The Prime Minister, in his recent speech during the inauguration of the All India Institute of Ayurveda, raised a point that needs careful consideration: Why do so many Ayurvedic graduates resort to the practice of Western medicine (Allopathy)? This essay is an attempt to answer this important question.

Two plainly obvious facts appear to drag the average Ayurvedic graduate towards allopathic practice:

1. That allopathic interventions produce more dramatic outcomes; such outcomes, needless to add, are linked to better patient satisfaction.

2. That Western medical literature appears clearer and far more accessible to the average student than classical ayurvedic literature.

Scholar-physicians versed in both Ayurveda and Western medicine emphasise upon an important distinction in the kinds of outcomes that these medical systems produce. While Ayurveda produces outcomes that are generally less dramatic and more sustainable, Western medicine seems to produce those that are, generally, more dramatic but less sustainable. Ayurvedic classics, in fact, hold that gradualness of disease remission is indispensable for its sustainability. A remission that is sudden and dramatic, on the other hand, is deemed superficial; it has the potential to cause adverse effects.

Ayurveda, thus, differentiates between real patient benefit that is the result of gradual remission and apparent patient gratification that is the result of fast symptomatic relief. The physician is expected to keep the former in mind and not so much the latter. It's plain that this approach is salutary in most medical conditions; only, it might not be appropriate in emergent ones.

Medical thinkers of the West too have alluded to the aforementioned distinction between apparent patient gratification and real patient benefit. That the medical community as a whole should, giving up petty short-term pecuniary gains, orient towards the latter is their thrustful petition. This communal orientation, in the long run, can be hoped to educate the people at large about the importance of sacrificing short-term gratification for long-term benefits.

Sadly, this strength of Ayurveda in emphasising upon gradualness of recovery and patient-benefit is often misconstrued as its weakness by the professional and the lay alike. Consequently, the student gets lured towards a system that promises dramatic results.

Allied to this matter is the question of legitimising cross practice by the ayurvedic graduate in a few well-defined primary care emergencies. While emphasising upon Ayurveda's strengths, it is unwise to be blind to its obvious deficiencies. An Ayurvedic graduate, it should be understood, can function as a full-fledged primary care doctor only if he is made legally eligible to practice Allopathy in a few primary care areas where it is absolutely required. These areas may be statutorily specified and brazen transgressions, penalised. Strange as it may seem, this important change coupled with a proper education of Ayurveda's core competence in managing chronic illnesses and minor illness syndromes, will actually have the paradoxical effect of reducing the Ayurvedic graduate's helpless zeal for cross practice.

The second issue, as has been outlined at the very outset, concerns the fogginess and the consequent inaccessibility of classical Ayurvedic literature to the average student. The ayurvedic classics, as is well known, are all in Sanskrit - a language unfamiliar to most students. Although his unfamiliarity with Sanskrit does play a role in distancing the average student from the core texts, its role is often unreasonably exaggerated. A diligent study of the first year Sanskrit course alongside making use of the good translations that are available can easily mitigate this problem.

The real reason for the student's difficulty, however, is vastly different and somewhat harder to remedy. It is to be traced to the hopelessly unscientific approach the Ayurvedic academia have unwittingly adopted to the study of ancient Ayurvedic texts. Deriving usable patient care information from centuries-old medical treatises first requires a dispassionate sifting of their contents. This sifting, guided by the great scientific tradition of classical Ayurveda, should aim at removing the obviously discernible pseudoscientific vestiges on the one hand, and at enhancing the scientific compatibility of its theory and practice on the other. The current approach of the academia to the study and teaching of the Ayurvedic classics is characterised by woeful ignorance of this obvious need.

The ayurvedic academia hold, seldom declaring it expressly, that the ancient Ayurvedic texts, being 'divined' by sages, are perfected products relevant almost in their entirety. This gross superstition is often presented pretentiously as the "epistemological distinction" and the "trans-scientific" nature of Ayurveda. These high-sounding words, when probed, are simply a cover for pseudoscience of the most ludicrous sort. The consequence of institutionalising this worldview is the sad spectacle of science students getting schooled at the university level in the weirdest of pseudoscientific fantasies. The Ayurvedic intern thus ends up finding his theory ununderstandable and its practice, often fruitless. The problem gets amplified when seen in the backdrop of the sad reality that the Ayurveda course does not attract the most meritorious of science students.

It is pertinent here to briefly discuss the evolution of the scientific worldview in the Ayurvedic tradition. The switch from the predominantly faith-based (daiva-vyapashraya) therapeutics of the Atharvana Veda to the predominantly evidence-based (yukti vyapashraya) form of the Ayurvedic classics did not happen as a single disruptive event. It happened over a period of time as a gradual process. A change resulting from such a process, though not unremarkable for the path-breaking turns it takes towards scientific advancement, should still be expected to retain ideological vestiges. That the daiva-vyapashraya practice is merely vestigial becomes clear even from a cursory reading of the classical texts. Charaka's repeated emphasis upon reason (yukti) is unmistakable throughout his text. He says rather sweepingly in one place: "Vina tarkena ya siddhihyadrichchasiddhirevasaa". Vagbhata most memorably finalises the idea when, characterising all of Ayurveda as “Nirmantra”, he declares, “Ayurveda does not derive its authority by the fact of its being divined by Brahma; its merit comes simply from the verifiable truths it contains”.

An inadequate grasp of this yukti vyapashraya spirit that guided the origin and evolution of classical Ayurveda is the central bane that's marring Ayurvedic education today. Outdated medical facts are held as current and imperfect hypotheses eulogised as perfect laws. This process is aided by laboured misinterpretations of ancient aphorisms to suit contemporary scientific findings. Add to this the extremely crass new age fancy of 'discovering' the ideas of Quantum Physics in Indian philosophical literature, the Procrustean bed of laboured misinterpretations achieves its lethal completeness. This dangerously flawed approach leads to imperfect clinical applications, on one side and to a complete smothering of the innovative spirit, on the other.

Science, that is not clear enough, is often simply science that is not science enough. Richard Feynman, the Nobel Physicist, was once asked by a Caltech faculty member to explain a rather complex physics concept to young students. He gauged his audience and said, “I’ll prepare a freshman lecture on it.” But a few days later he returned and said, “You know, I couldn’t do it. I couldn’t reduce it to the freshman level. That means, we really don’t understand it”.

The Ayurvedic academia, from university professors to journal editors, lack this plainness - the plainness that comes from a simple-minded yet courageous love of truth. Their student, therefore, needs empathy, not condemnation. He is, in fact, the victim of being schooled in a worldview that the great yukti vyapashraya tradition decisively outdated about three thousand years ago! His migration to allopathic practice in such a scenario should come as no surprise at all.

G L Krishna

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