Is Ayurveda Pseudoscience? ~ Matthew Remski

Via yoga 2.0 lab
on May 29, 2013
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The following article brings together some early treatments of subjects that I will be addressing in more polished form in my forthcoming book called Ayurveda: an Ecotherapy for our Time. Because I belong to no distinct Ayurvedic lineage, school, or professional organization, I offer this work in draft form to the global Ayurvedic community with a request for feedback, criticism, and correction.


The Charge

A little while ago, a friend posted an update to his social network.

He wrote “Dear Facebook friends: “detoxing” is pseudoscience. Save your pennies and invest in wholesome food and clean water, get plenty of rest and sweat/exercise every day.”

This friend co-directs a successful yoga studio, so he was well aware that his charge would be provocative to dozens if not hundreds of contacts who hold the principles of detoxification in very high esteem.

On cue, a debate erupted, with commenters hashing out the finer points of evidence, ethics, and the placebo effect. Several commenters brought up Ayurveda as an example of an alternative medicine that adds value to biomedical culture without needing to adhere to scientific methods.

One commenter—I’ll call him “Tom”—argued with my friend against the proponents of ayurveda, insisting that if ayurvedists are going to call their practice “medicine”, they draw upon the expectations inherent in scientific discourse, and, if they fail those expectations, they lump ayurveda together with the kind of quackery that cheats patients of money, hope, and access to effective health care.

I’m glad this issue is coming up these days, because those of us who love ayurveda have to get clear on what we’re doing, and how it both meshes with and grinds against the biomedical paradigm.

Specifically, we have to get really clear on how we use language and method in a markedly non-scientific way as we pursue individualized rather than statistically measurable health results.

My friend and Tom were in some senses correct about the pseudoscientific notion of “detoxification” in global ayurveda.

To the outsider, Ayurvedic discourse may suggest that there are procedures and protocols involving oleation, massage, emesis, purgation and enema that have been proven to safely remove “toxins” from living tissues.

If this were true, ayurveda should be of great interest to medical toxicology. But it’s not, because there has been no controlled testing of ayurvedic cleansing protocols that would define the target of cleansing, the mechanism by which the target is cleansed, and the resultant chemical or organic changes. I doubt that such studies—whether they quantify the claims of ayurvedic cleansing, rejuvenation protocols, or digestive theory – will ever emerge.

Part of me actually hopes that they don’t; then we could all turn our attention to what I consider to be ayurveda’s primary gift—its intuitive and empowering language.


Ayurveda’s “Polysemic Lexicon”

For ayurveda’s relevance to abide, it must cease making medical or scientific-like claims without clarifying its polysemic language bias, which I’ll describe below, or, of course, without medical or scientific evidence, the gold standard of which is now large-sample, double-blind, randomized testing with control and placebo groups.

If claims or predictions or even descriptions of biological function are made without adhering to this rigour, they may indeed be pseudo (“pretending to be”) scientific. Such claims seem to proliferate within ayurveda and yoga therapy discourses, which blend paradigms in an exuberantly un-self-conscious way.

We need look no farther than Dr. Vasant Lad’s reverie on the relationship between the twenty amino acids and the twenty qualia (gunas) of sensual experience (Lad, 98), or B.K.S. Iyengar’s assignment of specific medical benefits to specific asanas in Light on Yogawhich references exactly zero peer-reviewed medical literature.

Happily, it’s neither scientific illiteracy nor charlatanism that fuels the correlations of Lad and Iyengar, but rather an older, more metaphoric usage of language that is meant to illuminate the descriptive and suggestive arcs of our healing narratives, rather than the diagnostic and the definitive.

Their discourse is “psychosomatic”—a term that has been commonly reduced to belittle health conditions that are “all in the head”, but should be more properly understood to refer to a paradigm in which physiological factors and symptoms are inextricable from cognitive-emotional factors and symptoms.

In the older medicines that Lad and Iyengar speak from, all health conditions are psychosomatic. There is no such thing as diabetes, rheumatoid arthritis, or cancer without distinct cognitive-emotional correlates.

While biomedical discourse gains meaning through the isolation of specific causes, psychosomatic discourse gains meaning through generalized correlations that allow for richer health stories to emerge.

Medical anthropologist Jean Langford (2002) describes the psychosomatic discourse of ayurveda as using a “polysemic lexicon” to describe bodies that are neither the “disciplined” nor “positivistic” objects of the medical gaze, but rather sites of interconnected experience.

