Integrating Mainstream and Alternative Systems of Medicine
By Jitendra N. Gupta, MD & Vidya Bhushan Gupta, MD

The various systems of treatment, Mainstream Medicine, Homeopathy, Acupuncture, Ayurveda, and Unani, etc., have evolved in separate parts of the world, at different periods of time, by persons of different experiences, knowledge, and attitudes. As a result they all have their own unique assumptions and beliefs, but the unity in this seeming diversity is that they all pertain to the human body only. According to ancient Hindu philosophy, the human body is organized in five levels called the Koshas. On careful analysis of the tenets laid down in various systems of medicine, it appears that each of theses pathies acts on one or more of these five levels of human existence or Koshas. If a hierarchical classification of the pathies can be made based upon the Koshas, these can be amalgamated together to form a Single Unified Medicine. Predictions, then, can be made as to how the various pathies will inter-react – whether synergistically or antagonistically under given clinical situations. These predictions may be tested on suitable human or animal models1.

The Five Koshas

The five Koshas, as described by the Hindu sage, Adi Shankaracharya, in his book entitledvivek Chunamani'2 are: Annamaya Kosh, Pranmaya Kosh, Manomaya Kosh, Vigyanmaya Kosh and Anandmaya Kosh. These Koshas, in this order, are consecutively from the coarser and outer to the subtler and inner. The coarsest and most superficial is the Annamaya Kosh (the physical body), which we can see, and feel. The subtler ones respectively are more pow- erful and exercise control over the lower ones.

The five Koshas, in turn, are organized into 3 bodies : Sthool Sharir, Sukshm Sharir and Karan Sharir. Of these Sthool Sharir (the physical body) consists of the Annamaya Kosh, Suksham Sharir (the subtler or ethereal body) consists of the next 3 Koshas : Pranmaya, Manomaya and Vigyanmaya, and Karan Sharir (the casual body) consists of the Anandmaya Kosh. A brief description of the five Koshas is presented here:

Annamaya Kosh, the gross human body is made up of the Panchmahabhutas – the five primordial elements, i.e., Akash (vacuum), Vayu (air), Agni (fire), Jal (water) and Prithvi (earth)3. Its details have been best described in the textbooks of anatomy, histology, physiology, pathology, etc. It is made up of various chemicals which react with other chemicals called drugs in accordance with the principles of pharmacology. All medicines prescribed in modern medicine act on this Kosh4. It is directly under control of the next subtler body, the Pranmaya Kosh. The latter consists of the vital energy, Pran which according to its location, movement and purpose has been divided into five major and five minor components. Yogic literature mentions the presence of 72,000 pathways along which the Pran moves in human body. These pathways cannot anatomically be seen but the existence of some of them seems to have ben proved indirectly by using acupuncture needles tipped with radioactive phosphorus. The pathways have been named as nadis in Yogic literature and as meridians in Chinese literature – they are entirely distinct and unique from all known anatomical pathways i.e., arteries, veins, lymphatics, nerves, etc. The famous six Chakras or whorls of energy and Kundalini (the Serpentine Fire) are also a part of this Kosh. Certain magnetic effects of this Kosh and Chakras have been recorded in separate works by various scientists. Separation of this Kosh from the Anitamaya Kosh constitutes death or Pranant (literally, end of Pran). Acupuncture, reiki and magnetotherapy seem to be working on this Kosh. Homeopathic medicines in moderate potencies like 30C - which means extremely high dilutions to the tune of 10-60 and above at which no chemical constituents of the medicines can conceivably exist in the solution5 also seem to act on this Kosh.

The interaction between Annamaya Kosh and Pranmaya Kosh may be compared to that between a moving car and its driver. A small pressure on the accelerator by the driver is amplified into the tremendous force running the car. Similarly an infinitesimal change of entropy of the physico-chemical system of enzymes in the physical body seems to be all that is provided by the Pranmaya Kosh to keep the metabolism of Annamaya Kosh running. Work done by several workers scattered through scientific literature can be cited to support this point. The aura recorded through Kirhan photography of psychic healers also seems to be Pran moving under the influence of the next higher Kosh, the Manomaya Kosh.

