Safety & Efficacy of Traditional Medicine

Twenty years ago, in 2006, I was involved in the organisation of a regional meeting on traditional medicine in south Asia, which was held in Bangalore in India.

Recently, I have read some discussions about research on the safety and efficacy of traditional medicine. They reminded me of a speech given my friend Dr Bala on this theme in that meeting. Therefore, I have decided to share some extracts from his speech in this post.

Background to the Regional Meeting Held in Bangalore in 2006 

I was asked to organise and coordinate a meeting on traditional medicine practices in South Asia by a group of international NGOs. Similar regional meetings were held in that period in other parts of the worlds. Final reports from those meetings were put together and provided to the department of Traditional Medicine in the World Health Organisation (WHO) in Geneva.

However, my participation in the whole process was limited to the meeting held in India, since I was busy in other research work in that period. My friends from People's Health Movement in India had played a fundamental role in organising that meeting. 

Dr K. Balasubramaniam (1926-2011) from Health Action International Asia-Pacific (HAI-AP) had given the keynote address at that conference. Dr Bala, as everyone called him, had done pioneering work in access to essential medicines and was a key and respected figure in the international People's Health Movement (PHM) in those days. That meeting was also an opportunity to meet some of my old friends including Dr H. Sudershan from Vivekananda Girijana Kalyana Kendra, Dr Mira Shiva & Dr Ravi Narayan from PHM-India.

That conference was my first real encounter with traditional medicine. It was also the first time that I had visited an Ayurvedic medical college and understood the kind of training Ayurvedic doctors receive in India.

In this post, I would like to share some extracts of the keynote address of Dr Bala focusing on "Evaluation of Safety and Efficacy of Traditional Medicine". His keynote was much wider in scope. For example, he devoted a significant part of his speech to the subject of "Preserving and safeguarding biodiversity sustainability and traditional knowledges". 

In the coming days, I want to share some more papers from that conference. If you wish to read more documents from that meeting, I invite you to check the final report of that conference, which can be freely downloaded.

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Evaluation of Safety and Efficacy of Traditional Medicine 

Dr K Balasubramaniam, Sri Lanka

I believe that this conference will focus on herbal remedies which constitute the therapeutic armamentarium of traditional systems of medicine in the region.

The World Health Organization (WHO) has defined herbal medicines as "Finished labelled medicinal products that contain ingredients from aerial or underground parts of plants parts or other plant material or combination thereof, whether in the crude state or as plant preparations. The same WHO document adds "Medicines containing plant material combined with chemically defined active substances, including chemically defined substances and isolated constituents of plants are not considered to be herbal medicines".

It will therefore, follow that chemically defined isolated constituents of plants used in modern medicine are not herbal medicines, it has been estimated that these medicines derived from plants constitute about 25 percent in modern pharmacopoeia.

The World Health Organization posed a question 2002 whether a herbal medicine can be used clinically if no harm has been found after the use of that herbal medicine for generations and there is no documentation of such an effect. For an answer to the question, reference is made to an earlier WHO document published in 20003 which states "Absence of reported or documented side effect is not an absolute assurance of safety of herbal medicine. However, a full range of toxicology tests may not be necessary. Tests which examine effects that are difficult or even impossible to detect clinically should be encouraged. Suggested tests include immuno-toxicity, geno-toxicity, carcinogenicity and reproductive toxicity", It adds the following caveat, "only when there is no documentations of long historical use of a herbal medicine or when doubts exist about its safety; should additional tests be performed.

A rigid framework that has been prepared for modern synthetic drugs will never be possible for herbal medicines. There has to be some flexibility in toxicological requirements for herbal medicines.

Accordingly, a group of experts met in Chandigarh, India, to develop a suitable framework for carrying out toxicological studies on herbal medicines. The framework developed was broadly accepted by the Indian Council of Medical Research and the WHO. The actual tests to be carried out in the Chandigarh model are given in tables 1 & 2 (click on the tables for a bigger view).

The tests recommended by the WHO are given in Table 3 below (click on the tables for a bigger view).

WHO has called on clinical researchers to conduct clinical evaluation of traditional medicines within the specific framework of rigorous clinical pharmacological principles without ignoring or trampling on the concepts of the traditional systems of medicine.

I wish to take this opportunity to present an alternate view for evaluation of traditional medicine.

