Palm leaves of the Sushruta Samhita from Nepal, saved on the Los Angeles County Museum of Artwork. Picture: Public area
- When Ayurveda professor Kishor Patwardhan introspected on sure features of Ayurveda analysis and educating, his views modified drastically – to the purpose of risking his profession.
- “Just because the verses [in Ayurveda texts] are amenable to interpretation, it’s not within the true scientific spirit to superimpose trendy science over classical references.”
- “Ayurveda clinicians have argued that Ayurveda is a holistic science and the prescriptions they write are individualised. That they use this an excuse to evade scientific scrutiny is what I’ve gathered.”
- “I realised that every one my [teaching and research] efforts had been directed at making the prescribed curricula look related and rational, and forgot that such laboured misinterpretation may result in medical misapplication.”
- “As a substitute of educating out of date ideas in Ayurveda, our college students need to be taught in-depth modern anatomy and physiology,” he writes.
On this essay, I narrate my experiences of educating Ayurveda physiology by way of an method that concerned laborious reinterpretation of historic literature utilizing latest advances within the discipline of medical physiology. Although this method made the traditional ideas and theories seem trendy and related, it didn’t contribute a lot apart from apparently decreasing cognitive dissonance amongst college students.
I cite examples describing the processes of formation of shukra (semen) and rakta (blood) to indicate how we regularly over-interpret Ayurveda ideas to make them sound rational by proposing advert hoc conjectures. I illustrate why my earlier writings had been defective by making use of the falsification precept proposed by Karl Popper. I additional clarify how this method made these ideas solely verifiable however not refutable, and therefore, non-falsifiable.
I argue that as a substitute of utilizing such re-interpretation to show out of date ideas, they are often dropped altogether from the curricula of Ayurveda programmes. There’s a have to develop a dependable technique to determine such outdated content material.
I’m a trainer of Ayurveda physiology, and for the previous twenty years or so, I’ve harboured a perception that advances in modern sciences should be used to interpret descriptions documented in historic Ayurveda texts. This has been a central theme of most of my previous writings.
This perception originated in my coaching at postgraduate degree, after we consulted the books of students resembling C. Dwarakanath, B.G. Ghanekar and Gananath Sen. These students ensured that trendy anatomy, biochemistry and physiology had been abundantly used of their books to attract parallels between historic and trendy literature. Additional, Banaras Hindu College provided me a novel alternative to study primary sciences like anatomy, physiology, pharmacology, biochemistry, microbiology and pathology, and to take a look at Ayurveda literature by way of the present science lens.
The background literature, particularly by C. Dwarakanath, V.J. Thakar and V.V. Subrahmanya Sastri, made me really feel that my method was legit and scientific. I even authored a e-book titled Human Physiology in Ayurveda, which turned fairly common amongst our college students because it noticed many reprint editions1. The e-book discusses how Ayurveda physiology and present physiology will not be inherently distinct and the way they are often merged effortlessly.
The e-book accommodates chapters with titles resembling “Cardiovascular System”, “Digestive System” and so forth, a sample adopted in many of the trendy textbooks on medical physiology. I consciously chosen probably the most rational variations of historic aphorisms to make them seem related. I believed I used to be persevering with the custom of writing commentaries, whereby commentators amended the literature to swimsuit their modern instances.
“It is a custom that has stored Ayurveda vibrant and related,” I at all times thought. I seen all my writings as commentaries on historic scriptures. I additionally felt that it was my responsibility to be loyal to my topic and to the acclaimed students in whose footsteps I used to be following.
What I didn’t realise was that my efforts at this stage had been directed at searching for validation of what I used to be supposed to show, which was in any other case largely out of date materials. This urge for validation was presumably rooted within the frustration that I had developed when this topic was taught to me throughout my graduate research.
About thirty years in the past, I had noticed and even ridiculed the primitive and out of date nature of physiology contained in our historic textbooks. I needed my college students to not understand the topic the identical approach as I had, and needed them to learn present physiology extra significantly. Therefore, I made each effort to legitimise historic literature utilizing a technique of “strained interpretation” (drawing unintended however handy meanings of sure phrases and phrases utilizing cherry-picked references from commentaries) – which I known as “rationalisation” – to make it sound trendy and related. A number of of my lecturers who adopted this technique had had a profound affect on me as they made it attainable for us to attach very nicely with the topic.
