Whenever the question of juxtaposing Ayurveda with modern medicine arises, it is posited by some influential commentators as a case of placing holism side-by-side reductionism (1)(2). Such a view is an overstatement of facts and this essay seeks to put things in perspective.

Reductionism is the endeavour to understand a thing by a knowledge of its constituent parts. In the context of medicine, it is the application of physics and chemistry to the study of life-processes. This approach is valid inasmuch as these are the most basic tools we have to study natural phenomena. If these tools are illegitimised, the human mind would have no means at all of making sense of the random facts of nature. As such, reductionism generates the knowledge that holism must synthesise, contextualise and apply.

How reductionist knowledge ripens to deliver holistic patient care is best explained with a clinical example. A middle-aged obese woman, working as a school teacher, with the complaint of swollen feet towards the end of her workday, is a typical everyday case in primary care settings. The commonest cause of swollen feet in a case like this is the incompetence of valves in the leg veins in preventing the back-flow of blood. As a result, blood pools in the veins of the feet, seeps into the surrounding tissue fluid and swelling ensues. The age-related incompetence of venous valves becomes more pronounced in the context of the woman’s obesity and work-related prolonged standing. Emotional eating being a common cause of obesity in such patients, her swollen feet might eventually be recognised to have their cause in her low moods!

It must be clear from the above description that unless the functional anatomy of veins is properly understood, there can be no way of assessing what has gone wrong in the case. Swollen legs can be due to several causes ranging from infections to heart and kidney disorders. Unless the functions of these body-parts are understood in their normal and abnormal conditions, no sense at all can be made of the patient’s signs and symptoms. Such an understanding of the underlying pathophysiology of illnesses is the result of reductionist studies and research. Needless to add, this is the most basic knowledge a clinician has to equip oneself with. But, this is hardly enough. As in the case illustrated above, there is generally a psychological and social context to a patient’s illness. When these contexts are ignored, the treatment would be partial and often counter-productive. If in the present illustration, the patient is merely advised compression bandages and swelling-relieving drugs, the treatment would be both partial and unsustainable. She will have to be educated about the root cause of her illness and a collaborative strategy drawn up to manage her work-related and emotional issues too. Such an approach would be synthetic, contextualised and therefore, holistic.

How would Ayurveda approach a case like this? The classical Ayurvedic understanding of anatomy and physiology is understandably primitive. It tries to make up for it by employing the dosha theory to explain and categorise ailments. But, because the dosha model is far from being a robust framework to explain pathological observations and make therapeutic predictions, not all aspects of the disease would be cogently adjustable within the categories allowed by this model (3). Consequently, an Ayurvedic approach that is uninformed by current sciences, would be foggy and suboptimal in both diagnosis and management.

The singular importance of reductionist studies in the making of a holistic medical science was well understood by the pioneers of Ayurveda. It is this understanding that mandated cadaveric dissection as a course for medical students during the times of Sushruta, the Ayurvedic colossus (4). Such studies in the basic medical sciences are now greatly advanced and Ayurveda must renew itself in their light. True holism can result only from such a renewal.

Holism that is not supported by products of reductionist studies would only be a mystical abstraction. Sadly, such abstractions, supported by weird New Age fancies, dominate the current rhetoric on Ayurveda. That these fancies have zealous takers within the Ayurvedic academia is worrying. An editorial in an Ayurvedic peer-reviewed journal even suggested that such primitive concepts as mahabhutas and doshas can be correlated with quantum spin types and super-fields! It went on to propose that these ideas of quantum physics be introduced into the Ayurvedic curriculum (5).  The habit of fossilising ancient theories by super-imposing current scientific understanding upon them has throttled straight-thinking in this field (6).  Sooner the Ayurvedic ecosystem recovers from such flights of fancies, the better it would be for the revival of this ancient science. Millennia-old philosophical speculations cannot be a substitute for today’s concrete scientific observations. The view of the Ayurvedic orthodoxy that the dosha theory can make up for deficient anatomical and physiological knowledge (7) does not, in this sense, hold water.

It is true that Ayurveda’s thrust upon salutogenesis (health-generation) rather than on pathogenesis makes it a medical system oriented constitutionally towards holism. When the focus is upon health-restoration rather than merely on illness-conquest, the uni-pronged ‘pill for an ill’ approach would naturally take a backseat. The thrust would shift towards whole person healing.  But this holism, unbacked by reductionist knowledge, remains mostly aspirational.

It is upon us to realise this aspiration by approaching and reforming Ayurveda scientifically. Charaka’s paradigm-shifting spirit of yukti-vyapashraya (evidence-based reasoning) can be our guiding light here.  Clinical observations meticulously documented in the Ayurvedic classics would acquire greater clarity and value if refined by science and evidence. This process of refinement might even stretch the frontiers of biology and medicine. As a vital first step, researchable observations documented in these texts are to be sifted from implausible speculations and outdated conjectures. The current approach of assuming that fundamental Ayurvedic theories are perfect and unalterable (8) would only perpetuate the intellectual mishap of expecting rough-and-ready models to function as sophisticated scientific laws (3). Armchair researchers can afford such mishaps; practising physicians cannot.

This essay has hitherto considered holism in its most usual connotation in the context of medical practice. A brief allusion to its newer connotation in medical research would not be out of place.  There is a recent trend in this field that emphasises upon holism as the fundamental interconnectedness of all things. This trend, called the systems biology approach to medicine, is contrasted with the reductionist molecular biology. Although it might not be as much of a conceptual shift as it appears, its tenet that “cellular and organismal constituents are interconnected, so that their structure and dynamics must be examined in intact cells and organisms rather than as isolated parts”, might indeed promote a more holistic understanding of life-processes (9). Needless to clarify, the suggestion that ancient Ayurvedic theories are the result of such an approach is too overblown to merit attention. Only this much is a reasonable claim: the idea that a full knowledge of the whole can scarcely be acquired from an isolated study of its parts has clear philosophical antecedents in the Ayurvedic classics (10). This idea has antecedents in Aristotelean thoughts too! But, philosophical antecedent is one thing; real world science is quite another.

References

1. Patwardhan, Bhushan. 2014. Ayurveda and Systems Biology. Annals of Ayurvedic Medicine, 3 (1-2), 5-7.
2. Shankar, Darshan. 2018. Directions for revitalisation of Ayurveda in the 21st century. Journal of Ayurveda and Integrative Medicine 9, 245-247
3. Krishna, G L. 2019. The Ayurvedic Dosha Theory : A Deconstruction. Confluence.
4. Sushruta Samhita, Sharira-sthana, chapter 5
5. Sharma, Hari. 2018. Correlation of Physiological Principles of Ayurveda with Spin Types of Quantum Physics. Annals of Ayurvedic Medicine Vol-7 (3-4)
6. Krishna, G L. 2019. The history of a superstition. Current Science 117 (1), 9
7. Thirumalpad, Raghavan. 2011. Ayurveda-parichayah. Samskrita-bharati, New Delhi
8. Patwardhan B. 2014. Traditions, rituals and science of Ayurveda. J Ayurveda Integr Med. 5(3):131-3.
9. Fang, Ferric C and Casadevall, Arturo. 2001 Reductionistic and Holistic Science Infection and Immunity 79(4) 1401-1404
10. Charaka Samhita, Vimana sthana, chapter 4

G L Krishna is an Ayurvedic doctor practising in Bengaluru. He may be contacted at gl.krishna@yahoo.com.