Synthesis Of Ayurved With Modern Scientific Medicine

The isolation, purification and characterization of biologically active compounds from plants have become major activity of modern drug development. India is the region of extremely rich biodiversity having a very large number of plant species. Therefore, our country has attracted much interest of the worldwide drug industry as a source of already known as well as hitherto undiscovered medicinal plants. It has also being gradually recognized that traditional Indian system of medicine, Ayurved, can provide a rich source of knowledge about medicinal plants and their uses. Further, dissatisfaction with various aspects of modern allopathic medicine and growing awareness about the benefits of herbal medicine has resulted in rapid and vast growth of the industry engaged in preparation and supply of Ayurvedic herbal preparations. Despite growing awareness and much increased pace of researches in various aspects of Ayurved, there are many impediments to the growth of this valuable system. Some of these are:

1. Scarcity of Ayurvedic literature owing to:
(a) Destruction during repeated invasions of India;

(b) Loss due to secretiveness of practitioners of Ayurved;

(c) Problem of the change of language;

(d) Change of culture with passage of time.

2. Lack of the understanding of the concepts and methodologies of Ayurved.

3. Problem of proper identification of medicinal herbs described in Ayurved.

4. Non-availability of proper herbs in sufficient amounts owing to:

(a) Decreasing forest areas;

(b) Increasing environmental pollution.

5. Lack of knowledge about proper farming/culture methodologies of medicinal herbs.

Thorough identification and investigation of the Ayurvedic medicinal plants
Amongst these various important impediments, the problem of proper identification of medicinal herbs described in Ayurvedic texts concerns most the industry dealing with Ayurvedic preparations as well as the researchers involved with investigating Ayurvedic medicinal plants. Reference to the ancient text of Vrikshayurved may hold the key to this problem.

The Vvikshayurved given by Parashar in the post-Vedic period i.e. 1st BC to 1st AD is the oldest available full-fledged treatise on plant science. The manuscript of Vrikshayurved was discovered by Vaidyashastri Jogendranath Vishagratun of Navadwip in Bangla Desh. His son N.N. Sirkar published an account of this work in journal of the Asiatic Society in 1950. This book is written in Sutra style and is divided into six parts. These parts deal with

1. outline of plant morphology,
2. description and nature and properties of soil, distribution of forests,
3. detailed morphology of plant members,
4. definition, structure, function and classification of the parts of flower, fruits
5. discussions on the root, stem, bark, heartwood, spines and prickles, seeds and embryonic plants,
6. sap excretion and oleaginous products.

Sirkar has stated that Vrikshayurved evidently formed the basis of botanical teaching preparatory to pharmaceutical studies in ancient India. This practice was quite comparable to the modern practice in this regard. It also appears that the Parashar’s methods of nomenclature is based on three types of synonyms e.g. those of botanical significance, these with therapeutic index and those associated with names of habitats or special events. Charak, Sushrut and other authors of medical treatise particularly in the preparatory chapters of Ayurvedic pharmacopoeias largely followed the classification system of Parashar. It may be suggested that thorough study of the work of Parashar be of much value as it can help in the identification and classification of plants mentioned in ancient Indian medical treatises.

Investigation of the methods of preparation of Ayurvedic medicines & their clinical trials
Ayurvedic herbs are preferred over Ayurvedic bhasm/churan because of the fact that herbs can be recognized and grown organically and their use is simple while in case of Bhasma and Rasayana, the very purity of materials is not guarantied. Further, the method of Shodhana i.e. preparing these agents is not well known due to destruction of Ayurvedic literature during thousand of years of invasions and slavery in the country. However, thorough scientific investigation of the methods described in Ayurved should be undertaken. This may bring out the underlying physico-chemical basis of these methods. Such knowledge may be used in modernizing and refining these ancient methodologies with the help of advances in modern scientific methods.

In preparation of Ayurvedic herbal medicines and preparations also, it is observed that there is great variation in the method of preparation and formulation. The same preparation or medicine prepared by different methods has different clinical effects. Therefore, it is also necessary that the formulations and methods of preparation of even simple herbal medicines and herbal preparations should be thoroughly investigated with scientific methods and standardized after application of modern methods of clinical trials.

Adoption of the modern scientific investigative, diagnostic & clinical methodology in the Ayurvedic system
The system of investigating a patient in Ayurved is largely subjective depending upon the experience, concepts and knowledge of the practitioner (Vaid). The method of diagnosis of the disease condition is similarly not well defined or standardized but depends upon the intuitive arrival at a decision by the investigator Vaid. Thirdly, the treatment for a particular disease condition varies with the individual patient as well as the Vaid. Therefore, it is important to develop the objective methods of investigation, diagnosis and treatment based on the concepts and methods of Ayurved but that are scientifically tested, standardized and repeatable. The possibilities of applying the methods of investigation, diagnosis and clinical practice used in modern scientific medicine in the Ayurved also as far as possible and applicable should be thoroughly explored. This may be useful in integration of the two systems.

Proper cultivation and propagation methodologies for the plants used in Ayurveda.
In the modern times, there are acute problems of decreasing forest areas, destruction of natural vegetation and increasing chemical pollution of the natural environment. The amounts of medicinal herbs required by the spreading Ayurvedic herbal medicinal industry is also increasing constantly. Consequently, it is increasingly becoming difficult to obtain proper medicinal plant materials that are free from chemical poisoning. Harmful levels of lead, mercury and/or arsenic have been found in the Indian Ayurvedic medicines sold in U.S.A. by Dr. Robert B. Saper, and his collegues of the Harvard Medical School in a study published in the Journal of American Medical Association (2004). Therefore, the development of organic farming and application of modern biotechnological methods to the cultivation and propagation of Ayurvedic herbs has become pressing need.

Vrikshayurved

Vrikshayurved: Key to proper identification of medicinal plants described in Ayurveda.

Shakil Ahmed

The isolation, purification and characterization of biologically active compounds from plants is major activity of modern drug development. India is the region of extremely rich biodiversity having a very large number of plant species. Therefore, our country has attracted much interest of the worldwide drug industry as a source of already known as well as hitherto undiscovered medicinal plants. It has also being gradually recognized that traditional Indian system of medicine, Ayurved, can provide a rich source of knowledge about medicinal plants and their uses. Further, dissatisfaction with various aspects of modern allopathic medicine and growing awareness about the benefits of herbal medicine has resulted in rapid and vast growth of the industry engaged in preparation and supply of Ayurvedic herbal preparations. Despite growing awareness and much increased researches in various aspects of Ayurved, there are many impediments to the growth of this valuable system.

Amongst the various important impediments, the problem of proper identification of medicinal plants described in Ayurvedic texts is of utmost concern to the industry dealing with Ayurvedic preparations as well as the researchers involved with investigation of Ayurvedic medicinal plants. No detailed descriptions of the plants are available in Ayurvedic texts. Presently, everybody interested in Ayurvedic medicinal plants has to depend on native people, tribal people or practitioners of Ayurved. It is not possible to ascertain with desirable accuracy whether the proper material intended to be used as described in the Ayurvedic treatise has been identified and collected. Wondering as to how students of Ayurved were taught to identify medicinal plants properly and accurately during ancient times, I came to know about an ancient text by the name of Vrikshayurved that may hold the key to this problem.

The manuscript of Vrikshaurved was discovered by Vaidyashastri Jogendranath Vishagratun of Navadwip in Bangla Desh. His son N.N.Sirkar published an account of this work in Journal of the Asiatic Society in 1950

The Vrikshaurved was given by sage Parashar in the post-Vedic period supposedly between 1^st B.C. and 1^st A.D. It is the oldest available full-fledged treatise on plant-science. This book is written in Sutra style and is divided into six parts. These parts deal with various aspects of plant-science. The topics dealt with in the book are:

1. Outlines of plant morphology;

2. Nature and properties of soils;

3. Description and distribution of forests;

4. Detailed morphology of plant members;

5. Structure, function and classification of the parts of flower; definition, function and classification of fruits; discussions on the root, stem bark, heartwood, spines, prickles, seeds and embryonic plants;

6. Sap excretions and oleaginous products.

N.N. Sirhar has stated that Vrikshaurved evidently formed the basis of botanical teachings preparatory to pharmaceutical studies in ancient India. This practice was quite comparable to the modern practice in this regard. It also appears that the Parashar’s methods of nomenclature is based on three types of synonyms e.g. those of botanical significance, these with therapeutic index and those associated with names of habitats or special events. Charak, Sushrut and other authors of Ayurvedic medical treatises largely followed the classification system of Parashar, particularly in the preparatory chapters of their pharmacopoeias.

It may be suggested that by undertaking thorough study of Vrikshayurved of Parashar the ancient system of describing plant characteristics, their classification, habit and habitat and other relevant botanical details might be corroborated with modern botanical knowledge. This might be highly valuable as it can help in the proper identification of plants mentioned in ancient Indian medical treatises and inaccuracies or confusion prevalent today in this matter might be lessened.

