| Ram Manohar Is Ayurveda an old system of thought based on ancient Hindu and Persian beliefs? 1. Does it need to borrow the methods of science to resurrect itself as a respectable system of medicine in the modern world? Such and other analogous questions daunt one’s mind as one watches the resurgence of this age-old medical tradition of India in the global scenario under the umbrella term CAM – Complementary and Alternative Medicine. Methodological Rigor in Knowledge Building – Ayurveda and the Scientific ChallengeP. Ram ManoharThe Preamble:Is Ayurveda an old system of thought based on ancient Hindu and Persian beliefs? 1. Does it need to borrow the methods of science to resurrect itself as a respectable system of medicine in the modern world? Such and other analogous questions daunt one’s mind as one watches the resurgence of this age-old medical tradition of India in the global scenario under the umbrella term CAM – Complementary and Alternative Medicine.There is a need for alternatives to scientific medicine it seems, which is increasingly being complemented with other health care approaches2. The crisis in global health care that brings the older medical traditions back into the vanguard gives room for a subtle epistemological debate on knowledge systems. Have we reached a point from where we need to look beyond the ken of science – seek an alternative not just to medical systems, but science itself?Throughout the long span of its evolutionary history, religion, military onslaughts, politics and law have challenged Ayurveda. Once upon a time, Ayurvedic physicians became outcastes on religious grounds because they touched impure and diseased bodies. Centres of Ayurvedic learning and rich collections of medical manuscripts were destroyed by ruthless invaders. The British colonizers politically subjugated Ayurveda and withdrew state patronage. In modern times, international law does not recognize Ayurveda as a legitimate system of medicine outside India, save for a few exceptions.Withstanding and overcoming these challenges, Ayurveda has survived into the new millennium and is fast gaining acceptance in various forms amongst the general public at a global level. At the same time, it is facing an intellectual confrontation – an epistemological challenge that is more profound than all the challenges that have been thrown at it and which may have far reaching implications in terms of its future growth and development. The testimony of science is being demanded from Ayurveda to prove itself as a medical system worthy of recognition and adoption by the developed nations of the world.The scientific validation of Ayurveda has already been initiated with international bodies like the World Health Organization and National Institutes for Health announcing research agendas for CAM3. Only time can tell what the outcome of these projects will be and how they will influence the destiny of Ayurveda. At this critical juncture, an enquiry into the position of Ayurveda as a knowledge system assumes significance as it has never before. For the simple reason that such an exercise will enlighten us on the innate potential that Ayurveda possesses to withstand the emerging epistemological challenge from the scientific community.Belief, Knowledge and Science:Organized systems of thought that humanity has developed through the ages can be categorized as belief systems or knowledge systems. Science is a highly evolved and rigorous knowledge system that has gained such universal acceptance and popularity that it has become synonymous with knowledge itself. In this paper an attempt is being made to distinguish between a belief system and knowledge system as well as to characterize science as a specialized knowledge system. An attempt will be made to epistemologically position Ayurveda in the backdrop of this canvas.Belief System and Knowledge System:We can look at five characteristics based on which a belief system and a knowledge system can be distinguished from each other. They are:1. Origin2. Proof3. Acceptance4. Revisions, and5. Methodology.A belief system advocates supernatural origins of knowledge. The concept of divine revelation is central to this system of thinking. Most of the major religions of the world exemplify this approach. On the other hand, a knowledge system professes natural origins of knowledge and human agency as the key component in the process of knowledge acquisition. Rational systems of thought that were nurtured in ancient India, Greece and such other parts of the world and of course, science, illustrate this approach.In a belief system, the authority of a deified personality is the ultimate proof for the validity of knowledge. In very rigid belief systems, a single authority is worshipped as the ultimate source of knowledge. In a knowledge system, however, observation and experience become the criterion for valid knowledge. What cannot be verified experientially does not constitute knowledge.A cardinal feature of a belief system is the tendency to accept a teaching uncritically and without investigation. Everything is a matter of belief and nothing can be questioned. A knowledge system accepts a proposition only after a thorough investigation. Any new suggestion is subjected to critical enquiry before being accepted as knowledge.A belief system resists change and does not allow revision of previously accumulated knowledge. What has been said once is the final truth. A knowledge system is typically open to revisions and accumulates