Nevertheless, COVID-19-related restrictions provided me an opportunity to learn a number of fascinating articles and books, and enough time to introspect on sure factors, which in all probability wouldn’t have occurred to me in any other case. This studying and introspection modified my views so dramatically that I made a decision to jot down about it realizing very nicely that this would possibly put my whole profession in danger. However the fact should be advised – and the sooner the higher.
Beneath, I hint how I modified my views on the topic. The books and articles which have had immense affect on my new considering have been listed within the reference part. I strive analysing my very own faults in my previous writings and viewing these errors by way of the falsifiability precept.
The issue of shukra
Right here, I talk about why my method was incorrect by taking the instance of shukra (semen). This was probably the most disturbing idea that I needed to cope with throughout my graduate research. Although testicles have been recognized because the roots of the channels that carry shukra, Ayurveda proposes the formation of the identical in majja (bone marrow), for no matter motive2. Historical students additionally felt that shukra existed in the complete physique3.
Since I discovered it troublesome to make it sound scientific, I took some references from commentaries and argued that the time period “majja” needn’t solely denote bone marrow, however may stand for all tissues that crammed bony cavities. One reference from a commentary on Sushruta Samhita referring to the mind as “majja current within the cranial cavity” provided aid. Therefore, majja turned two substances to me – mind and bone marrow.
I argued that translating phrases resembling majja wanted to be carried out extra cautiously as this might prohibit the unique broader that means.
Then, I took one other reference from a commentary stating that two sorts of shukra could also be recognized — one indicative of semen and the opposite indicative of a substance that was current in the complete physique4. Now, my information of contemporary physiology made me relate gonadotropin-releasing hormone and different hormones within the hypothalamic-pituitary-gonadal axis with the substance that circulated everywhere in the physique. Since one in every of my lecturers had additionally recommended this interpretation, I discovered it convincing. Thus, I believed, we had solved the issue by bringing in readability.
Whereas I knew that the existence of hormones had solely been found within the latest previous, it didn’t matter to me as my enthusiasm to show historic Ayurveda literature related was boundless. On the idea of my postgraduate coaching, I argued that such interpretations had been legitimate. Although the traditional students didn’t know what hormones had been, the ideas had been amenable to re-interpretation.
If such an interpretation may scale back cognitive dissonance (the holding of conflicting beliefs concurrently) amongst our college students, I believed, “why not?” Although I by no means recommended that the traditional students knew all of it, I actually made their writings sound related. “That is what all commentators have carried out” was my justification.
Formation of blood
That is one other instance which exhibits that the traditional students didn’t know by which organ blood was shaped, as a result of they didn’t know what blood cells had been. Their observations had been restricted by the instruments and different means to which they’d entry.
Utilizing some oblique references and laborious re-interpretation, one can argue that bone marrow was thought of as one of many locations of blood cell formation; however clearly it’s not the case. They thought that the liver and spleen had been the organs that imparted the pink color to blood5. Vagbhata added amashaya (abdomen) to this record6. Incorporating the information from physiology that describes the function of the liver and spleen in erythropoiesis in adolescence, one may argue that these too are essential organs within the formation of blood.
One may additionally argue that this was recognized to the traditional students. Contemplating the function of the abdomen in absorption of vitamin B12, Vagbhata’s proposition too might be justified. Nevertheless, aside from making our college students really feel that “physiology” is comparable in each the methods, it doesn’t serve any helpful goal. On the similar time, within the title of re-interpretation, we do a disservice to our historic scriptures. I have to admit I’ve dedicated this error in my earlier writings.
Even in my paper on the physiology of blood circulation, I’ve tried re-interpreting some ideas of blood circulation that relaxation closely on the writings of students resembling V.J. Thakar. My paper proposed that the outline of three vascular segments resembling arteries, veins and capillaries may presumably be traced again to Ayurveda literature. Equally, by translating rasa as blood utilizing some references from a commentary7, it turned simple for me to counsel that the scheme of blood circulation could be traced back to those historic textbooks.
