Abstract

Medicine is ready for a synthesis that would incorporate the best of modern scientific medicine and traditional systems of medicine. The synthesis needs a critical but unbiased and sympathetic look at the fragments that we wish to synthesize. That will give us a synthesis for the right reasons, a synthesis that will be rich and powerful. The first step in the synthesis is to understand the basic principles, and the underlying philosophy of each system that we wish to incorporate in the synthesis. This will require not only studying the systems, but also getting rid of several misconceptions and prejudices that abound about each system. For example, yoga is not a system of medicine but a physical and mental discipline designed for spiritual growth. But yoga does make a person physically fit, emotionally stable, intellectually agile, and gives him a way of looking at the world that can fill life with love, peace and joy. That is why yoga becomes a valuable tool in the practice of mind-body medicine, which is the latest incarnation of modern medicine. That is the concept that has been incorporated into the practice of modern medicine by cardiologists such as Dean Ornish. That is the view of yoga that guided the establishment of the Integral Health Clinic at the All India Institute of Medical Sciences, New Delhi, in the year 2000. Without this understanding, either we would reject yoga in favour of less effective relaxing and counseling techniques available in modern psychology, or just add yoga as an adjunct to modern medicine and treat it as a close cousin of physiotherapy. On the other hand, ayurveda is a system of medicine that treats the mind and the body as a unit, its prescription touches all physical and emotional aspects of life besides drugs, and the treatment is tailor-made to the individual uniqueness of the patient, the season, and the place where he lives. Ayurveda has a coherent underlying philosophy, although it cannot be understood easily in terms of modern science. Without this understanding of Ayurveda, either we would reluctantly accept a few of its drug formulations, or even reject it altogether because its formulations have not yet gone through the mill of randomized controlled trials. Appropriate synthesis of different systems of medicine has immense potential for promoting positive health, preventing disease, and making healthcare less expensive, more effective and culturally acceptable. The first step towards the synthesis should be making some bold and radical changes in our policies in the areas of medical education, research and healthcare.

The inspiration for the subject of this paper came from one of the major works of Sri Aurobindo, The Synthesis of Yoga. When Sri Aurobindo worked out his synthesis, yoga was passing through a phase similar to medicine today. Starting with the broad idea of self-perfection so that the body-mind complex would work in light of our divine essence, yoga had branched off into several schools, which had specialized in different aspects of perfection. While schools such as hatha yoga and raja yoga had demonstrated the amazing heights to which the perfection of the body and the mind respectively could be taken, the emphasis on superficial features had come to overshadow the spirit of yoga. Looking at the process in a dispassionate manner, Sri Aurobindo pointed out that all “the greater forms of human activity” are characterized by a cycle of specialization and synthesis. Starting with a “harmonized complexity and totality”, the form “breaks apart into various channels of special effort and tendency, only to unite once more in a larger and more puissant synthesis” (Aurobindo, 1970). The era of specialization is important because it allows development of one aspect of the totality to a level that would not have been possible without concentrated attention to just that aspect. But specialization tends to emphasize details that eclipse the underlying spirit; hence the need for periodic synthesis to revive the vibrant harmony with which we started. The new synthesis is more powerful than the original totality because it can incorporate the advances made during the era of specialization. The cyclic process is exemplified by medicine no less than by yoga. Starting with the totality that the General Practitioner of yesteryears mastered so that he could take care of people from womb to tomb, we reached dizzying levels of super-specialization. The drawbacks of specialization prompted an urge for synthesis symbolized by disciplines such as community medicine, family medicine, holistic medicine, and mind-body medicine. While these disciplines were developing, modern medicine also rediscovered mind-body approaches such as yoga, which can serve as tools in mind-body medicine (see, e.g. Ornish 1996, Siegel 1990). The limitations of modern scientific medicine also drew attention to traditional systems of medicine such as ayurveda (see Chopra 1989). Some of the practitioners of modern medicine have taken a deep interest in several other systems of medicine (see e.g. Weil 1996). As a result, a powerful synthesis of different systems of medicine has already begun. The synthesis that is now underway is incorporating the advances of the era of specialization in modern medicine, traditional systems of medicine, and also the spiritual wisdom enshrined in disciplines such as yoga (see Dossey 1999).

