Evolution of Medicine

Abstract

This chapter describes the philosophy, history, and evolution of science and medicine from ancient times to Aristotle and Hippocrates, and to Osler of modern times. A comparative account of the philosophy and history of science provides an analytical perspective of important events from the West, and the East. In the West, modern biology and modern medicine evolved through the use of reductive logic, mostly after the Renaissance. Anatomical dissections led to a better understanding of physiological processes such as the description of the function of the heart, and the circulation of blood by William Harvey. In the West, scientific and technological advances facilitated the emergence of disease-centric modern medicine, with powerful drugs, pharmaceuticals, and surgical innovations. In the East, ancient systems like Ayurveda, Yoga, and Traditional Chinese Medicine (TCM) continued with a holistic approach to health, disease, and wellness involving body/mind/spirit. The Eastern approaches give wider recognition to the role of diet, nutrition and exercise, and lifestyle through the practices of Ayurveda, Yoga, TCM, Kampo, Chi Gong, acupuncture, and natural medicines. A short review of important developments in Eastern and Western medicine helps to understand transitions in social, cultural, and behavioral aspects. The historical and philosophical underpinnings discussed in this chapter provide a rationale for integration, and lay the foundation for rest of the book.

Keywords

Arabian; Biomedicine; Chinese; Ethnomedicine; Greek; History of medicine; Holistic; Kampo; Korean; Modern medicine philosophy of medicine; Reductionist; Traditional medicine

The doctor of the future will give no medicine, but will interest patients in the care of the human frame, in diet, and in the cause and prevention of disease.

Thomas Edison

Shamanic and Ethnomedicine

The history of medicine dates back to the period of human existence. The understanding of health and disease has evolved over thousands of years. Most of the great civilizations—Egyptian, Assyrian, Babylonian, Hebrew, African, Arabic, Chinese, and Indian—had their own traditional medicine.

Archaeological evidence of knowledge of diseases and treatments during prehistoric periods is debatable. The customs and traditions among several tribes in Africa and aboriginal people in Australia, and the Americas provide a few glimpses. During ancient times, the priests or shamans were responsible for diagnosing and treating diseases.

During prehistoric times, medicine men, also known as witch-doctors, were responsible for the maintenance of health, and treatment of ill health in many tribal and ethnic communities. Ethnomedicine used medicinal herbs as well as supernatural, ceremonial, and ritualistic treatments such as magic formulas, charms, jujus, prayers, and drumming; these were commonly used to remove evil spirits. These god-men were believed to be able to communicate with gods or spirits, and cure the patient through supernatural powers. Medicine men used to be central figures in the tribal system because of their medical knowledge, and people’s faith in their ability to contact the gods. Most of the knowledge about such traditions—religious and medical training—was passed on orally. This unwritten and noncodified knowledge must have undergone several transitions, and transformations, intentional changes and unintentional errors over centuries. Therefore, in the present context, the relevance of the processes and materials of the shamanistic traditions is highly questionable, unless it is subjected to rigorous study and validation.

Prehistoric people probably knew about medicinal plants and other substances to treat disease. The Ebers Papyrus dating to 1550 BC is considered the oldest and most important medical papyri of ancient Egypt. Imhotep, who was supposed to be the chief minister to the Egyptian King in the twenty-seventh century BC, is considered to be the first doctor; he is identified with the Greek god, Asclepius. Asclepius is the Greek god of medicine, and his daughters represent important branches of medicine. The snake-entwined staff of Asclepius is a symbol of medicine today. Those physicians and attendants who served the god Asclepius were known as the Therapeutae of Asclepius. The use of these terms in modern medicine today shows the influence of these civilizations. There is some archeological evidence that clay tablets bearing specific signs were used by physicians of ancient Mesopotamia. One of the oldest, deciphered stone carvings, the Code of Hammurabi, was promulgated by a Babylonian king during the eighteenth century BC, and contains a few laws relating to the practice of medicine.

Quite surprisingly, the widespread practice of the preservation of dead bodies as mummies by the ancient Egyptians did not lead to a deeper understanding of anatomy. However, they indicated evidence of arthritis, tuberculosis of the bone, gout, tooth decay, bladder stones, gallstones, and the parasitic disease, schistosomiasis—maladies which are seen even today. Modern medicine was nurtured in the European region, and draws substantially from the knowledge and approaches found in papyri of Egypt, Greek, and Hebrew origin.

While the Harappan Civilization also existed during the same time as the ancient Egyptians in the Indian subcontinent, reliable archeological evidence is not available; hence the nature of medical practices prevalent in the Indus Valley Civilization is unknown. The nature of the art and science of medicine, which developed during this period still remains a mystery. Charaka Samhita, the classic of Ayurveda, is supposed to have been written sometime during the fourth century BC. Hippocrates’ contributions to medicine were made around this same time. While medicine traditions existed during Buddhist and Jain periods sometime during the fourth and sixth century BC. However, for all practical purposes, the reference point for cause and effect based, rational medicine in India remains the Charaka.

Philosophy of Medicine

Although, this book is about integrative approaches for health, we begin with a discussion of medicine. We find much confusion between these two terms. Many times they are used as synonyms. During the last two centuries, the focus on health was slowly shifting to disease and treatments. The possible reasons for this shift are rooted in the concepts and philosophy of medicine. Therefore, it is important to clearly understand the term medicine. It is necessary to explain a few similar sounding, but often interchangeably used terms related to health and medicine.

The contemporary and dynamic dictionary/search engine, Google, gives two definitions of medicine. The first definition is quite broad, and describes medicine as “the science or practice of the diagnosis, treatment, and prevention of disease.” The second definition is specific, and relates to a substance or a product as “a drug or other preparation for the treatment or prevention of disease.” Thus the term medicine incorporates science and clinical practice, together with substance or drug components. This word is supposed to originate from the Latin word, medicina, meaning drug, and medicus meaning physician. The term clinician is often used as a synonym for physician, or a medical doctor. The term clinician has its origin in the Greek term clinike, which actually means bedside. The terms physician, clinician, and doctor generally refer to medical doctors who treat sick people. Thus, even today, the notion continues that medicine and doctors are for sick people. However, this is not so. Rather this should not be so. Doctors should actually help people remain healthy. Their role should not be restricted only to the treatment of diseases. To get a little better insight into this approach, it is advantageous to delve into the philosophy, ontology, and history of medicine.

