Historical future of Ayurveda

To the discerning, the history of any phenomena carries the seed for its future evolution.

Ayurveda is defined by many scholars as ‘science of life’. Those who know the sophistication of Ayurvedic theory and practice can ‘see’ that it could only result from very objective and inquisitive minds.

Progress of any science happens in inquisitive, dynamic, and open environment. History of science teaches us how the persistent searching questions of scientists have led to generation of the world's present knowledge base. “The study of history is quite different from the study of archeology. History is not descriptive study of relics, artifacts, and events; but consists of unraveling the stories underlying them. It necessarily involves a critical outlook. It can be likened to pieces of burning ambers which can take shape of flame to show right directions for future.”

A renowned biomedical scientist and senior editor of J-AIM Ashok Vaidya made these loaded statements during my recent conversations with him. His MD thesis on Bhrigu Samhita was not accepted by the university during early sixties probably on the grounds that it has no relevance to modern biomedical science. While there may be several philosophical arguments on what is modern, Darshan Shankar, a senior editor of J-AIM simplifies modernity as ‘evolving traditions’. History of progress of sciences from Socrates, Pythagoras, Aristotle, Archimedes, Newton, Einstein, Bose to Higgs, and likes teach us that taking a snapshot view does not give sufficient insight into any changing and evolving phenomena and therefore is not sustainable although it may appear attractive. The temporal division of knowledge systems into ancient or modern categories often ignores the reality that they both, the past and present are part of evolving traditions. Maintaining the continuity and connectivity threads between past and present is essential to show us right direction to future. Studying history of Ayurveda is important because it teaches us evolution, progression, and the context in which to understand the present and glimpse the future. With this perspective, the history of Ayurveda will continue to be a rich source of knowledge and inspiration to facilitate much desired renaissance in the near future.

REAL VALUE OF CLASSICS

The classics like Samhitas are frequently read, recited, and referred for treatments and medicines, but are seldom studied for their perspective, logic, and approaches. These classics have not been carefully studied to understand their underlying wisdom. Sushruta and Charaka the two foundational treatises on Ayurveda, facilitated the transition of Ayurveda from a subtle and abstract, mystical tradition to a clinically robust, evidence-based knowledge guided by causative factors, that is, etiology, detailed observations, and logic. Sometime during 2000 BC, Indian subcontinent was facing epidemic of many diseases due to lifestyle and diet changes. The civilization was also undergoing a myriad of transitions. New cities were being created. A struggle-based, labor-intensive lifestyle was slowly moving towards relatively easier work patterns and sedentary lifestyles were emerging. This was coupled with a decline in value systems even during historical times. Like today's epidemiologists, sages like Bharadwaj, Punarvasu, and Bhrigu came forward to address these public health challenges. The proceedings of this Himalayan conference have probably led to compilation of the structured text, the Charak Samhita. There is a consensus on the clarity, rationality, clinical observations, and thus the value and wisdom available from these classics. Significant emphasis on subjects like Swasthavrita as a health promotion and disease prevention branch must have emerged because of public health needs of that time. Charaka's writings reflect an open, inquisitive, and inclusive mindset reflecting in the sutras of Vimansthan, the principle that ‘the whole world is a teacher for a true scholar’.

LEGACY OF EXPERIMENTATION

Sushruta Samhita and Charaka Samhita describe approaches, guidelines, and methods for understanding Loka and Purusha relationships similar to macrocosm and microcosm. They outline theory of progression of diseases, methods of observation of systemic physiological changes, and applying these theories and methods they illustrated the description of various prevalent diseases, their etiology, diagnosis, prevention, and treatments. They presented this scientific approach to health two to three millennia ago. Subsequently, Vagbhata reclassified these Samhitas and carved a concise version with many contemporary additions, well known as the Ashtanga Sangraha. Vagbhata emphasizes the importance of redacting revisions in accordance with continuously changing contexts - . Thus an era of rediscovering Ayurveda may well have started with Ashtanga Sangraha. The dynamic approach, which is the hallmark of science, is clearly evident in the development process of the Nighantus or materia medica, which describes drugs referred in Charaka, Sushruta, and later texts. Many new drugs, dietary recipes, treatments for various diseases, particularly for diseases prevalent at the time were added. Several foreign botanicals, minerals, metals, and dietary recipes were studied for their effects on Dosha, Dhatu, and Malas and were included in Ayurveda texts and practices. This is an example of how science, knowledge, and developments are linked to practices with advantages to the community.