PHILOSOPHY, CONCEPTS AND THEORIES OF AYURVEDA

The medical knowledge in India, as in every other land, must have grown out the sheer necessity of overcoming injury, sickness and pain. The prehistoric art of selecting substances which could be assimilated by the human system with benefit and their cooking and compounding to give the most of nourishment and health forms integral part of indigenous Indian medical systems. The traditional Indian medical system is known as Ayurved. The term ayus means duration or the span of life and the term veda means the unimpeachable knowledge. Hence, Ayurved, commonly translated as ‘the knowledge of the duration or span of life’, is concerned mainly with prolongation of healthy life and prevention of disease and senility and only secondarily with curing of disease. In recent times, the interest in Ayurved has grown nationally as well internationally. The Ayurvedic system of medicine has been professionally recognized in India and much attempt is being made to integrate it with modern scientific medicine. However, all the attempts to integrate Ayurved with modern medicine have been been unsuccessful because of mutually incomprehensible philosophies, concepts and theories of two systems. Therefore, these aspects of traditional Indian medicine have been explored in the following discussion.

HISTORICAL BACKGROUND

There are many legends describing divine origin and corresponding antiquity of Ayurved and such legends are found in the introductory passages of many Ayurvedic texts e.g. Charak, Susruta and other Samhitas. Despite such claims, the origin of Ayurved can not be credited to any particular place, age or person. The earliest recorded instances of rational medical knowledge are found in Rigveda and Atharvaveda, both of which are considered to be of second millennium B.C. However, There is much evidence to show that Ayurved was preceded by an earlier medical knowledge developed by the builders of pre-Aryan Indus valley civilisation. It appears that the Aryans took up the beliefs and practices of this civilisation. They further speculated and experimented freely in their own way, learned much and unlearned only that which was patently wrong, thus developed and incorporated the pre-Aryan medical knowledge into Ayurved.

There were two main schools of Ayurveda at that time. Atreya- the school of physicians, and Dhanvantari – the school of surgeons. These two schools made Ayurveda a more scientifically verifiable and classifiable medical system. There are two main re-organizers of Ayurveda whose works are still existing in tact today – Charak and Sushrut. The third major treatise is called the Ashtanga Hridaya, which is a concise version of the works of Charak and Sushrut. Thus the three main Ayurvedic texts that are still used today are the Charak Samhita (compilation of the oldest book Atreya Samhita), Sushrut Samhita and the Ashtangha Hridaya Samhita. These books are believed to be over 1,200 years old. Ayurveda was delineated into eight specific branches of medicine during its systematization.

Charak Samhita and Sushrut Samhita are the two major sources on which Ayurved is based.

Charak was an ancient Indian worker credited with giving a complete medical treatise in the form of Charak Samhita. This work forms the basis of Ayurved. The most commonly accepted date for the composition of Charak Samhita is 1^st A. D. The work of Charak was originally the Samhita of Agnivesh who was the disciple of medical sage Atreya. The long passages in Charak Samhita are in the form of questions and answers between Atreya and Agnivesh. The Samhita mentions the eight different branches of the medical knowledge but the treatise is not written accordingly. Charak Samhita is an exclusive work on the first branch (therapeutic medicine) only though it also contains many sections dealing with surgery and other six branches. It deals mainly with anatomy, physiology, etiology and prognosis, pathology and treatment, objectives of treatment, influences of environmental factors, medicines and appliances, procedures and the sequence of medication.

The work is divided into eight sections containing 150 chapters in all for the discussion of abovementioned topics. The Materia Medica of the Samhita is extensive and represents a full utilisation of environmental resources. More than six hundred drugs of animal, plant and mineral origins used as medicines are described in Charak Samhita. The large variety of medical prescriptions, methods of compounding employing specific instruments for each type of medicine and therapeutic methods including psychiatric procedures are scientific, sound and exhaustive.

Sushrut was an also an ancient Indian worker credited with giving a comprehensive medical treatise in the form of Sushrut Samhita. His Samhita alongwith Charak Samhita form the basis of Ayurved. The most commonly accepted date for the presently available Nagarjuna’s redaction of the older original Sushrut Samhita is 3^rd to 4^th A. D. Sushrut Samhita contains a series of discourses between the holy sage Dhanvantari and his disciple Sushrut. The Samhita mentions the eight different branches of medical knowledge but the treatise is not written accordingly. This Samhita also follows more or less the same pattern of treatment of different branches as in Charak Samhita but gives surgery the place of honour. It belongs to Dhanvantari school of medicine that believes surgery to be the most ancient and most efficacious of the eight branches of medical knowledge. The Samhita contains six sections. The first five sections deal with the established knowledge of the fundamental postulates, pathology, embryology and anatomy, therapeutic and surgical treatment and toxicology. The sixth final section deals with subseqently gained specialized knowledge of the topics dealt with in earlier sections. It contains 184 chapters in all. This Samhita is more concise and repository of more factual knowledge than Charak Samhita. It describes the necessity and modus operandi of the dissection on human cadavers for gaining accurate anatomical knowledge. The Materia Medica of this Samhita is also extensive and represents a full utilisation of the environmental resources. About six hundred drugs of animal, plant and mineral origin used as medicines are described in Sushrut Samhita. Symtoms are also described for a large number of psychiatric disorders and the methods of their treatment.

The Vrikshaurved given by Parashar in the post-vedic period i.e. 1^st B. C. to 1^st A. D. is the oldest available full-fledged treatise on plant science. The manuscript of Vrikshaurved was discovered by Vaidyashastri Jogendranath Vishagratna of Navadwip in Bangla Desh. His son N. N. Sirkar published an account of this work in Journal of the Asiatic Society in 1950. This work written in Sutra style is divided into six parts. These parts deal with outline of plant morphology, nature and properties of soil, description and distribution of forests, detailed morphology of plant members, structure, function and classification of the parts of flower, definition, function and classification of fruits, discussions on the root, stem, bark, heartwood, spines and prickles, seeds and embryonic plants, sap, excretion and oleaginous products. N.N. Sirkar states that Vrikshaurved evidently formed the basis of botanical teaching preparatory to pharmaceutical studies in ancient India. This practice was quite comparable to the modern practice in this regard. It also appears that the Parashar’s method of nomenclature is based on three types of synonyms e.g. those of botanical significance, those with therapeutic index and those associated with names of habitats or special events. Charak, Shushrut and other authors of medical treatises particularly in the preparatory chapters of Ayurvedic pharmocopoeias largely followed the classification system of Parashar. Therefore, the work of Parashar is of much value as it can help in the identification and classification of plants mentioned in ancient Indian medical treatises.

For centuries in the past, people from numerous countries came to Indian Ayurvedic schools to learn about this world medicine and the religious scriptures it sprang from. Learned men from China, Tibet, the Greeks, Romans, Egyptians, Afghanistanis, Persians, and more traveled to learn the complete wisdom and bring it back to their own countries. Ayurvedic texts were translated in Arabic and under physicians such as Avicenna and Razi Sempion, both of whom quoted Indian Ayurvedic texts, established Islamic medicine. This style became popular in Europe, and helped to form the foundation of the European tradition in medicine.

In 16th Century Europe, Paracelsus, who is known as the father of modem Western medicine, practiced and propagated a system of medicine, which borrowed heavily from Ayurveda.

Ayurved is the basis of ancient and traditional Indian system of medicine and health care. With the passage of time the theories, concepts, beliefs and practices of Ayurved became so widespread that it seems difficult today to isolate technical Ayurved from the local, regional and lay medical and health-care traditions. Therefore, much knowledge of Ayurved, apart from the available texts, can also be gathered from the local traditions and practices. The importance of local traditions as a source of useful medical knowledge was recognised even by Charaka and Sushruta:

“The goatherds, shepherds, cowherds and other forest dwellers know the drugs by name and form…” (Chraka Samhitaa, Sutra Sthaana, Chapter I, Shloka 120-121)

“One can know about the drugs from the cowherds, tapasvees, hunters, those who live in the forests and those who live by eating roots and tubers” (Sushruta Samhitta, Sutra Sthaana, Chapter 36, Shloka 10)

Like every branch of organised knowledge in India, the concepts, theories and philosophy of Ayurved is also rooted in the philosophical traditions of India. Therefore, to understand the basic philosophy of Ayurved, it is necessary to understand the basic philosophical traditions of India and their development with time.

Indian tradition has always recognised that the classical texts in any area of learning only set out the broad general principles as well as their application in a given context, say a particular region of the country. However, the knowledge exists in different contexts or regions and it is expressed based on the given situation. The generalities as given in the texts may get adapted, modified or even overriden based on the specificity. The Indian classical texts have repeatedly emphasised that the particularity of the context that is the overriding consideration and the textual principals are to be considered as precepts and guidelines and not applied in a mechanistic or legalistic manner. In the Indian medical system this fact was considered to be particularly important. Charaka specifically pointed out that “For a person who belongs to a particular country or region, aushadhi (medicine) from the same region are most wholesome”. Another shloka states “A vaidya (medical practitioner) who comprehends the principals of Rasa etc. would discard the treatment if not wholesome to the patient in a given situation, even if it is prescribed in the texts. On the contrary, he would adopt treatments that are helpful to the patient, even if they do not find a mention in the text”.

A classical text like Charaka Samhitaa expounds the general principles of drug action based on six factors- Dravya, Guna, Rasa, Veerya, Vipaaka and Prabhava. It also discusses remedies for several diseases and lists specific drugs. However, these may be modified to suit the local conditions. In any recipe for a drug, a non-principal component (Apradhaan Dravya) with an equivalent that may be chosen from the list given in the text or selected from locally available materials based on the principles of Rasa, Veerya etc. Keeping the principal of the specificity of the context, Indian medical practitioners (Vaidyas) wrote texts and manuals setting out prescriptions of drugs for any given area based on the materials available and suitable to the requirements of that particular area. For example, The text Rajamriganka lists 129 recipes. Ayrvedachaarya Natraja Shastri, editor of the text, states in the foreword “The text is a compilation that must have been made by a practitioner (Vaidya) belonging to Tamil Nadu – it contains recipes based on herbs readily available in Tamil Nadu”.

