The topic of my presentation this morning is Ayurveda: An Alternative or Complementary Medicine? I am not sure, however, that this is the right question to ask. I think we must first ask several other questions before we can answer this one.
Does modern medicine need alternatives and complements? The answer, I believe, is yes. Modern medicine responds admirably to crises which require quick, intensive, invasive intervention, and deals far less effectively with slowly progressing degenerative diseases The Journal of the American Medical Association recently reported that nearly half the people in the United States suffer from at least one chronic illness, and that together these illnesses account for three-fourths of all medical expenses in our country1. In this climate of change in the West which is now calling into question many of the assumptions which we once accepted unthinkingly an awareness is growing that our paradigm is shifting. A system's paradigm is its pattern, the archetype which structures each of its products.
Crisis medicine promotes a crisis-based lifestyle. An imbalance that begins in one location can surface elsewhere, since all facets of the organism communicate with each other; physical imbalances can thus be generated from disturbances of the mind or the life-force, mental disorders can be due to physical derangements, and so on. Imbalanced individuals tend to perturb their surroundings, and a polluted habitat will pollute its inhabitants. Ayurvedists who survey today's world find the human creature destroying its environment and itself everywhere they look, and are not surprised to discover the gargantuan imbalances thus created emerging as rampant disease.
The inability of crisis-based medicine to deal with these crises has led to the present situation in the West in which many alternative paradigms compete for the acceptance of scientists and public alike. Last week I spoke at a conference on organ transplantation organized by Howard University. While I was there I attended a lecture by Dr. James Gordon, Professor at the Georgetown University School of Medicine and first Chair of the Advisory council of the OAM at the NIH. During the course of his talk Dr. Gordon mentioned that 2 out of every 3 people who consult with M.D.s in this country are also doing something extra: herbs, supplements, chiropractic, whatever. 2 out of 3 is a decisive majority. Is it possible that our health care system is changing faster than our ability and willingness to perceive and describe it? Do all the people who are being served by the system still accept the fundamental premises that make up the system? It would appear that the majority wants change.
Is Ayurveda a worthy alternative? This answer is also, in my opinion, yes. This "superstition" has already contributed much to modern medicine, including the drug reserpine, which is extracted from a plant (Rauwolfia serpentina) that is still used today in India to safely control hypertension. More recently it has provided the cholesterol-controlling gugulipid (from Commiphora mukul), which apparently binds cholesterol in GI tract and has been reported to be as good as Lopid at lowering blood cholesterol levels.
Ayurveda has also given us plastic surgery. During the nineteenth century the Germans translated from the 2000-year-old treatise of the Ayurvedic author Sushruta the details of an operation for repair of damaged noses and ears. This operation, which appears in modern textbooks of surgery as the pedicle graft, led to the development of plastic surgery as an independent specialty. Today Sushruta is regarded by plastic surgeons around the world as the father of their craft.
Ideally, all Ayurvedic treatment is carefully tailored to the individual. Though it concentrates first on making simple changes of diet and behavior, for simple alterations are sometimes sufficient to produce big results, Ayurveda does not hesitate to use surgery, shock therapy, and other intensive treatments when mild interventions fail to produce results.
Ayurveda's materia medica and therapeutic techniques have much more yet to contribute. I maintain, however, that Ayurveda's most valuable contributions will be made to the new theory that medicine is trying to grow. These contributions will be derived from Ayurveda's way of seeing the world, its darshana, a vision which will facilitate medicine's ability to teach people not just how to avoid disease but how to proactively develop and maintain a healthy "state." Modern medicine defines health as the absence of disease, Ayurveda focuses on health as a positive condition that is independent of disease, an active state of being that can be promoted by appropriate behavior. When you can upgrade your health you may find diseases disappearing without ever having been directly addressed. The same Ayurvedic principles that are used to correct yourself when you are out of balance can be used to preserve your balance once it is corrected.
