Ayurveda between the poles of Patient oriented Medicine and Medicine based Evidence
10.05.2017 | Since 2004 I have been able to gather during the course of my sixteen visits to South India i.e. Kerala, Tamilnadu and Karnataka valuable insights from numerous ayurvedic physicians and chief physicians from hospitals and clinics.
06.04.2017, by Klaus-Rupprecht Wasmuht, HP
It appears that Ayurveda in the areas I visited is more and more challenged between the poles of patient-oriented medicine and modern health care politics like medicine-based evidence.
The author visiting Dr. L. Mahadevan, BAMS, MD in February 2017
The world has become a large village in the last decades. In a few hours each point of the earth can be fooled. Yet conscious being does not yet seem to have arrived at cosmopolitan awareness. The medical progress of modern medicine runs the risk under the dogmatic constraint of scientifically measurable verifiability as "medicine-based evidence” to entangle itself into an apparatus-medicine without soul in the struggle with increasing global disease (“Verkrankung”).
The holistic approach of Ayurveda as a traditionally patient oriented medicine with the understanding of complex interactions of individual dynamics of life realization of a person offers the best conditions for the shift from a purely curative to a preventive curative medicine and finally to a medicine, which primarily seeks prevention through health promotion.
Can the above-mentioned medical systems complement one another for the benefit of humanity, or is the integration of the one into the other a desirable undertaking to solve the dilemma of current health policy?
The following contribution is a modest attempt to highlight some problems and to suggest certain approaches to the solution.
Is it not high time to open up the eyes and senses and recognize that in the present era the eternal dream of leading a healthy long life that ultimately ends in natural death is not realized and will not approximately be realized by maintaining the present flawed health policy?
As a response one draws the attention not only in medical circles to the astonishing progress of modern medicine, claiming success in the fight against diseases which have been known for a long time and against increasingly insidious diseases of modern times. It is also pointed out that the average life span has considerably increased in recent decades. Has with it also the quality of life improved? Probably hardly!
Illness is interpreted as an opponent who must be successfully combated and defeated. To what conclusion would one come when illness would be interpreted as a warning signal of the body which would lead man to correct the disease-related misguided lifestyle?
Instead, in a kind of distraction maneuver, one turns away from the unpleasant truth that consists in the fact that main reasons for the unfortunate situation of modern health politics are, for example, commercial considerations, deficient diagnoses, mistreatments, irrational prescriptions of medicines and unnecessary therapeutic interventions, which are becoming the order of the day.
It should be more than thought-provoking that health systems of highly developed countries, such as the United States, are the third-largest cause of death in this country according to a study 1). Similar can be said for Germany.
The increasing incidence of dangerous chronic diseases with persistence of newly emerging infectious diseases apart from the multi-drug resistance problem in modern medicine and the occurrence of several iatrogenic diseases have developed into a serious health burden for an aging society. Despite advancing medical technology, targeted health care and social security policies, the situation deteriorates more and more.
Is there a danger for natural medicines and, in the case of India, for Ayurveda - the oldest medical system in the world - to fall into the pull of apparatus medicine or questionable business practices?
The young generation of Ayurvedic physicians is increasingly fond of modern medicine, assuming that by means of complex imaging procedures, detailed laboratory findings and further methods of medical technology, better and more reliable diagnostic results can be achieved and applied leading to faster therapeutic intervention compared with the traditional approach. This trend is by no means a disadvantage, as long as blind trust is not given to the relevant measurement results. Applying medical devices may mediate perhaps a sense of security but does not make necessarily a doctor to the benefit of the patient.
In Germany, various Ayurveda groups, guided by doubtful motives, have been trying to win wealthy patients. For example, potential clients in search for their meaning are wooed by a billionaire rich organization under the cover of a controversial ayurvedic guru with various temptations such as: costly meditation training, overpriced rasayanas (rejuvenation products), award of a costly secret personal mantra and promises to achieve supernatural powers like "yogic flying".
Unfortunately, such practices are contrary to a desirable acceptance of Ayurveda in the Western cultural sphere.
Under the pretext of scientific knowledge and the willingness to support general acceptance of Ayurveda in the western cultural community, various bodies in the West try to integrate Ayurveda into the school medicine. This endeavor conceals the fact that today's medicine, with its claim to scientific knowledge, uses a science of the nineteenth century 2) and de facto develops into an appendix of the pharmaceutical industry of a deficient health system 3).
