In our series “Myths Under the Lens” we publish articles scrutinizing subjects that agitate our minds. In this article, the author discusses the science behind ayurveda and juxtaposes it against allopathy.
The ‘modern’ mainstream medical system has always looked down upon alternative systems of medicine. These systems are called unscientific, even fraud.
In India, the debate has taken an ugly turn just now (October 2020). On October 6, the ministry of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homoeopathy) issued a protocol to prevent and fight COVID-19. The protocol is a compendium of guidelines primarily on building strength in the body to ward off coronavirus. On October 10, the apex body of allopathic doctors in India, the Indian Medical Association, issued a press release vehemently criticising the protocol and the minister who had formally released it.
Let me quote a portion of IMA statement, [quote] “Whether the proponents of this claim and his Ministry are prepared to subject themselves as volunteers to an independent prospective double-blind control study in prevention and treatment of COVID? How many of his ministerial colleagues have so far made the informed choice of getting treated under these protocols?… What is stopping him from handing over COVID care and control to AYUSH ministry? IMA demands that the Union Health Minister should come clean on the above posers. If not, he is inflicting a fraud on the nation and gullible patients by calling placebos as drugs.”
The working of modern medicine
Let us not hurriedly jump to conclusions about the scientific basis of ayurveda. But it is interesting to see the working of what we refer to as the ‘modern’ system of medicine.
In modern medicine, except for some traditional over-the-counter medicines (e.g. balms), each prospective drug molecule (usually a complex chemical) is studied minutely. The experience with related molecules gives an idea about how this one would act on humans. Trials are conducted on small animals, big animals and finally on humans – under controlled conditions. Safety and efficacy are measured at every stage and dose is calibrated as development of medicine progresses. Combinations of molecules are also tested extensively before their mass use.
Drugs under development go through a detailed process of scrutiny before they are approved for human use. Each new drug has to undergo extensive clinical trials using scientific sampling/ data collection, and under strict supervision. Scrutiny goes on even after these drugs are approved, and if found deficient or producing undesirable results (including side-effects), they can be pulled back. The dosage is well-calibrated, counter-indications are well-documented, expiry dates are pre-determined. If a medicine has the potential to hurt under certain medical/ health conditions, it is administered under medical supervision.
Every modern (allopathic) medicine has a chemical basis; researchers know its generic constituents and how they individually act on different organs and systems in the human body.
Modern medicine takes care of all stages of progression of a disease: prevention, diagnosis and treatment. Then there are many concepts/ branches such as evidence-based medicine, social medicine and epidemiology that deal with medicine in different contexts. For the sake of brevity (the article is still going to be longer than 3000 words), let us limit the present discussion to treatment of an individual using one or more medicines.
There seems to be no chance of error in the modern medicine, if administered properly. There can be issues with doctors not doing diligence, but the science of modern medicine seems beyond reproach.
In a simplistic and theoretical sense, yes. But let us look a bit deeper.
In the drug development process and also when the drug is administered, humans are taken as a biochemical entity that would react in a particular fashion to the chemical introduced into it. However, biological entities, especially humans, do not react to drugs in isolation except possibly when they are in coma and are have no physical or biological activity to perform other than assimilating what is injected into them . Living beings not only have a genetic memory, they also have an evolutionary baggage and a life-time history of how their bodies have adapted to different situations in the current life. In the case of humans, psychology and neurology play an important role in numerous reactions in the natural course and when a medicine is introduced. There are many more aspects, some possibly unknown to us – including the spiritual ones. So, treating a patient as the mass of tissue in a petri-dish may look fully scientific, but is not holistic. Modern medicine system thus does not have the DNA (if you find pun here, that is unintended) to heal a patient; it can at best treat him.
The way allopathy is practiced makes it even more detached from healing. A day-to-day observation of how modern medicine system works would illustrate this. Mind it, I am taking the example of hospitals with specialists and sophisticated equipment, not as allopathy is practiced in hospitals wanting even in basic facilities- as mostly happens in developing and poor countries.