There are diverse views regarding what constitutes a philosophy of medicine. One of the authorities in this field Arthur Caplan, in 1992, raised the question “Does the philosophy of medicine exist?” According to Caplan, the philosophy of medicine is a subdiscipline of the philosophy of science [1]. The philosophy of medicine includes medical ethics and bioethics, but its scope is much wider, involving epistemological, metaphysical, and methodological dimensions of medicine, which include therapeutic, experimental, diagnostic, and palliative aspects. If we consider medicine only as a branch of the basic sciences like anatomy, physiology, and biochemistry, then the philosophy of medicine will be a branch of philosophy of science.

However, medicine is not limited to pathophysiology, pharmacology, psychology, microbiology, or genetics. The main purpose of the science of medicine is to understand human body functions and dysfunctions through sound hypothesis, robust experimentations, observations, analysis, and a continued search for truth. However, the real purpose of medicine is more than all this. It is indeed a search for truth, with the definite objective to attain health and healing. Probably this is the reason why religious places like churches, temples, monasteries, and mosques were involved in medical care before the evolution of clinics and hospitals. These sacred places protected traditional knowledge during invasions and dark periods in their respective regions. In many ancient civilizations like Egypt, priests worked as doctors and healers. Even now in some parts of Africa and India, such practices exist. During the ancient time, medicine was not restricted to material drugs; rather, the approach was holistic—involving body, mind, and spirit.

Medicine has a much larger role than that of science. It is not merely a sum of philosophies of science, biology, or the humanities. Medicine has a very strong ethical aspect that relates to the good of patients [2]. Its present commercial nature as a fee-based service goes against the true spirit of this noble profession. In any case, the philosophy of science can, and probably will lead to a better understanding of the philosophy of medicine. Philosophers have been trying to define the term science for a long time.

Philosophy and Science

During ancient times, science and philosophy were considered as one. Therefore, ancient Egyptian, Roman, and Greek thought actually exhibits a dominance of holistic philosophy over reductionist science. These Western traditions slowly were transmuted into modern science as a result of sharp-eyed observations, and rigorous experimentation and analysis by several philosophers and thinkers such as Aristotle, Archimedes, Galileo, Newton, and Einstein. On the other hand, many of the ancient Eastern traditional knowledge systems became frozen parts of history. They remained static for a long time, and lost the dynamism that is necessary for the progression of science. As a result, many of the Eastern traditions, like that of Tibet, remained more a philosophical bulwark against the adaptation of the culture of science. The ancient knowledge systems like Ayurveda and Yoga seem to fall somewhere in between.

The discipline of natural philosophy gradually became natural science, which is now known as modern science. Socrates first tried to apply philosophy to the study of human nature and human knowledge. At that time, he actually criticized the way in which physicists were thinking. In the process, he challenged the mythology and dominion of traditions. As a result, Socrates was viewed as a rebel, and was executed in 399 BC. Later, Aristotle (384–322 BC) proposed a less-controversial systematic program; he maintained the sharp distinction between evolving experimental science, and the traditional, practical knowledge of artisans. He advocated that theoretical studies are of higher intellectual activities than skills of artisans. In a way, he started differentiating levels of intelligence, and hierarchical, professional classes. Aristotle emphasized importance of the theoretical steps in deducing universal rules from raw data. According to him, mere experience, and the collection of raw data is not part of science. For the first time, Aristotle proposed that the earth was round, and not flat. He promoted theories of reductionism, and encouraged deeper studies on parts. This Aristotelian reductive logic and quest for new knowledge has led to today’s science of analytics.

A paradigm shift happened when philosophy and science were separated, and the seeds of reductionism were sowed. Quite interestingly, almost up to the seventeenth century AD, the words science and philosophy were used interchangeably [3]. Probably during Newton’s time natural philosophy branched out, and evolved as natural science [4]. As philosophy and science were separated, the division between East and West became sharper. With the help of the Aristotelian logic, modern science rapidly progressed in the West, and grew into many branches such as physical, chemical, and biological sciences; this led to new technological applications. Aristotelian deductive reasoning used cause and effect, premises, and analysis to draw conclusions. With valid and true premises, and strict observance of deductive logic it is possible to derive accurate conclusions. These approaches subsequently led to hypotheses building, and theories such as generalization, causal relations, statistical syllogism, detachment, validity soundness, predictions, and finally, empiricism.

Empiricism holds that any knowledge comes primarily from experimentally measurable or experiential, sensory experience. This was further supported by rationalist criteria where proof is drawn from intellectual reasoning and deductive methods. From antiquity through to the Middle Ages, the Aristotelian reductionist approach was rigorously used in understanding several natural phenomena; this gradually prepared the way for the evolution of the modern science. However, in the process of scientific advancement, some valuable insights and ancient knowledge were either lost, or remained in obscurity. This background will be useful when we discuss the meaning of evidence, and its application to medicine.

Science in the West

The term science normally denotes modern science and involves a broad spectrum of human activities—from understanding the universe and nature through understanding of bosons, electrons, atoms and particles; lasers, microscopes and telescopes; animals, plants, microbes and species; tissues, cells and genes; and an array of activities from space odysseys to decision analysis. Generally, science can be considered as a body of knowledge, and the processes of its acquisition, retrieval, and applications. It is not only about the collection of information or laboratory investigations, or statistical analysis; it is a process of logical, consistent discovery leading to the enhancement of holistic understandings. The knowledge generated by science is reliable, reproducible, and can be applied to develop new technologies.

Science is very dynamic in nature; concepts, hypothesis, assumptions, relevance, and interpretations may keep on changing as the body of knowledge grows. The serious study and practice of science normally lead to new questions for future investigations. Therefore, theoretically, true science never will reach finality. Several traditional knowledge systems existed in the premodern era. These are categorized as the ancient sciences. Today’s modern medicine essentially developed through the theories and principles of modern science. Modern science relies more on rational, experimental, and reductionist approaches; traditional practices like Ayurveda rely more on holistic, empirical, pragmatic, experiential, and intuitive strengths.

In the Oxford English Dictionary, science is defined as “an intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experimentation.” Thus, modern science is restricted to the physical and natural world. Modern science has revolutionized our life by generating knowledge that provided us with powerful diagnostics, new medicines, vaccines, and many technological marvels like robotic surgery. Modern science helps us to understand many important problems, and provides answers to questions: Who were our evolutionary ancestors? Why and how do humans differ from monkeys? How do microbes cause disease?

While modern science can address questions related to physical, chemical, and biological phenomena or processes, it also has its limitations. Typical, searching, philosophical questions: “Who am I? Where did I come from? What is the goal of my life?” cannot be answered in the context of our present understanding of science. Modern scientists are able to arrive at different theories concerning the origin of life, but they do not have an answer to the question: What is the purpose of life? Modern science does not deal with moral or aesthetic judgments. These issues typically are the domain of philosophers. It is interesting to see how science and philosophy are related to each other.