Another problem is the misconception that modern cognition represents per se already science. However, modernity alone has no scientific value. The older generation of the Indian "Vaidyas, Vaidyarājas and Pranaacharyas" observe this development with astonishing serenity since, on the basis of years of practical experience, it is knon that much of what is supposed to be newly discovered is already known in the past but has fallen into oblivion, since every new generation tends to reject the experiences of the previous generation and tends to falsify authentic knowledge.
This is a global phenomenon, according to Dr. Issac Mathai M.D., medical director and founder of the holistic health center SOUKYA in Bengaluru in the state of Karnataka:
"During my travels, it became clear to me that the harmonic impact of integrated medicine has fallen into oblivion around the world. They were so isolated in their specialized environment that they were no longer able to relate the strength and benefits of each other's healing abilities. I saw this as a main obstacle on the way of health care.
For the future, I hope that every medical system, every member of the medical community, first considers the patient's interest rather than of concentrating on proving that their own medical system is recognized as the best. I hope that the understanding of health care in the future is not primarily characterized by the treatment and cure of diseases, but by maintenance of health and disease prevention ".
Ayurveda has proven its worth over a thousand years, has survived five hundred years of Muslim invasion and three hundred years of English colonial time – during which time it was forbidden by the colonial rule – and will not succumb to "missionary efforts" of modern medicine.
On the other hand, serious attempts to intensify the exchange of experience between medicine from the West and the East are highly promising. For example, the Association of European Ayurveda Physicians and Therapists (VEAT) has set a goal for sustainable public relations, quality management and the establishment of national and international contacts. In India, a ministry has recently been established for Ayurveda and Yoga. The Ayurveda Office AYUSH (Ayurveda, yoga and naturopathy, Unani, Siddha and Homeopathy), is responsible amongst other issues for the promotion of cooperation between Ayurveda and modern medicine. The European Academy of Ayurveda, Birstein, actively supports this development.
The patient - a living being of body, mind and soul
The surgeon Bernd Hontschik affirms that medical art consists in treating the patient as a subject, as a living being 4). "Guidelines, however, act as a leveling-up of the subjective, thus bringing both the practitioners and the sick into the danger of losing a vital element of vitality."
Ayurvedic synchronous massage with heated and medically enriched oils for the physical relaxation and dissolution of "Ama" on a psychological level
This danger arises for example from the trend of modern medicine to rely only to objectively existing reality by applying to guidelines of Evidence Based Medicine (EBM).
"In order to achieve truly deep healing, the patient must make a shift in consciousness on the mental and emotional level and rebuild the perception of the self (Swastha). Only then can a state of balance be reestablished in body-mind-soul. Medicines do not heal, they only control or suppress symptoms. Western medical models tend to ignore the cause of the disease because their focus is elsewhere "5).
Dr Remya Krishnan (associate professor of the Rajiv Gandhi Ayurveda Medical College, Govt of Puducherry) sees in the Western medical approach - as currently EBM is practiced and updated frequently - nothing other than medicine-based evidence (MBE) 6). In other words, proofs are outlined by statistical methods and not really linked to basic science.
Evidence based Ayurveda and modern Medicine based Evidence
Dr. R Krishnan concludes that: Integrating modern Medicine based Evidence in Evidence based Ayurveda is ineffective in achieving health and well-being. Modern medicine uses the use of medications which, due to abnormal stimulation, act on both, targeted and non-targeted tissues and cause suppression, or blocking of the immune response.
Ayurveda relies on insights from guidelines principles of basic science, which ensure the safety and efficacy of applied medicine.
In Ayurveda, it is not only the diagnosis of diseases that is so important, but rather the identification of the responsible complex of aetiological factors and their deep networking, which are the real causes and resulting effects.
Modern medicine is not aware of this kind of deep functional knowledge; on the contrary, it is involved with intensive differentiations to every system of the human body. Super-specialists have developed in modern medicine an immense know how of rather limited branches of medicine but little in relation to the central regulatory processes of functional coordination between the different organ systems in the body.
Modern pharmacology compared with the pharmacology of Ayurveda
Dr. R. Krishnan convincingly presents the most important differences between modern pharmacology and Ayurveda pharmacology. She writes among other issues:
The pharmacology of modern medicine is the science of drugs. The effect of synthetic / semi-synthetic drugs in modern medicine is tested by laboratory studies, animal experiments or by clinical studies in a targeted group of people. Today these actions are called effectiveness tests.