A polysemic (“having many meanings”) language resists the precision and reductionism demanded by science. We only have to think of the thousand meanings of “prana” to intuit the power of the polysemic: prana means breath, movement, organization, design, vitality. It is part of a lexicon that alludes to and connects, rather than names and isolates.

A lexicon that produces a poetics of medicine, and, therefore, a lexicon that biomedicine can’t understand or evaluate.

The problem is: many ayurvedists seem to be using this polysemic language without knowing it, and, more importantly, without acknowledging how incomprehensible it is to standard scientific discourse.

When Mr. Iyengar, as a psychosomaticist, claims that a particular twist of the abdomen “tones the liver”, he is not only referring to the circulatory benefits of compressing and then relaxing the bile ducts, but also suggesting that a twisting massage focusing pressure on the lower right abdomen dissipates and pacifies any accumulation of bilious heat that can lead to frustration or anger. Biomedical discourse might view the first effect to be medical in scope, and testable, but would completely dismiss the second.

In yoga therapy and ayurveda, however, the two effects are intrinsic, and fall under the category of “liver palliation”, in which “liver” refers to much more than the biomedical organ that can be viewed through ultrasound, blood work, or dissection.

Likewise, when Dr. Lad and other ayurvedists assert that the principle of kapha refers not only to the general solidity of the musculoskeletal system, fat tissue, triglycerides, cholesterol, myelin nerve sheathing, the faculty for hormonal secretions, and the capacity for long-term memory and emotional resilience, he is using a language that blends biomedical and psychosomatic principles in a way that serves his holistic purpose, but directly attracts the charge of pseudoscience.

The challenge for ayurvedists is to own up to our own unwitting obfuscation in regularly blending these two discourses, and, additionally, to acknowledge that the languages of biomedicine and the psychosomatic are mutually inclusive only from the perspective of the psychosomatic.

Psychosomatic discourse (like Hinduism, the religious ethos consonant with ayurvedic culture) is syncretic by nature, eager to assimilate any paradigm into its poetic masala.

From the psychosomaticist’s point of view, biomedical language simply provides one more flavour to the palette of our health stories. No language is a complete language, according to the psychosomaticist.

Moreover, the psychosomatic practitioner asserts that using differing languages comparatively enriches our exploration of experience, because we can never actually name the thing-in-itself, but the silent light that shines between its multiple names brings us closer to it.

We should understand that biomedical discourse must resist being appropriated in this way, because it derives its power precisely from its reductionism and specificity. Psychosomatic discourse that tries to appropriate biomedical discourse is swallowing a blade that will only lacerate the tongue of its poetics.


Opposing Methods

It’s not only on the level of language that ayurveda and biomedicine are ships passing in the night: it’s also on the level of method.

Ayurveda can’t easily dialogue with the controlled-study paradigm, because it is very hard, if not impossible, to control for variables that ayurveda takes to be fundamental in the narratives of ill-health and wellness: constitution of the client, season of the symptoms, how the herb is harvested, where it’s harvested, time of day the herb is applied, the client’s relationship to the region where the herb grows, period of life, partnership status, number of children, strength of libido, etc.

In essence: it is a daunting challenge to control for the ecological uniqueness of each health story. Designers of biomedical studies would only be scratching the surface of ayurvedic complexity if they even tried to control for “stress”—which is becoming a biomedical quantity—as they test medications and procedures.

While Indian ayurveda races to test the ancient pharmacopeia, we are seeing that the modern laboratory is a round hole to ayurveda’s square peg.

Only a very few studies, including this one, co-funded by the NIH and the Arya Vaidya Pharmacy of Coimbatore, have passed scientific muster. But to even modestly succeed it seems that the study designers must abandon traditional protocols.

For instance, most active ingredients cannot be isolated and remain active in ayurvedic herbalism. Herbs, like every other treatment in ayurveda, derive their power from context: the supporting herbs the focal herb is blended with, the food that is taken before or with or after the herb, and the vehicle (whether water, juice, broth, alcohol, cow’s milk or cow’s urine) by which it is carried to a particular tissue-layer or organic location.

The ayur-medical research designer faces an impossible task. How exactly do we test the effectiveness of an herb like tulsi while remaining faithful to the rules that have governed its usage for millennia, which in some lineages demand that the herb be harvested on a particular day of the lunar cycle, be given to a person of a particular constitution and age (and even caste), and during a particular stage of etiology, in fresh or dried form depending upon whether toning or reducing effects are desired, and finally, activated through puja, mantra and devotion to Siva?