Science in the East

While modern science took shape in the West, the East faced invasions and instability. The geopolitical situation in the East was not conducive to research or development. For a long time, the Indian subcontinent was under the rule of Mughal emperors, followed by the British. Although, significant knowledge, wisdom, and competence existed in this region, hardly any scientific advancement was possible; Indian communities were more concern about preserving knowledge. This led to the compartmentalization and monopolization of knowledge. This was a period of great stagnancy. Some examples of notable contributions, which emerged from Eastern regions include Charaka (400 BC), who is considered the father of medicine. He compiled a comprehensive encyclopedia of medicine, the Charaka Samhita, which elaborates principals, diagnoses, and treatments. This classic text gives detailed knowledge of human anatomy, embryology, pharmacology, blood circulation, and diseases like diabetes, tuberculosis, heart disease, and details of thousands of medicinal plants used in Ayurveda.

Other notable contributions from Indian subcontinent include work of Aryabhatta (476 AD), a master astronomer and mathematician. In his classic text known as Aryabhatiyam, he described the process of measuring the motion of planets and eclipses. Aryabhatta proclaimed that the earth was round, it rotates on its axis, orbits the sun, and is suspended in space. Aryabhatta’s most spectacular contribution is the concept of zero. Varahamihira (499–587 AD) in a classic text, Panchsiddhanta, notes that the moon and the planets are lustrous not because of their own light, but due to sunlight. In the Bruhad Samhita, he detailed many discoveries in the domains of geography, botany, and animal science. Another great scholar, and master of arithmetic and astronomy is known as Bhaskaracharya (1114–1183 AD). In his classic text, Surya Siddhanta, he made a note on the force of gravity. Nagarjuna (800 AD), in the classic text Rasa Ratnakara, outlined many interesting experiments in metallurgy, alchemy, and chemistry. He also used metal-based ingredients in medicinal preparations. Many other spectacular contributions have come from the Indian subcontinent, however, due to limitations of space, only a few representative ones are mentioned here.

Indian Ayurveda and Traditional Chinese Medicine (TCM) are part of the Eastern or Oriental traditional medicines. India and China have rich traditions, spanning thousands of years, in the arts, humanities, sciences, and medicine. From 400 BC, Indian knowledge became available to European and Arabic regions through invasions by Alexander the Great, and others. There is evidence of some communication between Greece and India even before Alexander the Great’s invasion, possibly through the Achaemenid Persians [5].

A closer look at the history of Western science, uncovers the influence of Vedic and ancient Indian knowledge systems on many philosophers and thinkers from the West. Evidence of this influence is also found in the works of pioneers in the field of medicine such as Hippocrates, Avicenna, Galen, and Osler; the influence of Vedic knowledge on Greek science and medicine is apparent. Yet hardly any mention or recognition appears in the documents including the most cited book of Osler on history of modern medicine.

In contrast to the lack of attribution in the Western scientific, philosophical and medical texts, Persian scholars duly acknowledged their sources of knowledge. For instance, Abdulla-bin-Ali, Manka, and Ibun-Dhan translated several Ayurveda texts into Persian and Arabic. Charaka Samhita (Sharaka), Sushruta Samhita (Kitab-E-Sushrud), Ashtanga Hridaya (Astankar), and Siddhayoga (Sindhashtaq) reached the Arabic and Persian physicians in the sixth to eighth centuries. In 850 AD, Ali-bin-Raban-al-Tabri authored a textbook of medicine, Firdausu’l-Hikmat. He appended a chapter on the Indian system of medicine in this book; this was much earlier than Avicenna wrote his famous Canon of Medicine.

The Eastern process of dialogue, dialectical method of enquiry, and hypothesis building also form the foundation of Western philosophy. Many concepts have roots in Vedic literature. The Delphi method of participatory, consensus building, which is used widely today, might have roots in a tradition of Ayurveda known as Tadvidya Sambhasha. Detailed rules and procedures for conducting consultations, debates, and discussions are given in Ayurveda. The Greek theory of macrocosm and microcosm, the concept of the four elements (fire, air, water, and earth), the four qualities (hot, dry, wet, and cold), and the four humors (yellow bile, blood, phlegm, and black bile) have striking similarities to the theory of Loka–Purusha, the five Mahabhoota, the three Dosha, and six Rasa—which form the basis of Ayurveda.

The Indus Valley Civilization, and the ancient Chinese, Mesopotamian, and Egyptian civilizations had several similarities. In the beginning of the first millennium AD, three principal systems of medicine—Ayurveda, Greek, and Chinese—were active. The fundamental attitude to the relationship of man and nature was similar in all the three ancient civilizations. However, their explanations of the human body, physiology, pathology, and therapy were different in some respects [6]. Their approach to health was holistic.

Later, Greek medicine followed the modern science path, and gradually evolved as modern medicine. Ayurveda emerged as a remarkable, holistic system both in its foundational ideas, and therapeutic measures. Later, during the period of invasions in India, Ayurveda was suppressed and stagnated for several centuries—a severe setback for systematic progress and development of Ayurveda. Moreover, because of the dominance of modern medicine during the colonial period, Ayurveda was further fragmented, deteriorated, and was marginalized.

In illustrating a few examples from India and Ayurveda, it is not the authors’ intention to raise a debate about the supremacy of any civilization or approach. We simply wish to highlight the tradition of exchanges, dialogue, and similarities between Eastern and Western thought—especially during the time of ancient civilizations. Similarity in approaches is evident in the advice given by Charaka and Hippocrates. It is unfortunate that due to geopolitical, environmental, and socioeconomic changes, a healthy dialogue and a free exchange of knowledge between East and West were significantly reduced. Western societies, especially during the Renaissance, embarked upon the dynamic, reductionist path of modern science and technology. On the other hand Eastern societies remained isolated, and struggled to protect and continue their own traditions.

Before the Renaissance, the division of the world into East and West was not very sharp. The Renaissance of the fourteenth to the seventeenth centuries AD, started in Italy and spread throughout Europe. This triggered a new era of creation, transformation, and progress of civilization. In real sense, this is an early example of disruptive innovation. With the availability of paper and early printing tools, the dissemination of ideas was facilitated. This period witnessed spectacular revolutions in humanism, and social, political, and intellectual pursuits. Some of the world’s greatest artistic achievements were made during this period. Remarkable artists like Leonardo da Vinci and Michelangelo made timeless impacts during this period. The benefits of the Renaissance to various disciplines including art, culture, science, medicine, and humanism were mainly seen in the West and Middle East including European, English, Arabic, and Russian regions. Sadly, these developments of science, technology completely bypassed the East, including the Indian subcontinent, and other parts of Asia. As a result, today’s modern science is known as Western science, and modern medicine is also known as Western biomedicine.