knowledge on the go. Old theories are modified, elaborated or abandoned and new theories are introduced.A belief system is not based on any well-defined or rigorous methodology to acquire and verify knowledge. It just transmits beliefs from one generation to the other. In contrast, a knowledge system thrives on rigorous methodology. Transmission of knowledge itself is a process of verification, where in, the teaching is subjected to rigorous analysis and internalized before acceptance.The characteristics that essentially differentiate a belief system from a knowledge system can be summarized succinctly in the form of a table.FEATUREBELIEF SYSTEMKNOWLEDGE SYSTEMOriginSupernatural origins of knowledgeNatural origins of knowledgeProofAuthority is the proofObservation is the proofAcceptanceUncritical acceptanceAcceptance after criticismRevisionsResistance to revisionsOpenness to revisionsMethodologyLack of well defined methodologyHas well defined methodologyAyurveda as a Knowledge System:In the background of this discussion, we can now attempt to explore and define the character of Ayurveda as an organized system of thought. Is Ayurveda a belief system or a knowledge system? What position does Ayurveda take on the origin of knowledge?Interestingly enough, a careful study of the classical texts of Ayurveda yields contradicting answers. For example, the mythological account of the origin of Ayurveda states that it was first remembered by Lord brahmā, thereafter transmitted to prajāpati who imparted the knowledge to the aśvini twins and from whom indra obtained it4. These are all mythological characters and hence at the first look, it appears as though Ayurveda is promoting itself as a belief system by tracing its origins to supernatural sources. Indra is the link between the mythological personalities and human beings and various sages, who were essentially human beings, acquired the knowledge of Ayurveda from indra. In stark contrast, another section of the text talks about direct perception (pratyakṣa), inference (anumāna) and verbal testimony (āptopadeśa) as the true sources of knowledge5. A particular passage even goes to the extent of subsuming the importance of verbal testimony and stating that direct perception and inference make up the tools with which the wise acquire knowledge. Some times correlative logic (yukti) is also considered as a valid tool of knowledge6. The celebrated Ayurvedic text, the caraka samhitā, states that the scope of knowledge is to distinguish between what is real and unreal and this is done by employing the tools of knowledge, which is fourfold – verbal testimony, direct perception, inference and correlative logic7. Unmistakably, Ayurveda projects itself as a knowledge system through such positioning. One cannot help, but be intrigued by the apparent dichotomy of the thought process discernible in the Ayurvedic tradition – a blend of the elements of both belief systems and knowledge systems.The same ambiguity is reflected in the context of proof of knowledge. There are passages in the classical texts that almost attribute absolute authority to the precepts of a particular individual or revered teacher of the past. The celebrated author vāgbhaṭa, who composed the aṣṭāṇga hṛdayam, for instance, struggles to prove that his exposition is only a repetition of what the authorities of the bygone days have expounded and that he has not deviated even by a syllable from what they have said8. In spite of being one of the most outspoken exponents of classical Ayurvedic learning, vāgbhaṭa in one context distinguishably characterizes Ayurveda as a belief system. He states that the knowledge of Ayurveda should be used like a mantra, without ever being subjected to critical examination, because it has come down from authoritative persons and produces practical results9. In several other situations, he throws all caution to the winds and criticizes authority without mincing words and advises the aspiring physician to rely on his own intelligence and understanding without blindly relying on the teachings alone10. In his characteristic and pithy remarks like “a statement does not become acceptable just because it comes from the mouth of a ṛṣi, rather it is accepted on the merit of the truth that it conveys”11 and “the fact that oil alleviates vāta, ghee pitta and honey kapha remains unchanged whether it is uttered by brahmā or his son”12, one cannot miss the sarcastic tone that scoffs at authority with unveiled contempt. To sum up, Ayurveda fluctuates across the domains of a belief system and knowledge system when it comes to deciding what constitutes the proof for knowledge.We can notice a much more volatile situation when we try to examine and understand the position that Ayurveda has taken with regard to acceptance of propositions as valid knowledge. The Ayurvedic texts get transformed into an arena for hot debates and discussions. Technical discussions and debates are very much encouraged in the tradition and the teachings are not so easily accepted without questioning13. This has given rise to different schools of thought in Ayurveda and variations in theories and explanations of its basic tenets. However, much of the energy seems to have been diverted in proving and consolidating already proposed theories and establishing the supremacy of the older ideas, which ultimately overrides the importance of the newer notions. In some instances, new ideas are accepted only if they confirm to and do not contradict the