A statue of Charaka, the sage who wrote one of the principal early Ayurveda texts. Photo: Alokprasad/Wikimedia Commons, CC BY SA 3.0.
Note: This article was first published on February 14 and was republished on February 15, 2021.
Allegations of irrational practices in Ayurveda have raised many problems for the indigenous medical system of late – ironic considering it has survived for three millennia sans any patronage.
Ayurveda became sidelined during colonial rule in India when the western, subsequently modern, system of medicine became part of the country’s education and medical practice. Experts today say this system more than influences how Ayurveda is practiced and taught.
To many Ayurveda practitioners and teachers, this is not surprising: they see this state of affairs as the product of, among other things, a ‘trial and error’ method of practice born out of a flawed education system.
Many of them expressed concern about training in colleges, which prioritises knowledge of modern medicine over its Ayurvedic counterpart, and about the Sanskrit language, an oft-unanticipated hurdle for students before they can come to terms with Ayurveda as a medical system.
And all of them recognise that, as a result, students that graduate with Bachelor’s in Ayurvedic Medicine and Surgery (BAMS) degrees often start off confused, low on confidence, without any major job opportunities and not always aware of good science.
Faculty members of various colleges told this correspondent that practitioners often use terms rooted in modern medicine when they record patient history, instead of their Ayurvedic counterparts.
Dr P. Rammanohar, director of research at the Amrita Centre for Advanced Research in Ayurveda in Kollam, called this the “allopathisation of Ayurveda”.
One professor at a self-financed college in Kerala said on condition of anonymity that students are taught the classical texts in theory but a practical approach to Ayurveda is missing from their curriculum.
Every medical college begins training its students to attend to patients with the precepts of clinical examination and history-taking. But in Ayurveda colleges, this aspect seems to exist mostly in its ‘modern medicine’ form. And this appears to be true at both government and private colleges, according to the professor.
“About 90% of teachers in Ayurvedic medical colleges don’t know this art themselves,” the professor said. “Students don’t learn to take clinical history in Ayurveda terms because they are not being taught properly in the medical school.”
Dr Remya Krishnan, an associate professor and head of the department Ayurvedic clinical pharmacology at Rajiv Gandhi Ayurveda Medical College, Mahe, said clinical learning would be possible only if teachers know the sastra artha – the meaning-knowledge embedded in the corresponding Sanskrit verses. According to Dr Krishnan, teachers should also be able to convey the intent of each sastra properly.
“It is not the mere meaning of the sloka but the intention of the sloka that is important,” she said.
Dr S. Gopakumar, an associate professor and head of roganidana (aetiology) at the Government Ayurveda College, Thiruvananthapuram, also said that though the existing education system is enough for students to begin practicing once they have a BAMS degree, it isn’t the end of the road.
However, economic factors have a say in how far new doctors can steer their careers along with their individual interests. Very few eventually have the opportunity to pursue postgraduate education and further refine their skills.
Then again, the fact that there aren’t many Ayurveda practitioners able to utilise their graduate-level education could mean that there are some limitations on that front too, Dr Gopakumar – who is also secretary of the Akhila Kerala Government Ayurveda College Adhyapaka Sanghatana – added.
Dr Sreeja S., head and professor of Shalakyatantra (ENT health) at the Government Ayurveda Medical College (GAMC), Tripunithura, agreed with Dr Gopakumar about the pros and cons of technologies used in clinical settings.
According to her, digital tools have helped check, verify and document prognoses in the Ayurvedic management of diabetic retinopathy for many years. She said that the Kerala government had recently accepted a proposal for the GAMC to conduct a public screening for diabetic retinopathy.
However, she also said over-reliance on such technology doesn’t bode well for students and practitioners alike because it glosses over Ayurveda’s concepts of darsanam (observation), sparsam (inspection) and prasnam (questioning the care-seeker).
The problems with learning Ayurveda begin early in the course of obtaining a BAMS degree. Dr T. Sreekumar, a professor and head of Shalyatantra (surgery) at the P.N.N.M. Ayurveda College, Shornur, said that for new students just beginning to learn Ayurveda, the first shock is the Sanskrit language.
Around 15% of students could be somewhat familiar with the language, he said, and for most of the others, it is completely new – more so when students from Kerala or those speaking other Indian languages encounter it in the Devanagari script. And many of them are distracted by having to learn the language in the time they are required to learn medicine.
“They joined a medical school, and now they are stuck with learning Sanskrit.” For six months, they would be like fish out of water, Dr Sreekumar said. It is only by the end of the year that they come to terms with the language – although, according to Dr Nandini Hareesh, an Ayurveda practitioner, a few students may also drop out by that time.
Dr Gopakumar agreed that Sanskrit is often the first barrier. “It happened to me too,” he recalled. “I did not have any background in the language nor did I come from any of the traditionally known Ayurveda families.” But he has since received three awards for teaching Ayurveda.