It’s the similar in different subjects, such because the function of kidneys in urine formation. Although there isn’t a clear proof to counsel that historic students knew the physiology of urine formation, it may be argued in any other case by way of strained re-interpretation and might be made to sound as if they’d this information.
Now I realise that just because the verses are amenable to interpretation, it’s not within the true scientific spirit to superimpose trendy science over classical references.
Rescuing tridosha idea
As tridosha idea lays the inspiration for all features of Ayurveda, making it sound related was very important for me.
Ayurveda makes use of the idea of three doshas, viz, vata, pitta and kapha, to explain one’s structure, to elucidate physiology, to plan food regimen and life-style, to elucidate the pharmaceutical results of herbs, to elucidate the pathogenesis of various ailments, to elucidate varied signs and to plan therapeutic interventions. It’s the elementary idea that every one Ayurveda college students cope with throughout their whole instructional programme.
One in every of my lecturers had already satisfied me that this was a mere idea and didn’t symbolize any materials entities within the human physique – which, I believed, solved many of the issues. I went on to elaborate how completely different entities within the human physique at completely different ranges of organisation may slot in nicely inside this framework. I additionally included the latest advances in neuro-endocrine immunology to justify this idea.
All these efforts made tridosha idea look very sensible, trendy, related, and engaging.
The place is the issue?
Although such interpretations may apparently scale back cognitive dissonance amongst our college students, as proven in our analysis on educating strategies8, the important thing query stays: “What extra contribution do they make to Ayurveda?”
The actual fact is that many of those subjects are not related, and needn’t be within the curriculum within the first place. Why ought to out of date physiology be taught to our college students in any respect? I realised that every one my efforts had been directed at making the prescribed curricular framework look related and rational. That such laboured misinterpretation may result in medical misapplication and misjudgement is one thing we are likely to overlook. Such an method may additionally smother innovation.
The curriculum of the not too long ago notified Nationwide Fee for Indian System of Medication demonstrates a few of these elementary errors. It prescribes stringent tutorial strategies resembling goal structured sensible examination (OSPI) and case-based dialogue (CBD), to show medical expertise in assessing many Ayurveda parameters in physiology resembling dhatu-sara (type of medical examination to evaluate the structural and purposeful well being standing of various tissues within the physique); whereas, in actuality, the sensible utility of this idea is but to be decided and there exists large inter-rater variability in its evaluation.
Which means that, when two or extra physicians independently assess dhatu-sara of the identical set of people, the possibilities of acquiring a major degree of settlement amongst these physicians will not be excessive.
Making use of the falsifiability precept
I have to admit that I finished at this level, and didn’t ask troublesome questions that might presumably have made my existence within the system irrelevant. “If I argue that many of the theories and ideas of Ayurveda physiology are irrelevant, why ought to I be a part of the system? How can I even say that the topic which I used to be appointed to show is generally out of date? Will it not be an injustice to my topic and to my establishment?”, and lots of such apprehensions stored me constrained throughout the prescribed curricular framework.
Nevertheless, change just isn’t attainable with out introspection, and a few disruption is required to set off it.
Falsifiability is a precept that’s used to differentiate between a scientifically sound idea and one that’s scientifically weak. The idea of “null speculation” and “various speculation” proposed in our postgraduate analysis proposals has its origins on this precept.
Karl Popper, the proponent of this precept, argues that “verifiability” is a weak proof to guage the validity of a idea. He takes examples from Freud’s psychoanalysis, Adler’s particular person psychology and Karl Marx’s idea of historical past to indicate how all these theories can simply be verified. He goes on to display how every one in every of these theories might be rescued by proposing advert hoc conjectures or assumptions or re-interpretations. In brief, he means that theories that can not be refuted (no less than in precept) can’t be known as scientific.
What I realised was that, all these years, now we have been trying to rescue our theories utilizing re-interpretation by introducing advert hoc conjectures. For instance, as a substitute of an easy translation of majja and shukra as bone marrow and semen respectively, by adapting the technique of laboured interpretation, I had introduced in advert hoc conjecture to suggest “two types of majja” and “two types of shukra”. This makes our theories look much more unscientific – which is what I didn’t realise.