What is a true synthesis?

In The Synthesis of Yoga, Sri Aurobindo says that a true synthesis is neither placing the elements to be incorporated in the synthesis side by side, nor the successive practice of these elements. For example, having in the same hospital modern medicine in one block, ayurveda in another block, and homoeopathy in yet another block would not be a synthesis. Also, treating the same patient with ayurveda for one month, naturopathy in the next month, and Tibetan medicine in the third month would also not be a synthesis. A true synthesis, according to Sri Aurobindo, takes into account the central principles of the elements to be incorporated in the synthesis, and then unites them into a harmonized entity. Such a synthesis allows the simultaneous application of the best features of each element. Moreover, the synthesis cuts through the superficial conflicts between the elements being synthesized, and thereby re-vitalizes the spirit of the original.

How may the synthesis be achieved?

The broad principles which may be followed while working out the synthesis have been illustrated below by using, as examples, modern scientific medicine, yoga and ayurveda. The choice is based purely on the fact that the author knows something about these three systems, and virtually nothing about the other systems of medicine. But a real synthesis of medicine would be incomplete without incorporating several other systems of medicine.

Central principles of modern medicine

The central principles of modern medicine are a rational approach, the emphasis on experimentation, and being open to revision.

1. Rational approach

Modern medicine is essentially the product of the European Renaissance, which was a revolt against unquestioning respect for religion, tradition, and authority. It was a rather abrupt departure from the age of convention to the age of reason. Therefore, it is not surprising that reason occupies a very high pedestal in modern medicine. The reasoning has sometimes been crude, as in the doctrine of signatures of Paracelsus. If the starting premise is wrong, reasoning may lead to ridiculous conclusions. Therefore, in spite of being rational, it has been fashionable in modern medicine, at various times, to either apply leeches to withdraw blood, or to give additional blood by transfusion. But reason is not, as a matter of principle, abandoned in favour of tradition or authority in modern medicine. While reason does not necessarily lead to truth, well-developed and refined reason is the highest faculty of man that he can routinely and reliably use in his search for truth. Therefore, any synthesis of medicine would do well to retain a rational approach.

2. Experimentation

Reason cannot work in a vacuum. The facts for reason to work on consist of experimental observations. The typical approach in modern medicine has been to start with a question. Then a situation is designed (or found) that would allow answering that question with least possibility of error. The observations generated by the situation are processed by reason. Reasoning may lead to more than one plausible conclusion. One of the conclusions is accepted and the others rejected. The selection of the acceptable conclusion may be subjective, and not necessarily right. This is one of the reasons why the interpretation of experimental observations may be wrong, in spite of the logic being thorough. The experimental approach has many other pitfalls as well, but it also has remedial measures built into it. The conclusions are considered tentative, and are subject to verification by more and better experiments. The experiment not only answers questions but also raises new questions, which may be answered by still more experiments. It is through experimental studies in the laboratory, community and the clinic that modern medicine has grown to its present stature during the last few hundred years. The scientific rigor of modern medicine is a strength that any synthesis of medicine can benefit from.

3. Open to change and growth

As science and technology have grown, the capacity of modern medicine to peep into the body with imaging techniques, to study the chemistry of blood, and to study biological processes at cellular and molecular levels has grown enormously. This has made it possible to perform experimental studies that are more comprehensive, incisive and reliable. As a result, old knowledge may be proved wrong, and new knowledge continues to reduce our ignorance. The readiness to revise long-standing practices, the humility to accept that what we know is much less than what we do not, and the eagerness to expand the armamentarium in light of new knowledge, are the strengths of modern medicine that no synthesis should discard.