The polyvalent and polysemic scope of ayurveda cannot be carved into specialized biomedical categories. Which also means that it cannot focus as sharply upon the task of isolating etiological causation.

It is a medicine of vision, not of the microscope. It is a medicine of word-clusters, not flow-charts. I would argue that we need both in our age, and we should begin by understanding the contrasts.

We must recognize that the epistemologies are different, separated by thousands of years and revolutions in instrumentation and even notions of personhood and subjectivity. We must recognize that because biomedicine can manage chronic diabetes, transplant organs, and deliver babies via emergency c-sections, it cannot have the breadth of language or vision to weave psychosomatic meanings into its treatments. Ayurvedists, who practice “water medicine”, as I’ve started to call it, can do exactly this, because they are unburdened by the reductions of “hard healing”.


The Example of “Cleansing”, the Limits of Modern Practice, Notes on Etiology, and the Indeterminacy of What Works

To fold these reflections back into the cleansing debate that my Facebook friend instigated, I’ll give an example of how polysemic/psychosomatic/generalist therapies such as ayurveda work in action.

I have directed over a hundred clients in ayurvedic “home pancha karma” cleansing protocols—protocols that my friend might call “pseudoscientific”.

The first thing to say is that if clients come to me with a biomedical diagnosis and expect it to be “cured”, I refer them back to their conventional practitioners. I cannot help them, by definition. My client waiver states that I am not a medical doctor, and that I cannot diagnose illness or prescribe medications according to a biomedical paradigm. If they tell me that they want ayurvedic support for their biomedical treatment protocol, then we talk further.

With or without formal diagnosis, everyone wants to feel better in one way or another, and their structural, digestive, reproductive, social, or emotional concerns spread horizontally throughout their lives, touching all fields of experience.

I spend an hour or three with the client, discussing the nature of their difficulties in their full context, and then we negotiate our inferences as to whether they are congestive, inflammatory, or wasting, and what regions, organ systems (the interconnected concerns presented by the category of “liver” for example), and emotions are bearing these affects, and how they might be calmed or even reversed.

Then, we negotiate a two-to-four week discipline to burn away congestion, cool inflammation, or to tonify wasting (general malabsorption). There are “standard” protocols for each, including dietary, herbal, exercise, and self-care directions, but each is tailored to individual need and capacity, and each is predominantly self-directed.

This means that it would be very hard to generate hard evidence from the traditional cleansing techniques of Ayurveda. Each application is individual in terms of dosage, timing, and length of treatment. There are guidelines, but no rules. Peer review of these techniques would be an even more challenging concept, as the familial lineages that administer and teach these practices at the highest levels are kaleidoscopic in their variations, and are often protective of their trade secrets.

The fierce localism of ayurveda’s various lineages—based in part upon the unique biodiversities of the regions they arise within—makes them ill-disposed towards universalized peer review.

One promise of peer-reviewed evidence-based medicine is the generation of predictable outcomes.

I do not practice biomedicine, and one way in which I avoid the pseudo-scientific is that I never predict an outcome. I say to the client: “In the ayurvedic system I’ve learned, people who share your constitutional profile, age, career profile, symptom history and relationship status (etc.) will often apply these therapies over this amount of time to try to restore balance and wellbeing. Would you like to talk about how they might be workable in your circumstances?”

I work in a very conservative range, knowing what I’m giving access to (not prescribing) based on the oral and folk traditions that I’ve learned, and my experience in observing clients who try these therapies.

The practice is exploratory, cooperative, and not designed to address acute symptoms, nor to substitute for biomedical therapies that have been prescribed for biomedically-defined diagnoses, nor to dissuade clients from pursuing all available health care opportunities.

When symptoms are more serious than general depressed vitality, standard digestive disturbances such as sweet cravings, bloating, flatulence, constipation, or loose stool, sleep difficulties, a lull in libido, stiffness or soreness in the musculature or joints, lowered seasonal immunity, non-chronic but sub-acute skin-rashing, I refer the client on to a biomedical specialist for further assessment.

If there is localized organic pain, a report of internal blockages or growths, if I feel arrhythmias in the pulse, if I smell ketones on the client’s breath, if they meet the clinical definition of alcoholism, if they tell me that their period has lasted twice as long as usual, or waking up more than twice per night to urinate, if their pallor is anemic accompanied by a flaccid pulse, etc., etc.: all referrals.

Psychosomatic and generalist approaches must acknowledge that as symptoms deepen, localize, and become chronic—in a sense, as the symptoms themselves specialize—the client is wading into the illness territory that the specialization of biomedicine is designed to observe and target.