already established conceptions, failing which, they are rejected. One gets the impression that Ayurveda exhibits greater flexibility when it comes to critical examination of a proposition before acceptance but offers much resistance as far as revision of older theories are concerned.Radical revisions to the basic theories of Ayurveda are literally unknown in the long span of its historical evolution though the expositions have been refined and elaborated as well as new applications derived from them in the course of time. For example, the tridoṣa theory was well established at a very early period but the concept of five types of pitta and kapha was a later development14. Finally, when it comes to methods of knowledge acquisition, the Ayurvedic texts are quite eloquent in elaborating rigorous protocols and systems for validating knowledge. The texts distinguish between speculative thinking (tarka) and definite knowledge15. It is the existence of a sufficiently rigorous methodology for acquisition of knowledge that helps us to characterize Ayurveda as primarily a knowledge system. This discussion has revealed the dual character of Ayurveda, which appears to take on the features of both a belief system and knowledge system. How do we make sense of this paradox? In order to understand this peculiarity of Ayurveda, one has to delve into the complex structure of Ayurveda as an organized body of knowledge.The texts clearly state that the knowledge of Ayurveda has been organized to address three levels of intelligence – the dull, the mediocre and the bright16. For the dull student, the knowledge of Ayurveda has been packaged as a belief system and for the bright student it becomes a knowledge system opening up new frontiers of knowledge. For the mediocre, it takes on a dual nature and is partly a belief system and partly a knowledge system. The dull witted has been advised to just follow instructions and not to attempt to understand subtle implications of the teachings17. On the other hand, the bright person should go beyond what has been taught and discover new knowledge18. The ancient teachings have therefore been clothed in three layers of interpretation and one will have to delve into the deepest level to discover the not so obvious character of Ayurveda as a knowledge system.Ayurvedic knowledge has been organized on a three tier structure, which corresponds to the three levels of intelligence. This constitutes the realm of application (vyavahāra), which is based on operational concepts or theories (śāstra) and which in turn stems from a direct experience of a truth principle (tattva). The dull witted has to just follow instructions (dos and don’ts called as vidhis and niṣedhas) at the level of vyavahara to get expected results. The mediocre can attempt to understand the sastra or theory behind an application and thereby handle it more efficiently. The intelligent student, however, can have a direct experience of the truth behind a theory and improvise or modify the theory as well as invent novel applications. The ideal physician according to suśruta, is well grounded in the practical applications and delves into the tattva (truth content) behind the śāstra (theory) and becomes an innovator or inventor himself19. Belief based on direct perception of results (pratyakṣaphaladarśana) is sufficient for one who operates at the level of applications. This has to be supplemented with inference at the level of theoretical discussions. At the level of direct perception of the truth principles, altered states of consciousness have to be invoked and the world of sensory experiences transcended to obtain direct knowledge.The allusion to the origin of the knowledge of Ayurveda from the mythological personalities is an indication that the real substance of the body of Ayurvedic knowledge has emerged from higher states of consciousness. indra, meaning knowledge is sahasrākṣa20 (one who has a thousand eyes), with an ability of perception that has been increased thousand fold by rigorous discipline (śatakratu21 – performance of a 100 yāgas to purify and refine the cognitive apparatus). Knowledge from the level of tattva is purely a matter of verbal testimony for the dull witted and a matter of direct perception for more advanced seekers. The level of vyavahāra is always changing as new applications have to be constantly discovered in response to varying spatio-temporal situations. The level of śāstra is relatively stable but subject to modifications, revisions and elaborations reflecting change in human understanding of the truth principles. The level of tattva is stable and purely experiential reflecting the innate and unchanging nature of the fundamental truth principles and laws that govern the universe. In the light of the above discussion, we can conclude that Ayurveda is essentially a knowledge system with an inbuilt flexibility to present itself as a belief system for aspirants with lower levels of intelligence.Knowledge Systems and Science:Let us now try to position science in relation to knowledge systems. Science no doubt is a knowledge system and the very term ‘knowledge system’ includes science. It is however, important to realize that science is a specialized knowledge system, which differentiates itself on the basis of some rigorously defined basic premises from other knowledge systems. What are the characteristic features of science?Science is essentially empirical. Confronted with the limitations of the sense organs, science attempts