Traditional systems of medicine are a summation of several thousands of years of human experience in the selection of plants for preventive and curative healthcare. Practitioners of traditional systems of medicine argue that the efficacy of herbal remedies is due to the synergistic activity among the several ingredients of herbal mixtures. Complex mixtures of plants or herbs form the basis of traditional medicines. The mixtures are usually subject to crushing, heating, boiling, etc. It is possible that this process may change the chemical structure of the active ingredients in the plants.

Clinical pharmacologists and other scientists working on medicinal plants, on the other hand, focus all their attention on isolating and identifying biologically active ingredients in medicinal plants and herbs. When a promising new biologically active chemical ingredient is isolated, it goes through all subsequent investigations identical to those for a new synthetic chemical ingredient.

Traditional healers do not accept that the efficacy is necessarily due to the active ingredients in the plant.

According to the active ingredient approach the modern clinical pharmacologists, take the knowledge from the plant but throws away the wisdom of centuries.

If there is acceptable historical evidence that traditional herbal remedies have been effective in the treatment of certain diseases, but neither their active ingredients nor the mechanisms are known, is it ethically or morally acceptable to not use that treatment? Examples of successful treatment by traditional medicines will be useful to answer these questions,

In the fate 1980s children attending the Dermatology Department, Hospital for Sick Children, Great Ormond Street, London showed marked improvements in their eczema symptoms. These improvements were due to oral treatment with aqueous decoctions of a mixture of 10 Chinese medicinal herbs. Clinical experimentation and pharmacological testing revealed that a mixture of the 10 herbs were necessary and that the efficacy could not be attributed to any single active ingredient from any one of the 10 Chinese herbs, A placebo controlled double-blind clinical trial using the 10 Chinese herbs was carried out on 47 selected children with non-exudative eczema. The conclusions of the trial were to validate the standard of current conventional clinical trials utilized in the UK that the traditional Chinese therapy was efficacious.

If these children had to wait till the clinical pharmacologists had screened the 10 Chinese plants for active ingredients and tested them for biological activity, they would never have been given the chance of getting effective treatment with a mixture of 10 Chinese herbs.

Potential cytotoxic drugs are tested for their activity against experimental or human cancer cells. Efficacy depends on the ability to kill specific cancer cell types without affecting normal body cells. Studies on the effects of certain Ayurvedic herbal preparations for possible cytotoxic activity revealed that these herbal preparations did not kill the cancer cells but transformed them into normal healthy cells. These drugs, therefore, have a different mechanism of action, Classical testing methods would have missed this important anti-cancer activity.

I wish to pose a philosophical question. Is medical science one universal and uniquely expressed (western) paradigm – a biomedical paradigm? If it is possible to conceive of alternative methodologies, theories and practices in other domains such as music, logic, linguistics, art and politics, is it not possible to consider possibilities of alternative methodologies in medical science, knowing that doctors practice medicine within a biopsychosocial paradigm?

The guiding principles by which knowledge is built up in the biomedical paradigm are those of the scientific method where hypotheses are clearly stated, then tested and accepted or rejected as truth "until further notice" or "within the stated confidence limits” using only experimental or quasi-experimental designs – a deductive approach to problem solving.

Is it possible for research scientists to examine other methodologies, for example, using experiential methods – an inductive approach, to evaluate traditional herbal remedies?

There is an enormous amount of research on medicinal plants in research institutes in developing countries and the transnational drug industry.

Based on the WHO definition of herbal remedies and the herbal remedies used by practitioners of the traditional system, I wish to pose the following questions:

The Indian Council of Medical Research has taken the plant Pterocarpus marsupium from its use in folklore and Ayurvedic medicine to Phase III clinical evaluation for the treatment of diabetes mellitus using well accepted pharmacological principles. It was handed over to the industry for pharmaceutical development and marketing. This product will be marketed to practitioners of modern medicine. Table 4 (click on the tables for a bigger view) lists examples of modern drugs derived from plants that have been used in the traditional systems of medicine by ancient people around the world.

The question I wish to pose is as follows: "Will this type of research and development to isolate therapeutically active chemical ingredients achieve the objectives of this conference which is to promote the continuous development of traditional medicinal in the region to maximize its contribution in preserving and improving public health."

Let me make it clear that R & D to isolate therapeutically active ingredients from medicinal plants is of critical importance. There is no doubt about it.

But what I wish for you'll to discuss is the need for research to evaluate the safety and efficacy of the herbal remedies used by practitioners of the traditional systems of medicine. For example table 5 gives a 5 list of Ayurvedic remedies for some common ailments (click on the tables for a bigger view).

