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Let’s Not Be So Quick To Dismiss Ayurveda

Let’s Not Be So Quick To Dismiss Ayurveda

A statue of Sushruta in Haridwar, Uttarakhand. Photo: Alokprasad/Wikimedia Commons, CC BY-SA 3.0.

We Indians are a lucky lot. No other civilisation can boast of so many different traditional medical knowledge systems. Today, however, this is both a boon and a curse.

The amendment introduced by the Ministry of AYUSH sanctioning Ayurveda practitioners trained in surgery to practice certain types of surgical procedures has received mixed attention. It has once again stirred debate of a binary kind: either go the modern way or the Ayurveda way. The lack of an intermediate space is unfortunate – not just for care providers but, importantly, for us, the patients.

Ayurveda proponents rightly claim that India gifted surgery to the world, with the Sushrutha Samhita being perhaps the oldest medicinal text to discuss surgical procedures. Commentaries on the history of Indian medicine have recorded the resemblance of surgical instruments and procedures described in the classics and those in use today – like the Simhamukha, described for use in grasping bone fragments, and the modern forceps to hold bones.

While it’s possible that the forceps represent the simplest possible design to achieve a certain kind of grip, there is room here to acknowledge that both Ayurveda and more modern techniques are capable of following these principles unto their logical conclusion. Such historical continuity in toolsets matters.

However, such antiquity-based arguments are also self-defeating at times. A sceptical reader may observe that simply being ‘old’ is scant justification for relevance today.

This observation would be correct. While we can claim historical rights, our inability to either preserve or evolve the traditional craft in line with modern medicine has been a glaring lacuna. Casual references to mythology or history, such as “Lord Ganesha was the first example of plastic surgery”, also significantly dent any academic argument to support Ayurveda-based surgical practices.

So it is time we moved away from the cultural and historical defence of Ayurveda, and began conversations about how this knowledge can strengthen our healthcare system. An example is in the area of suturing, mentioned in the Sushruta Samhita (Sutrasthana, chap. 25; shloka 20-26). This section details different types of suturing materials to ensure a clean finish and prevent scarring. Imagine the possibility of using this knowledge as a base to develop and test better suturing materials.

In one broad stroke, the AYUSH ministry appeared to declare those with a postgraduate degree in Shalya tantra and Shalakya tantra as mainstream. However, this is not arbitrary: such training has been informally transmitted in India, and has been formally recognised since 1971, through the Indian Medicine Central Council Act. The amendment is therefore a minor change in the status quo. And through the amendment, the government has provided definitive clarity on which procedures can be performed by an Ayurveda surgeon, and which can’t.

It must be emphasised that Ayurveda surgeons are limited in their scope. They can only perform certain types of general surgery – and those types have remained unaltered both before and after the amendment. Notably, in some cases, like the use of ‘Kshara Sutra’ (medicated thread) in treating fistula-in-ano, clinical trials that compare it to modern surgery suggest similar efficacy and sometimes better long-term outcomes (studies here, here and here).

On the matter of training – there seems to be chagrin that the Ayurveda postgraduate course borrows heavily from western medicine, and simply replaces terminology with Sanskrit translation. This is quite right, but we must ask why this is so. This is not the product of a poor imagination or an intention to usurp western medicine. Instead, it is the result of the sad fact that documentation and archiving haven’t been strong suits of Indian culture.

As N.V. Krishnankutty Warrier notes in his book History of Ayurveda (2005), Ayurvedic knowledge was transmitted orally and recorded much later, and a lot may have been lost by the time scholars began to compile books. Quotations and references available in the major commentaries (Samhita), indicate the existence of several works that are not available today. For example, in P.V. Tewari’s English translation of the Kashapa Samhita, the sutra-sthana begins only from chapter 18; the first 17 are missing.

But while much knowledge has been lost, there is no reason for us to stop investigating what is left. This lack of investment in research, to understand the rigour of the procedures as well as other aspects of surgery in Ayurveda, is something the community feels keenly.

For example, consider the notion of ‘surgical conservatism’. Muralidhara Sharma, professor emeritus, S.D.M. Ayurveda College and Hospitals, says his patients seek him out to explore other options in instances where modern medicine only prescribes surgery. To treat a diabetic foot, a common complication of untreated diabetes, an Ayurveda practitioner will first exhaust all known procedures to heal the wound; amputation is the absolute last resort. Ayurvedic precepts also disallow surgeries for some conditions that are deemed ‘incurable’.

To some of us, the image ‘Ayurveda surgery’ perhaps conjures a saffron-clad baba in a tent performing an operation without any drugs. This is far from reality. Ayurveda surgery is conducted in purpose-built facilities, with anaesthesiologists, nurses, antibiotics and a sterile operation theatre being standard features.

The issue is that while the academic syllabus of Ayurveda surgery graduates is similar to those of western medicine, their exposure to practice is limited. And it is this gap that the Ministry of AYUSH ministry needs to bridge so that India can utilise this cadre of surgeons well.

One way could be to provide certification courses that insist Ayurveda surgeons complete internships with surgeons in modern medicine for a certain meaningful period of time. Doing so would sharpen the skills of Ayurveda scholars and also instil confidence among allopathic surgeons of their compatriots’ capabilities. Such cross-bridging training programmes aren’t new. Since 2008, Maharashtra has allowed Ayurveda practitioners who have completed a course in pharmacology to also prescribe some modern medicines.

But rather than thinking of new ways to make such amendments work for India’s patients, it is unfortunate that the Indian Medical Association has occupied itself with semantics and sloganeering. Their resistance includes words like “mixopathy” or “khichdification”. These are not academic arguments, nor does the vilification of mixopathy of any sort hold water. Why silo knowledge into bins that can’t speak to each other? We only become more knowledgeable when we let disciplines of study speak to each other. In fact, we are all better off acknowledging that modern medicine is itself a ‘mixopathy’ that, over time, has borrowed both legitimate and inhumane ideas from chemistry, neuroscience, anatomy and psychiatry.

Language aside, the current debate has been reduced to the protection of narrow professional interests. We should instead seek from our medical experts to strengthen our medical system by infusing oversight and regulation into training and practice. To rephrase Sushrutha, the ten fingers of the hand are the best instruments but for which the operation of other instruments ceases. Let that hand be well-trained.

Megha is an assistant professor at the Centre for Ayurveda Biology and Holistic Nutrition, The University for Trans-Disciplinary Health Sciences and Technology, Bengaluru. The views expressed here are the authors’ own.

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