Philosophy of Ayurved

Any specialised system of knowledge in a society is always rooted in the philosophical systems prevalent in that society. The specialised knowledge system goes on incorporating the developments and modifications of the philosophical systems. As such, the Indian Ayurvedic system of medicine is also rooted in the Indian philosophical systems of Sankhya, Yoga and Nyaya-Vaishashik.

The above feature of the Ayurvedic tradition points to the epistomological position that may best be described as rationalism under control of empiricism.

Concept of health and life goals

Ayurvedic theory believes that health results from harmony within one’s self. To be healthy, harmony must exist between your purpose for being, your thoughts, your feelings, and your physical actions. Your purpose is peaceful, yet if your thoughts are fearful and your emotions negative, your physical body will manifest some dis-ease as a “wake-up call” to change. In Ayurveda, the manifestation of disease is actually considered to be a good sign, because it reveals a previously hidden aspect of oneself . . . an aspect to be healed. Health is harmony within all aspects of self. This inner harmony also becomes manifest as harmony with family, friends, co-workers, society and nature. Often the first questions an Ayurvedic physician may ask are: “What is your purpose in life? And what is its appropriate form (work, job, activity, etc.)? How are your relationships?” When harmony exists in these areas, physical healing is so much easier. The goal of Ayurveda is true freedom from death and disease; enjoyment of uninterrupted physical, mental and spiritual happiness and fulfillment. It may sound surprising, but according to Ayurvedic philosophy, enjoyment is one of life’s purposes. But you can lose your ability to enjoy if you overindulge, and disease is one of nature’s ways of saying you’ve overindulged. Either you limit yourself or Mother Nature will limit you. We have more degenerative disease in the West because of our abundance and tendency to overindulge.

Ayurveda maintains four basic goals of life:

l. The fulfillment of your duties to society.

2. The accumulation of possessions while fulfilling duties.

3. Satisfying legitimate desires with the assistance of one’s possessions.

4. The realization that there is more to life than duties, possessions and desires.

Ayurvedic philosophy believes that only a person with a strong immune system can be healthy. The practitioners identify the immune system as a fragment of nature (the Divine Mother). This gift from her creates us, sustains us, nourishes us, and protects us from outside invasion. As long as our immune system is strong, we suffer no disease. The ancient Vedic word for immunity means “forgiveness of disease” — from the concept that negative thoughts and lifestyles cause disease. Disease, therefore, is a message about a need for change . . . if only we can understand this. In this sense, strength comes from transforming our projections about our symptoms. Healing comes from seeing adversity as a challenge, by taking back our negative thoughts about people and events. We can transform disease into a “perfect opportunity.” Spiritual health, then, is a dynamic balance between a strongly integrated individual personality and nature (a nature that’s understood to encompass all aspects of existence). This is only possible when people remember their debt to nature.

In summary, Ayurveda believes that health results from the relationship (the connectedness) between self, personality, and everything that goes into our mental, emotional, psychic and spiritual being. It believes that health also results from good relationships with others, from an acknowledged indebtedness to Mother Nature, from the realisation of one’s purpose, and from the pursuit of legitimate goals in life. Ayurvedic philosophy maintains the importance of a strong immune system, that forgiveness is strengthening, and that immortality is possible.

Concept of Panchmahabhuta (The Five Element Theory )

Ayurveda believes that everything in this universe is made up of five great elements (Panchmahabhutas) or building blocks. These are Prithvi (earth), Jal (water), Agni (fire), Vayu (air), and Akasha (ether).

Prithvi (Earth) represents the solid state of matter. It manifests stability, permanence and rigidity. In our body, the parts such as bones, teeth, cells and tissue are manifestations of the earth. Prithvi (Earth) is considered a stable substance. It is representative of the solid state of matter; it manifests stability, fixedness and rigidity. We see around us rocks and soil standing against the wearing forces of water and wind. Our body also manifests this earth/solid-state structure: bones, cells and tissue are physical structures through which our blood courses and oxygen is transported. Prithvi (Earth) is considered a stable substance.

Jala (Water) characterizes change and represents the liquid state. Water is necessary for the survival of all living things. A large part of the human body is made up of water. Our blood, lymph, and other fluids move between our cells and through our vessels, bringing energy, carrying away wastes, regulating temperature, bringing disease fighters, and carrying hormonal information from one area to another. Jala is a substance without stability. Jala characterizes change. In the outer world, we see water moving through the cycle of evaporation-clouds-condensation-rain. We see it moving around solid matter such as rocks and mountains, and we see it eventually wearing away solid, immovable matter as it flows from the mountains to the sea. We see rivers carrying dissolved soil and nutrients. We see the earth’s bodies of water nurturing life everywhere. Our blood, lymph, and other fluids move between our cells and through our vessels, bringing energy, carrying away wastes, regulating temperature, bringing disease fighters, and carrying hormonal information from one area to another. Jala is considered a substance without stability.

Agni (Fire) is the power to transform solids into liquids, to gas, and back again. In other words, it possess power to transform the state of any substance. Within our bodies, the fire or energy binds the atoms together. It also converts food to fat (stored energy) and muscle. Fire transforms food into energy. It creates the impulses of nervous reactions, our feelings, and even our thought processes. Agni (Fire) is considered a form without substance. Fire – is the power to transform solids to liquids, to gas, and back again. The heat of the sun melts ice into water that becomes vapor under its influence. Fire provides power to the water and weather cycles of nature. The sun’s energy is the initiator of all energy cycles on earth — including all food chains. Within our bodies it is Agni (Fire) that binds the atoms of our molecules together; that converts food to fat (stored energy) and muscle; that turns (burns) food into energy; that creates the impulses of nervous reactions, our feelings, and even our thought processes. Agni (Fire) is considered the form without substance.

Vayu is mobile and dynamic matter. Within the body, Vayu- is the basis for all transfer reactions. It is a key element required for fire to burn. Air is existence without form. Vayu- is the gaseous form of matter which is mobile and dynamic. We do not see the air that blows through the tree’s leaves, but we feel it. We know how material it can be — how it can respond to energy, absorb it, and give it off — when we watch or experience a hurricane, typhoon or tornado. We feel air as it courses down our throats and into our lungs — cut that off for more than a few minutes and we know with our whole being how fundamental air is to life. Within the body, Vayu is the basis for all energy transfer reactions — oxidation. Clean and pure, it is a key element required for fire to burn. Vayu- is existence without form.

Akasha (Ether) is the space in which everything happens. It is the field that is simultaneously the source of all matter and the space in which it exists. Akasha is only the distances which separate matter. The chief characteristic of ether is sound. Here sound represents the entire spectrum of vibration. Akasha is the space in which everything happens. Like outer space with millions of miles between celestial bodies, or the inner space of our bodies where our very atoms are only .00001 charged particle and .99999 emptiness. Space, the distance between things — that which helps to define one thing from another. Akasha is only the distances which separate matter.

Everything in our world is made up of these Panchmahabhutas (five elements). All substances can be classified according to their predominant Mahabhuta (element). For example, a mountain is predominantly made up of earth element. A mountain also contains water, fire, air and ether. But these elements are very small compared to the earth. So, it is classificatied as the earth.

According to the Panchmahabhutas (five elements) Theory, the human being is a small model of the universe. What exists in the human body exists in altered form in the universal body. Ayurveda believes that everything is made up of Panchmahabhutas (five elements), or building blocks. Their properties are important in understanding balances and imbalances in the human body.

In Ayurvedic philosophy, the Panchmahabhutas (five elements) combine in pairs to form three dynamic forces or interactions called Doshas.

Concept of Tridosha (Three dynamic forces)

In Ayurvedic philosophy, the Panchmahabhutas (five elements) combine in pairs to form three dynamic forces or interactions called doshas. The term Dosha means “that which changes” because doshas are constantly moving in dynamic balance, one with the others.. It is a word derived from the root ‘dus’, which is equivalent to the English prefix ‘dys’, such as in dysfunction, dystrophy, etc. In this sense, dosha can be regarded as a fault, mistake, error or a transgression against the cosmic rhythm. The doshas are constantly moving in dynamic balance, one with the others. Doshas are required for the life to happen. In Ayurveda, dosha is also known as the governing principles as every living things in nature is characterized by the dosha. Doshas are primary life forces or biological humors. They are only found in life forms (similar to the concepts of organic chemistry), and their dynamism is what makes life happen. The three active doshas are called Vata, Pitta and Kapha.