Can modern mechanical medicine adequately perceive, describe, understand and implement Ayurveda? I rather doubt this. Many similarities already do exist between the standpoints from which Ayurveda and modern medicine survey the world. Both believe in technological progress; on its part Ayurveda has absorbed therapeutic innovations from many sources within and without India over its history. Empiricism too is fundamental to both; the Ayurvedic author Sushruta declares, "A learned physician must never try to examine on grounds of pure logic the efficacy of a medicine, which is known by direct observation as having by nature a specific medical action." Both agree that an allopathic approach to disease is ordinarily efficient, and both thus usually treat conditions with their opposites: fever is countered with temperature-lowering measures, obesity with reduction in caloric intake, and so on.
In spite of this Ayurveda does not yet have a sterling reputation among physicians of Western medicine; in fact, one recently called it in print "a superstition of ancient times." But then this is because the majority of modern physicians do not know what to look for when they look at Ayurveda. Western materialist science presupposes that the way to eschew ambiguity in science is to distance ourselves from the things that we measure. This posture achieves precision by denying a place in Western experimental philosophy to any phenomena that are not externally measurable, and discourages Western medicine from accepting, or even grasping, that which cannot be explained phenomenologically.
The Ayurvedic system maintains that all phenomena however ambiguous are worthy of investigation if they influence embodied life. It encourages the free application of both rationality and intuition to scrutinize all states of being, internal and external. Over thousands of years the sages who moulded Ayurveda studied how embodied life is affected by what we do and how we do it in all of life's arenas, including diet, exercise, vocation, avocation, and personal relationships. Though most of their experiments were performed internally these were no less rigorous and systematic than those that scientists perform in external laboratories. Nor were they less logical; Ayurveda is a different "language" from modern medicine, and its logic is a fuzzier sort of logic (in the non-pejorative, cybernetic sense of "fuzzy logic").
Their inner explorations led these savants to conclude that consciousness is omnipresent in the universe, and in fact pre-existed the cosmos. This premise is fundamental to Ayurveda: that consciousness is omnipresent in the universe, and pre-existed the cosmos. Everything in the universe that is not pure unconditional consciousness is a form of matter, and the material universe and all that is within it evolved from and continues to evolve because of that consciousness. Consciousness expresses itself in and through everything that exists, its expression varying with the density of the matter that contains it. Everything with which an organism comes in contact interacts with its matter and its consciousness, however minimally; consequently, all living organisms are innately interdependent.
This is the gulf that truly parts Ayurveda from materialist science, which teaches that consciousness evolved from matter. No conclusions drawn by reasoning from one of these two competing and mutually exclusive postulates can be expected to prove or disprove the "validity" of the other postulate. The "consciousness" model, however, continues to gain ground as scientific evidence of consciousness's ability to influence matter, at least in the form of observers affecting their observations, continues to accumulate.
Ayurveda's approach is more alchemical. The alchemical paradigm holds that that reality is paradoxical. This means that a thing is closely related to its opposite, as we see today in love-hate relationships and the like. The approach of Chinese medicine is similar. India and China have always appreciated life's innate ambiguities. Carl Jung wrote, "The Chinese have never failed to recognize the paradoxes and the polarity inherent in what is alive. The opposites always balanced one another-a sign of high culture. One-sidedness, though it lends momentum, is a mark of barbarism."2 While Ayurveda and traditional Chinese medicine try to mirror this ambiguity in their processes, materialist science abhors ambiguity.
Ambiguity has not always been anathema to science. John Maynard Keynes discovered in 1936 that Isaac Newton had been obsessed with alchemy and had mentioned it in early editions of his books. He eventually decided that he would have to repress this side of himself if he wanted to get ahead in the world of that time, and so purged all references to alchemy from later editions of his works.
Newton's early form of "political correctness" reflects the sad truth that even modern medical science, research and practice alike, is structured in large measure through political means. Modern medicine itself succeeded in gaining a paramount position in our country with substantial help from political sources; consider for example the generally successful attempts at the end of the nineteenth century to outlaw homeopathy at a time when in many parts of the country homeopathy was more popular than allopathy. This is merely the most recent incarnation of a generalized ancient trend to support orthodoxy at the expense of innovation. Galileo's fate and the witch-burnings were two other European examples, but no culture (including India's) is spared this sort of thing entirely.