The Western ideas fueled by the Aristotelian reductive approach shaped the modern world due to robust developments in sciences and technologies. The modern world became rational, logical, mechanistic, materialistic, and self-centered. The Eastern world continued with traditions, remained suppressed, pragmatic, intuitive, and spiritual. If an epistemological bridge between these two worlds would have existed, the face of Ayurveda as well as modern medicine would have been much different.

The Western mind and philosophy seems more restrictive, reductive, quantitative, calculative, and analytical—relying more on empirical, measurable parameters within the understanding or experiences of human sensory organs, or from instruments as their extensions. In a way, Western philosophy is dominated by the left brain.

The Eastern mind and philosophy seem more open, inclusive, holistic, qualitative, creative, and intuitive in approach, and not restricted to sensory experiences, but often marked by transcendence involving body/mind, and spiritual insights. In a way, Eastern philosophy is dominated by the right brain. The earth can be visualized as a brain: the East and South dominated by the right brain, and the West and North by the left. Interestingly, the difference in Eastern and Western approach is seen in the respective regions (Figure 2.1).

We are aware that while psychologists agree with the left and right brain theory, brain scientists differ. We feel that psychology as a systemic science focusing on mind, represent right side, while the neurology as a structural science focusing on brain, might represent the left side. According to Jeff Anderson, neuroscientist from the University of Utah, who studied over 7000 regions of brain with help of magnetic resonance imaging (MRI), “It’s absolutely true that some brain functions occur in one or the other side of the brain. Language tends to be on the left, attention more on the right. But people don’t tend to have a stronger left- or right-sided brain network” [7]. Agreeably, at a physical level, the division between left and right brain may not be seen by MRI. However, we feel that current science still has many limitations to know the real functioning of the brain leave apart its relation with an entity called mind. The analysis of the brain by a neuroscientist is typical feature of Western analytical mind, while an artist depicting the brain as a globe to show the right and left divide is a typical feature of Eastern creative mind. We are considering the division of the East and West, not merely in geographic sense, but more in terms of approaches and mind-sets.

Both the Eastern and the Western approaches are important, and should not be seen as mutually exclusive. Both the left brain and the right brain approaches are essential, and complementary. A judicious convergence of Western and Eastern philosophies is vital for the evolution of future medicine, and for constructing integrative approaches for health.

Eastern Traditional Medicine

Eastern medicine, also known as Oriental or Asian medicine, comprises mainly health systems and traditional practices from India, China, Japan, Korea, and Tibet. In addition, there are traditional medical systems in most of the Asia–Pacific region including Myanmar, Thailand, Malaysia, Vietnam, Cambodia, and Indonesia. Ayurveda and Chinese medicine remain the largest systems in the East. Other traditional medical practices from this region include Japanese Kampo, Arabic Unani, Tamil Siddha, and Tibetan Sowa Rigpa. Acupuncture is a specialized therapeutic technique predominantly practiced in TCM. Yoga remains a stand-alone knowledge system from India that focuses on health of mind and body, using relaxation, meditation, mindfulness, and consciousness techniques.

A brief review of a few important Eastern medical traditions will help to understand the interplay between science and traditions.

China

The organized form of TCM appears to have originated sometime during the third century BC when the Emperor Huang Ti, also known as the Yellow Emperor, wrote the Canon of Internal Medicine, also known as the Nei Ching. Other classics of TCM include the Mo Ching (known as the Pulse Classic) of the Han dynasty (202 BC–220 AD), and the Golden Mirror, which were compiled sometime during 1700 AD. From the nineteenth century onward, Western medicine started becoming popular in China; however, TCM continues to be popular, and remains in practice even today.

TCM is based on the dualistic cosmic energy theory comprised of yin and yang. The yang is the male principle. It is believed to be active and light, and represents the heavens. The yin is considered as the female principle. It is passive and dark, and represents the earth. Both principles and their properties are quite similar to the Prakriti and Purusha principles described by Indian philosophy. Quite similar to Ayurveda, TCM also holds that the human body comprises five phases or elements: wood, fire, earth, metal, and water. These phases are associated with other groups including the five planets, the five conditions of the atmosphere, the five colors, and the five tones.

TCM concepts of anatomy are based on presence of 12 channels, the 3 burning spaces, 5 storage organs (heart, lungs, liver, spleen, and kidneys), and 5 viscera organs (stomach, intestines, gallbladder, and bladder). Each organ is associated with one of the planets, colors, tones, smells, and tastes. According to TCM, there are 365 bones and 365 joints in the body. In TCM physiology, the blood vessels contain blood and air as per proportions of the yin and the yang; the blood and air circulate in the 12 channels, and control the pulse. In TCM pathology and diagnosis, the physician makes use of a detailed history of the illness, and the patient’s taste, smell, dreams, voice, color of the face, tongue, and most important—the pulse.

The Chinese materia medica is exhaustive, consisting of over 1000 vegetable, animal, and mineral remedies. The Great Pharmacopoeia prepared in the sixteenth century AD has 52 volumes, and is still authoritative. Drugs are used mainly to restore the harmony of the yin and the yang, and are prescribed in relation to the five organs, the five planets, and the five colors. The art of diagnosis and prescribing in TCM is very complex and personalized, and quite similar to Ayurveda.

Many herbal drugs from TCM have entered the modern pharmacopoeia: rhubarb, castor oil, kaolin, aconite, and camphor. The most frequently used plant from Chinese sources is ginseng, which is used as a tonic and aphrodisiac. The herb Ephedra vulgaris has been used in China for at least 4000 years; the alkaloid, ephedrine, isolated from Ephedra vulgaris, is used in the West to treat asthma. Artemisinin is another successful modern drug, which originated in TCM. Artemisinin is isolated from Artemisia annua, and has been used for thousands of years in China for the treatment of malaria.