Vata (Va-ta) is conceptually made up of the elements ether and air. The proportions of ether and air determine how active Vata is. The amount of ether (space ) affects the ability of air to gain momentum, as expressed in Vata. In the body, Vata is movement (a dynamism of the combination between ether and air), and manifests itself in living things as the movement of nerve impulses, air, blood, food, waste and thoughts. The proportions of ether and air determine how active Vata is. The amount of ether (space) affects the ability of the air to gain momentum. If unrestricted, as in ocean, air can gain momentum and become forceful such as a hurricane. Vata means “wind, to move, flow, direct the processes of, or command”. Vata enables the other two doshas to be expressive. The actions of Vata are drying, cooling, light, agitating, and moving. Vata governs breathing, blinking of the eyelids, movements in the muscles and tissues, pulsations in the heart, all expansion and contraction, the movements of cytoplasm and the cell membranes, and the movement of the single impulses in nerve cells. Vata also governs such feelings and emotions as freshness, nervousness, fear, anxiety, pain, tremors and spasms. The primary seat or location of the Vata in the body is the colon. It also resides in the hips, thighs, ears, and bones, large intestine, pelvic cavity, skin, and is related to the touch sensation. If the body develops an excess of Vata, it will accumulate in these areas. Vata has seven qualities viz. coldness, lightness, irregularity, mobility, rarefied, dryness, and roughness. These qualities characterise their effect on the body. Too much Vata force can cause nerve irritation, high blood pressure, gas and confusion. Too little Vata, we have nerve loss, congestion, constipation and thoughtlessness. When the movement of air is unrestricted by space (as in the open ocean) it can gain momentum to become hurricane winds moving at speeds of over 150 mph. When air is restrained in a box, it cannot move and becomes stale.

Pitta (Pit-ta) is conceptually created by the dynamic interplay of water and fire. These two seemingly opposed forces represent transformation. They cannot change into each other, but they modulate each other and are vitally necessary to each other in the life processes. In our bodies Pitta is manifested by the quality of transformation. Pitta is responsible for digestion of our food and the regulattion of our metabolism. In the mind, the Pitta is transforms impulses into understood thoughts. Too much Pitta can cause ulcers, hormonal imbalance, irritated skin (acne), and consuming emotions (anger). Too little Pitta causes indigestion, inability to understand, and sluggish metabolism The Pitta is described according to eight characteristics viz. hotness, lightness, fluidity, subtleness, sharpness, malodorousness, softness and clarity. When you boil water on a fire, if the fire is too hot, all the water boils away and the pot burns. If you put too much water into the pot, it overflows and puts out the fire. Pitta is a force created by the dynamic interplay of water and fire. These forces represent transformation. They cannot change into each other, but they modulate or control each other and are vitally required for the life processes to occur. (For example, too much fire and too little water will result in the boiling away of the water. Too much water will result in the fire being put out.). Pitta governs digestion, absorption, assimilation, nutrition, metabolism, body temperature, skin coloration, the luster of the eyes: and also intelligence and understanding. Psychologically, pitta arouses anger, hate and jealousy. The small intestine, stomach, sweat glands, blood, fat, eyes and skin are the seats of Pitta.

Kapha (Ka-pha) is the conceptual equilibrium of water and earth. Kapha is structure and lubrication. One can visualize the Kapha force as the stirring force to keep the water and earth from separating. For example, if we take a pot, fill it half with water and then add sand to it, the sand will gradually sink to the bottom of the pot. (It separates from the water). The only way to keep the sand in equilibrium with the water and separate is to stir the mixture continuously. The Kapha force can be visualized as this stirring force in our body. Kapha cements the elements in the body, providing the material for physical structure. This dosha maintains body resistance. Water is the main constituent of Kapha, and this bodily water is responsible physiologically for biological strength and natural tissue resistance in the body. Kapha lubricates the joints, provides moisture to the skin, helps to heal wounds, fills the spaces in the body, gives biological strength, vigor and stability; supports memory retention, gives energy to the heart and lungs and maintains immunity. Kapha is present in the chest, throat, head, sinuses, nose, mouth, stomach, joints, cytoplasm, plasma and liquid secretions of the body such as mucus. Psychologically, Kapha is responsible for emotions of attachment, greed and long-standing envy. It is also expressed in tendencies toward calmness, forgiveness and love. The chest is the seat of Kapha.

Dosha	Related Elements
Vata	Vayu (Air) and Akash (Ether)
Pitta	Agni (Fire) and Jala (Water)
Kapha	Jala (Water) and Prithvi (Earth)

Effect of Constitution Types on Body or Microcosm

Head	Vata	Pitta	Kapha
Function of the Dosha (or controls)	Movement, Breathing, Natural Urges, Transformation of the tissues, Motor functions, Sensory functions, Ungroundedness, Secretions, Excretions,Fear, Emptiness, Anxiety,Thoughts, Life force, Nerve impulses	Body heat, Temperature, Digestion, Perception, Understanding, Hunger, Thirst, Intelligence, Anger, Hate, Jealousy	Stability, Energy, Lubrication, Forgiveness, Greed, Attachment, Accumulation, Holding, Possessiveness
Manifests in living things as	The movement of nerve impulses, air, blood, food, waste, thought	The quality of transformation. Pitta controls the enzymes that digest our food and the hormones that regulate our metabolism. Pitta transforms the chemical and electrical impulses in our mind to thoughts we can understand.	Cells that make up our organs and fluids which nourish and protect them.
Characteristics	Cold, light, irregular, mobile, rarefied, dry, rough	Hot, light, fluid, subtle, sharp, malodorous, soft, clear	Oily,cold,heavy,stable,dense,smooth
Too much of the dosha force can result in	Nerve irritation, high blood pressure,gas,confusion	Ulcers, hormonal imbalance, irritated skin (acne), consuming emotions (anger)	Mucous build-up in the sinus and nasal passages, the lungs and colon. In the mind, it creates rigidity, a fixation of thought, inflexibility.
Too little dosha force can result in	Loss of nerve, congestion, constipation, thoughtlessness	Indigestion, inability to understand, sluggish metabolism.	Experiences a dry respiratory tract, burning stomach (due to lack of mucous, which protects from excess stomach acids), inability to concentrate.
Where in a plant found	Flowers and leaves (the parts which reach farthest into air and space)	Plant’s essential oils, resins and sap	Roots (The roots are where water is stored. Roots also stay within the earth.)
Climatic influences	Dry climates or cold autumn winds increases Vata	Hot summers or hot climates will increase Pitta	Wet winters and damp climate add to Kapha.
Predominant during the life stage of	Old age. As we get older, we “shrink and dry out”.	Teen and Adult. During this stage, our hormone changes, transforms us into adults.	Childhood years. During this period, we grow or increase in substance of the body.

Concept of cause-effect

In the Ayurvedic organization of cause and effect, too much Kapha causes mucous buildup in the sinus and nasal passages, the lungs and colon. It creates rigidity, a fixation of thought and inflexibility in the mind. If not enough Kaph is present, the condition causes the body to experience a dry respiratory tract, burning stomach (due to lack of mucous, which gives protection from excess stomach acids), and inability to concentrate. The Kapha has the qualities of oiliness, coldness, heaviness, stability, denseness and smoothness. When a handful of sand is thrown into a container of water, the two will separate as the sand settles to the bottom. Only by continuous stirring will the mixture remain in balance. The force of Kapha is like the stirring, maintaining the balance of Jala (water) and Prithvi (earth).

Basics of sicknes

Ayurveda holds that specific disease conditions are symptoms of an underlying imbalance. It does not neglect relief of these symptoms, but its focus is on the big picture: to restore balance and to help you create such a healthy lifestyle that the imbalance won’t occur again. Living in health and balance is the key to a long life free from disease.

Perhaps the most important lesson Ayurveda has to teach is that our health is up to us. Every day of our lives, every hour of every day, we can, and do, choose either health or illness. When we choose wisely, nature rewards us with health and happiness. When we persistently choose unwisely, nature, in her wisdom, eventually sets us straight: She makes us sick and gives us a chance to rest and rethink our choices.

Ayurveda defines a human as the assemblage of the five great elements plus the “immaterial self”.

Changing Tridoshas

According to Ayurved, the three Tridoshas are constantly changing and balancing each other in living things. They make life happen.. In a plant, the Vata is concentrated in the flowers and leaves (which reach farthest out into space and air). The Kapha is concentrated in the roots (where water is stored in the embrace of earth) and Pitta is found in the plants’ essential oils, resins and sap (especially in spices which stimulate digestion). Different plants have different concentrations of V-P-K (Vata, Pitta, Kapha). We can use different foods, plants, and specific plant parts to alter our body’s proportion of V-P-K. Eating root vegetables, milk products, or sedating herbs like valerian, increases our Kapha. Drinking herbal flowers like jasmine, or eating dry grains, increases our Vata. Eating hot, spicy foods like cayenne, or concentrated protein like bee pollen, increases our Pitta tendencies.

Concepts of Rasayana-Tantra

Rasayana Tantra is one of eight major specialities of Ayurved. This branch refers to nutrition, natural resistance and geriatrics. Rasayana can be a drug, a food or a life-style (Acara). Acara rasayana forms important part of the Rasayan Tantra. According to Ayurved, a Rasayana helps in strengthening Oja, Bala and Vyadhikshamatva. Bhel Samhita clearly indicates that there are twelve types of Oja. The Oja is essence of all the Dhatus. It also indicates their sites. The Ahara, Vihara, and Manasa Bhava, if properly used, support Ojas but if abused, they have bad effect on it. Three types Baal are recognized. These are Sahaj Bala– that is naturally present, Kalaj Bala– that comes with passage of time i.e. season and changes in age and Yuktikrita Bala– that which is provided through therapeutic measures viz. Rasayan Prayoga etc. The Bala is influenced by a variety of factors. The Tridoshas i.e. Vata, Pitta and Kapha influence the Bala mainly through the Prakriti. The Agni is another factor influencing Bala. The Prana and Bala, both produced by Oja, are synonyms of Kshamatva. The Vyadhikshamatva is capacity of the body to limit virulence of the factors producing disease. It is of two types namely Vyadhi-Utpad-Pratibandhakatva (the capacity to restrict the products of disease) and Vyadhi-Bal-Virodhakatva (the capacity acting against the force of disease). Dhatu-Sarat, especially that of the Shonit (blood), Mamsa (Flesh) and Asthi (bones) result in good Vyadhikshamatva. Samhat-Sharira i.e. a well-nit, compact and well composed body has good Vyadhikshamatva and is said to resist the ill effects of a disease in efficient manner.