The real strength of a generalist approach is expressed through aids to general vitality, and its effect is measured by the self-reporting of the client. And as the client becomes familiar with the interoceptive language of ayurveda, their self-reports become more and more nuanced. This in itself empowers the client’s desire to be proactive in their health choices.

Fortunately, ayurveda comes with its own etiological scaling, by which contemporary practitioners can define their scope more precisely than ever before in the history of our art, against the backdrop of available biomedical interventions.

The psychosomatic humours of kapha, pitta, and vata are said to become vitiated through the six stages of accumulation, aggravation, overflow (of their proper sites), relocation (to foreign sites, as in first signs of desiccation of cartilage through the migration of excess vata from the colon), manifestation (of patterned chronic symptomologies that be diagnosed), and diversification (in which one category of diagnosis catalyzes others).

Prior to the biomedical age, the ayurvedist was responsible for initiating stronger and stronger interventions along this etiological arc, while expecting diminishing returns.

The classical texts are disarmingly frank about what this scale implies. Diseases are classified as curable (stages one through three), curable with difficulty (stage four), incurable but palliable (stage five), and simply incurable (stage six).

In common practice today, most ayurvedic consultants and practitioners profess confidence in their advice when dealing with the first three stages, but if they’ve practiced for long enough they know that once an imbalance hits the threshold of “relocation”, their tools diminish in the shadow of biomedicine.

Interestingly, the traditional etiological narrative can now be used to define its own limits with respect to the sophistication of biomedicine, which can more effectively deal with the critically complex issues presented by the last three stages, increasing quality of life and longevity more efficiently than a water medicine ever could.

In my opinion, the last three stages of ayurvedic etiology have become an artifact that once demanded an escalation of the same therapies that treated the first three stages of “soft healing”, but now strongly encourage the practitioner to stand down, and refer the client over to the “hard healing” of biomedical specialized interventions.

Does ayurveda lose strength or relevance by surrendering its higher levels of practice, which have faded from view precisely because they cannot compete with biomedicine?

Emphatically not. In my opinion, ayurveda actually gains strength by limiting itself to its preventive focus within the first three stages, in which it employs levels of intuition and horizontal thinking that biomedicine cannot afford.

The first three levels of ayurvedic etiology define sub-clinical complaints: ongoing irritations that biomedical practitioners often answer with a shrug and a common prescription. Bloating, broken sleep, and overheated stool are ayurvedic concerns precisely because they point to the beginnings of longer-term imbalances, and because their sources are polysemic. Digestive bloating is rarely isolated from depressed confidence. Overheated stool is usually correlated with rage.

Back to cleansing—and language—for a moment.

The target of ayurvedic cleansing is said to be “ama”, which has numerous translations from Sanskrit to English: “uncooked”, “unannealed”, “immature”, “undigested”, “non-nurturing”. (The fact that Sanskrit is not a living colloquial language stimulates the polysemic nature of its translations.)

With Sanskrit in our age, we are always working with translations of translations, each of which add meaning and texture to an original, now-abstract referent.) The general principle of is that all inputs (ahara)—food, relationships, environment—must be digested as experiences, and that digestion depends primarily upon the strength of agni (psychosomatic digestive fire). Otherwise they will leave residues that impede function.

“Ama” clearly means too many things to yield a testable target. None of its translations map sensibly onto the biomedical meanings of toxicology, for example. “Ama” can refer to pathologies of excess tissue, chemical factors, or even movement (tumours, bone spurs, high triglycerides, or tremors), but it also refers to emotional excesses, such as melancholy, rage, or anxiety, or to emotional poverties such as possessiveness, lack of courage, or dissociation.

“Ama” cannot be located, measured, or distinguished.

It is often said to be detectable through various post-digestive secretions upon the tongue, in the sweat, in the urine, or in the stool. But just as often it is configured as a material waste product, it is also alluded to as a kind of psychic trash, disturbing “prana” and “nerve tissue” (more polysemic concepts!). It is an image of putrefaction, a suggestion of “blockage”, evidence for the suppression or contraction of the fluid movement of life. Saying that an ayurvedic therapy is meant to “cleanse ama” is not and never could be a scientific statement. But this does not mean that it is without meaning as a description that speaks to our ongoing need to unburden ourselves of time and fatigue and resist the gradual clouding of our life force.

So what do my clients actually feel after “cleansing”?

Here’s a list of descriptors: buoyant, energetic, hopeful, less reactive, lighter, less itchy, impassioned, more clear, inspired, grounded, connected, forgiving, lubricated, uncluttered, directed, intuitive.