Is there a need to develop appropriate methods for clinical evaluation of traditional herbal medicines: methods and criteria not to be limited to the methods and concepts of modern biomedical science.

Interestingly much of the scientific literature for traditional medicine uses methodologies comparable to those used to support many modern surgical procedures: individual case reports and patient series with no control or even comparison group.

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For a full version of the keynote address by Dr Bala at the South Asia Regional Conference on Traditional Medicine, held in Bangalore, India in 2006, including the list of references, I invite you to download and read the conference report, that I had prepared. Please write to me at sunil.deepak@gmail.com if you would like any of the presentations made at the meeting.

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The 100 Sarees of Ms Roy

You never know where an online research will take you. Recently, an online search took me to a website where Indian women talk about their sarees and their memories linked to them. I spent a few hours reading about different kinds of saree-textiles, their designs and traditional weavings.

At the end, I have a new understanding about the kind of relationship persons can have with textiles, about which I had not thought earlier. It also brought back some memories from my childhood about my mother's sarees.

Let me start this by telling you about how I landed on that website.

Starting from Sonali Sen Roy

I was looking for information about the childhood of Sonali Sen Roy, who had become famous during the 1950s for her story with the Italian film director Roberto Rossellini.

Sonali was born in Banaras in the British India, her father was a doctor in the United Province and her mother was the elder sister of well-known Indian film maker from the 1950s, Bimal Roy.

The search took me first to Sonali's elder sister, then to her daughters and then to one of her grand-daughters, Ms. Bhattacharya Roy. Some years ago, Ms Roy had taken part in an online challenge of presenting 100 different saris, where she had talked about some of her family stories.

100 Sarees Pact Website

 The 100 Saree Pact website collects the stories of sarees, it describes its mission as, "This blog is an invitation to join and share the magic. Celebrate life, celebrate relationships, celebrate your past, your heritage, your memories, your moments, your connections through saree wearing. Enjoy the stories shared already, be enthralled ! Bring your sarees and their stories out into the world. Let them spread the happiness and positivity that we have all been surrounded with."

100 Sarees of Ms Roy

Ms Roy presented her 100 sarees on this blog during 2015. Her sarees come from different sources - the ones she bought, the one brought as gifts by her husband, the family heirlooms, the ones on loans from aunts and cousins ... Each saree is accompanied by a brief or a long description including some of her family memories.

For example, in one post, she talked about her maternal grand-mother, Sonali's elder sister: "This sari belonged to my Dimma (mother’s mother). She usually wore whites, greys, beige or very light colours. This is one of the few coloured saris I saw her wear, mostly when she went abroad. I lost her when I was still in college and hence a very occasional sari wearer but I did get two of her saris. This sari is special for another reason too. I wore it one of the first times I went out with my (then to-be) husband ..." 

In another post, she talked about the saree worn by her mother for her wedding: "The magenta Benarasi was bought from Indian Silk House. The zari work is exquisite, with three different kinds of butis all over and an intricate border and pallu. Even after almost 40 years, the zari hasn’t lost its sheen. Ma wore it only a couple of times after her wedding though ..."

There was one post, which might have been about Sonali, though she did not specify it: "She was for me a strand of red corals that my mother has always treasured and which I have worn on a couple of occasions. She was for me a letter she wrote to my mother when she lost my father and another she wrote at the time of my wedding, with an alpana-like doodle at the end. She was for me a frantic hunt for a fresco on a hot and humid afternoon in Santiniketan. I never saw her. For me, she lived in the many black and white photographs, and a few more recent ones in colour, from the family album and the many stories I heard about her from Ma and her siblings ..." 

Sarees as Repositories of Weaver-Traditions, Cultures, Memories

I don't have any emotional bond with any of my clothes - I buy most of them in the supermarkets, and when I am tired of them, give away some of them and throw out the others. There is no emotional relationship between me and the clothes. I guess that this would be true for most of us today.

On the other hand, reading about Ms Roy's posts about her sarees, gave me a glimpse of the different weaving traditions, the traditional motifs they use, the festive occasions on which special sarees are worn, the memories associated with them and how some sarees become family heirlooms. Even when they are old and worn out, their borders and embroidered parts may be kept and used for other sarees.

It is a completely different relationship with our clothes, something that we lose when we shift to today's factory made products and the consumer culture.

My Childhood Memories

In our old Delhi house, where we lived in one part and my maternal grand-parents in the other part, every year before the wedding season, a couple of men arrived from Banaras carrying on their heads, silk sarees wrapped in white cotton blankets. I think that they were middlemen and sellers, they did not weave themselves.