Learning from history, in the course of development, new techniques such as Rasashastra as, the science of mercury and metals were evolved. Significant contributions from the Buddhist sage Nagarjuna provided new dimensions to the traditional emphasis on Dosha, Dhatu, and Mala based treatment. One can imagine the critical intellectual discourses between schools of thoughts following Charaka, Sushruta, and Vagbhata traditions, and proponents of the approach of Rasashastra creating high potency drugs from metals needing only low doses. These developments must have led to introduction of further new instruments, techniques and concepts like bhasmikaran, bhavana, shodhana, and new dosage forms like parpati, kajjali, and druti. Subsequently, various processes and techniques of purification of toxic metals and substances were also evolved introducing innovative chemistry and pharmaceutics. Such developments from Rasashatra may even have laid the foundation for modern chemistry, and were rightly acknowledged by renowned scientists like Dr P C Ray.[1]

The Brihad Trayi schools of thoughts were open and accommodating enough to respect and accept novel approach. Drugs, formulations, and dosage forms of Rasashastra have roots to the Siddha traditions. These developments appear to have led to second set of classics including the Sharangdhar Samhita and Bhavpraksh Nighantu. This legacy of openness and research to meet contemporary needs must be continued today, when the world is going against use of heavy metals. Can we simplify classical formulations? Just as ‘Laghu Sutshekhar’ emerged from Vaidya parampara as a simplified version of Sutshekhar. Thus traditionally, Ayurveda has been very open to new ideas and inclusive to different cultures. Can we simplify many classic formulations like Arogyavardhini without using any metals? Already few efforts to optimize Arogyavardhini have been done by late Vaidya Antarkar and group.[2] Can we find abhava pratinidhi dravyas for endangered plant species? Today's Ayurvedacharyas need to address these questions in line with the principles of inclusive integration advocated by Charaka and other Acharyas.

Historically, several of Ayurveda's divisions of medicine evolved along with the holistic approach. For instance, the Rajvallabh Nighantu discusses lifestyle along with etiological and healing potential; Kaiyadev Nighantu is dedicated to diet and its therapeutic role. Continuous developments in Ayurveda's diagnostic practices taught other important lessons. Works like Madhavacharya provided deeper understanding of Samprapti concepts for many diseases. Madhav Nidana exemplifies the spirit of continuous research, which led to progress in diagnostics and pathology using the foundations laid by Charaka and Sushruta.[3] Newer clinical methods like pulse diagnosis were later elaborated in Basavarajeeyam and Yogratnakara. Later, in the 16^th century Bhavprakash Nighantu added many new substances, which were imported from Arabia, China, and other parts of the world. In the 18^th century, Nighantu Ratnakar included a section on Arka describing the distillation process and medicinal use of volatile oils.

Taking a closer look at these historical examples suggests a dynamic, open, and curiosity-driven approach by Ayurveda practitioners and scientists. Ayurveda was also going through a challenging phase due to hostile environments arising from the various invasions of the Indian subcontinent. Still, the quest for innovation and progress did not stop. During some periods saw Ayurveda receive the blessings and suppression by the rulers; however, it always received the people's patronage.

The Sanskrit and Prakrit streams of knowledge had reasonable interactions, and their exchanges made for continual enrichment. Significant contributions have been made to bring more rationality in Ayurveda, especially from various Darshanas such as Sankhya, Jnyaya, Vaisheshika, Yoga, Mimansa, Vedanta, Charvak, Buddha, and Jain. Undoubtedly, the rapid emergence of modern medicine together with colonial domination may have resulted in significant marginalization and stagnation of Ayurveda.

REVIVING THE ART OF QUESTIONING

Anonymous proverb says ‘it is not good because it is old; it is old because it is good’. An important lesson from the study of Ayurveda's history is revelation of its original spirit of curiosity, questioning, and experimentation as a means to being a progressive science. Most of the Ayurveda classics are structured as dialogues, composed of questions and answers between Guru and Shishya. Undoubtedly, Ayurveda represents a rich tradition of knowledge based on sound logic, reasoning, questioning, and critical assessment. The culture of inquisitiveness and the art of questioning are extremely important for any knowledge-based society. Blind faith-based practices without any challenge, questioning, curiosity, or experimentation are tend to drift into cultism, or a ritualistic environment leading to mysticism and unreasonable superstitions. The spirit of scientific progress requires dynamic thought processes, vibrant interactions, and free exchange of ideas. Tadvidya sambhasha has remained one of the important practices in Ayurveda. Healthy discussions amongst various schools of thoughts, the ability to intellectually resolve conflicts to arrive at consensual decisions helps the process of building scientific evidence. The culture of continuous observation, examination, and validation of methods to generate new knowledge is clearly evident from the study of history of Ayurveda - In this context, the article is being published in this issue on foundational principles of classical Ayurveda research’ which highlight decision making of Charaka seems to be very timely.[4]

In its dark period, Ayurveda has suffered from apathy towards inquisitiveness and innovation, which seem to be continuing even today. In the modern world the strengths and limitations of modern medicine are becoming even more evident. Availability and accessibility to even primary healthcare still continues to be a serious issue. Emerging and reemerging diseases pose ever new challenges. Studies of public health-seeking behavior indicate increased preference for traditional medicine. However, because environmental changes and deforestation are threatening and endangering many species, associated quality and safety issues are affecting the global herbal drug market. In such a situation, we need rigorous research on Ayurveda especially in the areas of Dravyagunavidnyan, Bhaishajya kalpana, and Rasashastra. We need to assess the most recent Ayurvedic drugs and dosage forms, which will be most relevant and acceptable today for better, safer, and affordable treatments. In a globalized knowledge society like today's, we cannot continue to take a conservative line limiting Ayurveda to 57 books given in some schedule. We need a new generation of Charaka, Vagbhata, and Nagarjuna. We need second Himalayan conference to rediscover Ayurveda and evolve integrative health care models for the future.

