The health care needs of the elderly will be a great burden on the budget of not only the industrialised west but also of the developing countries with infant mortality falling and health status improving. We have to innovate to get a cheaper system that combines the modern medical hi-tech stuff for emergency use and surgery but has other well tested systems to look after the minor illness syndromes and chronic illnesses in a complementary fashion. Here I suggest the following remedy.

Modern medicine, with its reductionist scientific base, seems inadequate to meet the medical care needs of mankind. Barbara Starfield’s commentary on a recent Institute of Medicine audit on American Medicine entitled “is the US medicine the best in the world”, makes very sad reading what with doctors and hospitals being the third cause of death in that country and adverse drug reactions coming fourth in the list!(1) The human body works as a whole. We need to look at a holistic science for this purpose.

The ancient Indian system of Ayurveda, a part of the Vedic wisdom contained in one of the four known Vedas, the Atharva Veda, had been in use for times “out of mind” in India. Its scientific basis is so strong that we find there detailed descriptions of even the aetio-pathogenesis of diseases. The holistic science of Ayurveda seems to be ideally suited for the dynamic human physiology, while our modern medical scientific predictions of the time evolution in man seem to be inadequate.(2)

Ayurveda is being confused for herbal folk medical traditions practised in many parts of South East Asia. This is very far from the truth. While herbal medicines do form a small part of Ayurvedic pharmacotherapy, as it does even in modern medicine, the main thrust of Ayurveda, the science of life, is to preserve the health of the population. The core of Ayurveda is “swasthasya swastha rakshitham”, to preserve the health of the well.(3)

To meet that end Ayurveda has an elaborate system, panchakarmas, wherein most of the health preserving and health restoration techniques are detailed. All the Ayurvedic literature is in the ancient Sanskrit language. To dissociate Ayurveda from Sanskrit and equate it with herbal medicines is blasphemous, to say the least. Having said, that I must hasten to add that we need to innovate some of the ancient methods of Ayurveda using the modern hi-tech methods to get better outcomes. Change is life and research to refute false dogmas alone can take knowledge forwards.

In addition, Ayurveda has an elaborate system of classifying human beings into separate genetic-constitutional types which makes comparisons of two human beings, for the purpose of controlled studies, much more scientific, unlike today in modern medicine where we just compare two cohorts based only on a few phenotypic features, the reason why most, if not all, controlled study results have come to naught in the long run: time evolution in a dynamic system being dependent on the whole initial knowledge of the organism.1 Ayurveda lays stress on the main role played by the human mind in human illnesses, a point being realized lately in modern medicine.(4), (5)

Time has come, as the Walrus said to talk of many things, “cabbages and kings”, and the science of modern medical systems, to do most good to most people most of the time. While modern medicine is a must for emergency care and in surgical urgency, most of the minor illness syndromes that form the bulk of illness and sick absenteeism load along with the chronic degenerative diseases could be managed better with the best in Ayurveda.(6) We need to pick the best in other complementary systems to make a new integrated scientific medical care delivery system for the good of humankindReferences:

1) Starfield B. Is the US medicine the best in the world? JAMA 2000; 284: 483-485.

2) Firth WJ. Chaos-Predicting the unpredictable. BMJ 1991; 303: 1565-1568

3) Sharma RK. Caraka Samhita.(English Edition) Vol iii,2002 Chowkamba Sanskrit Series Publishers, Varanasi, India .

4) Whiteman MC, Fowkes FGR, Deary IJ. Hostility and the Heart. BMJ 1997;315:379-81

5) Hippisley-Cox J, Feilding K, Pringle M. Depression as a risk for IHD. BMJ 1998; 316:1714-9.

6) Hegde BM. The tyranny of prevailing opinion. Indian Heart.Jr. 1997;49:439-441.










Rapid Responses published:

[Read Rapid Response]The Creation of a Thousand Forests is in One Acorn.

BM Hegde (19 August 2005)
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The Creation of a Thousand Forests is in One Acorn.


19 August 2005



Next Rapid ResponseTop

BM Hegde,
Retired Vice Chancellor
Mangalore-575 004, India

Send response to journal:
Re: The Creation of a Thousand Forests is in One Acorn.


Dear Editor,

Chronic heart failure, better labelled cardiac impairment, is not a disease and is a multi-system syndrome which starts almost from the time the cardiac output falls for any reason.

The first organ to feel the pinch is the skeletal muscle, where, initially under undue exertion and later under usual exertion, anaerobic metabolism takes place producing anion collection inside the muscle cells, only to be relieved when the patient takes rest in the initial stages.

When the muscle cells become hypertonic with anions compared to the extra cellular fluid water seeps into the muscle cells through osmosis making the cells swell. The swollen muscle cells trigger the intracellular pain fibres to give rise to muscle cramps, at times.

The resultant increase in the osmolality of the extra cellular fluid (as water has seeped into the muscle cell) stimulates the posterior pituitary to secrete the anti-diuretic hormone. This is the beginning of the end and the end of the beginning of all that there is to cardiac impairment physiology.

Consequently, the extra cellular fluid in the blood vessel becomes hypotonic stimulating the aldosterone system in the kidneys to later give rise to oedma etc. Still later the renal blood flow decreases as the cardiac output further goes down resulting in the vicious cycle of mouth eating the tail business!

Hence all through the course of cardiac impairment the heart shows its power on the skeletal muscle indirectly stimulating the posterior pituitary.The key to chronic cardiac impairment saga is held by the skeletal muscle.

Cardiac impairment is not only the cardiologist's cup of tea. The ejection fraction is a very poor cousin of other tests like BNP for the simple reason that the EF is not even the sole representative of the ventricular function. Some of it depends on the after load and preload, which, in turn, depend on the human mind! yours ever, bmhegde

Competing interests: None declared




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