to expand the scope of sensory perception through sophisticated instrumentation. Valid knowledge originates from observation and though intuition is recognized as a way to know, it has to be substantiated by actual observations of multiple observers. Thus science is not only empirical but also objective. Constant observation being the method of science, it has a characteristic tendency for self-correction. In the light of new evidence old theories are revised or rejected quite often and replaced by new ones. Science therefore advances in the quantity and quality of the knowledge it accumulates in the passage of time. Science is concerned with theorizing. Science is empirical like intuition and its higher expression of mysticism. Common sense is also a kind of empirical knowledge but differs from science in that it confines itself to merely a working knowledge of the Universe. Common sense accepts an idea as knowledge if it works. But science is concerned about the theory of how something works. Another important characteristic of science is the process of experiment wherein a hypothetical assumption is verified by planned observations under controlled conditions.Last but not the least, the unique characteristic of science is the criterion of falsification. It is easy to look for confirmations or verification to support the veracity of a theory. But the real test of a theory that would accord it a scientific status is the possibility of attempting to refute it or falsify it. A theory is accepted not just because it can be verified but only if one fails to falsify it22. We can thus arrive at the understanding that science is a specialized kind of knowledge system with unique characteristics.Ayurveda and Science:At the very outset, it has to be emphasized that there are both points of divergence and convergence between Ayurveda as a knowledge system and science. Both Ayurveda and science are empirical but science, as mentioned, does not formally accept intuition and common sense as valid sources of knowledge. Ayurveda includes all these and also objective methods as sources of valid knowledge. Thus, one of the essential differences between Ayurveda and science lies in what constitutes the sources of valid knowledge.The next difference is in the operational realm. Being empirical, both Ayurveda and science rely on sensory observations. But when confronted with the limitations of the sensory apparatuses, Ayurveda attempts to transcend the sensory realm through mystical approaches to knowledge (alaukika pratyakṣa) whereas science extends the scope of sensory perception by extending it with technology. On account of differences in the source of knowledge as well as the level of reality on which they operate, there is a certain degree of incommensurability between Ayurveda and science. This incommensurability stems from paradigmatic differences and becomes more pronounced when science attempts to understand Ayurveda. This is because science adopts an exclusive approach while Ayurveda is inclusive.Problems of incommensurability can be better tackled if Ayurveda attempts to accommodate the methods of science in a proactive way. When science approaches Ayurveda, there is the danger of reductionism trimming the scope of Ayurveda within the framework of science. On the other hand, if Ayurveda approaches science, there is a better chance of preserving the totality of Ayurveda as a knowledge system. The rest of this paper is a discussion to explore whether Ayurveda has the potential to meet the scientific challenge in terms of methodological rigor in knowledge building. For this we need to see if there are at least a few major points of convergence between Ayurveda and science.The very word Veda is an elaboration of the process of knowledge acquisition. This word means existence, conceptualization, analysis and realization23. These are four stages in the knowledge cycle, which starts with observation of existent phenomena and its conceptualization. Such conceptualized knowledge is transmitted as a teaching and subject to analysis and internalized experientially. Knowledge seeking is an attempt to differentiate between what is real and what is unreal. This is clearly an empirical exercise and all knowledge is experiential. But all expressions of empiricism cannot become knowledge or in other words, knowledge is experiential but all experience is not knowledge. Validated experience alone becomes knowledge and therefore knowledge acquisition is all about validating experience24.The tools used to validate experience are called as pramāṇas and the number and type of pramāṇas vary from system to system. Ayurveda recognizes at least three such tools or pramāṇas – verbal testimony, direct perception and inference and also correlative logic in certain contexts as already pointed out earlier. The knowledge gained through verbal testimony is basically conceptual (jñāna). When it is verified through direct perception and inference, it becomes experiential (vijñāna). Therefore, the real tools of validating knowledge are direct perception and inference. This exercise is technically known as parīkṣā meaning investigation25. Thus, we can conclude that Ayurveda accepts empirical knowledge only after validation and meets science eye to eye in this regard.The need for objectivity is also emphasized in the Ayurvedic tradition. Knowledge has to be theorized, objectified and validated by multiple observers before it is accepted as a doctrine or siddhānta26. anumāna, one