Comparison of different health-care systems

The basic aim of all the medical systems is same in terms of the maintenance of good health and removal of disease. However, tremendous variations exist between different systems in the approach to this matter. Indian tradition holds the view that the decision whether two systems are same or different can be taken only after examining the Prameya, Pramaana and Siddhaanta of the systems in question.

Prameya refers to any object of valid knowledge.

Pramaan refers to the valid means of obtaining knowledge. Some of the Pramaans accepted by Ayurved are Pratyaksha (direct perception), Anumaana (inference) etc.

Siddhaanta refers to the underlying fundamental principles and theories of the system.

Some of the basic Siddhaantas of Ayurved are:

Panchamahabhoota siddhaanta of the nature of existence of objects

Tridosha siddhaanta of the cause and treatment of disease

Dravyagunvichaar siddhaanta of understanding the nature, characteristics and properties of the substances (medicinal or otherwise) in terms of their Drayva, Guna, Karma, Rasa, Veerya etc.

Balasubramanian, A.V. & Radhika, M. (Local Health Traditions: An Introduction, LSPSS Monograph No. 1, June, 1989) have attempted to examine the question whether Ayurved can be termed as a scientific discipline or not and have concluded that:

1. Various civilizations have evolved sciences, technologies and knowledge systems having their own individual characteristics and bearing the stamp of the world view and values of the society which gave rise to them.

2. No system of scientific thought and practices can claim any uniqueness or universality- each is equally valid and applicable in its own domain.

3. Ayurved (and other Indian systems of medicine) constitute a body of scientific knowledge in the most rigorous sense of the term.

They have very aptly pointed out that for a comparative study of two systems it is essential to have proper terminology and language for a dialogue. Here it may be pointed out that the terminology and language of a system are based on a particular philosophical-conceptual framework.

Balasubramanian and Radhika consider the Ayurvedic definition and analysis of Matter in terms of Panchmahabhutas to be subjective as it is related to the sense impressions resulting from the contact of Matter with the senses. They consider the modern scientific analysis of Matter in terms of physical/chemical elements to be objective as it is not directly related to sense impressions of the Matter. However, it seems inappropriate to term the Indian approach as subjective. The generalization and abstraction of the sense impression data to derive five basic categories i.e. Mahabhutas is fundamentally similar to the empirical approach of modern scientific method forming generalized and abstract categories having most basic and irreducible attribute differences. The two differ only in the philosophical and conceptual frameworks through which determines the type of empirical data gathered, methods of its analysis, generalization and abstraction. Science identified a small number of elements constituting a large number of different forms of matter, progressed to recognizing smaller number of nuclear particles and then further to describing these nuclear particles in terms of very few fundamental particles, “quarks’. The approach of Indian analysts describing all the matter in terms of few Mahabhuts is not basically different. . It appears that the Indian thinkers had quite early realized the limitations of the reductionist approach and turned to synthetic, integrative holistic approach to understanding and systematizing the multiplicity of empirical data.

Balasubramanian and Radhika have further attempted to argue that aetiological principal of the disease is similar in both Ayurved and scientific medicine i.e. both systems agree that the causation of diseases is by agencies outside of the individual. However, the analysis of such agencies by Ayurved and scientific medicine shows characteristic features differentiating the two systems. According to Ayurved, the natural healthy state of a body depends on the maintenance of the particular equilibrium of Vaata, Pitta and Kaph in that body. On the other hand, scientific medicine identifies numerous component parts of the body and describes natural healthy state of the body as the equilibrium between them. Thus the Ayurved can describe disease and prescribe treatment by analysis of only three component elements while allopathy had to consider a very large number of components. This difference of analysis is due to the approach to analysis of matter in the Indian and modern scientific traditions. . Is appears that the Ayurvedic conception of Tridoshas describes much more fundamentally the causative principles underlying the functioning of living systems.

AYURVEDIC CONCEPTS OF TRIDHOSHA AND VYADHIKSHAMATVA AND CONCEPTS OF CELLULAR COMMUNICATION AND IMMUNITY

POSSIBILITIES OF INTEGRATING AYURVEDIC CONCEPTS OF TRIDHOSHA AND VYADHIKSHAMATVA WITH CONCEPTS OF CELLULAR COMMUNICATION AND IMMUNITY.

P.K.Garg* and Shakil Ahmed

*14-A, Khurshedbagh, Lucknow.

Abstract

With the emergence of holistic thinking in medicine, fundamentally holistic nature of Ayurved is being recognized. The realization of the need of evolving a holistic system of medicine and health-care has prompted serious attempts towards investigation of the concepts and practices of Ayurved with open mind. The modern scientific medicine has begun to recognize that the traditional Indian system of medicine, Ayurved, is a vast storehouse of knowledge relevant to human health, disease, medicines and general health-care. However, mutual incomprehensibility of the terms and concepts has been a major impediment in meaningful dialogue between modern scientific medicine and Ayurveda. Some attempts in bridging the gap of this incomprehensibility have indicated that the modern concepts of molecular recognition, immunity and immunomodulation are recognizable in Ayurved. The Ayurvedic concept of Tridosha as the basis of disease seems to be similar to the concept of disease as dissonance. The related Ayurvedic concepts of Atiyoga, Ayoga and Mithyayoga appear to be similar to the concepts of excessive interaction, absent interaction and erroneous interaction between receptor molecules and recognition molecules, currently being developed in molecular medicine. Similarly, it is being recognized that the central concept of Rasayana Tantra, one of the eight major branches of Ayurved that deals with the concepts and methodologies of drug designing, is Vyadhikshamatva, which is similar to the concept of immunity. The basic principal of Rasayana-designing seems quite similar to current scientific concept of immunomodulation. These realizations indicate that concerted efforts may be helpful in bridging the gap between the concepts and practices of Ayurveda and modern scientific medicine. Such understanding shall go a long way towards integration of the beneficial aspects of the two systems and development of a truly holistic system of human health.

Introduction

The traditional Indian system of medicine and health-care, Ayurved, was developed painstakingly over many centuries through a vast amount of careful observations, experimentation and building up of a coherent theoretical paradigm. During its golden period of growth, this system influenced many other systems of medicine viz. Unani, Siddha, Chinese, Tibetan etc. due to its underlying rational approach. However, in the last few centuries it was gradually eclipsed by the phenomenal success and growth of scientific medicine. Ayurved also stagnated due to its parochial inward looking approach and a lack of willingness to have dialogue with others, particularly with scientific medicine. Mutual distrust, bordering on hostility, between Ayurved and modern scientific medicine impeded evolution of a mutually complementary interface amongst them. This has, on one hand, weakened Ayurved and on the other hand, failed to transfer the benefits of Ayurved to modern medicine. Only in recent times, Ayurved has started gaining global recognition as a vast storehouse of important and useful medical knowledge. It is now being recognized that there is need to develop an effective interface between the two systems to complement the respective strengths of each other. However, the most exasperating problem in developing meaningful dialogue between Ayurved and modern medicine is that they have basic difference in their perceptions as well as theoretical paradigms towards observing the reality – the healthy individual or the patient.

The Ayurved treats the patients as a whole. Its etiology and pathogenesis of any disease condition is based on the Theory of Tridosha i.e. imbalance of the three body humors (Doshas, viz. Vata, Pitta and Kapha). The imbalance in Doshas and the consequent impact on the body components (Dooshyas, viz. Dhatus and Malas) are supposed to be responsible for disease. This in turn is supposed to influence the pathophysiology (Kriya) of the body. The properties of all the natural and synthetic substances are dealt in terms of their Rasa (taste), Guna (inherent property), Veerya (potency), Vipaka (manifest property) and Prabhava (influence on the body). Management of the patient may require multiplicity of interventions (Poorva karmas, Shodhan and Shaman etc.) but it may not always be possible to point out the exact component of intervention that results in the management of a specific causative factor.

Modern allopathic medicine, with its reductionist approach and mechanistic view of man, tries to identify the cause of any disease at the level of some structural part i.e. organ, cell, cellular organelles, molecules etc. With the same reductionist approach, it also tries to relate the etiology and pathophysiology of any clinical condition to a single cause. Consequently, it believes that an intervention at the specific causative level may result in a pointed attack on the disease and thus, may lead to its cure/management.