Japan

Japanese traditional medicine, which uses herbal drugs, is known as Kampo. Its practices are like acupressure and acupuncture; known as shiatsu. The term Kampo is synonymous with Japanese medicine. This system has been in use for nearly 1500 years, and is integrated into Japan’s modern health care system. In the sixth century AD, along with the spread of Buddhism, Japanese scholars imported concepts and practices of Chinese medicine. The Chinese medical practices were modified to suit local needs, and became Kampo. This term literally means “Chinese style” in Japanese language. At the beginning of the nineteenth century, Kampo was suppressed by legislation that allowed only doctors trained in modern medicine to practice medicine. However, the Japanese people continue to use Kampo. The study of traditional medicine facilitated drug discovery in Japan: the isolation of ephedrine from Ephedra vulgaris, rotenone from Derris ellipticai, and the synthesis of methamphetamine. Many Japanese people object to calling Kampo alternative, or complementary [8]. After World War II, Kampo practice was strengthened; in 1967, it was covered under health insurance [9].

The Kampo system is a pragmatic and simplified version of Chinese medicine. Kampo treatment is based on the symptoms of the patients at the moment (sho), interpreted into three basic substances (qui, blood, and water). It considers hypofunction and hyperfunction, heat and cold, superficies and interior, and yin and yang. There are five parenchymatous visera, and six stages of disease. The selection of the treatment is based on sho: symptoms, systemic conditions, and physical constitution. The formula is prescribed for the specific sho. Kampo has been included in curricula of medical and pharmacy education since 2002. There are no separate courses in Kampo, the result of which is a lack of trained teachers [10]. A survey of patients reports that half of the patients use Kampo in combination with Western medicine. The factors associated with the usage of Kampo in Japan include people’s belief in philosophy, holistic approach, and efficacy of Kampo [11].

Korea

Traditional Korean medicine (TKM) possibly has its roots in Chinese and Japanese medicine [12]. There is evidence of the importation of Chinese literature into Korea around the tenth century. The classification of Korean drugs was known since the twelfth century. In the last 700 years, Korean medicine developed its therapeutic regimens—mainly whole, person-centric Sasang constitutional classification, and Saam acupuncture methods. By the seventeenth century, traditional Chinese and Korean medicine were distinct as Saam acupuncture practices were in use by this time [13].

Sasang constitution types are based on anatomical characteristics, temperament, and other traits of an individual. Every individual can be categorized into any of the four constitutional types: Tae-eum, So-Yang, So-eum, and Tae-Yang. Each constitution type is specific for appearance, personality traits, disease proneness, drug responses, and physiological attributes of the individual [14]. Treatment is based on constitution type, rather than symptoms. The Buddhist monk, Saam propounded acupuncture based on the five elements—earth, metal, water, wood, and fire, and six types of qi (energy). He suggested that the five elements have either nourishing or suppressing relationships. The Saam technique is based on 12 meridians, representing all the physiological processes. Each organ has a dominant element, and energy type.

TKM remained progressive in its theory and practice. Recently, a Korean scientist D.W. Kwon proposed eight constitution acupuncture types. The four Sasang constitutions types were further divided by functioning of organs (strong or weak functioning). The Korean doctors tried to integrate modern concepts into their practices. They also developed different acupuncture types based on specific meridians and constitution types. They developed the newer packages as bactericidal formula, and paralysis formula. Korean acupuncture types evolved further as herbal acupuncture, where the practitioners used herbal extracts (or bee venom) at specific acu-points [15]. Though the Korean medicine has roots in TCM, today it is an independent medical system with it’s own principles, philosophy, and practices. Another contributing factor to the growth of TKM is the acceptance of paradigms and diversity. TKM doctors have formed various academic societies, which contributed to scientific discussion, and development of clinical disciplines [16].

Tibet

Traditional Tibetan medicine is known as Sowa Rigpa. It is based on Buddhist tradition. Buddha’s teachings spread in Tibet after the eleventh century. Gyud-Zhi (Four Tantra) is the classical text that describes eight branches, and three principles, similar to Ayurveda. Health is the state of the balance of the three principles: Kapha, Pitta, and Vata. Diagnosis is based on pulse analysis, and urine examination. Treatment consists of behavioral and dietary modifications, and certain herbs. There are physical therapies similar to Ayurveda, such as massage. The Tibetan system also uses acupuncture and moxibustion in treatment. Apart from Tibet, the system is practiced in India, Nepal, and Bhutan, and the Himalayan regions, China, Mongolia, and in some parts of Europe. The Indian government has included Sowa Rigpa in AYUSH systems.

India

The Indus Valley Civilization represented by the Harappan phase seems to be from twenty-seventh century BC to the seventeenth century BC. This was followed by Aryan Vedic civilization which lasted until 1000 BC. The Jain and Buddha period was around 500–200 BC. Alexander the Great’s invasions of the fourth century BC were followed by the golden period of Ashoka from the third century BC, until that of Chandragupta, of the fourth century AD. The most authentic record and scholarly works on Ayurveda—Charaka and Sushruta Samhita—seem to be from the Chandragupta period.

India has codified systems like Ayurveda and Yoga, as well as noncodified, ethnomedicine and local health traditions. Siddha and Sowa Rigpa are mainly practiced in Tamil Nadu and Tibet, respectively. In addition, India has embraced Unani, which has Greek–Arabian origin, and Homeopathy, which is of German origin. All these are bundled together as AYUSH (Ayurveda, Yoga, Unani, Siddha, Sowa Rigpa, and Homeopathy). Yoga is an integral part of the Indian knowledge system. Principles of Yoga existed in the Vedas, Upanishadas, and ancient Indian texts. Yoga is considered a path toward the ultimate reality. Broadly, it has two parts. The first part relates to meditation, breathing, and relaxation techniques. The second part describes sophisticated, physical postures, and exercises.

More details about the philosophy, epistemology, logic, and foundational principles of Ayurveda and Yoga can be found in the “Primer” in Annexure A.

Evolution of Ayurveda and Yoga

Ayurveda literally means the knowledge of life. It considers the harmonious relationships between macrocosm and microcosm as a continuum. The holistic approach of Ayurveda addresses the preventive, as well as the curative aspects of medicine. Ayurveda is not folklore or a herbal tradition. It has its own epistemology and principles of anatomy, physiology, pharmacology, and therapeutics. Its history goes back to the Vedic and post-Vedic periods.

Ayurveda went through several transitions from 800 BC until about 1000 AD, and slowly moved away from a faith-based, ritualistic system of medicine, to a cause and effect-based, rational, and evidence-based system with sophisticated concepts of pathophysiology and therapeutics. Scholars like Charaka, Sushruta, and Vagbhata laid foundations of systematic, cause and effect relationships based on logic and evidence. There is no agreement concerning the time period of Charaka and Sushruta—which ranges from 800 BC to 200 AD. Many scholars believe Sushruta was sometime during 700–800 much before Charaka ∼400 BC. Many scholars also believe that Sushruta Samhita was compiled during ∼100 AD after Charaka Samhita. The time of Vagbhata is considered to be ∼700 AD. The three classic compilations known as Charaka Samhita, Sushruta Samhita, and Ashtang Hridaya of Vagbhata are still considered authoritative.