The standard ayurvedic explanation for these subjective reports is as follows: the preparatory actions of internal and external oleation, combined with sweating therapies, set in motion a general rhythm of tissue dilation and circulatory stimulation.

The bitter herbs helped the toxified tissues disgorge retained digestive and emotional wastes. The time of the practices imbued the client’s daily schedule with renewed purpose and reconnected them with the solar cycle, and their simplified diet brought them back into a regular relationship with cooking from scratch. Their homes became spa-like for three weeks (perhaps their loved ones treated them with a different type of dignity!) and when it came time for the stronger measures of fasting, herbal purgation, and enema, the home became a sanctuary, the site of a newer, secret life emerging.

If the client had weight-loss goals, the pungent and bitter herbs I advised surely helped, though I can’t say how much they helped in relation to the simplified and restricted diet. If the client had skin-cleansing goals, the bitter diuretics and turmeric that I advised surely helped, though how much compared to the massage and sweating protocols is hard to say. I’ve been taught that the preparatory oleations and sudations encourage ama to retreat to the alimentary canal, where the purgations will remove it. I watch for the signs by which I can intuit that this is happening, but I have no way of formally measuring it.

I am aware that some clients feel better simply because they have taken initiative. I suspect some clients feel better because they have successfully interacted with an ancient tradition they idolize (or an authority figure who writes books and from whom they seek approval), and the success of their compliance gives them a virtuous feeling that they may confuse with more stable feelings of wellness.

So I know what the tradition says about how it works, and I know what my clients say about how it feels. I know I cannot measure the ancient claims against subjective reports in a way that would satisfy any modern standard of evidence.

I also know: something is happening.


Placebo, or the “Meaning Response”?

This all brings up the question of placebo, and whether the actions taken to cleanse ama are clinically ambiguous but psychologically powerful. (This framing of the placebo effect is problematic in itself, as it isolates the “psychic” as a disembodied category—an isolation that ayurveda rejects.)

In my opinion, ayurvedic therapies surely draw on placebo effect, but they in themselves are far too sensual, far too therapist-client cooperative, far too scheduled and contemplative to be equated with sugar pills. The person who engages with cleansing as a psychosomatic discipline is doing too many things to be accused of cognitively fooling themselves into thinking they feel better.

Most notably, they are learning to identify the phenomenology of unwellness within themselves, outside of externally-imposed diagnostic language: feelings of too-hot, too-dry, too-cold, too-contracted—too-sticky, too-mobile, etc., and then learning the many environmental, behavioural, dietary, kinetic, social and emotional approaches that counteract the phenomena. T

hey become more engaged with the granular detail of their lived experience; they begin to melt their dissociation away. They begin to tell a story about their imbalances and their recovery that pulls on multiple threads of experience.

It happens because they have entered a therapeutic relationship, both with themselves and with someone who tries to help connect the dots of wellness that biomedicine must isolate in order to form testable hypotheses.

In effect, they both create and derive support from what Daniel Moerman calls the “meaning response”, which Dominik Wujastyk introduced me to through this elegant paper on the empowerment of patient involvement in ayurvedic practice.

Adding and responding to meaning in a health narrative is undoubtedly a crucial part of the healing process. Biomedicine provides some meaning, alternative medicines provide other meanings. Psychotherapy adds to the stack.

What’s interesting to me is that all of us, regardless of the territory we stake out along the sciences/humanities spectrum, are blending meanings from each category. Which is why my friend’s Facebook post, while technically sound, also rings a little hollow: “Invest in wholesome food and clean water, get plenty of rest and sweat/exercise every day.”

If only it were so easy to feel “detoxified” of what really wears us down: the phlegm of melancholy, the acids of anger, the astringency of worry. People drawn to detoxification are looking for something more than a fitness-pro pep-talk. They’re looking to change the ways in which they disconnect from themselves, which might include ditching the common-sense feel-good platitudes that cover over the intricacies of how we suffer.


Multiple Narratives of Wellness

In my experience, even those who favour a “common sense” biomedical epistemology employ multiple discourses—from the scientific to the psychosomatic to the aesthetic—to embody or even perform their wellbeing ideals.

To illustrate, I’ll tell you a little bit more about my Facebook friend.

He’s an old-timey all-around physical culturalist: yoga teacher, grappler, practitioner of Brazilian Jiu-Jitsu. I’ve learned everything I know about the MMA world from his finely-curated posts.