According to Dr Sreekumar, it is “mainly because of their young age” that “they are able to accommodate both the study of modern medicine and Ayurveda”. The curriculum is “a mixture of anatomy, physiology, basic principles of Ayurveda, Sanskrit and so on”.
Then there is the philosophy: “They learn an alien system of medicine, an alien science, an alien language, an alien philosophy… Indian philosophy is not known to the majority of students,” Dr Sreekumar said. “But then like swimming, nine out of ten learn to swim when they are pushed into a pool.”
The quality of education has become diluted over the last few decades, and Dr Sreekumar said Ayurveda hasn’t escaped this trend either. “But when you consider the crude manners in which dissections were taught to us, during our student days – there has been a marked improvement.”
He also said the overall infrastructure and knowledge of pedagogic methods available for Ayurveda instructors has improved. And learning about modern medicine in this context is, according to him, a useful way for students to stay updated. So in that sense, a little more needs to be added to the curriculum.
Ayurveda’s concepts have to be built over and above a foundation of modern methods, Dr Gopakumar said. He added that those who are able to blend both are able to set up their practices early – but those who spend more time understanding the Ayurvedic system developed a more refined practice.
However, Dr Krishnan disagreed, saying most doctors continue their irrational practices even after many years because they haven’t properly understood any science in the system.
According to Dr Hareesh, “Clinical learning is most inadequate in colleges.”
Even so, Dr Sreekumar said, the rise in the numbers of Ayurveda clinics indicates a BAMS graduate doesn’t feel the burden of not having a postgraduate degree the way a student of allopathic medicine might.
The infrastructure at medical colleges has been a long-standing concern. Even after private colleges began to blossom around Kerala, regulatory authorities have been hard-pressed to allow them to admit students because they typically had only half the facilities.
Dr K. Murali, a former superintendent of the GAMC Hospital in Tripunithura, has inspected many of Kerala’s medical colleges as a member of the state Directorate of Ayurveda Medical Education. He said the infrastructure and teaching in government Ayurveda colleges is much better today than before – and better than many self-financing colleges.
But not all government colleges are adequate, he clarified. According to Dr Murali, they meet only 70-75% of requirements. These colleges also have problems getting doctors of modern medicines to work with them, causing these posts to remain vacant. They’re also slow to execute administrative work thanks to the bureaucratic mindset of their leaders.
Per Dr Murali, the situation in private Ayurveda colleges is worse, with most of them fulfilling only 60% of their infrastructural requirements. He also said most private colleges had managed to circumvent the Central Council of Indian Medicine inspection using dubious methods. But there has been some improvement more recently, he added, after the Kerala University of Health and Allied Sciences took a strong stand on the matter.
Correspondingly, he continued, the quality of graduates has also improved – although their fortunes still depend on whether they have mentors to help them. Some are lucky enough to be attached to good practitioners before they start on their own. But others find good jobs only in resorts and such – which are not places for clinical practice.
Overall as Dr Rammanohar said, there are a host of factors that contribute to subpar post-education outcomes.
“A degree in Ayurveda is a fallback option for students who don’t get admission in mainstream medical colleges,” he said. “There is also more value in the tag of a ‘modern medicine doctor’ in society.”
The problem continues even after the graduates have entered the healthcare system. For example, Dr Rammanohar said, Ayurveda practitioners are often expected, especially in North India, to provide care of the ‘modern medicine’ variety. And they do so, but often in irrational fashion – practising what the Indian Medical Association calls “mixopathy”.
But no Ayurveda physician in Kerala prescribes modern medicines, said Dr Sadath Dinakar, general secretary of the Ayurveda Medical Association of India. But there are also rumours that the Indian Medical Association’s position against “mixopathy” could be limiting Ayurveda practitioners to prescribe only Ayurvedic treatments and drugs.
In addition, many health sector schemes, like colocating Ayurveda doctors in modern medicine settings, are responsible for having created counterproductive habits – like “Allopathising Ayurveda” – and expectations, Dr Rammanohar said.
“Unless the education system changes and more training is imparted to empower students, changes will not happen towards uplifting Ayurveda from its current status.”
There have been a number of recommendations to this end over the years, including a proposal for a bridge course on Sanskrit and Indian philosophy for BAMS students, Dr Murali said, but nothing has happened to date.
The ball lies in the court of the Central Council of Indian Medicine to revamp the education system such that students have a smooth learning experience, and that when they graduate, they are confident of what they have learnt and its place and usefulness in society. Many of the experts said doing this will also improve Ayurveda’s prospects in the country.
This report was supported by a grant from the Thakur Family Foundation. The foundation didn’t exercise any editorial control over the contents of this report.
Shyama Rajagopal is an independent journalist in Kochi. She was previously a health correspondent with The Hindu, for 20 years.