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 20th 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:
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Beliefs about the optimal size and shape of the healthy body,
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Beliefs about the inner structure and functioning mechanisms of the body.
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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:
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Food, diet and nutrition in relation to various aspects of body image
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Natural properties of food items and dietary and nutritional regimes
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Supernatural properties and religious sanctions related to food, diet and nutrition
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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.
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Nature of rationality
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Relative importance of objectivity versus subjectivity
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Relationship between mind, body, nature and supernatural
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Relative emphasis on individual person, family, community and society.
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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:
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Nature of disease, diagnosis and treatment;
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Nature of human existence, relationship between body, mind, nature (and may be supernatural also) and socio-cultural aspects of human health;
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Nature of objectivity and subjectivity;
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Nature of scientific and intuitive rationality
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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-17th 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 20th 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:
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It involves the people as a whole in the context of their everyday life.
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It is directed to actions towards the root causes of health, including the promotion of a total environment conducive to health.
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It combines different but complementary methods and approaches, in several areas of life.
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It aims especially as effective actual public participation.
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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:
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Panchamahabhoota siddhaanta of the nature of existence of objects
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Tridosha siddhaanta of the cause and treatment of disease
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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:
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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.
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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.
References
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