Since the beginning of 20th century, the serious limitations of reductionist-mechanistic approach began to be realized in various fields. Attempts began at synthesizing and integrating ideas and observations of different fields into a composite whole. Gradually, a shift from reductionist to holistic approach started influencing every field of knowledge. In the field of medicine, it was realized that human health and its management is a very complex problem. It can only be addressed by evolving a holistic paradigm of medicine and health-care. This realization resulted in reinvestigation of traditional systems of medicine, particularly Ayurved. It is being increasingly realized now that Ayurved fundamentally has a holistic approach to human health. As a result, serious attempts to develop interface between Ayurved and modern scientific medicine are being made. Further, some recent concepts of molecular medicine, immunology etc. have been found to have striking similarities with certain concepts of Ayurved. Therefore, it is being realized that it might be possible to develop a dialogue between modern scientific medicine and Ayurveda. It might be possible to specify the Ayurvedic concepts of Dhatu or Mala in mutually acceptable and yet chemically well definable forms. It might also be possible to better comprehend Ayurvedic concepts like Doshas or Dooshyas along with Rasas, Gunas, Veeryas, Vipakas and Prabhavas of Drayas in physico-chemical terms.

Concept of Tridosh and cellular communication

Molecular recognition is a fundamental feature of all the biological processes encompassing ligand-receptor, enzyme-substrate and antigen-antibody reactions. The scientific attempts at unreveling the molecular basis of the control of metabolism has lead to the development of the concept of cellular communication. The cells comprising body of a living organism are constantly communicating with each other through signaling molecules. All cells have specific receptors that recognize their specific signaling molecules. These receptors are protein molecules to which molecules of natural ligands or the administered drug become bound. The molecules binding to receptors are the specific signaling molecules. The binding of specific signaling molecule to the receptor molecule triggers signal transduction to produce specific response. Such binding, leading to specific response, activates or suppresses a metabolic function. It has been shown that immunocytes have receptors for neurotransmitters and the neurons have receptors for cytokinins produced by immunocytes. The communication between neurons and immunocytes forms the basis of relationship between nervous and immune systems of the body. Use of modern DNA-recombinant technologies and molecular cloning has made possible cloning of most of the important receptor and signaling molecules making them available for research. These developments have led to the development of current concept of molecular medicine – disease as dissonance due to excessive interaction, absent interaction or erroneous interaction between cell receptors and the recognition molecules. This concept of pathophysiology of disease at the molecular level appears quite similar to the Ayurvedic doctrine of Tridoshas, particularly in the concept of Atiyoga, Ayoga and Mithyayoga (Lele, 1997). Further, the use of the techniques of molecular medicine has revealed that the Ayurvedic medicinal herb Ashvagandha is GABA-A receptor agonist. Similarly, Sarpagandha has been shown to inhibit uptake and storage of dopamine, serotonin and nor-epinephrine in pre-synaptic neurons.

Arthritis is one of the most baffling ailments and modern scientific medicine has not been able to do much in its cure or management. Ayurved has extensively dealt with this condition. Charak mentioned various types of arthritis in different headings like Parvastamba (contractures in joints), Paravabheda (pain in joints, Mamsagat vata (deep pain in inside bones), Asthigata avirata vata (overlapping of Vata Dosha) etc. Term Amavata was used in later period to include such diseases. Madhava-Nidan, included in small Samhitas in Ayurvedic literature, gives the latest and most elaborate description of the cause and management this disease. This disease is described in terms of Tridosha in Ayurved. According to Madhava-Nidan, it is curable when caused by a single Dosha. The term Vyapya is used when it is caused by two types of mixed Doshas indicating a more severe condition in which it is difficult to cure. If caused by all the three types of mixed Doshas, the disease is Asadhya i.e. incurable. The cure and management of this disease is made easier by Panchkarma therapeutics if done in a proper way and in proper condition. Oleation and fomentation are pre-operative procedures (Poorva karma). The disease is said to be easy to control and possible to cure according to acute or chronic condition by proper application of oleation, fomentation, climination and basties (medical enimats). In addition, therapeutics includes emesis, purgation and several medicines. About 900 formulations incorporating nearly 190 ingredients are used singly or in combination in Ayurved. Many of the medicines are of plant origin like Guggulu (Commiphora mukul) or Rasna (Pluchea lanceolata), of mineral origin like Gold and Mercurial and of animal origin. Ayurvedic herbal formulation (RA-1) was investigated for treatment of Rheumatoid Arthritis and demonstrated to be safe and effective with slow onset of sustained action (Kasture, 1997; Bhat, 1997; Chopra, Patwardhan, Lavin & Chitre, 1997). Such studies point to the possibility that the detailed investigation of Tridosha theory of Ayurved and relating it with modern scientific concepts may prove helpful in understanding the cause and treatment of this disease.

Rasayana and Immunity

The modern scientific medicine is gradually realizing that mere presence of causative agent in the environment or its entry into the body does not always result in the disease. The most important in relation to health, disease and cure is the immunity of the body. Immunomodulation i.e. modulation of immune response through selective use of immunomodulators is currently being considered the most potent method in the management of health and disease by modern medicine. Recent advances in understanding the neuro-endocrine-immune axis and the influence of nutrition, exercise and circadian rhythms on it, are bringing modern medicine nearer to Ayurved. The concepts of immunity and immunomodulation appear to have been extensively explored and used in Ayurved, particularly in Rasayana Tantra.

Rasayana Tantra is one of eight major specialties of Ayurved. This branch refers to nutrition, natural resistance and geriatrics. Rasayana can be a drug, a food or a life-style (Acara). Acara rasayana forms important part of the Rasayan Tantra. According to Ayurved, a Rasayana helps in strengthening Oja, Bala and Vyadhikshamatva. Bhel Samhita clearly indicates that there are twelve types of Oja. The Oja is essence of all the Dhatus. It also indicates their sites. The Ahara, Vihara, and Manasa Bhava, if properly used, support Ojas but if abused, they have bad effect on it. Three types Bala are recognized. These are Sahaj Bala– that is naturally present, Kalaj Bala– that comes with passage of time i.e. season and changes in age and Yuktikrita Bala– that which is provided through therapeutic measures viz. Rasayan Prayoga etc. The Bala is influenced by a variety of factors. The Tridoshas i.e. Vata, Pitta and Kapha influence the Bala mainly through the Prakriti. The Agni is another factor influencing Bala. The Prana and Bala, both produced by Oja, are synonyms of Kshamatva. The Vyadhikshamatva is capacity of the body to limit virulence of the factors producing disease. It is of two types namely Vyadhi-Utpad-Pratibandhakatva (the capacity to restrict the products of disease) and Vyadhi-Bal-Virodhakatva (the capacity acting against the force of disease). Dhatu-Sarat, especially that of the Shonit (blood), Mamsa (Flesh) and Asthi (bones) result in good Vyadhikshamatva. Samhat-Sharira i.e. a well-nit, compact and well-composed body has good Vyadhikshamatva and is said to resist the ill effects of a disease in efficient manner. This conceptualization of Vyadhikshamatva has striking similarity with the modern concept of immunity. Teja of Dhatu and the living tissues along with normal functioning Shleshma (Kapha), should be comprehended as Oja. This possibly indicates about tissue immunity, as Dhatus of Ayurveda appear nothing but basic tissues of the body. The concept of Jivitashonitatmakam possibly indicates phagocytes. It has been suggested that Ojas has definite bearing on the immunological functioning of the body. (Mihaiskar, 1997; Misra, 1997).

Ayurved describes a very large number of Rasayanas and Ojovardhaka remedies like Ashvagandha, Silajatu, Tulsai, Amalaki, Punarnava etc. Ayurvedic preparations in general and Rasayanas in particular act more on the nutritional dynamics rather than pharmacodynamics. Apparently, Rasayana means an improved state of nourishment that in turn upholds immunity and youth. It might be rewarding to investigate the Ayurvedic concepts of Rasayana Tantra in terms of modern concepts of immunology. Attempts may be made to examine the immunomodulatory effects of Rasayanas. New methodologies should be explored that focus on the nutritional dynamics as the basis of immunomodulatory effect of a Rasayana. (Singh, 1997). Recent studies on opiates have uncovered the structural basis of neuro-hormone-immune axis and added a new dimension to the understanding of the action of adaptogens/tonics that are very close to rasayana drugs of Ayurved. The knowledge of structure and function of chemical constituents of Ayurvedic drugs would give better understanding of the pharmaceutical practices of Ayurved. (Nitya Nand, 1997)

National Institute of Immunology, New Delhi has carried out studies on various plant materials used traditionally in Ayurved with a view to identify immunomodulatory compounds in them having prophylactic/therapeutic effects against infections and tumors. Many traditional Indian medicinal plants have been shown to possess immunomodulatory effects. A glycoside (NII-78) isolated from mango (Mangifera indica) has been shown to enhance intracellular killing of parasites within the macrophages by stimulating the production of nitric oxide. In vivo, It is also effective against Leishmania and Mycobacterial infections and causes regression of P-815 tumor implants in mice. It has been confirmed in studies that the glycoside does not have any direct anti-Leishmanial/Mycobacterial or anti-tumor effect. It acts by enhancing the effector function of the macrophages. Another immuno-suppressive alkaloid (NII-60) isolated from Berberis aristata has been found effective in inhibiting Graft-vs. -Host reactions in experimental model and is more potent and less toxic than the currently used immunosuppressive drug Cyclosporin. (Upadhyay, 1997).