I remember standing there with other children, as they showed bright coloured silk-sarees with shimmering and richly embroidered zari borders and Pallus (the end of saree hanging over the shoulders).

Every year some of my aunts or uncles or cousins from the extended family was getting married and thus, the family-women needed new sarees. I remember some of sarees bought by my mother. When they became old, sometimes they were exchanged for pots and pans from another group of women visitors.

In The End

Going through some of Ms. Roy's posts and reading about her stories about specific sarees was a rewarding experience, it made me think of some of my old memories. It also brought out the importance of different textile museums and persons who are trying to conserve the priceless weaving traditions of communities such as sarees, kimonos and other traditional dresses.

Even in Italy, till some decades ago, families had traditions such as knitting, cross-stitching, embroidery and lace-making for their daughters' weddings. We still use some of the heirlooms from my mother-in-law's family at our home.

However, all those things are from the past, and often today's generation is dismissive about them, they would rather buy something new from the supermarket, as I do!

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Theyyam: When Gods Descend on earth

India has many rich religious traditions during which the Gods are supposed to come down to the earth and express themselves through some persons. Examples of similar traditions can be found in different parts of India. (Click on the images for a bigger view)

This post focuses on one such tradition called Theyyam, which is celebrated in northern Kerala in south India.

Gods Speaking Through Humans

Hindus believe that the Divine is present in each living being as universal consciousness. At the same time, they have a pantheon of a huge number of Gods and Goddesses, one for each of life’s different forms. The Gods, animals and plants are all inter-linked through the sacred stories and myths.

The religious ceremonies in which Gods speak through humans has 2 main functions – (i) as a part of celebration of specific religious and social events; and, (ii) to answer questions and to give blessings to people.

 

All over India, especially in small towns and villages, there are persons who are known in the communities as “carriers of God”, who can go into a trance, and invoke a God spirit to come and speak through them. In north India this process is called “Devi ka aana” (arrival of the Goddess). Usually they do it by sitting down in meditation with their eyes closed and then go into trance. The arrival of the God in their bodies is marked by signs like convulsive shaking while their voices turn rough. After that others can ask questions or ask for blessings and make an offering. This role can be played by both men and women.

In many parts of India, there are also elaborate make-up, costumes and rituals linked with this tradition. For example, in North Dinajpur district of West Bengal, persons manifesting the Gods wear colourful wooden masks during the sowing of fields – this tradition is known as Gomira. In East Burdwan district of West Bengal, the men invoking the Gods, paint their bodies with blue colour and transform into Shiva – this tradition is known as Shiva Gajan. Satyajit Ray's film Devi can be seen as one representation and exploration of similar ideas.

While God-manifestation roles are mostly enacted only by men, usually they are about Goddesses, the different forms of Shakti. In some places, persons of other religions, especially Muslims & Christians, are given specific roles to play during these ceremonies image below with Muslim characters in a Theyyam), which could be linked with specific historical events and indicate processes of religious inclusion.

Theyyam Tradition in North Kerala

The word “Theyyam” probably comes from “Devam” (God). This religious tradition is common in villages of northern Kerala, especially around the district of Kannur and surrounding areas of Kerala and Karnataka. Between October to March, every village holds one annual Theyyam at the village temple. In each temple, there can be different Gods/Theyyams, depending upon the presiding deity and his consorts. Bhagwati is one of the principle deities of the Theyyam.

The persons playing Theyyams usually belong to specific lower castes in villages. The responsibility belongs to specific families and is hereditary, so that male children watch and learn from their fathers and uncles putting on the make-up, making specific ritualistic dance movements and conducting specific rituals in the temple. For the duration of the Theyyam, persons of all castes, bow in front of Theyyams.

The ceremonies continue day and night for 3-4 days and are usually carried out in the open courtyards around the temple. During the celebration, sometimes there can be an occasional animal sacrifice, especially a hen. After their rituals and dances, each Theyyam receives devotees who pay obeisance, and ask questions or their blessings.

Visiting Theyyam ceremonies

I had seen a few Theyyam dancers in a cultural festival in Guwahati some years ago and had been struck by their elaborate make-up and costumes. Then, a few years ago, in a museum near Fort Kochi, I had seen the masks showing specific make-up face-patterns for different Theyyams, which had greatly intrigued me.

It is easier to see Theyyam performances as part of cultural shows, but I was interested in seeing them as a part of a living religious tradition of a village.

