Palm leaves of the Sushruta Samhita from Nepal, saved on the Los Angeles County Museum of Artwork. Photograph: Public area
- When Ayurveda professor Kishor Patwardhan introspected on sure facets of Ayurveda analysis and instructing, 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 each 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 scientific misapplication.”
- “As a substitute of instructing out of date ideas in Ayurveda, our college students need to be taught in-depth modern anatomy and physiology,” he writes.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 instructing Ayurveda physiology via an strategy that concerned laborious reinterpretation of historic literature utilizing latest advances within the area of medical physiology. Although this strategy made the traditional ideas and theories seem trendy and related, it didn’t contribute a lot aside from apparently decreasing cognitive dissonance amongst college students.
I cite examples describing the processes of formation of shukra (semen) and rakta (blood) to point out 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 strategy 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I argue that as a substitute of utilizing such re-interpretation to show out of date ideas, they are often dropped altogether from the curricula of Ayurveda programmes. There’s a have to develop a dependable technique to establish such outdated content material.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 reminiscent of 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 supplied me a novel alternative to be taught fundamental sciences like anatomy, physiology, pharmacology, biochemistry, microbiology and pathology, and to have a look at Ayurveda literature via 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 strategy was official and scientific. I even authored a ebook titled Human Physiology in Ayurveda, which turned fairly fashionable amongst our college students because it noticed many reprint editions1. The ebook discusses how Ayurveda physiology and present physiology usually are not inherently distinct and the way they are often merged effortlessly.
The ebook comprises chapters with titles reminiscent of “Cardiovascular System”, “Digestive System” and so forth, a sample adopted in a lot of the trendy textbooks on medical physiology. I consciously chosen probably the most rational variations of historic aphorisms to make them seem related. I assumed I used to be persevering with the custom of writing commentaries, whereby commentators amended the literature to go well with their modern occasions.
“This can be a custom that has saved Ayurveda vibrant and related,” I at all times thought. I considered all my writings as commentaries on historic scriptures. I additionally felt that it was my obligation 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 in search of validation of what I used to be supposed to show, which was in any other case principally out of date materials. This urge for validation was probably 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 wished my college students to not understand the topic the identical method as I had, and wished them to learn present physiology extra critically. Therefore, I made each effort to legitimise historic literature utilizing a method of “strained interpretation” (drawing unintended however handy meanings of sure phrases and phrases utilizing cherry-picked references from commentaries) – which I referred to as “rationalisation” – to make it sound trendy and related. A couple of of my lecturers who adopted this technique had had a profound affect on me as they made it potential for us to attach very nicely with the topic.
Nevertheless, COVID-19-related restrictions supplied me an opportunity to learn just a few attention-grabbing 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 understanding very nicely that this would possibly put my total profession in danger. However the reality should be informed – and the sooner the higher.
Under, I hint how I modified my views on the topic. The books and articles which have had immense affect on my new pondering have been listed within the reference part. I attempt analysing my very own faults in my previous writings and viewing these errors via the falsifiability precept.
The issue of shukra
Right here, I talk about why my strategy was improper 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 reason2. Historic students additionally felt that shukra existed in your entire body3.
Since I discovered it tough 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” supplied aid. Therefore, majja turned two substances to me – mind and bone marrow.
I argued that translating phrases reminiscent of majja wanted to be executed extra cautiously as this might prohibit the unique broader which means.
Then, I took one other reference from a commentary stating that two kinds of shukra could also be recognized — one indicative of semen and the opposite indicative of a substance that was current in your entire body4. Now, my data of recent physiology made me relate gonadotropin-releasing hormone and different hormones within the hypothalamic-pituitary-gonadal axis with the substance that circulated all around the physique. Since one among my lecturers had additionally prompt this interpretation, I discovered it convincing. Thus, I assumed, 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 cut back cognitive dissonance (the holding of conflicting beliefs concurrently) amongst our college students, I assumed, “why not?” Although I by no means prompt that the traditional students knew all of it, I definitely made their writings sound related. “That is what all commentators have executed” was my justification.
Formation of blood
That is one other instance which exhibits that the traditional students didn’t know during which organ blood was fashioned, 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-about 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 crimson color to blood5. Vagbhata added amashaya (abdomen) to this list6. Incorporating the data from physiology that describes the function of the liver and spleen in erythropoiesis in formative years, 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 could be justified. Nevertheless, apart from making our college students really feel that “physiology” is analogous in each the techniques, 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 reminiscent of V.J. Thakar. My paper proposed that the outline of three vascular segments reminiscent of arteries, veins and capillaries may probably be traced again to Ayurveda literature. Equally, by translating rasa as blood utilizing some references from a commentary7, it turned straightforward for me to recommend that the scheme of blood circulation may very well be traced again to those historic textbooks.
It’s the similar in different matters, such because the function of kidneys in urine formation. Although there is no such thing as a clear proof to recommend that historic students knew the physiology of urine formation, it may be argued in any other case via strained re-interpretation and could be made to sound as if they’d this data.