How we structure a thing determines to great extent its reality. "As Gregory Bateson has rightly remarked, Newton did not discover gravity; he invented it." How we structure our reality determines what might be "alternative or complementary" to it, and the key to structuring what we believe to be real usually boils down to the amount of repetition and intensity that is brought to it. If you call something a duck long enough and loudly enough many people will eventually become convinced that it is a duck, whether or not it actually quacks. The more that the medical establishment calls chiropractic or homeopathy or Ayurveda "alternative or complementary" the more that is what they will become: secondary to, adjunct to, assistant to modern medicine.
All medical systems are models, approximations of reality. The modern fixed and unchangeable view of medical reality has meant that until very recently few scientists were prepared to accept that the mind and the body can and do influence one another in measurable ways. Many of the problems that we have today stem from the fact that our reality system officially denies that the mind participates in the creation, preservation and destruction of our physical reality. Denying the mind its influence does not prevent that influence; it only prevents us from perceiving it. Modern medicine assumes that the reality we can perceive with our senses is the only reality there is, and that we can observe portions of this reality as non-participating observers. But this act of mechanically constructing a separate, rationally ordered reality for ourselves is itself an active participation in that reality from which we are trying to separate ourselves.
This totalitarian rationality, which by denying participation with our reality implicitly denies everything that is irrational about us, has created and is creating enormous difficulties for us humans and for our world. The most important of our irrational influences exist in the vast terrain of the unconscious mind, but modern science, by promoting the idea that rational knowledge is the whole of knowing, has cut itself off from the 90% of the iceberg of consciousness that is outside the control of the conscious mind. Now the mass of this iceberg is reacting against that neglect, counterattacking with epidemics of psychological and psychosomatic disease.
To be worthy of possessing alternatives or complements a system should accurately reflect and describe the reality that is embodied life to a substantial degree in a systematic and logical way. Modern medical science, which is currently in the throes of a revolution that will dramatically affect both its vision of the nature of medicine and the way that medicine is practiced, may not qualify as such a system.
How can we understand Ayurveda? The Ayurvedic model takes the approach advocated by Michael Polyani, who in his classic book Personal Knowledge showed that (even though most scientists like to claim otherwise) science is a craft. Whether it involves the growing of crystals or the reading of X-rays, a scientist becomes proficient at his science not by strictly following the dictates of some unambiguous rule book but by immersing himself in the slow trial-and-error process of discerning patterns and learning to follow those patterns. We have to do the same thing with our health; we must learn to improve it like we learn any other craft.
This process happens to be very natural to us humans. It is in fact innate to us, for this is how the brain learns as well. The brain is too parsimonious to assign one memory to one neuron. Instead, it organizes its neurons into neural networks. Any sensory stimulus that enters one of these networks activates each of the neurons to a different degree. The more highly activated neurons signal strongly and the weakly activated ones less strongly, the members of the network continuing to share information until a pattern develops. Many types of patterns arise and are held in the same net.
One of Ayurveda's basic theses is that similar patterns appear at all levels of a living organism's existence, both in its internal interplay and in the interplay between it and its environment. Each pattern affects us whether we are aware of it or not. Taste is one example of the many patterns in our daily lives than cannot be easily quantified. You can express your blood pressure in mm of Hg, but how do you measure taste? Most of us find it natural to believe that that well-cooked food tastes better than poorly-cooked food, even though there is no way to externally verify this internal perception. Ayurveda suggests that the self-evident good or bad taste of food has more than a trivial effect on the organism that consumes it. Ayurveda asserts that the internal reality of something as outwardly ephemeral as a taste pattern is in fact very real to the tasting organism. Evidence that supports this conjecture has also begun to accumulate in Western science (e.g. in studies on the ways in which the taste of fat or sugar in the mouth can influence physiology even before they are metabolized).