The above examples of some studies, thus, indicate that the investigation of Rasayanas may be quite fruitful in integrating Ayurved with modern medicine. However, if Ayurved is considered as part of a therapeutic approach only, it will restrict the view only to the products that the system has to offer. The attention shall be restricted to the potential of such products to be developed, standardized, evaluated, manufactured and marketed by established approaches of modern scientific medicine. The present approach to Ayurveda is mostly in such a direction. Contrary to this approach, it shall be more useful if basic concepts embodied in the Ayurvedic system are retained while developing a method for validation of their therapeutic usefulness in the context of our current scientific knowledge. (Nair, 1997).

Conclusion

The above brief review indicates that the fundamental Ayurvedic concept of Tridosha, and the related concepts of Atiyoga, Ayoga and Mithyayoga, may be related to currently evolving scientific concepts of cellular communication dealing with molecular basis of metabolic regulation. In the same way, Ayurvedic concept of Vyadhikshamatva appears to be similar to the concept of immunity. Investigation of the concepts pertaining to Ayurvedic Rasayana Tantra in light of the concepts of modern immunology, particularly the immunomodulation might be quite rewarding. Such attempts might bring about much needed integration of traditional Indian Ayurved and modern scientific medicine and help in the development of a holistic approach towards human health.

References

Bhat, Narendra S. 1997: Ayurvedic Medicines in Arthritis. Ayurved Conference –1997: Ayurved – Modern Medicine Interface for Futuristic Medicine; Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India. (Abst.), p. 17.

Chopra, A., Patwardhan, B., Levin, P & Chitre, D. 1997: A Clinical Study of an Ayurvedic (Herbal) Formulation (RA-1) in Rheumatoid Arthritis (RA). Ayurved Conference – 1997: Ayurved – Modern Medicine Interface for Futuristic Medicine; Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India. (Abst.), p. 18.

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HOLISTIC MEDICAL THINKING AND RELEVANCE OF AYURVED

HOLISTIC MEDICAL THINKING AND RELEVANCE OF AYURVED

P.K.Garg & Shakil Ahmed

*14-A, Khurshedbagh, Lucknow.

Abstract

Growing disenchantment with modern scientific medicine has led more and more people towards traditional systems of medicine. In every human society, beliefs and practices relating to ill health constitute central feature of its culture. The concepts, beliefs and perceptions of the family and society regarding body image, diet and nutrition, health, ill-health, diagnosis and treatment have significant influence on the health condition, health-care given, diagnosis and treatments followed. Basic premises, the concepts, perspectives and world-views of modern scientific and traditional systems of beliefs are vastly different from each other in different societies. This makes the problems of diagnosis, treatment and health-care very complex.

The emerging concept of holistic medicine aims to treat the whole human being and understand the intimate links between body, mind and spirit. Holistic approach to human health suggests and encourages caring and can make extensive contributions to improving the quality of life and health among people of all ages in all societies. The Health Promotion Program established by World Health Organization in 1984 fully recognizes the need to adopt the emerging holistic thinking while dealing with problem of human health.

Indigenous Indian Ayurved constitutes a body of scientific knowledge in the most rigorous sense of the term and etiological principle of the disease is similar in both Ayurved and scientific medicine. The language and terminology of Indian and modern scientific traditions differ due to apparent difference in their approaches to analysis of matter and causative principles of disease and health. Investigation of the concepts and philosophy of Ayurved points to the fact that this system is highly holistic in nature. Its integration with modern medicine may help in development of a future system of holistic medicine and health care.

Introduction

Health is man’s natural condition and is his birthright. Since time immemorial man has tried to understand the determinants of health and tried to device methods and practices to remain healthy, diagnose and cure illness. However, still today our ignorance about health continues to be profound. During the 20^th century, the system of scientific medicine has made dramatic progress in curing and reducing the incidence of many diseases. There has been massive reduction in death rates all over the world resulting from the achievements of scientific medicine. Scientific medicine has been able to bring forth a large number of highly effective drugs that have been discovered through painstaking medical research. It also has brought about significant improvement in general public health and hygiene. The advances and success of scientific medicine in the field of surgery has truly been amazing. However, the modern scientific medicine has not proved very effective in handling a whole area of chronic illness and general, not very well defined, ill health. It is now increasingly being realized scientific medicine is not very successful in addressing the problems of ill health having their roots in psychosomatic, social, cultural, behavioral, environmental or occupational causes. It has been much more concerned with curing illness and bad health rather than in preventing them in the first place. It has not appreciated or understood the role of personal problems and social disorders that are often the root cause of illness. Indeed scientific medicine has concentrated far too much on treating the symptoms without seeking and dealing with the complex set of factors that are at the root of illness. Its major strength has become its weakness, in the sense that it places too much reliance on drugs and surgery, both of which many a times lead to side-effects worse that the original disease. It is becoming increasingly clear that despite dramatic advancements, system of scientific medicine has serious limitations because its view of human existence and life is very narrow and restricted. Because of this growing disenchantment with modern scientific medicine, more and more people are turning towards traditional systems of medicine. Indian Ayurved has generated worldwide interest in recent times. However, it is needed to compare the modern scientific and traditional systems of medicine in general, understand the problems of integration of scientific medicine and Ayurved and evolve a realistic approach for such integration.

Scientific versus traditional systems of medicine

Foster & Anderson (1970) have pointed out that in every human society beliefs and practices relating to ill health are central feature of its culture. In all societies, the human body is viewed more than just a physical organism fluctuating between health and illness. It is also the focus of a set of beliefs about its social and psychological significance, structures and functions. The term body image is used to describe all the ways that an individual conceptualises and expresses his or her body whether consciously or unconsciously.

In general, concepts and beliefs related to body image can be divided into following main groups:

1. Beliefs about the optimal size and shape of the healthy body,

2. Beliefs about the inner structure and functioning mechanisms of the body.

3. Beliefs about the body as an instrument of interpersonal interactions, psychosocial interactions and spiritual experience.

Transformation of its raw food supply into processed food is one of the defining features of all the human societies. Cultural groups differ markedly from one another in many of their beliefs and practices related to food, diet and nutrition. These beliefs are particularly related to:

1. Food, diet and nutrition in relation to various aspects of body image

2. Natural properties of food items and dietary and nutritional regimes

3. Supernatural properties and religious sanctions related to food, diet and nutrition

4. Preventive, curative and other medical properties of food items along with dietary methods.

The concepts, beliefs and perceptions of the family and society regarding body image, diet and nutrition, health, ill-health, diagnosis and treatment have significant influence on the health condition, health-care given, diagnosis and treatments followed.

Basic premises and, therefore, the concepts, perspectives and world-views of modern scientific and traditional systems of medicine are generally found vastly different from each other. Most important differences are observed with respect to following features.

1. Nature of rationality

2. Relative importance of objectivity versus subjectivity

3. Relationship between mind, body, nature and supernatural

4. Relative emphasis on individual person, family, community and society.

5. Level of understanding, rapport and empathy with the socio-cultural aspects of patient’s life.

With growing awareness of the shortcomings as well as benefits of both modern and traditional medical systems, attempts at integration of the two are being seriously undertaken. However, such attempts have not focussed much on integrating their concepts, perspectives and world-views. Without such integration, it would be difficult to develop a comprehensive, consistent and useful system of medicine incorporating benefits of all the modern scientific and traditional medical knowledge accumulated throughout human history.

The most important aspects of the perspectives of modern scientific and traditional systems that need to be thoroughly understood and integrated may be summarised as:

1. Nature of disease, diagnosis and treatment;

2. Nature of human existence, relationship between body, mind, nature (and may be supernatural also) and socio-cultural aspects of human health;

3. Nature of objectivity and subjectivity;

4. Nature of scientific and intuitive rationality

5. Relative importance of scientific-reductionist versus traditional-holistic approaches in dealing with problems of human health, ill health, disease, diagnosis, treatment and health-care.

The concept of holistic health

In the scientific field, new paradigms like relatively theory, quantum mechanics, Big-Bang theory of origin and evolution of universe, general systems theory, non-equilibrium thermodynamics, mathematics of chaos and fractals, Gaia-hypothesis etc. have been major influences in emergence of holistic thinking. Ludwig von Bertalanffy, the founder of General Systems Theory (1952) proposed an organic theory of life. He expressed the view that the phenomenon of life can not be resolved into elementary units, but depends upon interactions, organization and dynamic order. The concept of ‘noosphere’ has been introduced by Pierre Teilhard de Chardin within the broader evolutionary conceptual framework. The life is explained in terms of natural evolution of self-organizing matter. A. N. Whitehead (1925, 1948) developed the theory of Organic Mechanism and proposed that the human life history is a part within the life history of some larger, deeper, more complete pattern. Arthur Koestler (1979) in rejecting the reductionist philosophy developed the concept of ‘HOLON’ as a system consisting of subsystems, which is also a subsystem of some supersystem. He further developed the concept of SOHO (Self-regulating Open Hierarchic Order), which is an explanation of a form of dynamic equilibrium (‘homeostasis’) that will occur only if the self-assertive and integrative tendencies of the components of holons counterbalance each other. If this does not happen, there will be disorder and chaos. His theory has profound implications for understanding human health in the actual setting of human society.

With the growing realization of the extremely complex nature of the human existence, there has evolved the concept of holistic medicine. The holistic medicine aims to treat the whole human being and understand the intimate links between the body, mind and spirit. It stresses that all the three have to be embraced to achieve lasting and effective healing. Holistic medicine is much influenced by the view of Abraham Maslow (1979) who has suggested that there is a hierarchy of human needs and every human strives to experience ‘peak experience’ at each of its levels. With such a view, it is evident that the important part of healing process is to release the human potentialities and to encourage the emergence of ‘peak experiences’ explored extensively by Maslow. Holistic approach to human health and medicine is vitally important because it suggests and encourages caring. It can thus, make extensive contributions to improving the quality of life and health among people of all ages within the society in which they live.