In February 2018, during a visit in Kerala, I had gone to Kunnur, where I had hired a local Theyyam guide. You can find online the calendar of Theyyam celebrations in different villages. However, more specific information is available only in Malayalam. Finding and reaching specific villages where the celebrations are being held is not very easy unless you know the local areas. Thus, a local guide can make things easier.

With my guide Chandran, I had visited Theyyam ceremonies in 2 different villages and seen different Theyyams, each with their special make-up and costume. As you can see from the pictures, both were colourful ceremonies filled with beautiful rituals, dances and faithful. Even elderly persons touched their feet and asked for their blessings.

 

 

In my opinion, they are not just a rich and colourful tradition, they are an expression of people’s faith. I found the ceremonies emotionally moving. Unfortunately, with changing times, some young persons feel that these are just old superstitions and are dismissive towards them. Though the Government is supporting some of the families engaged in Theyyam by making them a part of cultural festivals, I feel that to see them as part of people’s living traditions and faith, is a completely different experience.

Conclusions

In one of the villages I visited, I watched a young man patiently lying on the ground for a couple of hours, while the make-up of God Narsimha was being put on his face. While he was getting ready, his uncle, Mr. Narayan, who was one of the drummers and had come home from Delhi, especially for this ceremony, had explained to me the significance of different steps of his preparation.

The most beautiful moment for me had come when after getting ready, the young man had moved away from the group and walked up to a small hill (image above). There he had bent down to touch the ground and then stood there with his eyes closed in a silent prayer. When he had opened his eyes and turned towards people, there was a subtle difference in him – he had transformed into Theyyam. Moving with a feline grace, he had walked to the courtyard of the temple, a God descended on earth.

That transformation had touched me deeply. Gods and humans, together and separate, are bound together in the sacred stories of human imagination - Theyyam is an illustration of this bond.

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Note: Post originally written in 2018, updated in 2023

Reforming Hindu Traditions

In 2018, I had spent a few days in Rishikesh where a chance meeting with a young Swami ji (ascetic) had led to some interesting discussions about how to bring reforms in Hinduism. (Click on the images for a bigger view)

In terms of discussions around Hinduism, it is strange how a new aggressive narrative of Hinduism is being pushed in some traditional and social media (especially in English). Hinduism (along with Buddhism and Jainism) is predominantly seen as a religion of peace which accepts people of different religions and creeds, as shown by the millennium-long Indian traditions of accepting people persecuted in their own lands including Parsi, Jews, Armenians, etc. International image of Hinduism is also associated with spirituality and Mahatma Gandhi including elements such as Yoga, meditation, non-violence and vegetarianism. However today, there are many persons in India and outside, who talk of Hinduism exclusively in terms of hate, violence and discrimination.

This post is about a discussion with a Swami ji from Rishikesh about how to reform Hinduism, it does not go into the new narratives being built around it.

Rishikesh

Rishikesh is the last mountain town where the river Ganges passes before reaching the plains in Haridwar. I had been to Rishikesh a few times as a child. My most memorable visit was in early 1968 with my maternal uncle. At that time, the Beatles had just visited the ashram of the Guru Mahesh Yogi and this had brought international spotlight on this obscure town. Last year when I went to Rishikesh, I had vague memories of those old journeys. I went to look for the old ashram of Mahesh Yogi but it was closed and covered with overgrown vegetation. This part of Rishikesh has now many new ashrams and there is a new huge white statue of Shiva built in the middle of the river.

As the river Ganges comes down, the old town of Rishikesh is located along its left bank, near the area of Triveni Ghat. All the new ashrams and yoga centres of Rishikesh are located to the north of the old town, along the opposite side of the river.

I was staying near Triveni Ghat and spent a great deal of time sitting along the river bank, with my feet in the ice-cold river waters, talking to old men and women who had come here on pilgrimage from different parts of India. Every afternoon, underneath the trees of Triveni Ghat, persons gathered in small groups and discussed. These discussions were usually very down-to-earth and mixed an earthy humour and occasional obscenity with the spirituality.

Meeting the Swami

The Swami ji was much younger to me, probably around 40 years and was clean shaven. He wore the saffron cloth of renunciation and seemed well educated. I met him near Bharat temple, which is one of the oldest and most beautiful temples in Rishikesh. He was from West Bengal and I talked to him about my experience of living in Assam. I was curious to ask him what had brought him to the path of renunciation, but felt a bit embarassed, it seemed like a very personal question to ask to an occasional acquaintance.