Taste is only one of the many patterns that characterize our bodies and minds. Another is prana, the force of life, which the Chinese call chi and the Japanese ki. We can describe prana as the energy that inspires life to persist within a particular living being. Students of yoga, Tai Chi and the martial arts who learn to identify and circulate this force within themselves discover that prana is as easily measured with their own internal instruments as it is difficult to measure with external gadgets. The pattern that these practitioners call prana is as real to them as the patterns that neural networks of taste produce when they sample a mango. Whatever their external reality, patterns are very real to the organism in which they occur.
Athletes around the world are now studying the life force as they learn that cultivating a healthy pranic pattern facilitates the type of body-mind cohesion that allows one to shine out on the playing field. Athletic training is basically a matter of breaking down old physical and mental patterns and building up new ones. Each living body hosts a wide variety of strongly-held metabolic patterns which influence its ability to build up new patterns. Ayurveda classifies each these many metabolic patterns into one of three classes. Each of these classes forms a metapattern, a pattern which actively reproduces itself whenever it is given the opportunity to do so. These three metapatterns are the Three Doshas, the body's so-called "humors." They are called doshas ("mistakes," in Sanskrit) because when they are deranged they induce the organism to go off balance, in predictable ways. Students of Ayurveda work with the reality of life from the dosha perspective because of its practical utility in everyday practice. The dosha approach allows associations to be detected between seemingly unconnected causative pathways and manifested symptoms.
Ayurveda defines health as balance and ill health as imbalance, in all aspects of existence but particularly in the context of the Three Doshas. When they are balanced the Three Doshas ensure that the organism functions well. Disease-causing imbalance patterns may result whenever an organism fails to adapt properly to a change in its internal or external environment. The need to adapt is universal, but the ways in which people adapt differ from person to person. Though many of these adaptation patterns are learned behavior others are innate properties of the organism itself. Everyone has physical, psychological, pranic, and emotional strengths and weaknesses; taken together these form a set of "reaction prints" which are as characteristic of their owners as are fingerprints or footprints. The aggregate of these innate properties forms the individual's "nature" or "personal constitution" (in Sanskrit, prakriti), a temperament which profoundly influences predisposition to health, general and specific sensitivity to illness, and responsiveness to various forms of therapy.
The Ayurvedic approach to healing concentrates first on making simple changes of diet and behavior, for simple alterations are sometimes sufficient to produce big results. Ayurveda escalates into surgery and other intensively invasive therapies only when mild interventions fail to produce results. Modern researchers continue to rediscover truths that Ayurvedic researchers learned many centuries ago.
For example, since 1935 modern science has known that when mice and rats are fed a very low calorie diet (30 - 50% of their normal intake) in the laboratory they live about 30% longer than do well-fed rodents, so long as they receive sufficient nutrition. Though the mechanism of this effect remains in doubt (it may be due to decreased production of free radicals) the effect itself is clear.
Americans not only eat too much food, too much of that food is fat. Dr. Dean Ornish has shown how a judicious program of exercise and dietary change can not only control but in some cases reverse the course of obstructive coronary artery disease.
Recall that the two most common diagnoses requiring transplantation in African-Americans are hypertension and diabetes. High blood pressure afflicts one-third of all Americans in their 50's, half of those in their 60's, and more than two-thirds of those over 70. But hypertension is not inevitable; it is a disease of civilization. Preindustrial people rarely get increases in blood pressure as they age, whether they live in China, Africa, Alaska, or the Amazon, mainly because they do not eat processed foods.
Dr. Paul Whelton of Tulane University's School of Public Health has spent the past decade tracking 15,000 indigenous Yi people in southwest China. As long as they eat a traditional diet-rice, a little meat, and lots of fresh fruits and vegetables-almost none of them suffer from hypertension. But when they migrate to nearby towns their blood pressure starts to rise with age3.