of the tools to validate experience, is not merely inference but inference based on perception. anumāna proposes a rigorous methodology to establish causal relationship between events in a systematic way. When an association between two events is observed repeatedly for a number of times, a correlation is suspected. This is called sāhacarya or vyāpti27. Establishing this correlation is tantamount to discovering a law and helps us to control the event. In scientific parlance, this is the study of two variables; one is independent and the other dependent.However, mere association cannot help us to formulate a law of correlation between two variables. Certain other criteria will also have to be fulfilled. They are:(a) Law of exclusivity (avyabhicāritva) – the dependent variable should not be influenced by another independent variable than the one being studied, it should be exclusively associated with the independent variable under study.(b) Law of invariable concomitance (avinābhāvasambandha) – the two variables should always be seen together or in other words, the dependent variable should be influenced by the independent variable on all occasions of observation.(c) Law of inherence (ayutasiddhatva) – The two variables should always co exist and should not be observed independent of each other28. In this approach we can discern the rudiments of the experimental method to validate hypothetical assumptions.In the biomedical context, the clinical trial design seeks to study a trial drug against a control and a placebo. For the trial drug to be acceptable, its action should be comparable to that of the control and not comparable to that of the placebo. This is very similar to what is meant by pakṣa, sapakṣa and vipakṣa in the process of validation through anumāna29. sapakṣa is equivalent to the trial drug; it is a context in which a particular effect is doubted to exist. pakṣa is the control; which is a context in which the effect being studied is proved to exist. And vipakṣa can be compared to the placebo; i.e., a context in which the effect being studied is established to be non-existent. Such a suggestion does not seem to be improbable altogether and it does look like the importance of validation of clinical outcomes was recognized in ancient days. The caraka samhitā states clearly that a clinical outcome that has not been validated by proper reasoning can only be dismissed as accidental success30.It is beyond the scope of this paper to engage in further discussions on the parallels between Ayurveda and science. The objective of this discussion has been to demonstrate the fact that though not a science in the strict sense of the word, Ayurveda has the right ingredients ingrained in its epistemology to confront the scientific challenge that has been thrown at it in recent times. The future of Ayurveda as a knowledge system and a medical system in its own right will very much depend on how successfully it understands and accommodates science and at the same time operates from within the larger framework of its epistemological foundations.About the Author:The author is the Director of Research at Arya Vaidya Pharmacy in Coimbatore.REFERENCES1. What is Ayurvedic Medicine? Backgrounder – NCCAM, October 2005, NIH US DHHS p. 22. Expanding Horizons of Health Care – Five Year Strategic Plan 2001-2005, NCCAM, September 2000, NIH Publication No. 01-5001 p. 73. Expanding Horizons of Health Care – Five Year Strategic Plan 2005-2009, NCCAM, December 2004, NIH Publication No. d 251; WHO Strategy on Traditional Medicine 2002 – 2005, WHO, Geneva 20024. A.H. Su. St. 1.35. C.S. Vi. St. 4.36. C.S. Vi. St. 4.67. C.S. Su. St. 11.178. A.S. Su. St. 1.209. A.H. Ut. St. 40.8110. A.S. Su. St. 7.26111. A.H. Ut. St. 40.8812. A.H. Ut. St. 40.813. C.S. Vi. St. 8.1514. The five fold divisions of pitta and kapha are not seen mentioned in Caraka Samhita but only other texts dated at a later period.15. C.S. Sa. St. 7.1416. C.S. Su. St. 30.18, C.S. Vi. St. 8. 317. C.S. Su. St. 4.2018. Ibid19. S.S. Su. St. 34.1920. C.S. Su. St. 1. 23 indra is referred to by the synonym Catakratu here21. C.S. Su. St. 1. 18 indra is referred to by the synonym Catakratu here.22. Karl Popper, Conjectures and Refutations, London: Routledge and Keagan Paul, 1963, pp. 33-3923. The word veda is derived from the root vid, which has four meanings – sattA, jJAna, vicAra and prApti. sattAyAm vidyate vetti jJAne vinte vicAraNe, vindate vindati prAptau rUpabhedA videh amI24. Tarkasangraha, pp. 152, 15325. C.S. Su. St. 11.2626. C.S. Vi. St. 8.3727. Tarkasangraha, p. 16028. Tarkasangraha p. 160 – 17129. Tarkasangraha, pp. 165,16630. C.S. Si. St. 2.28ABBREVIATIONSCS – caraka saMhitA; SS – suCruta saMhitA; AH – aSTAGga hRdayaM; AS – aSTAGga saMgraha; Su.S. – sUtrasthAnaM; Sa.S. – CArIrasthAnaM; Si.S. – siddhisthAnaM; Vi.S. – vimAnasthAnaM, Ci.S. – cikitsAsthAnaM, Ut.S. – uttara sthAnaM.BIBLIOGRAPHY1. Yadavji Trikamji Acharya ed., caraka samhitA, Chaukhambha Surabharati, Varanasi, 20022. Yadavji Trikamji Acharya ed., suCruta samhitA, Chaukhambha Surabharati, Varanasi, 19943. Hari Sadasiva Sastri Paradakara, ed., aSTAGga hRdayam, Chaukhambha Surabharati, Varanasi, 19944. Ananth Damodar Athvale, ed., aSTAGga saGgraha, Mahesh Anand Athvale, Poona, 19805. Acharya Kedaranatha Tripati, tarka saMgraha: nyAyabodhinI Sanskrit and Hindi vyAkhyAna, Varanasi: Kashi Hindu Viswavidyalaya, 1985, 2nd edn P. Ram ManoharAbout the author:The author is the Director of Research at Arya Vaidya Pharmacy in Coimbatore. |