TRIPLE BURDEN OF CHALLENGES

The Ayurveda sector seems to be carrying a triple burden of conflicting challenges. On first front there are increased national and global expectations; on the second front, the sector is experiencing severe deficiency in capacity building, human resource development, and education; while on the third front its practice and research are experiencing severe stagnancy. Ayurveda needs to bridge this gap through imaginative and dynamic efforts with futuristic vision. During last 60 years after independence, several administrative and regulatory efforts have happened.

India's parliament passed the Central Council of Indian Medicine Act in 1970. However, this has resulted in a mass production of graduates with suboptimal knowledge and skills to practice Ayurveda.[5] A separate department of ISM now known as ‘AYUSH’ was established in 1995, but this has resulted in isolation of Ayurveda from mainstream healthcare. In 2002 the department announced a policy on Indian systems of medicine aiming to strengthen its regulatory framework for quality medicine practice and educational institutes, but today's young graduates, aspirants, and practitioners are still feeling frustrated. A proposed amendment of the Drug and Cosmetics Rules for phytopharmaceuticals by the Government of India is expected to enable traditional knowledge-inspired, plant-based products to be known as ‘phytopharmaceutical drugs’. This may facilitate utilization of herbal drugs in the mainstream market. The drug industry and researchers may have increased opportunities to develop standardized, safer, and better botanical drugs. However, it is not clear how this will help the Ayurveda sector. To make these reforms more meaningful, we need to create an environment conducive to the original spirit of Ayurveda culture of questioning, historically encouraged by the Samhitas and practiced by the Acharyas. The present situation in Ayurveda education, administration, practice, and research needs a revival and strengthening of its original scientific temper.

WE CAN STILL LEARN

George Bernard Shaw once said, “We learn from history that we learn nothing from history”. A glorious history contrasting with a pitiable present means that Ayurveda needs serious introspection, and an open attitude towards necessary change. Courses on Ayurveda history have been taught in Ayurveda colleges for decades, but we have hardly learnt anything from them.

Despite a long tradition and glorious history, the sector is experiencing over dominance by modern medicine at governmental, policy, education, research, and practice levels. Many experts have repeatedly expressed the need for an open environment and cross talk between different schools of thoughts and disciplines.[6] Even after several decades of emotion and pride-based position on traditional knowledge, we have hardly any noticeable or exemplary contributions of evidence-based practice, quality education, or innovative research. Unlike China, which has success stories like Ginseng and artemisinin, we do not have any successful drug despite many leads existing like curcumin.

Ironically, we have not been able to come up with any new clinical process, research protocols, or methods. We have not been able to scientifically project whole system treatment regimens. Unique experiences and excellent work done by many senior Vaidyas still remain undocumented and unpublished. Hardly any Ayurveda intervention has been implemented in public health to improve health or to tackle serious national issues like malnutrition or anemia. Most major national programs like the New Millennium Indian Technology Leadership Initiative, Traditional Knowledge Digital Library, and Science Initiatives in Ayurveda, which have received reasonable attention from the global scientific community are outcomes of imaginative projects initiated by Council for Scientific and Industrial Research and Department of Science and Technology. Many good initiatives like Vaidya Scientists, AyuSoft, high impact projects like AyuGenomics, Shatkriyakal, Kayakalpa, and good publications like International Journal of Ayurveda Research are still waiting for due attention and support. Even after over 6 decades of independence, we have little to boast of except products like AYUSH 64 (for malaria) and Ksharasutra, which despite great potential have not made desired impact either on public health or research.

LET OUR VISION GROW

Any honest introspection and constructive critique should not even remotely mean that Ayurveda has no potential. In fact the public health system for a country like India should be based on principles and practice of Ayurveda and Yoga. However, this is unlikely to happen only by studying history or merely holding Ayurveda as a piece of heritage pride. As Gautam Buddha said “No one saves us but ourselves. No one can and no one may. We ourselves must walk the path”. We have to learn from history and then take the right direction towards the future. We have a lot to learn from Yoga, which has rapidly globalized and has attracted some excellent scientific minds. There is a long way to go. We need strong determination to broaden our vision, open our minds and hearts when gazing into the future.[7] We need to catch the real, integrative spirit of Ayurveda and not just get trapped in practice of rituals and recitals. Let's re-visit history, re-read the classics, and re-interpret and re-discover its meanings in the context of both the present and the future. The great sages and traditions have provided us a wealth of knowledge. We are truly standing on the ‘Shoulders of Giants’. The real questions are ‘when are we willing to liberate Ayurveda from a mere collection of 57 books and restore a dynamic, progressive, inclusive, innovative, and integrative path for the future? ‘When do we decide to wake up from slumber and realize the true value and magnitude of our own heritage to shape the future? It is high time to practice the spirit of Charaka, when he said ‘Let our vision grow and our quest never end’.