Our ancestors subsisted mainly on fresh plant foods for about seven million years, and anyone who lives on such a diet ingests about ten times more potassium than sodium. "Civilized" people consume far more sodium; for instance, while a four-ounce tomato contains 9 mg. sodium four ounces of bottled tomato sauce has nearly 700 mg. Modern humans are the only mammals that consume more sodium than potassium, and we are the only ones that suffer from hypertension.
Dietary changes can reduce blood pressure as markedly as drug treatment, and in as little as two months. In a study known as DASH (Dietary Approaches to Stop Hypertension) researchers at several institutions put volunteers on one of three diets. Normotensives who ate a low-fat menu including ten daily servings of fresh fruits and vegetables plus two servings of calcium-rich dairy products reduced their systolic and diastolic readings by 5.5 mm and 3.0 mm respectively. Hypertensives had reductions of twice that magnitude. Potassium supplements can bring a similar but less dramatic effect, but consuming fresh, unrefined plants provides you the bonus of phytochemicals which combat cancers and boost immunity.4 Dietary change is potentiated by exercise, which in judicious amounts can help everyone, even the frail. Dr. Maria Fiatarone of Tufts University recently got ten chronically-ill nursing home residents to lift weights three times a week for two months. At the end of this period their average walking speed had nearly tripled, and their balance improved by half. Two went so far as to throw away their canes.5
A positive attitude is also a big plus in regaining and preserving health. Most people who live to be a hundred maintain through their lives a social network of support, keep their minds active, manage stress well, and never give up. It has been said that "patients suffer illnesses and physicians diagnose and treat diseases." The two may have little in common. For example, in a seven-year study of 3,500 older people who were asked to evaluate their own health, those who rated their health as poor were three times as likely to die as were those who believed their health to be good. However, those who were clinically in poor health but who rated themselves as being healthy were less likely to die than those who believed themselves to be unwell.6
We are what we eat, what we do, and what we think. Observers can affect their observations; Larry Dossey, M.D. comments: "It appears that double-blind studies can sometimes be steered in directions that correspond to the thoughts and attitudes of the experimenters. This might shed light on why skeptical experimenters appear unable to replicate the findings of believers, and why "true believers" seem more able to produce positive results. The validity of decades of experimental findings in medical research would need to be reevaluated if it is proved that the mind can "shove the data around."7
Ayurveda seeks to find positive ways for each of us to "shove our data around."
By examining metapatterns in an organism it can help that organism's owner decide what kind of food, exercise, meditation, and other healthful habits will be health-promotive to the greatest degree. When it is too late for prevention early detection becomes the key. In all cases, removal of the causative factors is the first step: the patient's diet, lifestyle, and way of thinking all must change. Thereafter, one must carefully consider all the factors affecting the case, including the patient's constitution and age, the season of the year, and most importantly the strength of the patient versus the strength of the disease. When therapeutic intervention is called for we generally focus on plant materials, at least initially. In choosing herbs for a patient we focus primarily on the pattern that the disease has generated rather than the specific symptom alone.
"How necessary, desirable or useful is it that Ayurveda be described in and bound by terms provided by another model?" Our answer to this question might be, "Scientifically, not much. Politically, quite a bit." Two essential steps on the path to good health are to establish a healthy relationship between yourself and your environment and to enhance and maintain that relationship with your every choice and action. Promoting Ayurveda's health in North America in the current environment requires that it develop some sort of relationship with its environment, of which a major portion is modern medicine. The danger is that this will not be a mutually healthy relationship but will instead be one in which Ayurveda will be "commodified" and "mainstreamed" into the current disease-care system.
Ayurveda could be an alternative to modern medicine now except for the facts that the medical establishment in this country is not yet ready for it. Ayurveda is not yet ready either, for there is a dramatic scarcity of qualified Ayurvedic physicians. Now, therefore, it will have to act as a complementary medicine before it can become alternative.
It would be better it would be to first reestablish other modes of thinking and doing science, and create a new model of reality that is a culture of the alternative and complementary. This new model could do much worse than to model itself on the ancient model which continues to serve us so well: Ayurveda.
Dr. Robert Svoboda, Ayurvedic Doctor, World Renowned Author and Lecturer