The year 2015 began with a landmark speech and decision by President Barack Obama on personalized medicine or precision medicine when he declared “Doctors have always recognized that every patient is unique, and doctors have always tried to tailor their treatments as best they can to individuals. You can match a blood transfusion to a blood type — that was an important discovery. What if matching a cancer manageable to our genetic code was just as easy, just as standard? What if figuring out the right dose of medicine was as simple as taking our temperature?” The Precision Medicine Initiative (PMI) of the US Government is an attempt to revolutionize healthcare delivery by tailoring preventive and management strategies to individual’s unique characterstics. This sets a platform wherein principles of personalized medicine Ayurveda can be delved deeper to come up with strategies that can be made globally adopted for better health.
Ayurveda is experiential, intuitive and holistic as opposed to modern medicine that relies on experimental, analytical and reductive reasoning (Patwardhan B, 2014). The relationship between the 2 systems is akin to that between the ‘whole’ and the ‘parts’, with the sum of the parts not necessarily being equal to the whole (Shankar D, 2010).The strongest and possibly biggest contribution from Ayurveda may be its preventive and promotive healthcare strategies. All living beings are an extension of the environment whereby the constituents of nature can be understood as being represented in the body as earth element represented by hard organs, skin, nails, bone, teeth, hair, faeces, water element as fluid components, blood, urine, sweat, fire element as metabolic processes, vision, complexion, air element as respiration, motor functions, sensory modalities and space element as macro-microchannels and hearing. Owing to this, changes in the external environment have an innate tendency to affect the internal milieu. These changes can be termed physiological when they remain within the limits and pathological when the limits are breached and diseases are observed. Hence, it is imperative that an individual is aware of the changing rhythms and equips himself with strategies to combat progression to disease. To cite an example, cold and rainy weather as seen in winter and monsoon aggravates vata-doshain the human body and hence resorting to measures such as abhyanga (oil massage) periodically may prevent future degenerative diseases. Thus, the process of healing at a philosophical level is the union of the individual soul with universal consciousness. The unique advantage of Ayurveda in this process is that it can provide a functional frame work that can accommodate any medical condition one may encounter. It also gives a practical inventory of physical universe and their effect on the individual which, when understood makes everything around us a potential medicine.
As medicine evolved, a ‘one drug fits all’ approach was deemed appropriate and billions of dollars were invested in cutting edge research towards this end. However, while this strategy did help to combat several dreaded infectious disease, it doesn’t seem to be helping significantly in reducing the current disease burden non-communicable diseases (NCDs). This may require a more individual approach as they are caused by a complex interplay of a multitude of factors like diet, lifestyle, genetic predisposition, geographic variations etc. Hence traditional system of medicine like Ayurveda, Chinese medicine and Korean medicine, all have well defined constitutional types that are used to design individual therapeutics, bearing resemblance to personalized medicine. The father of conventional medicine Hippocrates had also astutely observed the importance of the individual being the crux of treatment as he had said “It’s far more important to know what person has the disease than what disease the person has”. The doyen of Ayurveda, Acharya Charaka states the same as “Those who treat merely with formulations and not aware of the implication of Desa (the habitat in which the patient lives), Kala (the time of disease manifestation) Prakriti (psycho somatic constitution), etc. of the particular person will be committing mistakes in treatment” (Charaka Samhita).
Ayurveda offers the following guidelines for assessment of an individual
- Identification of physiology prior to pathology.
- Tenfold examination (Dashavidhapariksha) that helps isolate components of the persons’ physiology and pathology – Planning of treatment based on the outcome of this measure.
Acharya Vagbhata has described 10 factors to be examined as Dushya (seven tissue elements and three metabolicwastes), Desha (habitat and body), Bala (physical ability), Kala (diurnal/seasonal), Anala (different states of normal and altered metabolism), Prakriti (phenotypes), Vaya (chronological age), Satva (psychological state), Satmya (compatibility factors) and Ahara (food and its constituents) (Ashtangasangraha).
A thorough examination based on these parameters aids comprehensive understanding of ;
- Physiological attributes–age, build, constitution, tissue health.
- Physiological processes – digestion and metabolism.
- Habits – food, lifestyle
- Environmental factors that can influence life–habitat,climate
Thus far, there has been significant steps to unravel secrets of this personalized approach of Ayurveda utilizing conventional biomedical research tools. Various activities under the Indian Genome Variation Consortium has shed light on how the phenotypic classification of individuals based on Prakriti can give deep insights on differential disease predisposition (Prasher B et al, 2008), identifying risk factors for high altitude pulmonary edema (Agarwal S et al, 2010) and identifying differential metabolic rates amongst prakriti sub-types (Ghodke Y et al, 2011). It is also now possible to identify discrete causal pathways for RA etiology in prakriti based subgroups (Juyal RC et al, 2012) and thrombosis/bleeding susceptibility and outcomes of hypoxia (Aggarwal S et al, 2015). Other studies have shown differential expression of CD14, CD25 and CD56 markers between three different prakriti types reflecting on their immune response and disease susceptibility (Rotti H, 2014a), association with BMI and place of birth with prakriti classification (Rotti H, 2014b), differential DNA methylation signatures in three distinct prakriti phenotypes (Rotti H, 2015) and PGM1 correlates with phenotype of Pitta (Govindaraj P et al, 2105).However, at this juncture, we can only say that we have seen only the tip of the iceberg. A wealth of information still needs to be assessed rigorously and interpreted appropriately to enable Ayurveda as a mainstream healthcare system. “The farther back you can look, the farther forward you are likely to see.” ? Winston Churchill
This article has appeared in the Journal of Science of Healing Outcome , Volume 8, No .30 January 2016 with following link. http://thejsho.com/iarch.aspx