For such a young guy, he has a wealth of knowledge in conventional kinesiology, neuro-motor patterning and more fringy types of movement-craft.

While he frames most of his movement coaching and teaching in evidence-based terms, he also has an obvious aesthetic and sensual component to his health discourse, which shows up in his epicurean foodie updates.

Every few days there’s a picture of porter-braised back-ribs laid out on his oak table, or an apple-cider-glazed bacon recipe, or an elk steak in some fancy marinade on his granite kitchen counter. His newsfeed mélange of George St. Pierre videos, gait instruction blogs, reasons to not overstretch the hamstrings, and how to roast a suckling pig over an open pit blends a musky eau of determined virility, in which health is as much a product of passion and sacrifice and existential honesty as it is of muscular intelligence and reason.

Although I’ve never met him, I get the same polysemic subtext from my friend’s friend Tom—who argued so strongly for the biomedical paradigm.

When not on Facebook, Tom constitutes half of a folk rock duo that smolders out finely crafted duets anchored by his own guitar-plus-pedals slickness. Ten seconds watching him sing into the eyes of his partner in life and music tells me that he doesn’t find the heart of his wellness in his doctor’s office.

Musicians live for the immersive flood of sound—they know they can’t measure or describe what pops and what doesn’t without stripping all of the juice out of it.

Tom might be interested in knowing that in ayurveda music has specific and material therapeutic value. Its media is space element, said to give a direct connection to the autonomic nerves, to all of our interoceptive movements, and to our subconscious language, while reverberating in the empty spaces of the flesh: the sinuses, the bladder, the colon.

The keys he plays in have distinct energetic qualities said to harmonize with the functions of particular organs, which is the basis upon which some ayurvedic physicians prescribe Indian ragas as medicine. The ragas are chosen by constitution, symptomology, and they are listened to at prescribed times of day. Dusk is said to be a particularly potent time to listen to ragas that soothe illnesses resulting from the muscular and circulatory contractions of anxiety and fear.

In other words, ayurveda provides a paradigm in which the untestable and immeasurable things that Tom clearly loves are the building blocks of what makes him holistically well in cognition, emotion and the tissues.

I don’t think that I’d be projecting to say that music is Tom’s shraddha—which from Indian philosophy is often translated as “source of faith”, but etymologically means “that which is heard in the heart (hrd)”, where the heart as the seat of emotions and the heart as the source of circulation are one and the same.

In the psychosomatic language of ayurveda, saying that music “opens the heart” is not just a psychological claim—it is a protocol for cardiovascular health.


Looking Forward and Etiquette for Time Travellers

There are at least two emerging disciplines that might provide insight for today’s ayurvedists who are looking for models by which psychosomatic and biomedical languages might begin to listen to each other, without appropriation or dismissal.

The research currently being done in mindfulness-based stress reduction (MBSR) is making great strides in being able to conjoin diagnostic and subjective/polysemic measurements of experience.

And then there’s the amazing field of psychoneuroimmunology, reaching back into the pioneering syncretism of Claude Bernard, which is quantifying with scientific rigour exactly what ayurveda has been correlating for millennia: how emotional experience, organic function, homeodynamism, and resistance to disease are inextricable values.

My hope is that ayurvedists worldwide turn to these discourses for inspiration as we get clear on the ways our language can enhance and humanize biomedical wizardry, without intruding upon it, or trying to appropriate it.

These days, when I sit with clients as an ayurvedic practitioner, I know that I’m a time traveller to the future. I’m looking at people’s energies, habits and uniqueness through the very old lens I’ve cobbled together from multiple teachers, threads, and fascinations.

This old lens is not pseudoscientific in itself, because it was ground in a pre-scientific age—but it will become pseudoscience if it forgets its heritage, and believes it should compete with biomedicine.

To assert in good faith that ayurveda has a healing gift to offer to a more advanced world, I must be a good guest, and open myself to an intelligence different from my own.

This means always asking the questions: How does biomedicine understand this presenting condition? What is the mechanism of its latest treatment for it? How does that treatment constitute a refinement of my older tools? And – is there something that the speed and precision of this brave new world has forgotten? What ancient poetry can lend the radiance of candlelight to these dazzling surgical lamps?



Lad, Vasant. Textbook of Ayurveda. Albuquerque, N.M.: Ayurvedic Press, 2002. Print.

Langford, Jean. Fluent bodies: Ayurvedic remedies for postcolonial imbalance. Durham: Duke University Press, 2002. Print.

Iyengar, B. K. S.. Light on yoga: yoga dipika. Rev. [pbk.] ed. New York: Schocken Books, 1979. Print.