Charaka gave a very sophisticated account of internal medicine, including information of over 500 medicinal plants. The Indian materia medica had a large list of over 3000 botanical drugs. Ayurveda also advocated animal products such as the milk of various animals, bones, gallstones, shells, horns, minerals, and employed metals like sulfur, arsenic, lead, copper, and gold. The Ayurvedic physicians collected, prepared, and dispensed their own medicines. Many of the original Ayurvedic plants and spices are listed in Western pharmacopoeias as well.

Sushruta is considered the father of modern surgery. He described several sophisticated surgical procedures including removal of tumors, incision sections, draining of abscesses, punctures to release fluid in the abdomen, extraction of foreign bodies, repair of anal fistulas, splinting of fractures, amputations, caesarean sections, and stitching of wounds. According to Sushruta, the surgeon should be equipped with 20 sharp, and 101 blunt instruments of various descriptions. The instruments were largely of steel. Alcohol seems to have been used as an anesthetic during operations, and bleeding was stopped by hot oils and cautery. Sushruta listed over 760 medicinal plants.

The earliest plastic surgery is believed to have been performed by Sushruta. Amputation of the nose was one of the prescribed punishments for adultery, and reconstructive surgery like repair was carried out by cutting from the patient’s cheek or forehead a piece of tissue of the required size and shape, and applying it to the stump of the nose. The results appear to have been tolerably satisfactory, and the modern operation is certainly derived indirectly from this ancient source. Indian surgeons also operated on cataracts by displacing the lens to improve vision. Recent reports suggest strong evidence that sometime during 800–600 BC an extraocular expulsion of lens material through a limbal puncture was described by Sushruta [17]. This recognition was made in 1940 by John Davis in the presidential address at the annual meeting of the American Surgical Association [18].

Sometime during the eighth century, Nagarjuna developed Rasashatra (Ayurvedic alchemy). This was a major development in history of Ayurveda. Rasashatra literally mean “science of mercury,” which also includes metals and minerals. Hundreds of new substances were added as Ayurvedic medicine. Apart from medicine, newer technologies and processes were added to Ayurveda pharmaceutics.

Madhava Nidana, a classic on clinical diagnostics was compiled in the eighth century. This comprised pathology and diagnosis of prevalent diseases. Many diseases that were not mentioned in earlier texts were compiled in the Madhava. This text also describes several additional risk factors, and variations in manifestations of diseases. It also describes prodromal symptoms, disease types, and possible complications. The trend of revision, review, and analysis leading to gradual, progressive development of this ancient science of life continued at least until the tenth century.

After the Indian subcontinent became the target of Persian and Greek warriors like Alexander, much knowledge from Vedic sources was acquired by the Persians and Greeks. Followed by the collapse of Gupta Empire in the sixth century BC, the Indian subcontinent remained almost continuously volatile, and a larger portion of India began to be ruled by invaders; the tenth century onward saw invasions by Gazani, Ghori, and several others. This was the beginning of a dark period for Ayurveda, which continued until India’s independence from British rule in 1947. Ironically, even after independence, due to lack of proper vision and strategy, Ayurveda and Yoga remained stagnant and could not be brought into the mainstream health care.

The development of Ayurveda took an interesting trajectory from mythology to logical, rational, and evidence-based practices. However, due to hostile environments as discussed earlier, the Indian traditions seem to have taken the ritualistic path to preserve their knowledge and identity. As a result, progress of scientific culture in India was arrested. The epistemology of Indian science was compromised. Due to unfavorable environments like colonial rule, and a wider acceptance of modern medicine, the growth and development of Ayurveda suffered for many decades. As a result, the rich, living tradition of Ayurveda was frozen for almost 10 centuries, and its growth was arrested; its tradition of science gradually became ritualistic.

It is interesting to note that, like Ayurveda, TCM, TKM, and Kampo were also suppressed and marginalized. However, they were revised and reestablished in line with their respective cultural backgrounds through systematic efforts. These traditional systems of medicine have been integrated into the national health programs in their respective countries [19].

Science and Traditions

Any science is dynamic in nature. It is about the continuous quest for knowledge. Many traditions have given important direction to the development of science. Ancient systems like Ayurveda and Yoga are considered science, as well as part of living traditions. Traditions refer to knowledge systems and practices in various domains of human experience. Such traditions contribute to the history of every society. They might concern science, philosophy, culture, language, and religion, and can be reasonably classified as healthy, or unhealthy. Healthy traditions change and adapt to contemporary needs. Much of the fabric of modernity has threads from evolving, living traditions. Traditions continue to evolve from generation to generation to become a heritage; the heritage shapes the religious, philosophical, and cultural practices of society.

Traditions can be living and dynamic. Living traditions allow debates and self-critique. A living tradition rejects uncritical approach and dogmatism of any kind. With a rational approach, living traditions can evolve into contemporary science. In the Western world, the Greek traditions followed a rationalist path, and progressed during the Renaissance, the age of Enlightenment, and Industrial Revolution. Many scientific discoveries and inventions occurred during this period. The emergence of modern science and modern medicine is a result of traditions adopting the rationalist and progressive approach.

Whereas traditions can be continuously evolving, rituals tend to be static. Traditions can remain frozen. Such frozen traditions become rigid and ritualistic. When this happens, adherence to traditional knowledge and practice degenerates into mere ritualism. As a result, tradition loses its contemporary relevance. Further, with the ritualistic approach, traditions can lead to blind faith and superstitions.

Indian health traditions have gone through these phases.

When the core ideology and purpose behind the tradition is lost, it becomes a relic in the form of rituals. Rituals can lead to customary practices, mysticism, and stereotyped, mechanical behavior. Many customs of yesterday may seem outdated, irrelevant, and redundant today. The process of transferring knowledge from generation to generation is adversely affected due to foreign invasions, dictatorial rules, and rigid social systems. Traditions can become irrelevant or outdated if they do not adapt to a changing environment. The ritualistic approach encourages worship instead of critical inquiry. Many times, ritualistic behavior is egoistic and aggressive. For instance, the concept of fasting has a scientific basis but today it has become a mere ritual. Healthy, living traditions like fasting, and Ritucharya can have a tendency to be reduced to worship, festivals, and food recipes. The Eastern world holds several healthy traditions. However, because of historical and cultural reasons, many living traditions are have tended to become ritualistic [20].