We started talking about Upanishads and I explained to him my fascination with Katho-Upanishad, which tells the story of Nachiketa's visit to Yama, the God of death and their discussions about the meanings of life and death. He was very knowledgable and recited different shlokas from that book, explaining his understanding of it.

Then he asked me if I had been to the Ganga-aarti? During this aarti a group of young Brahmins do a choreographed dancing prayer holding metal lamp-stands full of burning lamps, which has a great visual impact. I explained to him that for me, the teachings of Upanishads held the real meaning of Hinduism and I did not have much faith in rituals like aarti. I had found aesthetic pleasure in the choreography of the burning lamps and prayers sung by the faithful, but not any spiritual connection to it.

 

My comments about the aarti provoked a discussion during which Swami ji explained to me his understanding of Hinduism. He said, Hinduism is like Ganges, a river made of a lot of different streams. There is the Spiritual stream of Hinduism with an abstract view of God, and this stream finds a value in the sacred books of Veda and Upanishad. There are many other streams. Like the Vaishnav stream of belief which is practiced in Assam by the followers of Shrimanta Shankar Dev, which focuses on Bhagwat Puran and does not have any idols. However, according to him the biggest stream of Hinduism is that of simple persons who believe in the different Gods, in the different avatars of Vishnu and in the stories of Ramayan and Mahabharat. For them, the stories of Ram, Krishen and Shiva are the bedrock of their faith, these are felt as true in a material sense.

Swami ji felt that many of the present problems of Hinduism were caused by the disconnect between persons believing in different streams of the religion. According to him, most of the highly educated Hindus among the thinkers, writers, academics and other influential groups are like me, who appreciate the higher teachings of Gita, Veda and Upanishad but do not have the simple faith of common persons in their Gods.

"Persons like you, they dominate the society and what they say is taken up by TV and newspapers. You do not believe in Gods and Goddesses but you give your advice on what should be done about Hinduism. How to celebrate our festivals, where to make our temple, how big should be the statue, how to reform our traditions, you know everything and you want to take all the decisions for all the Hindus. The simple people for whom Ram, Sita, Krishna and Shiva are real, their opinions are considered as inferior and unimportant. This is creating problems in our society because they are the majority but they do not have a voice and people like you are a minority but you have a big influence", he said.

My point was that if a festival like Diwali creates pollution because of crackers or if we use Plaster of Paris statues covered with chemical paints at Ganesh Chaturthi and Durga Puja and after the festivals, throw them into rivers & create pollution, then something has to be done. Why can't we find another way to celebrate these festivals without feeling that others are persecuting us? Our religions need to change with the changed reality of the world.

He said that reforms in Hinduism must come from within, they can't be imposed by others. According to him we need persons like Mahatma Gandhi, or a Guru who understands the bigger picture and who shares the faith of common Hindu - only such a person can bring a change from the grassroots.

Conclusions

The words of that Swami ji have remained with me and I have reflected on them. I can see that I have a certain intellectual way of being a Hindu, I do not really believe in temple-rituals or Gods. I like visiting temples, just like I like visiting churches, museums and art exhibitions, for an aesthetic pleasure.

There is a lot about Hinduism in India, as it is lived by millions of persons, which I don't really understand - from Kanwariyas who walk for hundreds of kilometres to collect water from Ganges for their temples, to the pilgrims who spend weeks on the road for festivals like Ambubashi or Kumbha Mela - I understand all of it in an intellectual way but I can't understand the simple faith which moves these people.

The question is how can we promote a grass-root change in them? According to the Swami ji, the reformist movement has to come from them, and from their gurus and other persons in whom they have faith. These can't be forced by laws. In a way I understand this point, I had written about it in relation to the Sabarimala judgement.

But I am not convinced about the role of persons like me, who believe in Hindu spirituality but do not have the simple faith in rituals and prayers, do we have any role in promoting reforms related to that way of faith in following Hinduism? What do you think? Please do share your point of view in the comments below.

(Originally written in 2019 and updated in 2023)

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My Spiritual Journeys

I grew up in a non-religious family. However, I have always been interested in spirituality. This post is about the meaning of spirituality for me and some of my more significant spiritual experiences.

By "spirituality" I mean the ideas about the nature of soul, consciousness and reality. For me, spiritual experiences are usually related to reading, meditating, listening to music, watching stars and being in nature. They induce in me feelings of being connected with others and with the universe, as well as, feelings of peace and joy.

The Spiritual Gurus

The Indic traditions place a lot of emphasis on the role of a Guru, a spiritual teacher. For me, my spiritual teachers are the books and my favourite spiritual readings are the Upanishads of Hinduism.