Allow us to take up a hypothetical instance to grasp this extra clearly. Suppose we plan a examine to file resting blood pressures amongst adults of various prakriti teams. Let our speculation be that the people with kapha prakriti could possibly be extra susceptible to hypertension as they have an inclination to realize weight simply and are more likely to be main a sedentary life-style due to the “heavy” (guru) and “sluggish” (manda) nature of kapha. Kapha is also resulting in plaque formation within the arteries due to its “oily” (snigdha) nature.
Nevertheless, allow us to assume that the outcomes of our examine counsel one thing very completely different: “people with pitta prakriti are likely to develop hypertension extra steadily than these of kapha people”. Now we are able to argue that “pitta prakriti people are typically extra aggressive due to ‘sizzling’ (ushna) and ‘sharp’ (tikshna) properties of pitta, and therefore, their overactive sympathetic nervous system would possibly result in hypertension”.
Thus, each outcome might be justified, regardless of what our precise speculation was. On this instance, although the unique assumption stands falsified, we rescue the speculation by proposing an advert hoc conjecture and re-interpretation. This fashion, our theories won’t ever be “disprovable” or “refutable”. Even in Charaka Samhita, comparable advert hoc conjectures that had been proposed to rescue the speculation of tridosha have been noticed by G.L. Krishna in one of his essays.
The way in which forward
Alan Sokal, a reputed physicist, in an essay on pseudoscience identified two categories of specialists who advocate Ayurveda. One in every of these teams refuses to just accept the credentials of contemporary science by calling it “western ethno-science” and needs to retain Ayurveda as it’s, whereas the opposite tries to painting Ayurveda as already containing the information of all cutting-edge present analysis.
This second group makes use of contemporary science to validate Ayurveda. Each these approaches are defective and don’t promote Ayurveda being subjected to rigorous scientific inquiry, he argues.
Steven Engler has proven with examples that almost all Ayurveda literature doesn’t match into the present definition of “science” in its current kind, although empiricism clearly exists therein9.
After I learn the e-book The Intelligence Entice (2019) by David Robson, I may instantly relate it to many intellectuals who advocate Ayurveda, though they might not have undergone any formal coaching in Ayurveda. This e-book delves into an rising discipline known as “evidence-based knowledge”10.
Ayurveda clinicians have at all times been arguing that Ayurveda is a holistic science and the prescriptions they write are extremely individualised. That they typically make this an excuse to evade scientific scrutiny, is what I’ve gathered. This escapist perspective serves neither science nor humanity. The present tendencies in Ayurveda analysis don’t name for a re-examination of primary Ayurveda theories.
For example, the inter-rater variability of the evaluation of prakriti could be very excessive. However now we have not requested the questions: “Does the tridosha idea want modifications?” or “Can prakriti evaluation be made extra dependable by eradicating these markers/traits that result in most divergence?”. We assume that our texts are ever-relevant and irrefutable. Most of our analysis begins with the premise that these theories are true and are unquestionable (sources: 11 12 13 14 15).
In science, nothing ought to take priority over discovering the reality16. We should not hesitate to place our practices by way of scientific scrutiny. The scientific perspective is common, and it can not change from one stream to a different. The quick want is to evolve a rigorous technique to determine such content material within the current curricula of Ayurveda programmes that may safely be dropped.
The logical subsequent step is to topic our theories and ideas to scientific scrutiny. As a substitute of educating out of date ideas in Ayurveda anatomy and physiology, the Ayurveda system deserves that our college students be taught in-depth modern anatomy and modern physiology, since understanding the organic foundation of a illness is important for any doctor, regardless of the stream.
The writer thanks G.L. Krishna and Narendra Khairnar for suggesting some important studying materials. He additionally thanks G.L. Krishna for triggering this technique of introspection.
Kishor Patwardhan is on the Division of Kriya Sharir, School of Ayurveda, Institute of Medical Sciences, Banaras Hindu College, Varanasi.
This essay was first printed by the Indian Journal of Medical Ethics and was republished right here with permission.