In the modern world physical, chemical, biological, and computational sciences are converging on sophisticated technologies like genomics, biotechnology, nanotechnology, scientific computing, artificial intelligence, and robotics. New theories based on nonlinear, holistic, and systems approaches are evolving. Discussions about science and spirituality, consciousness, mind–body interactions, ecological sensitivities, value systems, and the searching questions about purpose are finding new grounds. We seem to be completing the circle by creating new bridges between science, philosophy, and spirituality.

Some concepts of Ayurveda have contributed to the development of modern medicine, surgery, and various specialties. Sushruta’s contributions to anatomy, surgery, urology, ophthalmology, and plastic surgery are well-acknowledged [21–23]. A few concepts like Prakriti are now appearing in modern scientific literature. However, several contributions have remained unrecognized in the development of modern medicine [24]. The reasons may be related to a language barrier, ontological divergence, different health care models, as well as bias against traditional knowledge.

Modern Medicine

Following the Greek revolution in philosophy and science during the era of Copernicus, Pythagoras, Socrates, Plato, and Aristotle is the notable period, the Galen era. This is recognition to the outstanding work by Claudius Galenus during the second century AD. Galen contributed significantly in several scientific disciplines such as pharmacology, pathology, physiology, and anatomy. Galen’s understanding of medicine was greatly influenced by Hippocrates’ theory of humorism. Galen also showed that the brain controls muscle movements through the cranial and peripheral nervous systems. He started systematic use of vegetables, animal products, and plant extracts. Even now, these dosage forms are known as Galenicals. Galen was a physician, and a philosopher interested in the debate between the rationalist and empiricist streams. He used direct observation, and dissection and vivisection to bridge these extreme viewpoints. According to Galen, the arterial and venous systems were separate; blood circulates between the ventricles through invisible pores. His anatomical observations and reports based on the dissection of monkeys and pigs remained uncontested practically until the sixteenth century. The Galen era remains historically important because the world witnessed the influence of Galen’s ideas over 1000 years after his death.

Paracelsus (1493–1541) was a medical doctor, alchemist, and philosopher who believed that a human being has two bodies: a visible body that belongs to the earth, and an invisible body of heaven. The invisible one is closely attuned to imagination, and the spiritual aspect of the individual. Paracelsus understood the psychosomatic abilities of people, as he stressed the importance of suggestion, and using signs and amulets to help a patient form mental images, which translated into profound, physical cures. He was the first to challenge theories of Galen.

In 1543, Andreas Vesalius also challenged Galen’s theories on anatomy and physiology with help of over 600 anatomical drawings in his classic book the Fabric of the Human Body. In 1616, William Harvey proved Galen wrong by showing that the heart, which acts as a pump, is responsible for blood circulation [25].

Typifying the advancement of the Renaissance, and the Enlightenment, during the seventeenth and eighteenth centuries, Bacon and Descartes stimulated robust advancements of natural science based on mathematical, method-driven, experimental processes. During the nineteenth century, John Herschel and William Whewell systematized methodology and coined the term scientist. Charles Darwin proposed the theory of natural selection and provided scientific explanation of origin of species. Many other spectacular discoveries marked the last two centuries where atomic theory, the laws of thermodynamics, electromagnetic theory, relativity theory, and quantum theory were established—raising new questions which could not be easily answered using Aristotelian logic or Newtonian approaches. Einstein’s theory of relativity and the development of quantum mechanics led to the replacement of Newtonian physics with a new physics containing two parts which describe different types of events in nature.

Scientific innovations during the two world wars of the last century also led to several discoveries, space missions, and to the endorsement of the value of modern science. In the process, the humanity also witnessed the misuse of science and technology through changes in socioeconomic fabric, growing violence, ill health, new diseases, industrial pollution, and ecological degradation. History is full of bloody violence, however, weapons of mass destruction are a gift of modern technology!

Sir William Osler gave a lucid overview of the evolution of modern medicine in series of lectures delivered on “Evolution of Modern Medicine” at the Yale University. The lectures give an exhaustive account of the history of ancient medicine, and the emergence of modern medicine. This lecture series has been published as a 233-page book, which provides an excellent overview of primitive and traditional medicine including Egyptian, Assyrian, Babylonian, Hebrew, Chinese, and Japanese medicines, with landmark contributions from Hippocrates, Galen, and Harvey. Surprisingly, Osler did not mention India or Ayurveda anywhere in the Yale lecture series, or even in the book [26].

Modern Medicine grew from the firm foundations of modern science. However, during its evolution some of the important theories were left behind, and escaped serious attention. Those omitted include the theory of conditional probability proposed by Thomas Bayes during the mid-seventeenth century, and the theory of falsification proposed by Karl Popper in early 1930s. Among different schools of thoughts in the philosophy of science, the most popular position is empiricism, which claims that knowledge is created by a process involving observations. Empiricism also holds that scientific theories are the result of generalizations from such observations. Karl Popper challenged the empirical approach in science. Popper rejected the connection between theory and observation. He claimed that theories are not generated by observation; rather, observation is made in the light of theories. Popper coined the term critical rationalism to describe his philosophy. Both these theories are gaining the attention of scientists, because they seem to be more relevant to holistic approaches in health and medicine.

Consistent and magnificent progress based on rationalism, reductionism, and inductive logic have led to the spectacular growth of modern science and technology. Modern biology and modern medicine also followed the same path.

Future Approaches

Modern science and modern medicine are about testable and repeatable experiments and predictions. Modern science has always been dynamic, and continuously evolving. In this journey, many path-breaking inventions were either considered as idiotic, irrelevant, unwanted, or even impossible. New technologies and industries like aviation, computers, telecommunication, and the Internet are good examples. These were in real-sense disruptive innovations, which changed many paradigms of their times. Today, cloud computing has become a reality, while many other innovations like Google Glass, sixth and seventh sense, brain-to-brain hypercommunications, and brain–computer interfaces are on the way to becoming a reality.

An interesting example of future trends is The 2045 Initiative. This was founded by Russian specialists in the field of neural interfaces, robotics, artificial organs, and systems regarding life extension possibilities. Its main goal is “to create technologies enabling the transfer of an individual’s personality to a more advanced nonbiological carrier, and extend life, including to the point of immortality.” More interestingly, this initiative is facilitating dialogue between the world’s major spiritual traditions, science, and society to discuss the possibilities of human development on the path of cybernetic immortality (http://2045.com/). Another ambitious program related to biological technology of the Defense Advanced Research Projects Agency of the United States portray astonishing picture of future developments in biology and medicine (http://www.darpa.mil/Our_Work/BTO/Programs/).