It was in 1968, when I had first met Mahesh Yogi, during the days when the Beatles were visiting him. Suddenly he had become The Guru for the world's famous. I had liked his smile and his explanations about transcendental meditation.

During the 1970s-80s, I had become very interested in reading the books of Acharya Rajneesh (Osho). 

Finally, during the early 2000s, I had visited the ashram of Sree Sree Ravishanker near Bangalore and then in 2015, I had gone to listen to him when he had visited Guwahati.

However, so far I have had no desire to follow any Guru. Perhaps, it means that I don't need a Guru, or, may be it means that I am not yet ready for a Guru.

Instead, about 40 years ago, I was fortunate to meet Don Silvio Favrin, a Catholic priest from Castel Franco V. in the north-east of Italy. He died earlier this year (April 2022). He was a friend for me, and at the same time, he was a great spiritual being - some of our conversations had a deep influence on me. He had the capacity to share the most profound ideas in simple words, often tinged with irony along with an ability to laugh at himself.

Unexpected Spiritual Interactions

Many of my memorable spiritual interactions with people have been unexpected. For example, during 2014-16, while I lived in Guwahati, I had a couple of spiritual experiences.

The Sadhu in the Forest: The first encounter was in the forest behind the Bashishtha temple, where I had come across a Sadhu, who had built his home beneath a rocky overhang. He told me about his wanderings across India. I asked him why he had chosen that particular place to set up his home and he started talking about the subtle energy that comes out of the earth and how he felt that energy in that rock.

"Put your hand in this place", he pointed to the rock, "then close your eyes and try to feel the energy." I tried but did not feel anything. So, he said that I needed to quieten my mind, then may be I will be able to feel that energy.

He was a simple person but listening to him talk about the universe and our connection with nature was a wonderful experience.

Ambubashi in Kamakhaya: Another intense spiritual experience for me was during the Ambubashi festival at the Kamakhya temple. Kamakhya is a Shaktipeeth, it celebrates the feminine principle of the nature and the Ambubashi festival celebrates the metaphysical mentruation of the mother-godess.

In a courtyard on the hill near the temple, I came across a group of Baul singers. Some of them were smoking cannabis. Others were dancing and singing Baul songs. At a certain point, a thin old man stood up, his eyes closed in an ecstatic trance, a box in the right hand and a bottle of talcum powder in the other, and he started dancing. It was one of the most amazing and emotionally touching spiritual experience that I have ever had.

The Mendicant in Orchha: I was staying with a family in a village just outside Orchha in Madhya Pradesh. A local NGO had organised my stay. One morning, I was walking towards Sundar Mahal, the dargah of a Sufi saint called Sundar Shah, when I met a poor mendicant, who was sitting on the ground.

I stopped to talk to him. He had left home due to some mistreatment by his daughter-in-law and had decided to wander around and to live on charity. We talked about his preivious life, his home and children, and his present life as a wandering mendicant. I felt very sorry about his plight that in his old age, instead of sitting and resting, he was forced to go around, ask for alms and never be sure if he will find a place to rest for the night.

"So, what do you wish for, what do you want now?", I asked him. He smiled and shook his head, "Nothing, I have found everything I need", he answered.

To remember that meeting and his words, can still make me emotional. As you can see, what I think of as "spiritual" experiences can be very different things.

The Spiritual Places & Broken Statues

I have been to a lot of pilgrimage places of different religions in different countries. I am not religious and I do not go anywhere to pray. However, I like to visit the religious places in search of spiritual experiences.

In India, I have travelled widely, from the Vivekanand rock in Kanyakumari to the Kumbh mela in Prayagraj. There have been many beautiful moments and it is always fulfilling to see the beauty in temples, mosques and churches.

Yet, when I think of my unforgettable spiritual moments, they are usually not associated with any of these places. However, I love the Hindu idea of creating statues out of mud for specific festivals and at the end, immerging those statues in the sea or a rivers. The divinity is thus an expression of nature, which goes back to nature. I love the sight of old broken statues left near the rivers.

While travelling in Assam, it was common to find statues of Durga, Kali and Saraswati left near the rivers and invariably, I used to stop to look at them.

One evening, I was walking along the Kolong river in Nagaon and I came across an old broken statue of Saraswati lit by the rays of the setting sun. For a moment, I felt as if the Goddess was speaking to me. That experience was so powerful that for about another 10 minutes or so, as I walked, it seemed as if everything was lit by an internal light.