Many thanks to Dr. Dominik Wujastyk for alerting me to the Arya Vaidya Pharmacy research on rheumatoid arthritis and for cluing me in to Daniel Moerman, and for directing me to his article “Medical Error and Medical Truth: the Placebo Effect and Room for Choice in Ayurveda.”


Republished with permission from



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Ed: Bryonie Wise



About yoga 2.0 lab

Matthew Remski is an Ayurvedic practitioner and Yoga Teacher Trainer in Toronto. His latest book, Threads of Yoga, is gathering international acclaim. He's teaching this online course starting 1/7/14. It's currently full, but there is a reduced-tuition option for auditing. The 12 weekly lessons will be available online for six months following the course. Participants receive a 130-page manual of notes.


11 Responses to “Is Ayurveda Pseudoscience? ~ Matthew Remski”

  1. Jenny says:

    Long and in-depth, and I'll have to set aside some time for reading it more thoroughly. A few points jumped at me; 1. the gold-standard of the double-blind experiment, and 2. "This old lens is not pseudoscientific in itself, because it was ground in a pre-scientific age—but it will become pseudoscience if it forgets its heritage, and believes it should compete with biomedicine."

    As a once-was-statistician-always-statistician-even-though-no-longer-practicing-statistics, I confess to my utter frustration with the self-proclaimed gold-standard. There are many, many kinds of experimental designs. The "gold-standard" just happens to be one of the simplest that can be most easily applied in, say, pharmaceutical research. This experimental design cannot be applied to individualized protocols, so can't possibly be a gold-standard design. It's a false standard. There are other kinds of designs, such as, for example: Nonlinear repeated measures (any individualized design would have to be a repeated measures design).

    As for 2) – completely agree.

    Thank you for putting this out here.

  2. matthew says:

    Thanks Jenny for adding value from way beyond my pay grade. I'll have to read up on nonlinear repeated measures. Cheers.

  3. Scott Miller says:

    By far your best post ever, Matthew. As you may recall, I've been critical of some of your previous pieces. They were "opportunistic." No sign of that here. This one is meaningful and more than well stated. I'm going to send it to my Ayurvedic practitioner friends. They'll love it. But I must admit that I was kind of hoping you might take a few shots at western medicine (and science in general). Probably best that you refrained. If you ever want some back-up there, you could use The Black Swan by Taleb. He describes the "narrative fallacy" unwittingly followed by scientists (who, for example, thought it was a great idea to use bottles instead of breast feeding without considering the effect on babies and their mothers) extremely well. And I imagine Jenny the statistician has read The Black Swan. She might want to work out the math-I.Q. relationships involved in how many views this post gets compared to your other wildly viewed nowhere-near-as-good opportunistic posts. Nice work.

  4. Jenny says:

    I haven't read The Black Swan, but it sounds like a good one. Is it one of those books that will provoke my pitta?;-)

  5. Scott Miller says:

    Parts of it, yes. My pitta was provoked about a quarter of the time. I kept wanting to talk to (yell at) the author about Consciousness as the Ground of Being (because his empirical perspective on randomness makes him admittedly miserable). But it wouldn't help. I'm sure Consciousness wouldn't be his thing, and yet the book is a powerhouse of ideas that definitely put all academics in their place (especially as far as the misuse of information is concerned).

  6. Thaddeus1 says:

    This is quite a fine piece Matthew, I must say.

    In echo of the comments above, I did wonder why there was not a more critical questioning eye turned towards the "gold-standard." I wouldn't advocate taking shots at it, as this might imply that there was nothing of substance upon which it could/should be critiqued. In the end, I think it is valuable to bring a critical eye to the inner workings of science because in not doing so, we merely serve to perpetuate the myth that somehow "science" has stumbled upon the God's eye objective vision/truth of the world.

    Perhaps in the next piece.

  7. matthew says:

    I suppose the critique is implicit/inverse, in the sense that by showing the problems of subjecting Ayurvedic practice to biomedical standards of evidence, I'm hinting at the narrowness of the latter. I think good science recognizes that it has stumbled upon a method (rather than vision) that at least tries to mediate subjectivity towards creating discourse that can be shared. What's unfortunate is that modes of evidence tend to dismiss each other, and so we see in our epistemologies what we see too often in our politics.