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 principle
As tridosha principle lays the inspiration for all facets 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 illnesses, to elucidate numerous signs and to plan therapeutic interventions. It’s the basic principle that each one Ayurveda college students cope with throughout their total instructional programme.
One in all my lecturers had already satisfied me that this was a mere principle and didn’t symbolize any materials entities within the human physique – which, I assumed, solved a lot of the issues. I went on to elaborate how totally different entities within the human physique at totally different ranges of organisation may slot in nicely inside this framework. I additionally included the newest advances in neuro-endocrine immunology to justify this principle.
All these efforts made tridosha principle look very sensible, trendy, related, and engaging.
The place is the issue?
Although such interpretations may apparently cut back cognitive dissonance amongst our college students, as proven in our analysis on instructing methods8, the important thing query stays: “What further contribution do they make to Ayurveda?”
The very fact is that many of those matters are now 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 each one my efforts had been directed at making the prescribed curricular framework look related and rational. That such laboured misinterpretation may result in scientific misapplication and misjudgement is one thing we are likely to neglect. Such an strategy may additionally smother innovation.
The curriculum of the just lately notified Nationwide Fee for Indian System of Drugs demonstrates a few of these basic errors. It prescribes stringent educational strategies reminiscent of goal structured sensible examination (OSPI) and case-based dialogue (CBD), to show scientific abilities in assessing many Ayurveda parameters in physiology reminiscent of dhatu-sara (type of scientific 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 enormous 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 big degree of settlement amongst these physicians usually are not excessive.
Making use of the falsifiability precept
I have to admit that I finished at this level, and didn’t ask tough questions that would probably have made my existence within the system irrelevant. “If I argue that a lot 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 saved me constrained throughout the prescribed curricular framework.
Nevertheless, change is just not potential 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 principle and one that’s scientifically weak. The idea of “null speculation” and “different 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 evaluate the validity of a principle. He takes examples from Freud’s psychoanalysis, Adler’s particular person psychology and Karl Marx’s principle of historical past to point out how all these theories can simply be verified. He goes on to reveal how every one among these theories could be rescued by proposing advert hoc conjectures or assumptions or re-interpretations. In brief, he means that theories that can not be refuted (at the least in precept) can’t be referred to as scientific.
What I realised was that, all these years, we’ve been trying to rescue our theories utilizing re-interpretation by introducing advert hoc conjectures. For instance, as a substitute of a simple 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 research to document resting blood pressures amongst adults of various prakriti teams. Let our speculation be that the people with kapha prakriti may very well be extra susceptible to hypertension as they have a tendency to achieve weight simply and are prone to be main a sedentary life-style due to the “heavy” (guru) and “gradual” (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 research recommend one thing very totally different: “people with pitta prakriti are likely to develop hypertension extra continuously than these of kapha people”. Now we are able to argue that “pitta prakriti people are typically extra aggressive due to ‘scorching’ (ushna) and ‘sharp’ (tikshna) properties of pitta, and therefore, their overactive sympathetic nervous system would possibly result in hypertension”.
Thus, each consequence could be justified, no matter what our precise speculation was. On this instance, although the unique assumption stands falsified, we rescue the idea 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 idea of tridosha have been noticed by G.L. Krishna in one among his essays.
The best way forward
Alan Sokal, a reputed physicist, in an essay on pseudoscience recognized two classes of consultants who advocate Ayurveda. One in all these teams refuses to simply accept the credentials of recent science by calling it “western ethno-science” and desires to retain Ayurveda as it’s, whereas the opposite tries to painting Ayurveda as already containing the data of all cutting-edge present analysis.
This second group makes use of recent 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 the majority Ayurveda literature doesn’t match into the present definition of “science” in its current kind, although empiricism clearly exists therein9.
After I learn the ebook The Intelligence Lure (2019) by David Robson, I may instantly relate it to many intellectuals who advocate Ayurveda, despite the fact that they could not have undergone any formal coaching in Ayurveda. This ebook delves into an rising area referred to 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 often make this an excuse to evade scientific scrutiny, is what I’ve gathered. This escapist perspective serves neither science nor humanity. The present developments in Ayurveda analysis don’t name for a re-examination of fundamental Ayurveda theories.
As an example, the inter-rater variability of the evaluation of prakriti may be very excessive. However we’ve not requested the questions: “Does the tridosha principle 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 truth16. We should not hesitate to place our practices via scientific scrutiny. The scientific perspective is common, and it can’t change from one stream to a different. The speedy want is to evolve a rigorous technique to establish 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 instructing 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, no matter the stream.
The writer thanks G.L. Krishna and Narendra Khairnar for suggesting some very important studying materials. He additionally thanks G.L. Krishna for triggering this means of introspection.
Kishor Patwardhan is on the Division of Kriya Sharir, College of Ayurveda, Institute of Medical Sciences, Banaras Hindu College, Varanasi.
This essay was first revealed by the Indian Journal of Medical Ethics and was republished right here with permission.