What is the epistemological principle of traditional medicine?

• "The definition does not mention a single science, but rather puts forward criteria that can be fulfilled by validating and systematising any knowledge, not necessarily dismantling its methods, or replacing it with modern scientific logic", 
• "It is known that efforts to understand the human body have started from the same point in Western medicine and Ayurveda, ie, dissection of the human body (Herophilus and Erasistratus, Sushruta)", 
• "Ayurveda preferred the identification of commonalities between structures and functions and utilised them to understand physiology, harmonious functioning of the body and mind, illnesses, and their treatment. This led to a convergence; the properties and functions that coexisted most frequently were grouped together (to reduce complexity and facilitate expression) and were named depending on the agents in nature resembling these functions. The tridosha concept is its culmination. In most Indian theistic philosophical schools, such variables are said to be “inferred” and they are considered existent (as they are felt through their effect on the manifest forms in the body). Such variables are termed “latent variables” in statistics. Reduction of complexity of data in statistics is also done using similar methods as in factor analysis "

• "This equivalence might also be rewarding in its potential to generate new research questions of mighty impact: Does a high volume of the ejaculate indicate a preponderance of Y-carrying sperms?! Was Sushruta subtly pointing at this truth when he said that excess semen engenders a male foetus?!"

Epistemological dichotomy: a flawed argument
Many scholars tend to argue that Western science and Ayurveda are two epistemologically different yet equally valid and mutually exclusive systems. Their argument is that all Ayurveda theories in their entirety remain relevant and can be shown to be correct using Ayurvedic logic and Ayurvedic methods. They also suggest that viewing these theories from a Western scientific perspective is wrong.
The argument proposing an epistemic divide suggests that Ayurveda’s knowledge originates from Nyaya-Vaisheshika schools of philosophy, which is misunderstood as being epistemologically distinct from Western science. This perspective is flawed as the principles in Nyaya-Vaisheshika closely resemble those in contemporary science, differing primarily in the tools used—ancient scholars employed basic instruments while we now utilise advanced ones. For example, pratyaksha meant using the sense organs to acquire knowledge in ancient times, while we now use instruments such as microscopes for the same purpose.
It is essential to remember that when Ayurveda was documented, the research methods were still in their nascent stage. Ignoring this historical fact, some scholars such as Sandhya Patel and others [1: readers’ comments] went to the extent of indirectly proposing the “epistemic superiority” of Ayurveda. They argued that ancient rishis were able to obtain special knowledge through their divine powers. However, this logic fails because there are diverse and often mutually contradictory views recorded in Ayurveda on many topics. If such a phenomenon were true, such a situation should not have arisen [4].
In fact, this approach of proposing a ‘distinction’ has harmed Ayurveda in the name of preserving our tradition. This position essentially questions the universality of the scientific attitude and, more importantly, discredits all evidence-based science documented in Ayurveda textbooks [5]. This argument also overlooks the simple fact that not all methods are equally accurate and effective in drawing valid conclusions. It is akin to asserting that ancient scholars, who lacked microscopes, had hypothesised about ghosts causing diseases, and that these ideas are just as valid as modern microbiology.

• Theory/principles of anatomy, physiology, and all the 20+ subjects in modern medicine.
• Evidence derived from practice (where an RCT can be used to answer a very specific and narrow question, and various other methods can be used to generate various other evidence)
• Clinician's expertise and subjective perception about the complex set of issues that is going on in an individual and what to do about these (drawing from the above 2 and general knowledge about the world).

