberation from the cycle of birth and death (Dasgupta 1997).
Tridōṣa (The Three Vitiators)
According to Ayurveda, the body is made up of pancabhiita or the five primordial elements prdhvi (“earth”), ap (“water”), tijas (“fire”), vdyu (“air”) and dkdsa (“sky”). The ability of the pancabhiita to modulate life processes under the influence of a driving force (atma) is denoted by the collective term tridosa, consisting of vdta, pitta and kapha. In other words, tridosa is a three-dimensional view of metabolism. Vdta represents vdyu and dkdsa bhdta, pitta represents tijas bhiita and kapha represents prdhvi and ap bhiita. The body is said to be healthy when the tridosa exist in steady state. Disease originates as a result of destabilization of the tridosa, which can be either of a “high” or a “low” nature. These pathological states of the tridosa can be identified by characteristic signs or symptoms (Upadhyaya 1975a). Due to dietary and behavioral indiscretions and effects of season, the tridosa get destabilized and if left untreated, they progress to produce well-defined disease entities like jvara (fever), atisdra (dysentery), vataroga (neurological diseases), kusdha (skin diseases) and so on (Upadhyaya 1975b).
Dhātu (Tissue Elements)
The human body is made up of seven tissue elements (dhatu) (rasa = tissue fluid, rakta = blood. mdmsa = muscle, midas = adipose tissue, asthi = bone, majja = bone marrow and sukra = reproductive element) and their waste products known as mala (purfsa = feces, mfttra = urine and svida = sweat). The essential products of digestion are collectively called rasa which transforms sequentially into raktarn, mdmsam, midas, asthi, majja and sukra. The end product of this dhatu cycle is known as ojas which is said to circulate in the body imparting strength and vitality. Ojaksaya or diminution of ojas follows the disruption of the dhatu cycle and varying states of illness originate therefrom. While taking part in the dhatu cycle, each dhatu gives out its characteristic waste product (mala). Dhatu and mala also exist in “high” and “low” states (Upadhyaya 1975a).
A simple model diagram illustrating the ayurvedic concept of the human body is provided in Figure 11.1. The communication between the tridosa, dhatu and mala is believed to be two-way, as shown in the figure. When vdta, pitta and kapha are in an undisturbed steady state, the other two conceptual compartments will also be in an undisturbed steady state, and the body is said to be in perfect health.
FIGURE 11.1 Relationship of tridosa, dhatu and mala among themselves as well as with symptoms and therapy. Reproduced with kind courtesy of National Institute of Indian Medical Heritage (CCRAS), Hyderabad.
Mathematical Modeling of Tridōṣa
Diseases and drugs are studied in Western medicine in compartmentalized models. Mathematical modeling is increasingly being used in drug design, drug delivery and medical management (Bellomo and Preziosi 1995; Chambers 2000; Siepmann and Siepmann 2008; Wang et al. 2013). Prabhakar and Kumar (1993) made a novel attempt to offer a simple model named the V:P:K code for quantification of diseases, in terms of ayurvedic principles. They transformed all the signs and symptoms of disease in terms of “high” (1), “low” (-1) or “no change” (0) of v, p and к states of tridosa, dhatu and mala by making basic assumptions that changes in these (v, p and k) will be responsible for each symptom or sign. This exercise furnished the V:P:K code of symptoms and signs of each disease (v, p and к represent the respective sub-components in tridosa, dhatu and mala. V, P, К are the sum total of all sub-components of v, p, k).
For example, an increase of vdta causes the appearance of symptoms or signs like leaning, black color, increased body movements, “feeling of pulsations”, interest in warmth, insomnia, constipation, flatulence, borborygmi, inability to concentrate, fear and anxiety. The V:P:K code of each of these symptoms or signs will be 1:0:0. Similarly, symptoms or signs like anorexia, nausea, disinterest in talking or work, decreased libido and indigestion appear when vdta decreases. The V:P:K code of each symptom or sign will be -1:0:0.
As any disease is a result of a combination of symptoms and signs, variations of v, p and к at all levels linearly add to one another and exert their resultant influence. Thus the V:P:K code of a disease state can be derived from the V:P:K codes of constituent symptoms and signs by the linear summation principle. A calculation protocol to derive the V:P:K code of a disease is illustrated using ка/т/ш-dominant heart disease (kapha hrdroga) as an example (Table 11.1).
Ayurvedic nosological data on 63 important vataja (rata-dominant), pittaja (pitta-dominant) and kaphaja (kapha-dom'imxnl) diseases were considered to verify the model. The V:P:K codes of these diseases were derived and their validity was tested through a correlation study using regression analysis with the least square method. An inverse relationship was found to exist between vdta and kapha in the kaphaja disease group (Figure 11.2). This finding is in agreement with evidence from ayurvedic theory. The V:P:K code is a novel finding that can be used for generating computer- based disease maps which can be used in experimental and clinical medicine. Although there are several reported studies of mathematical modeling in Chinese medicine (Ding and Wan 2008; Ming et al. 2010; Zhao et al. 2010; Han and Huang 2012; Kim et al. 2014) this is the first report of a mathematical model in Ayurveda.
Step-Wise Derivation of V:P:K Code of Kapha hrdroga (Prabhakar and Kumar 1993)
FIGURE 11.2 Graphical representation of the inverse relationship between estimates of vata and kapha in kaphaja group of diseases. Reproduced with kind courtesy of National Institute of Indian Medical Heritage (CCRAS). Hyderabad.