The next three Koshas, Manomaya, Vigyanmaya and Anandmaya pertain to the mental faculties of a person and are progressively subtler in the order named. The Manomaya Kosh is the mental faculty that receives all the sensory inputs, interprets them as good or bad and desires the good. This Kosha is much more powerful than the preceeding two Koshas and governs them and is, in turn, governed by the two Koshas superior to it. It is thus central to human existence. Many modalities of treatment like aroma, music, colour, placebo effect (giving the patient through speech and gestures the interpretation that the given inert substance or procedure is an effective therapy), shamanism, and taste (rasa as it is termed in ayurveda) affect this Kosh. The other therapeutic modality which can conceivably influence this Kosh is homeopathic medicines in the higher potencies,6 like 200C and 1000C, i.e. infinitesimal dilutions to the tune of 10-400 or 10-2000 or higher.

The feeling of 'me' and 'mine', and the faculty of intelligence and reasoning constitute the fourth or Vigyanmaya Kosh. The feeling of freshness that 'I had had a deep sleep' immediately on arising from a deep-dreamless sleep is said to arise from this Kosh. When one closes the eyes and relaxes during meditation, the functioning of the Manomaya Kosh becomes minimum because the sensory inputs and their interpretation are no longer the issue. The Vigyanmaya Kosh comes in the forefront and gets strengethed. In the final stages of meditation, the intellect becomes stable and this is called Samadhi. Meditation when used as a therapeutic tool therefore works by strengthening the Vigyanmaya Kosh. All sorts of reasoning and counselling (psychotherapy) also act on this Kosh. Since the road to this Kosh is through the preceeding one, successful counselling can only be carried out under such circumstances as are appealing to the senses, so that the Manomaya Kosh does not obstruct the way. A large part of this Kosh is in the realm, of the unconscious and is a major repository of information.

The fifth or the Anandmaya Kosh is the innermost Kosh in close proximity of the Soul. It is a reflection of the three divine qualities of the Soul, namely Sat, Chit and Anand. Since the Soul itself is a non-doer of anything, its qualities are manifest through this innermost Kosh. These three are the basic qualities of life per se. Sat means that it believes in truthfulness and its eternalness. When untruth is resorted to under the influence of the preceeding two Koshas, it is in disconsonence with this Kosh and the interaction can be seen as a turbulence on the lie detector. Chit means that it is alive and conscious and can therefore interact with various situations in an appropriate way. This characteristic separates the living and the non-living. Anand means that it is everjoyful-full of pleasure in itself. It does not need any outside agency or stimulus to be cheerful, though if they are present the effect is only compounded. Being joyful is a prominent characteristic of this Kosh. That is why depression is regarded as a disease.

Anandmaya Kosh is manifest as the smile on the face of a healthy person. A healthy person is cheerful and willing to undertake work – this is precisely Anandmaya Kosh shining through, as it were. How and why laughter therapy helps people is easy to understand now. Deliberately trying to laugh and be happy helps the various other Koshas to get in unison with this vital Kosh and thereby gain health, termed Swasth in Hindi, which means getting in the proper place.

The Panchkosha – based system vs. CAM domains of NCCAM:

The table given on pages 3-4 presents the suggestions made in this paper alongwith the presently used classification of Complementary and Alternative Medical Practices (CAM) by the National Centre for Complementary and Alternative Medicine (NCCAM) of National Institutes of Health, in Bethesda, Maryland. The following are the merits of the proposed system:

l. Systematic approach: This classifications helps in visualising the 'elephant'of CAM Practices 'as a whole'. It considers the mechanism as well as the level of action of various CAM practices in a hierarchical fashion. Thus, any CAM practice can be accommodated in this framework and its possible interaction with other CAM Practices as well as with mainstream medicine can be predicted and put to test.

2. Explaining variable results in clinical trials: This approach can explain the erratic and variable results obtained in clinical trails of CAM practices. How it explains is this:

The Panchkosha principle postulates that the approach to the causation, diagnosis and treatment of any disease should ideally be 5-pronged, addressing itself to each of the 5 levels of human existence. It is only when diagnosis is made of the malfunction of each of the 5 Koshas and therapy offered there for, that a complete cure can result. Undetected defects/variations in various Koshas lead to the treatment failures and erratic results in clinical trials.

Suitable techniques for defining the 5-Koshas using scientific approaches can be developed. The following table (on page 5) is suggested as possible measures to quantify the 5-Koshas. It, however, needs to be confirmed and modified by suitable research.