Central principles of yoga

Strictly speaking, yoga is not a system of medicine (Bijlani 1998). It is a physical and mental discipline designed for spiritual growth. But since good health is a by-product of the discipline, some components of the discipline have been used by several systems of medicine. The central principles of yoga, specially those relevant to medicine, are:

1. A way of life

It is a way of life based on the spiritual view of life. It is a way of life that includes taking good care of the body-mind complex, and living a life that is full of love and compassion with an attitude that is unselfish and non-judgmental. If life is so-lived, health takes care of itself.

2. Lifestyle as a part of the philosophy of life

A healthy lifestyle is characterized by moderate physical activity; a balanced diet in just the right quantity; keeping away from smoking, drinking, etc.; and good-quality sleep for the right duration. Such a lifestyle may be adopted out of fear of disease and death. But in yoga, the primary reason for adopting such a lifestyle is quite different. In yoga, the reason is that the body-mind complex is equipment that has been given to us for fulfilling the purpose of life, the purpose being spiritual growth. The Divine gives us the equipment, and also the conditions and circumstances for spiritual growth. The least that we can do is to take good care of the equipment, just as a responsible worker cleans and oils regularly the machine that he uses. Not taking good care of our body-mind complex would be a sign of ingratitude to the Divine. Therefore, adopting a healthy lifestyle is, in yoga, a sacred duty. Moreover, when the goal of life is union with the Divine, as in yoga, many of the ordinary pleasures of life such as tasty food, sleeping late, smoking, drinking, etc., lose their attraction. Therefore, a person on the path of yoga enjoys the healthy lifestyle. Enjoying the healthy lifestyle is quite different from adopting the healthy lifestyle out of fear of disease and death. If the healthy lifestyle is adopted out of fear of disease and death, the person is under stress. While he is eating fruits and vegetables, his mind is dwelling on omelets and cutlets. The result is that the good that the healthy lifestyle does is neutralized by the harm due to the stress due to missing the unhealthy lifestyle. Therefore a healthy lifestyle is most effective if a person does something because he wants to rather than because he has to.
Apart from the stress due to missing the fleeting pleasures of life, the other stresses of life also continue if a healthy lifestyle is adopted purely as a part of the treatment of a disease. Modern medicine has rediscovered that psychological factors often override physical factors when it comes to health and disease. Thus, even if the physical factors have been taken care of, if mental stress continues, the efficacy of treatment may be significantly compromised. Yoga relieves not only the stress of a healthy lifestyle because the person enjoys it as a part of an overall philosophy of life, yoga also relieves stress due to the problems, difficulties and traumatic events that are an inevitable part of life. That happens because the spiritual philosophy on which yoga is based looks upon the events of life in a neutral manner. It looks upon these events not as ‘good’ and ‘bad’, but as opportunities for spiritual growth, which is the purpose of life. We can grow spiritually through both ‘fortune’ and ‘misfortune’, and a mixture of both is necessary for appreciating this vital truth of existence.
Thus, yoga makes a person physically fit, emotionally stable, intellectually agile, and gives him a way of looking at the world that can fill life with love, peace and joy. That is why yoga becomes a valuable tool in the practice of mind-body medicine, which is the latest incarnation of modern medicine. That is the concept that has been incorporated into the practice of modern medicine by cardiologists such as Dean Ornish (Ornish 1996). That is the view of yoga that guided the establishment of the Integral Health Clinic at the All India Institute of Medical Sciences, New Delhi, in the year 2000 (Bijlani 2004).

3. Health is a by-product

Yoga transforms life; it makes us unselfish; it gives life a goal that goes beyond self. Living such a life leads to a healthy lifestyle and mental peace as primary by-products. A secondary by-product of the primary by-products is health. That does not mean a person on the path of yoga never gets a disease. But what it means is that, first, the risk for disease is reduced. Secondly, if the person gets a disease, recovery is more likely. Thirdly, if the person does not recover, he is not miserable, because he treats pain and disease also as external circumstances that he has been given for spiritual growth. Finally, if he succumbs to the disease, he dies in peace, because the philosophy underlying yoga has also taught him to overcome the fear of death.