  8. Bryan says:

    Hi Matthew,

    What do you know of all the research and work of people in India? I mean you can get an actual PhD in the subject over there, and there is a wealth of work being done on some of these topics. While a lot of it is taking a westernized approach ( I agree the western and eastern systems don't mix with their paradigms), there must be some other fertile ground in Indian research.
    As far as cleansing goes – I don't know what you do precisely, but anything involving purgation, enemas,etc.. should be done by someone who has studied with a real vaidya and had extensive in person clinical supervision. Unfortunately most of the education in the West at this time is quite frankly a joke compared to India and NONE of it follows the World Health Organizations guidelines for training int his field. The fact that people are calling themselves "practitioners" is along the lines of people calling themselves yoga "teachers" after a few hundred hours of training and shows our need to cash in on some silly certificate or course. This is very dangerous – even if it is just "basic" stuff like diet and lifestyle. That is huge and you can really mess people up. I've been seeing this quite frequently lately with charlatans practicing this medicine and recommending things like bitter or astringent herbs in the summer because "pitta" is supposedly vitiated according to some textbook. You can't work properly with Ayurveda around the three doshas, it's not how it works but is a lot of what is happening unfortunately. As far as yoga goes in the west, most of it is disease forming according to Ayurveda and is a sad sight to see.
    Traditionally there were not that many teachers of yoga and good vaidyas were hard to find as the classical texts warn time and again of quacks practicing medicine – yet this is what is going on and no wonder people think this is pseudoscience – can't blame them. If you want to test your practitioner ask them what are the questions that every vaidya should know. It's an actual test for an Ayurvedic practitioner from the classics, yet who knows this stuff?
    A lot of westerners are extremely naive and will think that any shift in energy is a positive one. I've fallen victim to this kind of thinking and have really messed up my body and mind thanks to it. I see a lot of people doing the same now and it keeps getting worse as this knowledge spreads. Your really a beginner with any of this stuff for 12 years or so as there is so much subtlety in these sciences it is not even funny. Ayurveda does have the ability to cure or reverse complex disease, but once again in the hands of a highly skilled and under the proper circumstances. The only reason diet and lifestyle is focused on in the west is likely because most people are not equipped to handle actual disease and downplay what Ayurveda can do. For example there is no pancha karma proper in the west that I know of, but a lot of people calling a lot of different things by the wrong name. This does no one any good in my opinion.

  9. matthew says:

    Hi Bryan — I share many of your concerns, which is why my tendency in practice is towards conservatism in expectation, to counter what I see as the overselling — not downplaying — of Ayurveda's capacities. As far as research in India goes, I am not well-versed, but this collection has been very helpful so far:…. I also think that concentration paid to diet and lifestyle according to even a beginner's understanding of constitution and circumstance can be priceless.

  10. Great article, Matthew. I somehow missed it when it first came out.

    Bob W. Editor
    Best of Yoga Philosophy

  11. Brad says:

    Nice article. Like Bryan stated above though, what is being taught in the West is hardly Ayurveda and is just a pseudo Western take of Ayurveda. is this what is to come of Ayurveda because of our lousy education and egos of what we call healing?
    I mean by this that i sit here in an Ayurvedic hospital in India daily and watch what is impossible by western mind. This is what i know to be Ayurveda. i come back to the states and am embarrassed and shamed by what is going on here in the name of Ayurveda. Other countries have now accepted Ayurveda as a legitimate medical system. What happens when it comes to America to do so, what, all that are "practitioners" of a lesser system that they actually believe to be ayurveda now are not going to be in their "practice" of whatever it is they think they are doing??? No BAMS can be built here in the US for many reasons besides the obvious.

    So we can talk and talk of the beautiful language that is surrounding all that is going on but that itself does not exist here in India in my day to day clinic.

    What is more to thee point is that the Western paradigm or mindset or heritage is missing major comprehension behind what is health that Ayurveda clearly defines.
    How can that fit?
    Square peg, round hole.

    Not to mention about the lack of a real eduation like Bryan spoke to, BAMS is the least eduation someone can have to call themself an ayurvedic anything in india. 5.5 full time medical school hours. America????? 24 weekends and you have a masters at Mount Madonna and leave knowing nothing as examples have shown to me by friends that have completed the course.

    I think this stuff is more to the point instead of thinking within the confines of the dark and blind box that America continues to create around Ayurveda.

    I think another point for your friend Tom is more to place what he understands under the knowledge and test of Ayurveda. We simply cannot research Ayurveda by western methods because it is a different paradigm as you have somewhat expressed. This does not in any way mean that it is not valid. Western medicine falls short in the paradigm of Ayurveda but can be used very well for its diagnosis tests and to be used in some circumstances from an ayurvedic vantage point.