3. Approach towards promoting positive health: Another advantage of this approach could be opening up avenues for promotion of positive health. If diagnosis of the status of various Koshas is made of healthy volunteers and CAM therapy given according to the defects noted therein, improvement in positive health can be expected just as healthy persons experience mood elevation after Mantra recitation and listening. And various Yogic practices like Pranayama, Asanas and meditation are advised for healthy persons, too,to help them improve their health.

4. The grand unification: A person suffering from any chronic aliment say grandmal epilepsy or bronchial asthma, is bewildered at present. He cannot afford not to take treatment under allopathy (modern medicine), for precise diagnosis and reliable control, yet cannot resist the temptation of trying the so-called alternative pathies like homeopathy, acupuncture, Ayurvedic, etc. And all this under the constant fear that one pathy may not be inimical to the other and cause some unknown harm because there is no common platform on which they stand. This fear of the unknown interaction at present prevents majority of the persons from awaiting themselves of the benefits of these alternative therapies.

It is hoped that the Single Unified Medicine thus evolved will make this fear a thing of the past. What a pleasure would it be to see physicians in general also seriously talking about a grant Unification of the Pathies much like physicists who have long been experimenting about a Grand Unification of the Physical Forces and have, in the bargain, won several Nobel Prizes, too!

Table showing the five Koshas in increasing order of subtilty and therapeutic modalities acting on them vs. NCCAM'S CAM domains:

 
Name of kosh
Major constituents
Therapeutic modalities
influencing the kosh
CAM domain according
to NCCAM
1. Annamaya
kosh
Panchmahabhutas (i.e., space, air, fire, water and earth) which make up the various chemical substances constituting the physical body – Mainstream Medicine
– Part of the action of Ayurvedic, Unani and Siddha medicines
– Part of the action of special dietary therapies like wheat grass therapy

Not applicable
Alternative medical systems

Biological based therapies

2. Pranmaya
kosh
– Vital energy called Pran or Chi
– Thousands of pathways along which Pran moves
– The six Chakaras
– The Kundalini ('Serpentine Power')
– Acupuncture
– Chiropratic and osteopathy
– Massage therapy (without using oil or any other lubricant)
– Reiki
– Magnetotherapy
– Hot/cold shock therapy (e.g., hot sauna followed by a roll in the snow)
– Homeopathic Medicines in moderate potencies

Alternative medical systems
Manipulative and body-based methods
– do –

Energy therapies
– do –
Not mentioned in any CAM domain


Alternative medical systems

3. Manomaya
kosh
Mental faculty that receives all sensory inputs, interprets them as good or bad and desires the good

– Treatment through sensory stimulation
(i) Aroma
(ii) Music
(iii) Colour

(iv) Taste (part of action of Ayurvedic medicines termed rasa)
– Placebo effect
– Shamanism
– Homeopathic medicines in higher potencies

 

Not mentioned in any CAM domain
Mind body interventions
Alternative medical systems
– (as part of Naturopathic medicine)
Alternative medical systems

Mind body interventions
Not mentioned in any CAM domain.
Alternative medical systems

4. Vigyanmaya
kosh
(i) The mental faculty of `Me' & `Mine'
(ii) Intelligence
(iii) Vast unconscious repository of information about previous actions as well as knowledge and experience gained previously, guiding the individual through successive lives
– Meditation
– Reasoning and counselling
– Hypnosis
– Therapy through Art, Writing, Creative Work. (They perhaps act by channelising and reducing the load on the unconscious repository of information)
– Abreaction
Mind-body interventions
Part of mainstream medicine
Mind-body interventions
– do –




(?) Part of mainstream medicine
5. Anandmaya
kosh

The 3 divine qualities :

Sat (truthfulness and belief in eternalness of the Self),
Chit (consciousness and ability to interact with circumstances) and
Anand (ever joyfulness)

– Use of lie detector (not a therapeutic modality)
– Laughter therapy
– Healing through prayer
– Namapathy [Healing through constant recitation of God's Name(s)]7
– Healing through Mantra listening or recitation
– Healing through Imagery (Vivid audio-visuals displaying triumph of Good over Evil) – Movie therapy8
– Bibliotherapy (treatment through reading)

Not applicable

Mind-body interventions
– do –
– do –


– do –

– do –


– do –

Table Showing The Possible Laboratory Techniques To Measure The 5 Koshas:

 
Kosh
Suggested diagnostic modalities of measurement
1. Annamaya Kosh

– As per mainstream medicine
– Measurement of the preponderance and activity of the Panchinahabhutas may be done as below:

Space and air manifest themselves as Vata, fire as Pitta and water and earth as Kapha in the human body according to Ayurveda and their status can be ascertained through

(a) suitable questionaires designed for this purpose, and through
(b) measurement of fasting serum levels of acetylcholine and cholinesterase (for Vata); catecholamines and monoamine oxidase (for Pitta); and histamine and diamineoxidase (for Kapha) as suggested by Udupa et al9

2. Pranmaya Kosh

– Part measurement is possible with:

(a) Kirlian photography, and
(b) Suitable magnetometric techniques

– Examination of shadow and reflection of the patient as done by pristine Vaidyas (classical practitioners of Ayurveda) perhaps measures this Kosha only and the ultraviolet photography done by ghost-busters also seems to assess the same

3. Monomaya Kosh

– Preferential liking for different tastes, odours, colours, time of the day, etc. as per homeopathic principles, confirmed by differential changes in Galvanic skin response and other autonomic parameters in response to varied senscry stimuli like different colours, odours. etc.
– `Suggestibility' as per modern psychometric techniques

4. Vigyaninaya Kosh – Part measurement may be done by psychometric techniques to quantify `Ego' and I.Q.
5. Anandmaya Kosh

– Psychometric techniques to measures emotional maturity quotient.
– Techniques to quantify mood and anxiety levels (measurement of Anand)
– Truthfulness in trivial matters of daily life (measurement of Sat) and
– Level of apathy towards self, family, community, country, mankind at large (measurement of Chit)

Footnotes

1. While human models may be terminally ill patients suffering from cancer or other incurable conditions, animal models can also be used without resorting to cruelty towards them. The use of homeopathy and other alternative pathies in veterinary conditions is well documented.

2. It is an ancient book in Sanskrit. Hindi rendering by Shri Muni Lal (published by M/s Gita Press, Gorakhpur – 273 005 India) and a commentary by Shri Nand Lal Dashora (publisher: M/s Randhir Prakashan, Shravan Nath Nagar, Hardwar – 249401) are considered authentic. In Vivek Chunamani the sage has explained the reality of human existence and that of the world in the form of a sermon to a pupil.

3. The primordial elements are much different from the chemical elements we are commonly tuned to. There are more than a hundred chemical elements like, hydrogen, oxygen, gold etc. which constitute the universe. But the meaning conveyed by primordial elements is much more subtle. Even vacuum (i.e., absence of everything) itself is an element. Thus, vacuum, being a constituent, is an essential requirement for man. Perhaps that is why the punishment for an evildoer is imprisonment or confinement to limited space. Nobody wants to be crammed up in a confined space and everybody wants a spacious house to live in, head space, leg space and so on, only because space or vacuum itself is a positive requirement. This is in a sense similar to the binary computer language of 0 and 1 where absence of signal i.e. zero itself is a digit.

The meaning of the other four primordial elements, too, is not necessarily the same as that in modern science. Moreover, in ancient Indian literature each term can have multiple connotations depending on the context. For example, air may mean the same as that we ordinarily understand in chemistry, but it may also refer to the living element Pran which is a component of the Pranmaya Kosh.

4. The mechanism of action Ayurvedic, Unani and Siddha systems of medicine is not being commented upon here, because it may or may not exclusively pertain to this kosh.

5. Everybody's Self-healer – Homeopathy Simplified for Beginners by Charles D. Ewart. Published by the author and printed by Rankin Bros. Ltd., 14-15 Trenchard Street, Bristol, 1. Year of publication not mentioned. (Pages X to XII, Article titled 'Dilutions, Potencies, or Attenuations'.)