Thus, although yoga is not a system of medicine, it has several elements that are relevant to medicine. Yoga, adopted in its true spirit, has relevance to the entire spectrum from health promotion and prevention of disease through management of disease, palliative care and dying with dignity. What is often done is to tear the yogic techniques (asanas, pranaymas and meditation) out of context and use them for treatment of chronic disease. Even that has generally given positive results. If so little done so half-heartedly has a favourable outcome, one can only imagine how much more may be gained if yoga is understood in its entirety.

Central principles of ayurveda

Ayurveda is an ancient system of medicine with origins that go back to the Vedic times. It was probably the first system of medicine that integrated principles of yoga into its underlying philosophy. The philosophy underlying ayurveda takes into account the totality of the being – body, mind and soul – exactly as yoga does. Besides the totality of the being, ayurveda also recognizes that the psychological constitution of individuals shows an enormous range, depending on which mode of nature – tamas (inertia), rajas (activity), or sattva (harmony) – is dominant. These three modes of nature are also a part of yoga, particularly the yoga of the Gita. Ayurveda further recognizes that the physical constitution of individuals also shows a similar range, depending on which dosha (humor) – vata (cold and mobile), pitta (hot and penetrating) or kapha (cold and stable) – is dominant. Not only people, but foods, time of the day, and seasons are endowed with similar characteristics based on the dominant dosha. The philosophy underlying ayurveda is difficult to understand in terms of modern science, but is coherent, and internally consistent. In view of its underlying philosophy, the central principles of ayurveda are:

i) Individualized approach

Unlike the predominantly one-size-fits-all approach of modern scientific medicine, ayurveda has an individualized approach to treatment. Modern medicine is gradually recognizing the value of this approach, and as pharmacogenetics develops into a well-developed science, modern medicine may be in a position to adopt the same approach. But it is unlikely that the tools for determining the genomic uniqueness of an individual will ever be as efficient and inexpensive as determining the prakriti (individual nature) of an individual on the basis of ayurvedic principles. Hence, there is a very strong case for exploring correlations, if any, between the genome and the prakriti of an individual.

ii) Influence of lifestyle, time and place

Besides the prakriti of an individual, his lifestyle, the season and the place where he lives affect the manifestations of the diseases to which he is vulnerable. Accordingly, the treatment also takes into account all these factors.

iii) Comprehensive management

The treatment of disease is tailor-made to the individual, time and place, and includes lifestyle modification, psychosocial interventions, and drugs. Further, the progress of the patient is monitored, and the treatment is periodically revised depending on which way the patient’s health is moving.

iv) The modus operandi of the synthesis

A true synthesis needs a critical but sympathetic look at the systems that we wish to include in the synthesis. For this, the starting point would be to understand the systems. Since one person may not be able to master all the systems, all those involved in the synthesis should know at least one system thoroughly but each of them should also know enough about the other systems to be able to participate in an informed discussion. Each of them should not only understand the basic principles of all the systems to be included in the synthesis, but should also use this understanding to unlearn and overcome the prejudices that he might have about some of the systems. The basic principle should be that if the synthesis accepts something from a system, it should be accepted because we understand it. Even more important, if something is rejected from a system, it should be rejected because we understand it. Based on these considerations, let us examine the most valuable contributions that modern medicine, yoga and ayurveda can make to such a synthesis.

Contributions of modern medicine

The most valuable contributions of modern scientific medicine to the synthesis would be:

a) Mechanisms of health and disease

Modern medicine has reached today an unprecedented understanding of the mechanisms of health and disease from the gross down to the molecular level; from the genetic up to the systems biology level. This knowledge can contribute enormous strength to any synthesis of medicine.

b) Diagnostic accuracy

Although history and clinical examination continue to be of primary importance for diagnosis, modern medicine has also available now remarkable imaging techniques and biochemical techniques that allow a very good peep into the body without any invasive intervention. The result is a very high level of diagnostic accuracy. For an accurate anatomical diagnosis, any synthesis of medicine can afford to lean heavily on modern medicine.

c) Amazing scientifically tested interventions

The way modern medicine has been able to hit the nail on the head in infectious diseases, endocrine deficiencies and nutritional deficiencies is truly amazing. The neat mathematical approach of modern medicine in these situations may not go to the roots of the problems in terms of the fuzzy psycho-social and spiritual realms of causation of disease, but from a pragmatic point of view, controlling typhoid within a week, or bringing blood sugar down with a shot of insulin have a lot of value. Any synthesis of medicine worked out for human beings, whose consciousness is still rooted primarily in the physical, will continue to find physical interventions useful.