The primitive societies have an instinctive holistic view, which is derived from their intimate knowledge of the local ecosystem. Each such society treats the local ecosystem as dominant and makes all human activities subservient to it. However, with the rise of scientific movement in the mid-17^th century, the materialistic-mechanistic worldview and reductionist approach to

analysis became dominant. This led to shifting of focus from the whole to the parts and the holistic thinking was gradually abandoned. The non-holistic nature of much of the modern education leaves most the people with conceptual frameworks that are too narrow to allow holistic thinking. However, in recent times, there has been a decline in reductionist thinking. Many attempts are being made to build a synthesis of ideas and evolve holistic paradigms in every field.

In the context of human life, the shift from reductionist to holistic thinking may be seen in the following words of Peter Russell (1982):

“For humanity to accomplish a profound shift in attitude, the skin-encapsulated model of the self needs to be augmented by the realization that the individual is an integral part of Nature, no more isolated from the environment than a cell in the body is isolated from the human organism.”

In the last quarter of 20^th century, it has been gradually realized that before we can devise ways and means for making and maintaining a human being healthy, it is necessary to first understand what is to be accomplished. This means that we should first understand what is the meaning of health of a human being. To achieve a state of health, it is necessary to understand the development and functioning of cells and organs. However, in the broadest sense, it is also necessary that we understand the development and functioning of an individual in his/her personal psychological, familial, occupational, cultural and social environment as well as of the human species in the global environment. If health of a man is to fully manifest, it must prevail not only in the individual but in mankind also.

Jonas Salk (1972) has defined the health as following:

“The health is wholeness and sickness implies impairment of parts of the whole. Distinctions must be made and the relationship understood between the parts and the whole, so that attention may then be directed to maintaining or to repairing the health of each appropriately. The meaning of the health as a wholeness can be revealed only if distinction between the parts and the whole and the relationship between them is properly understood.”

The problem of man’s health can not be dealt with by solving the problems of individual human body and the environment. Even if these problems are solved, it will still be necessary to deal with the health of the human species as a whole. A human being can attain and maintain a state of health only in a healthy biosphere, sociosphere and psychosphere. In this sense, human species needs to be studied from the viewpoint of health as wholeness. A science of holistic health, as distinct from the present science of curative medicine, needs to be developed to deal with the problems of sickness and misery arising in the bodies, psyche, society and environment of mankind.

Jonas Salk has pointed out that for developing a system of holistic health, it is necessary to first think about the mankind in terms of highly ordered, differentiated system of individuals having widely different attributes, characteristics and requirements. Only by thinking in these terms can it be possible to focus attention on the relationship between the parts i.e. the individuals and the whole i.e. the human species. An understanding of the relationship of individuals to each other and to the whole mankind is the starting point. This shall lead to the comprehension that human health is not only a question of the health of one part to the exclusion of another or of one part functioning against another, but as the health of the whole.

The Health Promotion Program established by World Health Organization in 1984 fully recognizes the need to adopt the emerging holistic thinking while dealing with problem of human health. The following five principles of health promotion were established in the WHO program:

1. It involves the people as a whole in the context of their everyday life.

2. It is directed to actions towards the root causes of health, including the promotion of a total environment conducive to health.

3. It combines different but complementary methods and approaches, in several areas of life.

4. It aims especially as effective actual public participation.

5. While it requires activities in the health and social fields, and is not a medical service as such, health professionals should develop their special contributions to health education and health advocacy, especially in primary health care.

Relevance of Ayurved in development of holistic medicine

The medical knowledge in India, as in every other land, must have grown out the sheer necessity of overcoming injury, sickness and pain. The prehistoric art of selecting substances which could be assimilated by the human system with benefit and their cooking and compounding to give the most of nourishment and health forms integral part of indigenous Indian medical systems. The traditional Indian medical system is known as Ayurved. The term ayus means duration or the span of life and the term Veda means the unimpeachable knowledge. Hence, Ayurved, commonly translated as ‘the knowledge of the duration or span of life’, is concerned mainly with prolongation of healthy life and prevention of disease and senility and only secondarily with curing of disease. In recent times, the interest in Ayurved has grown nationally as well internationally. The Ayurvedic system of medicine has been professionally recognised in India and many attempts is being made to integrate it with modern scientific medicine.

The basic aim of allopathic and Ayurvedic medical systems is same in terms of the maintenance of good health and removal of disease, yet an almost insurmountable gap exists between these two systems in the approach to this matter. Most of the medical and other scientists hold the view that the two systems are fundamentally different. However, Indian tradition holds the view that the decision whether two systems are same or different can be taken only after examining the Prameya, Pramaana and Siddhaanta of the systems in question.

Prameya refers to any object of valid knowledge while Pramaan refers to the valid means of obtaining knowledge. Some of the Pramaans accepted by Ayurved are Pratyaksha (direct perception), Anumaana (inference) etc. Siddhaanta refers to the underlying fundamental principles and theories of the system. Most basic Siddhaantas of Ayurved are:

1. Panchamahabhoota siddhaanta of the nature of existence of objects

2. Tridosha siddhaanta of the cause and treatment of disease

3. Dravyagunvichaar siddhaanta of understanding the nature, characteristics and properties of the substances (medicinal or otherwise) in terms of their Drayva, Guna, Karma, Rasa, Veerya etc.

Balasubramanian, A.V. & Radhika, M. (1989) have attempted to examine the question whether Ayurved can be termed as a scientific discipline or not and have concluded that:

1. Various civilizations have evolved sciences, technologies and knowledge systems having their own individual characteristics and bearing the stamp of the world view and values of the society which gave rise to them.

2. No system of scientific thought and practices can claim any uniqueness or universality- each is equally valid and applicable in its own domain.

Thus, the Ayurved constitutes a body of scientific knowledge in the most rigorous sense of the term. They have very aptly pointed out that for a comparative study of two systems, it is essential to have proper terminology and language for a dialogue. Here it may be pointed out that the terminology and language of a system are based on a particular philosophical-conceptual framework. The difference in the language and terminology is due to the approach to analysis of matter and causative principles in the Indian and modern scientific traditions.

Balasubramanian and Radhika consider the Ayurvedic definition and analysis of Matter in terms of Panchmahabhutas to be subjective as it is related to the sense impressions resulting from the contact of Matter with the senses. They consider the modern scientific analysis of Matter in terms of physical/chemical elements to be objective as it is not directly related to sense impressions of the Matter. However, it seems inappropriate to term the Indian approach as subjective. The generalization and abstraction of the sense impression data to derive five basic categories i.e. Mahabhutas is fundamentally similar to the approach of modern scientific method. Both approaches aim at deducing most generalized and abstract categories having most basic and irreducible differences in their attribute from the empirical data. Science identified a small number of elements as constituting the extremely large number of different forms of matter. It then progressed to recognizing smaller number of nuclear particles and then further to describing these nuclear particles in terms of very few fundamental particles, “quarks’. The approach of Indian analysts describing all the matter in terms of five Mahabhutas is not different. It appears that the Indian thinkers had quite early realized the limitations of the reductionist approach and turned to synthetic, integrative holistic approach to understanding and systematizing the multiplicity of empirical data.

Balasubramanian and Radhika have further argued that etiological principle of the disease is similar in both Ayurved and scientific medicine. Both systems agree that the diseases are caused by agencies outside of the individual that bring about disturbed functioning of the body. However, the analysis of such agencies by Ayurved and scientific medicine shows characteristic features differentiating the two systems. In Ayurvedic philosophy, the five elements combine in pairs to form three dynamic forces or interactions called doshas. Dosha means “that which changes”. It is a word derived from the root ‘dus’, which is equivalent to the English prefix ‘dys’, such as in dysfunction, dystrophy, etc. In this sense, dosha can be regarded as a fault, mistake, error or a transgression against the cosmic rhythm. The doshas are constantly moving in dynamic balance, one with the others. Doshas are required for the life to happen. In Ayurveda, dosha is also known as the governing principle as every living thing in nature is characterized by the dosha.

According to Ayurved, the natural healthy state of an individual depends on the maintenance of equilibrium between Vaata, Pitta and Kaph in his body. On the other hand, scientific medicine identifies numerous component parts of the body and describes natural healthy state of the body as the equilibrium between them. Thus the Ayurved can describe disease and prescribe treatment by analysis of only three component elements while allopathy has to consider a very large number of components. It appears that the Ayurvedic conception of Tridoshas describes the fundamental causative principles underlying the functioning of living systems.

Thus, it may be concluded that the Ayurvedic conception of human being, life process, life in general and its inseparability from whole of the nature is clearly rooted in holistic way of thinking. Therefore, it has much to offer to development of the futuristic, integrated and holistic medicine. As a starting point, the increasing interest of scientific and Ayurvedic communities in applying modern scientific techniques of investigation to Ayurvedic preparations, medicinal plants and methodologies is the correct realistic approach towards this aim. However, the deeper investigations into the philosophical and conceptual framework of Ayurveda should also be undertaken seriously to integrate traditional Ayurveda with emerging philosophical and conceptual framework of holistic human health.

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