• "The new version of PHC needs to recognize the existence,popularity and appropriateness of traditional medicine including home-remedies. But it shouldn't romanticize these systems, and should instead push the scientific community to devise suitable ways to understand and validate these systems and integrate them at the level of knowledge and practice"
  (implying that science hasn't been able to see the "science" of these alternatives)
• "Using completely different ontologies –or conceptualizations of reality. Thus concepts like tridosha, or yin and yang for example are quite inexplicable in terms of modern bio-medi-cine. The doshas, humors etc., also closely link to the question of balance which is a key aspect of many knowledge systems. The concept of balance points to a more dynamic conceptualization. Further balance also is con-ceptualized in a multi-level way which againchallenges a purely static and universalist view of health"
  

• "Its proponents argue that all other forms of health knowledge were no longer valid, were either obscurantist or proto-sciences that must be done away with to give way to this ‘modern science.’"
  (thereby implying that the view of AYUSH as proto-science is wrong)
  
• "When that dominant form is reductionist, the thinking ‘by default’ tends to become reductionist for others as well, unless consciously moored in a different mode of thinking. Conventional bio-medicine or allopathy is considered ‘reductionist’ and other traditions of health knowledge are characterized as ‘holistic.’ While this can be considered so on several counts, all knowledge systems also have several streams within them and are dynamic entities (Sujatha and Abraham 2012). The more holistic traditions, for instance, have attempted to adopt many of the dominant system’s modes of functioning. Their ‘pharmaceuticalization’ at the cost of other components of their multi-dimensional measures is an example of their moving in a reductionist direction (Banerjee 2009). Modern medicine is gaining from ‘systems biology’ and the biopsychosocial model and thereby becoming less reductionist."
  (wherein the claim is that all these AYUSH things are more "holistic" by default - which I don't see any proof of).

• "Based on this, Ayurveda researchers have argued that practice-based evidence and complexity research approaches are the primary methodologies of Ayurveda and the conventional research needs to be supported by whole system research which is more appropriate for traditional systems (Payyappallimana et al. 2020c). Patient management according to Ayurveda is multimodal, planned in the clinical context based on detailed profiling based on patient characteristics, disease stage, severity among others. Management is customized according to patient needs and not based on linear modern pharmacotherapeutics based on the specific biological mechanism or a single target. Such a holistic clinical approach requires novel methodologies for clinical trials."
  

• "We think there is one map for the human body, there isn't. There are multiple maps for the human body. And to see through those maps and follow those maps you have to learn the skills of the system. Which is why the nadi system requires years of understanding it. Which is why Reiki demands a certain kind of practice. Now allopathy teaches you one way. All these teaches you another. Depending on where you stand you will call this alternative or that alternative. Okay? I'll rest my case there."

• "It would seem as if most idiopathic ailments will have causes that are either particular to a small group of people or singular, i.e., that their circumstances are absolutely peculiar to an individual. Perhaps such idiopathic ailments mark the boundaries of a medicine that is based on the statistics of large numbers?"

1. G L Krishna

   Homi Bhabha Fellow , India

   04 November 2023

   Ayurvedic theories such as the doctrine of doshas need to be demystified, by subjecting them to an evidence-based appraisal, precisely because this demystification is necessary to glean researchable propositions on ayurvedic treatments. Propositions gleaned otherwise would always be subject to valid criticisms from ayurveda physicians. As R H Singh writes in one of his editorials, “Any research which does not take into account the denominators of ayurvedic biology such as Tridosha, Saptadhatu, Ojabala, Agnibala, Ama and srotas, that kind of research cannot be considered as ayurvedic research. It is merely a blind research endeavour.” (Paraphrased from his editorial ‘Ayurveda based scientific methodology for research in Ayurveda’; Annals of Ayurvedic Medicine Vol-6 Issue-3-4 Jul-Dec, 2017)

   So, the present article’s view that solving theoretical problems “need not precede or preclude the evaluation of Ayurvedic treatments using modern methods given the potential utility of Ayurveda interventions,” misses the nuance involved in the subject.

   Until the theories are cogently demystified and theoretical imperatives are clearly understood, it would be difficult to arrive at unanimous treatment protocols that are worthy of being tested.

   During the COVID pandemic, for instance, the AYUSH ministry released a treatment protocol that I found grossly wanting*. I suggested another protocol through a journal editorial**. Such a lack of unanimity in arriving at researchable protocols is, in part, due to an inadequate grasp of ayurveda’s theories and their imperatives.

   * https://confluence.ias.ac.in/why-the-national-ayurveda-protocol-on-covid-management-appears-wanting/

   ** https://articles.theindianpractitioner.com/index.php/tip/article/download/1006/946/