In this system, the doctor observes the patient’s symptoms, and to be sure of the cause of symptoms, makes the patient undergo one or more diagnostic tests. (Let us ignore that some tests are harmful.) Based on the tests, the patient is given treatment, often consisting of many medicines. These either work or work partially or do no work at all. The patient also develops side-effects, for which he is likely to be given more medicines. The new problems introduced by medication are treated as if these arose due to something inherently wrong with the patient’s body. More diagnosis, more medicines, complications – the cycle makes patients worse over time. Patients seem to suffer from medication more than the disease, especially when the disease happens to be of a major organ such as heart, kidney, pancreas and brain or a degenerative disease such as Parkinson’s, Alzeimer’s or cancer.
In the above illustration, there is hardly any human touch and hardly a concern for the patient’s mental condition (due to disease, pain, feeling of helplessness, dependence on others, expenditure). Some hospitals are now caring for a part of this – but that is more of an exercise in making money and PR. If some hospitals genuinely care for the ‘human’ aspect of cure, that is not part of ‘modern medicine’, it comes to them as a sense of humanity.
The working of ayurveda
If you do not know anything about ayurveda, let me introduce it in a few paragraphs before we deal with ayurvedic medicine. Ayurveda is a system of holistic healing that is supposed to have developed many thousand years ago in the Indian subcontinent. Its main treatises were written by multiple authors over centuries. This system believes that human health has bodily, sensory, emotional and spiritual dimensions; and that diseases develop when there is imbalance among key physiological factors. So, for prevention and cure of diseases, there is stress on creating equilibrium in metabolism, elimination of causative factors and metabolic toxins, and proper diet and activities.
By its very concept, ayurveda is for keeping the body healthy, more than treatment of specific diseases. So, even when treating diseases based on their symptoms, it tries to look at the cause – the imbalance – at the root of the problem.
It cannot be denied that ayurveda evolved organically (though mythology may attribute it to knowledge coming directly from the god of health). It must have gained through empirical observations by devoted and accomplished physicians, lost due to misinterpretations and corrupted due to insertion of unproved knowledge. In recent centuries, when the world learnt to do scientific research in a structured way, ayurveda decayed as it did not get the attention of the scientific community or was trashed as pseudoscience, even quackery.
Critique of ayurveda by modern medical practitioners
Practitioners of modern medicine and their professional bodies categorise ayurveda as a pseudoscience. The crux of criticism against ayurveda is that it is based on theories that have no scientific basis. In addition, its education and practice are not conducted in a scientific way. Finally, ayurvedic medicines have no sound chemical basis and they do not undergo extensive trials.
Unfortunately, part of the criticism is due to ignorance about the system and part due to non-standard practices adopted by medicine manufacturers and ayurvedic doctors. The outright branding of ayurveda as fraud and its medicines as a dirty mix or placebo seems to emanate from an exclusivist professional world-view and a deep sense of arrogance.
Dispassionate researchers have again and again argued and found with evidence that ayurveda is a holistic healing system, with deep roots and possibly a great untapped potential.
Before moving further, let me give just three quotes from research journals:
In the light of modern or current science, evidence has surfaced connecting the concepts of tridosha and prakriti with metabolic pathways, chronic diseases, and various genotypes. Such evidence has thrown up insights about the universality of Ayurvedic concepts as well as their apparent association with concepts in current science. [Source 13 given at the end of the article.]
In traditional Ayurdev, basic concepts such as Tridosha are introduced didactically. Students of Ayurdeva learn to appreciate their practical value through experience; their validity is empirical. In an age where validity of concepts is judged by their scientific relevance, establishing the scientific validity of Tridosha is a program of significance. It requires translating concept and practical application into the idiom of modern biology and medicine. Four different complementary approaches have been proposed to do so: factor analysis of human physiology; systems analysis of organism function; correlation of Dosha and genomic variations – Ayugenomics; and correlation of Dosha and cellular function. Together these four independent approaches present compelling evidence that the family of Dosha based, Ayurveda fundamental concepts – the three Doshas, their fifteen subdoshas, innate Dosha balance in the individual (prakriti), and Dosha imbalances (vikriti) are scientifically valid. [Source 8 given at the end of the article.]