1. Ayurveda on the other hand, is primarily scientific knowledge of human life, dealing with various scientifically proven and established theories, to grasp the basic nature and organization of man and various subtle internal organic mechanisms. The drugs used are from natural sources and are not recommended on the basis of "this medicine - this disease" approach. Ayurveda is not based on blindly tested drug efficacy, but on the effectiveness of scientifically based peculiarities in a particular medical situation (pathogenesis). Effectiveness is not the drug action, but it is "the intended therapeutic effect" in a situation. The drug is selected on the basis of the most appropriate "scientific justification" that is appropriate for the particular clinical situation.
2. Ayurveda examines ahead of treatment the possible disease, patients and medicine with the help of various scientific parameters. In modern medicine, drug efficacy in the affected disease is determined in various drug trials based on test evidence, provided by the popular medical search engines of the Internet. These tests are assessed as the best "evidence" which supposedly represents the safety and efficacy of a particular drug in a particular situation.
Integration of modern medicine in Ayurveda?
On this question, Dr. R. Krishnan clearly states the danger of combination therapies (Kriyaasankara)
1. Kriyaasankara refers to the aimless, simultaneous and undetermined mixing of different treatment protocols in the same patient.
2. Nowadays, the use of Kriyaasankara has become an uninhibited practice by physicians.
3. Ayurvedic texts reject the irrational practice of Kriyaasankara
4. Integrating modern medicine in Ayurveda is better than the reverse.
This is because Ayurveda is the best knowledge of both, life science and life-oriented medical science based on the holistic clinical assessment of a human being.
5. The scientific protocols in Ayurveda are not fundamentally the same as those of modern medicine and therefore there is absolutely no field of activity and no basis for their integration.
6. According to Dr. R Krishnan, the integration of the Ayurvedic system of medicine into modern medicine would therefore be nothing other than the encouragement of various strange and erroneous treatment protocols, which are not beneficial to mankind.
7. Ayurveda requires an autonomous and independent platform to make as much of its strength as possible for mankind.
Further considerations on the elimination of the dilemma
Dr. L Mahadevan ,, BAMS, MD, chief physician of the Dr.Y. Mahadeva Iyer`s Sri Sarada Ayurvedic Hospitals in Derisanamcope, Tamilbadu. regards in the integrated medical science of Ayurveda primarily as "Life Caring Medical Science." He is not only an extremely competent ayurvedic doctor (he received the "Best Doctor Award - 2012" from Dr. MGR Medical University, Chennai), but also has a broad knowledge of school medicine and is accordingly highly respected by colleagues of modern medicine.
The doctor is aware of the gap between the demands of a patient-oriented medicine and the restrictive realization of it. For this reason – as a pragmatist – he accepts statistical methods as long as they are assessed with regard to the final assessment by a practitioner who, through his experience, can recognize application errors for the individual patient in a timely manner. Good medicine consists of the interplay of good statistics with professional experience.
Dr. Kessler, a senior physician at the Immanuel Hospital in Berlin, claims: "Ayurveda is permeated with salutogenetic principles. Despite its ancient tradition, it is surprisingly modern 7). Primary, secondary and tertiary prevention as well as patient empowerment and self-efficacy play decisive roles. In addition, Ayurveda has strongly individualized approaches to therapy, which in the sense of integrative approaches could also be integrated into western health care systems”.
The ability to expand modern medicine is granted here. Dr. Krishnan goes a step further with the apt formulation: "Integrating of modern medicine in Ayurveda is better than the reverse phenomenon”.
Klaus-Rupprecht Wasmuht, HP
1) Dr. Starfield: “America’s Healthcare System is the Third Leading Cause of Death“.
2) Pietschmann, Die erweiterte einheitliche Quantenfeldtheorie von Burkhard Heim/. Wolfgang Ludwig. – Innsbruck: Resch, 1998. (Grenzfragen: 17). ISBN 3-85382-963-8. ;S.35
3) Dr. V. Coleman, Die Moderne Medizin ist keine Wissenschaft: https://www.naturepower.de/vitalstoff-journal/fakten-widerreden/medizinbetrieb/die-moderne-medizin-ist-keine-wissenschaft/
4) Dr. Bernd Hontschik: Körper, Seele, Mensch - Versuch über die Kunst des Heilens, 2006, Suhrkamp,
5) Dr. Issac Mathai: :Holistic Healing – A doctor´s guide to rediscovering health and happiness, naturally, 2014, S.68/S.84, ISBN 978-935029-093-4
6) Dr. Remya Krishnan: Evidence Based Ayurveda & Rational Prescribing, 2012 Vision Grafix, Trivandrum -695012
7) Dr. C. Kessler, Deutsches Ärzteblatt 2013; 110(37): A-1678 / B-1484 / C-1458