Contributions of yoga

Although yoga is not a system of medicine, several elements of yoga can be incorporated with profit in any synthesis of medicine as outlined below:

1) A healthy lifestyle

The yogic lifestyle that includes physical activity, a healthy diet consumed without greed, and adequate good quality sleep is particularly useful in the prevention and management of chronic disease. After the emergence of lifestyle disorders as major killers of mankind, lifestyle interventions based on yoga have already become a part of modern medicine.

2) Reasons for adopting the healthy lifestyle

More than the healthy lifestyle, yoga gives reasons for adopting the lifestyle in terms of a philosophy of life. This makes a person adopt the new lifestyle and enjoy it too. This aspect now stands on a sound scientific footing, and would be a value addition to any synthesis of medicine.

3) Positive thinking

It is generally known and acknowledged that stress depends not on a situation but on our attitude to the situation. Therefore, finding something positive in a situation that is a cause of worry, anxiety, anger or depression in an individual makes the situation seem less intolerable. This is called positive thinking, and is aimed at by counselors through a process technically called cognitive restructuring. However, positive thinking based entirely on logic has its limitations because there are some situations in which, no matter how hard one tries, it is impossible to find anything positive. But counseling based on the spiritual philosophy underlying yoga has no such limitation. Even if there is nothing else that is positive in a situation, there is one positive feature that it always has: it is an opportunity for spiritual growth. Thus, yoga can enrich the armamentarium available for counseling in any stressful situations, even in situations where the stress may be due to an incurable illness.

4) Happiness independent of circumstances

Managing stress through positive thinking makes stress manageable, or less intolerable. But yoga can inspire something far more positive: it can help make the person inwardly defined so that his happiness does not depend on external circumstances, such as his bank balance, the car that he drives, the food that he eats, or the way his or her partner behaves. By making the person discover the source of happiness within, yoga can give the person mental peace that is independent of external circumstances. This is relevant not only to mental health, but also physical health because of the intimate mind-body relationship, which now has a firm scientific footing.

Contributions of Ayurveda

Yoga is one of the oldest time-tested systems of ayurveda that has survived centuries of neglect. It has many features that modern medicine has just started incorporating recently.

– Individualized approach

The individualized approach, which is still in its infancy in modern medicine, is a major principle in ayurveda. How to individualize treatment on the basis of answers to a few simple questions is a valuable contribution that ayurveda can make to a synthesis of medicine.

– Making treatment suit time and place

Seasonal and geographical variations in health and disease are well known. Accordingly, these factors should logically influence treatment also. Ayurveda has such variations built into it on a rational basis, although the logic it employs is difficult to understand in terms of modern science.

– Holistic approach

The unity of body, mind and soul, which ayurveda subscribes to, is the basis of an integral approach to health and disease. Modern medicine is also moving in the same direction, although independently, and following a different route (Dossey 1999). Without this principle, any modern synthesis of medicine would remain incomplete.

– Time-tested drug formulations

Ayurveda has a large number of drug formulations, mostly herbal, many of them having a very large number of ingredients. There is considerable stress laid on the exact method of preparation. These preparations have been used for thousands of years because they have worked; and although some of the details are now lost or neglected, they continue to work. It would be a pity if this knowledge were discarded by a synthesis of medical systems just because most of the ayurvedic formulations have not been tested in carefully designed clinical trials.