Ayurveda based method of phenotypic classification of extreme constitutional types allows us to uncover genes that may contribute to system level differences in normal individuals which could lead to differential disease predisposition… An integration of Ayurveda with genomics holds potential and promise for future predictive medicine. [Source 9 given at the end of the article]
For the sake of keeping the discussion manageable within one article, the topic for discussion has been narrowed down to ayurvedic medicines, so let’s now talk specifically about medicines. If you are interested in going deep into the working of ayurveda, you can peruse resources given at the end of this article.
Ayurvedic medicines: bones, metals, placebo?
What we call ayurvedic medicines are a combination of medicines adopted from ancient books, evolved through common use and those developed by pharmacies and drug companies. The ancient formulations mainly use plant products, sometimes animal products (mainly milk and ghee) and rarely metals and minerals. Indian households traditionally use many herbs and spices that have curative properties, and some of these have been marketed as ayurvedic medicines. A repository of local medicines exists among tribal populations still living in their traditional habitations. Commercial ayurvedic pharmacies come out with branded medicines based primarily on ancient and traditional knowledge and modify it to suit modern requirements. Plant-based new formulations are also sold as ayurvedic medicines.
Ancient scriptures have given elaborate procedures for making special medicines (e.g. rasayans), which are not being followed by present-day practitioners or pharmacies because they are either too cumbersome or do not seem to make sense when [seemingly] better ways of producing a medicine are available. Some formulations that were suited to the pristine conditions when these were developed (e.g. availability of medicinal plants in wild and clean form, low levels of pollution, nature-driven diet and eating patterns, high levels of physical activities performed by people), but companies now replicate them without the same care, and doctors prescribe them with no consideration for their suitability to the present-day life.
In ayurveda, there is also emphasis on individualised treatment. Depending on different factors (balance of tridoshas, age, lifestyle, etc), the dosage of a formulation, relative composition of its constituents, method of drug administration, timings of administration, etc are decided for the medicine to give the desired result. The over-the-counter ayurveda formulations ignore all of this and take the spirit of ayurveda out of the medicine. Devoid of its essence, ayurvedic medicine gets reduced to its allopathic counterpart – a combination of molecules.
In some commercial ayurvedic medicines available in the USA, unacceptable levels of heavy metals were found. In this context, it is worth noting that ayurveda has a very complex process of purification of metals when they are used in medicine. Ayurveda does use plants with psychoactive components (e.g cannabis) and alcohol also, but there are precautions to be used in administering such medicines. In a controversy that arose some years back about medicines being sold by Divya Pharmacy, of Acharya Balkrishna and Swami Ramdev fame, it came out that ash of animal bones was being used in one formulation. The pharmacy clarified that bone ash was being used after proper treatment and in very small amounts.
It stands to reason that ayurveda has drawn a lot from traditional wisdom of societies living in close proximity to nature. But it evolved much beyond this; the concepts and elaborate procedures (e.g. panchkarma and dhatu shodhan) could not come by fluke or casual observations. There are many books that diagnose health issue in their entirety. Plant parts are combined and used with honey, ghee etc in a way that improves bioavailability of active ingredients, reduces toxicity or leads to slow absorption. Such results could not have been achieved without keen observation, validation of hypotheses with imperial evidence and trials over a long period of time.
In recent years, a large number of standard ayurvedic formulations, plant based medicines and plant extracts have gone through chemical examination as well as clinical testing. Some of them have been found to be effective against known diseases. Some have shown much better results than allopathic medicines in chronic non-communicable diseases such as internal ulcers, arthritis, lymph-related inflammations, etc.
In India, Nepal and Sri Lanka, ayurvedic institutions have been opened where research is being conducted on ayurvedic and traditional medicine systems and the results are reported to be promising.
In the research on many plants that are commonly found in the Indian subcontinent and are used in a number of formulations, it has been found that they have biochemicals with superb healing properties. The names of turmeric, ashwaganda, giloy and brahmi come to mind. Ironically, the active ingredients are being extracted, purified to molecular level and are adopted as allopathic medicines.
