Whole System Research (WSR) is an emerging approach to evaluation of complementary and alternative medicine interventions that are too complex to be studied by conventional research designs, especially the RCT design.
WSR aims to identify multiple variables involved in a clinical encounter as well as the treatment outcomes. It looks into the relationship between these variables. It also takes into consideration the multiple targets of a clinical intervention. So also, it assesses the clinical outcomes at multiple levels.
WSR is essentially clinical medicine oriented and focuses on individual patient rather than group of patients. In other words, the aim of a whole system intervention is to individualise therapy for a patient. Therefore, individualised treatment regimens becomes the focus of WSR. Both quantitative and qualitative research methods are employed to understand the complex behaviour and emergent properties of whole systems. Often, it is not possible to fully understand the complexity of whole system interventions. Only pragmatic studies that identify beneficial outcomes are feasible.
The concept of WSR seems to align well with the Ayurvedic concept of yuktivyapasraya Cikitsa. Yukti is a method of analysis that targets multiple variables. It also denotes multidimensional approach to healing. Yuktivyapasraya cikitsa means complex multicomponent clinical interventions. However, the scope of yuktivyapasraya cikitsa is restricted to medicine, diet and lifestyle interventions. Spiritual, religious and psychological are difficult to analyse rationally and are termed as daivavyapashraya and sattvavajaya. The modern concept of WSR seems to include all these three categories mentioned in Ayurveda. Ayurveda distinguished the components of treatment that are amenable and not amenable to rational analysis.
Ayurveda gives a lot of importance to the logic in combining plant, animal and mineral substances. A formulation does not become Ayurvedic just because it contains herbs or other ingredients described in the classical Ayurvedic texts. The combination of the ingredients, the methods of processing and the dosage form targeting specific pathophysiological states of the body is the hallmark of an Ayurvedic formulation.
It is pertinent to ask the question whether WSR methods are relevant and applicable to Ayurveda. One of the key characteristics of a whole system intervention is multiple targets of the treatment. An intervention becomes whole system if it has multiple targets. For example, combination of a herb, a dietary article, yoga and meditation would qualify as a whole system intervention. However, this combination may not qualify as an Ayurvedic intervention unless adequate rational justification can be provided to substantiate its appropriateness on the basis of Ayurvedic theory.
The soul of Ayurvedic therapeutics is the complex combination of plant, animal and mineral substances and their processing into complex dosage forms. A combination of such internal medications along with external therapies in the backdrop of dietary regulation and lifestyle modifications makes Ayurvedic treatment specifically customised to the individual. This aspect of Ayurveda may not necessarily get reflected in the emerging whole systems approach. Combining drugs with non-drug approaches would qualify for whole systems even if the use of herbal drugs do not reflect the Ayurvedic thought process.
We thus confront a paradoxical situation, where the adoption of WSR to address the complexity of traditional systems of healing like Ayurveda can itself lead to development of research designs that will simplify and distort the core approach of Ayurveda. There is a need, therefore, to exercise caution when defining and positioning Ayurveda in the context of WSR.