It is often suggested that ayurvedic drugs should be examined by the methods of modern science. Behind this suggestion is the fond hope, in fact usually a firm belief, that the examination will revalidate these drugs, thereby lending them greater acceptance and respectability. While the suggestion is inspired by the patriotic feelings of Indians as well as the urge for contributing to human welfare, it is not easy to implement. The positive effect of adhering to the multiple guidelines of ayurveda, or the negative effect of violating them, is likely to be small and subtle, and may take several years to manifest. Scientific studies cannot easily detect such small and subtle long-term effects. Also, the number of factors that could affect the outcome, and the number of outcome variables in such studies would be extremely large.  Going by the analytic approach of modern science, looking at the effect of adding or removing one ingredient at a time would not only be inappropriate but also very time-consuming: a double-blind placebo-controlled randomized clinical trial on just one drug formulation could easily keep a team of scientists busy for a lifetime. Add to that the classification of subjects into at least seven subgroups based on their prakriti, and the likely effect of the different ways in which the ingredients may be processed, and the variations in treatment required in terms of season, place and progress of the patient, and we will have an enormous task and extremely complicated data in store, if ever such studies are undertaken. The next question that may be asked is how Ayurveda acquired all this knowledge in the first place if it is so difficult to arrive at. The rational answer to this question is that it has been arrived at by trial and error as a result of natural experiments that have been going on in large populations for millennia. The non-rational, or rather supra-rational (to use an expression of Sri Aurobindo’s) explanation is that the pioneers of Ayurveda were not ordinary physicians or scientists but rishis (mystics). Ayurveda is revealed knowledge, knowledge revealed to the ancient Indian spiritual masters (Nishar & Nishar 2010). Be that as it may, the point is that the drugs work, and it is almost impossible to test them by the methods that are used for testing new drugs in modern medicine. An alternative is to modify the methods to suit the principles of ayurveda, as has been done in a few excellent collaborative studies (Furst et al 2011). But waiting for all ayurvedic formulations to be so tested before incorporating them in a synthesis would deprive mankind of some very effective treatments, particularly for chronic diseases, for which modern medicine has very little to offer. Therefore, a pragmatic approach that takes into account the clinical experience of ayurvedic physicians and consensus among experts may be adequate for determining which formulations to accept in a synthesis.

When should the synthesis be undertaken?

The time for the synthesis has arrived; in fact, a synthesis is already underway. Modern medicine has started expanding its boundaries to embrace concepts that it had forgotten, such as the mind-body relationship; concepts that it did not know enough about, such as self-healing; and concepts that it kept away from, such as healing through good intentions of the healer. The expansion of modern medicine has thus made it open to most of the concepts that other systems of medicine lean heavily on. Being conscious of the process of synthesis, and practitioners of different systems of medicine participating consciously in the process would accelerate the very process of synthesis, much to the benefit of mankind. What the synthesis would give us is the best from all systems of medicine. The integration of the most admirable elements of holistic disciplines such as yoga and ayurveda with modern medicine will make the practice of medicine based on the synthesis more effective in promotion of health and prevention of disease, less dependent on drugs, and address better the social, psychological and spiritual needs of the society. In India, and several other Eastern societies, the practice of the new version of medicine will have the added advantage of being more culturally compatible. Added to all these gains will be the mundane, but not unimportant, gain of reduction in the cost of healthcare.

Closing thoughts

The synthesis of medicine has begun, and will go on relentlessly because no idea can wait once its time has arrived. However, the rate at which the idea is translated into action, and who translates the idea into action, can be influenced by the choices made by all those who are in a position to either push or obstruct the idea. Since modern medicine and traditional Indian wisdom are destined to be two major components of the synthesis, it will be a pity if India and Indians make no major contribution to this revolutionary effort of great historical significance. For India to play the role that it can potentially play in the synthesis of medicine, we need radical changes in our policies and practices in relation to medical education, research and healthcare. The what, why and how of these changes can be the subject of another paper, but it is the author’s considered opinion that without such changes India will end up being just a spectator to the synthesis that has already made an unspoken but unmistakable beginning in the western world.

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