In fact, there is a strong case for using plant (and animal) products directly rather than extracting their active ingredients and administering them in pure form. Humans are biological creatures that have evolved over millennia, while living with nature. So, the human body accepts natural products much better than pure chemicals. It seems to know how to digest and assimilate the chemical when it comes through a natural product. Ayurveda does have some medicines in which natural products are processed, but the processes are for purification and amelioration, not converting them into chemicals. The way a medicine is taken plays an important role in ayurveda, and that also takes care of unwanted reactions that the formulation might have caused.
Demeaning of ayurveda seems to stem from arrogance of the mainstream science as against an unbiased scrutiny of a system that has much unexplored yet. Till a few years back, didn’t the mainstream science scoffed at yoga as baseless, and pranayamas and mudras as a sort of voodoo? Acupuncture looked utter nonsense until recently . Oriental prayers and meditation were considered inferior religious practices, until all efforts of the mainstream science failed to deal with stress.
The final word…
Ayurveda should be taken as the compendium of knowledge for keeping the human body healthy, more than a ‘pathy’. If some aspects of it need scrutiny based on modern scientific methods, it should be done – and is actually being done. Modern medical systems should build on the solid pedestal of knowledge that has been compiled over ages and organically evolved, not by trying to demolish it.
There is no doubt that when a serious disease manifests, allopathy will, in most cases, be the first choice for emergency treatment. Similarly, in case of life-saving surgeries, accidents and for diagnosis, modern science has developed tools and procedures much beyond ayurveda and other alternative systems of medicine. Yet, ayurveda, with its inherent strengths, stands on its own as a powerful system of healing. It promises a better (safer, less painful, permanent, with fewer or no side-effects, much less expensive) cure for many diseases than the modern system(s) of medicine. Ayurvedic medicines, when prepared and administered keeping the basics in mind, are not placebos; they differ from the modern medicine in that they are tested much beyond the mechanical clinical trials and work beyond mechanical treatment based on mechanically obtained diagnosis.
On the controversy raised by IMA about the AYUSH protocol on management of COVID-19, the Indian government has clarified that the advice was based on ayurveda and yoga after considering empirical evidences and biological plausibility as well as emerging trends from ongoing clinical trials.
A body of alternative medicine practitioners have brought to notice the use of allopathic drugs remdesivir, methylprednisolone and hydroxychloroquine on COVID patients without enough clinical trials. They have also pointed out that ayurveda protocol does not go against the mainstream treatment and does not claim anything that is not proven with evidence.
It has also been argued on the web that allopathy’s record has been pathetic (no pun intended) in the case of many major diseases of the modern world. In fact, many early deaths of COVID patients are supposed to have occurred due to faulty allopathic treatment.
- Ayurveda and the battle against chronic disease: An opportunity for Ayurveda to go mainstream? Alex Hankey [J Ayurveda and Integrative Medicine, Jan-Mar 2010]
- Ayurveda concepts
- Ayurveda Dossier
- Ayurveda: Facts About Ayurvedic Medicine
- Ayurvedic Medicine: In Depth
- Centre says Ayush protocol based on ‘empirical evidence’
- Establishing the Scientific Validity of Tridosha part 1: Doshas, Subdoshas and Dosha Prakritis. Alex Hankey [Ancient Science of Life, Jan 2010]
- Whole genome expression and biochemical correlates of extreme constitutional types defined in Ayurved. Bhavana Prashar and others. [J Translational medicine, Sept 2008]
- Evidence Based Ayurvedic Practice
- IMA questions health minister releasing Ayush-based Covid-19 management protocol
- National Clinical Management Protocol based on Ayurveda and Yoga for management of Covid-19
- Prakriti and its associations with metabolism, chronic diseases, and genotypes: Possibilities of new born screening and a lifetime of personalized prevention. Subhojit Dey and Parika Pahwa. [J Ayurveda and Integrative Medicine, Jan-Mar 2014]
- Revival, modernization and integration of Indian traditional herbal medicine in clinical practice: Importance, challenges and future. Saikat Sen, Raja Chakraborty. [J Traditional and Complementary Medicine, April 2017]
*About the author: This article has been contributed by MK. He does not like to call himself a rationalist but insists on scrutiny of apparent myths as well as what are supposed to be immutable scientific facts. Please don’t take the views of the author as the views of Raag Delhi.