Science fiction books like Coma and Nano by Robin Cook, the Robot series by Isaac Asimov, the Terminator film series, James Cameron’s film, Avatar, and the Wachowskis’ Matrix film series, give us glimpses of where future technology is headed. The progress of modern science has reduced the gap between imagination and reality, but more importantly, the progress of science has also raised the issue of its relation with tradition, ethics, and humanity. The brain-to-brain communication through direct information transmission from one human brain to another using noninvasive means between six participants has been reported by scientists from University of Washington [27]. Scientists are already envisioning that such hyperinteraction technologies might have a profound impact on the social fabric and raise crucial ethical issues [28].

As we were making final improvements to this book, in December 2014, renowned cosmologist Stephen Hawking publicly expressed worries about artificial intelligence and machines that can outsmart humanity. Dr Hawking in an interview to the BBC said, “The development of full artificial intelligence could spell the end of the human race. It would take off on its own, and re-design itself at an ever-increasing rate. Humans, who are limited by slow biological evolution, couldn’t compete, and would be superseded.”

We feel that in the thrilling yet terrifying journey of modern science, traditional knowledge and wisdom may be useful in several ways so that the future can be more humane and sustainable.

Modern medicine became what it is today because of the positive influence and advantages from developments in science and technology. This transformed the Greek, Roman, and Arabic traditions into modern medicine. Eastern medicine including Ayurveda mostly remained isolated, got suppressed during invasions, and was bypassed by the whole scientific progress and the industrial revolution.

In a process to become scientific, modern medicine lost sight of the person behind the patient. Eastern medicine preserved the holistic nature of healing involving body, mind, and spirit but lost an understanding of physics, chemistry, and biology. Eastern traditional medicine remained philosophic, nonlinear, creative, and intuitive; Western biomedicine became scientific, linear, logical, analytical, and evidence-based.

Arguably, today’s medical practice in most general clinics is not necessarily based on scientific evidence, or ethical practice. Many treatments, drugs, and diagnostics seem to have survived without rigorous, intellectual challenges. In the race to become evidence-based, modern medicine is relying more on pathology reports, and rigid protocols. The hegemony of large medical centers, high-impact journals, and iconic physicians is influencing the nature of clinical practice. Many drugs like statins, steroids, analgesics, psychotropic agents, vitamins, and antioxidants are being prescribed in blind acceptance of the protocols of professional bodies, and pharmaceutical companies.

The protocols, standards, and checklists are necessary requirements. However, their relevance and context must be kept in mind when making therapeutic judgments. Clinical acumen cannot be blindly replaced by laboratory reports. Because of an overdependence on rigid protocols, measurement tools, and techniques, contemporary, evidence-based, medical practice is going more the ritualistic way [20]. How health, physiology, and pathology are defined is driven by commercial interests, rather than by scientific evidence.

Modern medicine has become more scientific, rational, and evidence-rich. Unfortunately, in the process, it is becoming mechanical, impersonal, and ethics-poor. Going against the original ethos of this noble profession, both systems of medicine—Eastern and Western—have become commercial, where fees are charged for services rendered. This shift in attitude of medical doctors has led to the commercial interests overpowering the interest of the good of the patient. Slow, progressive deterioration of value systems, ethics, and morality, coupled with a distortion of the nature of science is the main reason for the contemporary challenges. Today’s medicine needs to be liberated from unnecessary medicalization, and need to refocus on health and wellness. Today’s medicine must maintain the interests of the public, and the patient as the primary concern. Present medicine needs a balanced integration of both sides of the brain—the creative and analytical. What is needed is a scientific and holistic mind-set where modernity and traditions go hand in hand.

It is interesting to witness that the European region, which was the epicenter of modern medicine evolution, is now rediscovering the importance of the holistic approach; the focus is shifting from illness to wellness. The new movement of integrative medicine is based on personalized approaches through diet and lifestyle modification. Thought leaders are proposing that the appropriate changes in lifestyle where increased physical activities can reduce use of machines and save natural resources and energy. The consumption of wholesome natural food instead of processed foods and a daily routine in relatively stress-free environments can actually have dual benefits where public health is improved and the global environment is saved.

There is growing realization that the ultimate purpose of science should not be only for economic development, or creation of wealth, but also should contribute toward humanity, human values, and nature. The global consensus is building in favor of using science for environmental sustainability and not just for human comforts and economies [29].

Perhaps this is a new beginning in creating integrative approaches for health through a confluence of traditional knowledge systems like Ayurveda and Yoga, the advances in modern medicine and the power of biomedical sciences (Figure 2.2). Indeed, tomorrow’s physicians will have knowledge of multiple disciplines and medicine will probably be more personalized, and will move beyond mere drugs and cures. Future medical practitioners might embody the essentials of an ideal doctor. New initiatives like predictive, preventive, participatory, and personalized medicine, and person-centered medicine and whole-person medicine, and other integrative variants emerging from Europe and other parts of the world seem like modern avatars of Ayurveda.

In concluding this chapter of the evolution of medicine, we wish to emphasize that the present approach to medicine and therapeutics has to change. The principle of the evolution of species is also applicable to medicine. History and science tell us:

It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change. In the struggle for survival, the fittest win out at the expense of their rivals because they succeed in adapting themselves best to their environment.

Whether or not to assign this statement to Darwin is debatable, but its soundness is largely accepted. The modern medicine must adapt itself to suit present environment and meet expectation of people.

The history and evolution of medicine tells us how the faith-based, ritualistic, mumbo jumbo practices gradually waned giving way to scientific and evidence-based medicine. However, this is not the end, and the process of evolution must continue.

The complexity and expanse of biomedical sciences are touching new heights. The speed of technology seems to be far ahead of human capabilities. How to use available knowledge, resources, drugs, diagnostics, medical procedures and surgical technologies is emerging as a major challenge. The ability to recognize the limits of current science and more importantly limitations of human capabilities; identifying and reducing the areas of ignorance and keeping an open mind to learn from experiences will be the key attributes while moving to the future medicine. The hubristic and monopolistic mind-set need to be changed to more humble, inquisitive, and open approach.

The next phase of evolution of medicine seems to be more holistic, personalized, and integrative. In the following chapters, we will try to visualize the shape of future medicine. The role of the future doctor might change from prescriber of medicine, to advisor for health. Tomorrow’s health care may indeed be what Thomas Edison visualized where doctors will give no medicine but will interest people by advising how to protect health through diet and lifestyle and how to avoid causes of disease. This will be the desired revolution in the evolution of future medicine.