6. First Steps to Homeopathy – A Primer by Noel Puddephatt, The Homeopathic Publishing Co., Ltd, 152, Landor Road, London, S.W.9. Chapter V: 'Which is the correct potency to give' – pages 15-16 mention that higher potencies are more likely to influence the mental sphere. (Year of publication not mentioned)

7. Namapathy is a little-known term coined by Swami Sivananda of Rishikesh – he was a medical practitioner who had renounced flourishing practice to embrace Sanyas and to advocate Nam-Sankirtan (chanting of God's names) and Nama-jap (constant repetition of the Name) as a cure for various ailments. In Sanskrit, God's names are considered to be Mantras (man meaning mind and tra meaning tool). Sravan (listening), Kirtan (chanting) or Sumiran (mindfulness or remembering in thought) of these Names (Mantras) is said to strengthen this Kosh so that it can exercise better control over the subordinate ones and lead them to Swastha. Repetition of other Mantras (like Om) are also said to lead to mood-elevation in scriptures. Importance of Name recitation and repetition is to be found in practically all religions of the world.

8. Such movies tend to bring the Sat and Chit characteristics of this Kosh to the forefront and thereby help in amelioration of the disease.

9. Udupa K. N. and Singh R. H.: Science and Philosophy of Indian Medicine, Shree Baidyanath Ayurved Bhavan, Nagpur, 1990, Page 89


Feedback

T.M. Mukundan wrote from India:

"I was disappointed to find in the article "Integrating mainstream medicine and alternative systems of medicines" by two MDs, some serious errors. First of all, the Ayurvedic practitioners of India do not consider their system(s) to be "alternative" systems. In fact, the last 50 years they have been trying to impress on an ignorant elite and the government that the Indian systems of medicine ought to be the mainstream systems, if we have to have any hope of reaching decent health care to all our people. This issue can be discussed at length perhaps some other time. Secondly, the authors of the above article have suggested an integration under some scheme proposed by the NIH in the US. Integration cannot take place under any Western scheme, for serious scientific reasons, and not just ideological reasons. The authors seem to be unaware that Ayurveda is a complete Sastra, which has a complete and comprehensive framework which is used even now to diagnose, and treat successfully many diseases. The authors even seem to suggest that only the Allopathic system has diagnosis for diseases like epilepsy and bronchial asthma! In fact, both diseases are very clearly described in the Ayurvedic texts and can be treated very well in that system, and cured too. From the Ayurvedic point of view, the Allopathic system is not scientific at all and this view has been expressed in India for more than 50 years at least. That is why there is no cure in Allopathy even for a common disease like asthma."

Response

I am thankful to Sh,T.M. Mukundan for the criticism and would like to offer a feedback as below.

  1. I, agree that Ayurvedic practitioners in India do not consider their system to be "alternative".

    We are not arguing here whether Ayureveda is a mainstream system or an alternative one. On the other hand we are trying to find out ways and means of
    amalgating the good in Ayureveda and that in modern medicine. Ayurveda is one of the systems of treatment and we are trying to find out how the good and
    rational features of all the systems of treatment can be pooled together. We are not trying to comment on the merits or demerits of any system of treatment.

  2. Shri Mukundan feels that we are trying to offer and integration under some scheme proposed by the NIH of US. This is wrong because we are trying to offer an scheme of integration based on the structure of human body in the form of five koshas as suggested in the philosophy of Vedanta enunciated by Adi
    Shankaracharya. We have only compared our scheme with the classification of alternative systems of medicine used by the NIH of US.

  3. The authors of this article completely agree that Ayureveda is a complete Sastra and does have treatment and diagnosis for various common diseases and
    that’s why there is a need of integration. The authors have quoted the work of Prof. K.N. Udupa regarding the correlation between the Tridoshas and the serum enzyme levels.

  4. Sh. Mukundan says that “from the Ayurevedic point of view Allopathic System is not scientic at all”. This is precisely the reason that this article is
    needed.

    Ayurvedic practitioners say that Allopathy is unscientific and Allopathic practitioners say that Ayureveda is unscientific. Still others, the Homeopaths
    say that we are the only scientific system of treatment in the world. And so on, the debate goes and not for anybody’s good.

    In this article we have tried to end the fault finding and have tried to bring all the systems of treatment to a common platform – so that the good points in
    all can be pooled down to evolve a Single Unified Medicine for the benefit of all.

I, would request you to please forward my feedback to Shri Mukundan. In case there is any other query or observation, I, would be glad to answer.

Once again thanking you for your letter and with best wishes.

Sincerely yours,
Dr. Jitendra N.Gupta
Hakim Aiyub Memorial Clinic
2203-5 Bazar Chitli Qabar,
Jama Masjid, Delhi 110 006