Music and Spiritual Experiences

One of the most profound spiritual experiences which I can remember was in Mandya in Karnataka, when I was staying with some Catholic nuns in a convent. One early morning, I listened to them gently singing hymns in a small chapel. The rise and fall of their voices was like the tide of an ocean, washing over me like waves, a truly wonderful spiritual experience.

Once, I was visiting a project in West Bank in Palestine and I was staying with some friends. I usually wake up early in the morning. I remember waking up in his guest room, listening to the sound of azaan coming from different mosques. They were not synchronous, the timber of their voices were different and together it created a wonderful spiritual experience.

Another occasion when music touched me deeply was in Bologna in Italy during a dance recital. Alessandra Pizza, the Bharatnatyam teacher, was singing a Ganapati prayer accompanied by the rhythmic beating of a gong on a wooden block. We were sitting in a gallery, under a high dome so that her voice had a little echo. It was so amazing that it brought tears to my eyes.

I also love listening to the singing of Gurubani in the Sikh gurudwaras. Often the Raagi (singers) in the gurudwaras are trained classical singers and their prayers have simple and yet profound words, that I find very moving.

As an adolescent and young man, some of my musical-spiritual experiences were listening to famous classical singers like Bhimsen Joshi, Pandit Jasraj, Kumar Gandharv and Kishori Amonkar. For example, even today listening to "Ud jayega hans akela" (The swan alone will fly away) by Kumar Gandharv can touch me deep inside.

Finally, some years ago, during a music concert in Bologna (Italy), Ms. Ashwini Bhide Deshpande sang my favourite bhajan "Ganpati Vighnaharan Gajanan" on my request. The acoustics of that place were wonderful and I felt surrounded by her voice. Just thinking about that experience makes me feel a great joy.

In the End

Writing this blogpost has been a wonderful experience. I wrote it originally for my Italian blog and then decided to translate parts of that into English. When I had started writing it, I had a completely different idea in my mind. However, as I started writing, a lot of forgotten memories came up in my mind and this post has gone in an unexpected direction.

Re-reading it, I can see that it is very much linked with India and Hinduism, which is natural since I grew up surrounded by these ideas. A person growing up in another culture and other religious traditions would have other kinds of spiritual experiences.

I hope that reading it would make you think about the meaning of spirituality for you and remind you of your own spiritual experiences.

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Importance of Alternative Medicine

Over the past couple of years, ever since we have broadband internet with unlimited use, I often watch some YouTube video channels including lessons on cooking and about the use of specific software. I also like some channels on politics, health related issues, Indian classical music and dances.

One of health related channels which I often watch is Medlife Crisis by Dr Rohin Francis from UK. Recently, I came across one of his older videos, which was about "alternative medicine". In this video he had explained about the importance of evidence-based medicine and how this scientific approach ensures that we can truly understand the efficacy of treatments and make rational choices about medicines. The other aspect of his intervention was that alternative medicine lacks this evidence-based approach and thus for him it was mostly hogwash.

In his intro on this channel he also says that "There's a lot of bad science on YouTube, especially medicine, with quacks and clowns peddling garbage", which probably also refers to alternative medicine, apart from other conspiracy theorists and No-Vax groups. The image below shows a person receiving a traditional treatment in Mongolia.

In another tiny video titled "How does Homeopathy work?", he has a short no-nonsense answer to this question - "It doesn't".

Rohin Francis is not the only one who speaks out against wasting money on alternative medicine. Some of my other doctor friends have been very active against quacks and untrained persons masquerading as doctors in India. Some doctors on Twitter regularly rant against homeopathy and alternative medicine practitioners.

I understand from where all these persons are coming from. However, I do not agree with them that alternative medicine is all about non-evidence based quackery. In this post I want to share some personal experiences and some opinions regarding the role of alternative medicine in today's world.

Disclaimer: Quacks & Clowns Peddling Garbage

I know that there are persons who claim to have miracle-powers and who can cure all kinds of conditions. They prey on people when they are most vulnerable and psychologically fragile and they do it to earn money and gain power. Some of these frauds may be mentally ill and may actually believe in their supernatural powers. This post is not about justifying any of them. They do need care and treatment for their delusions and if needed, deserve law-suits and prisons.

I also do not wish to say that alternative medicine can cure everything such as conditions like high blood pressure or diabetes or cancer. People who give up their blood pressure or diabetes medicines because of their beliefs in alternative medicine, often end up with irreversible body damage to their vital organs like kidneys or eyes. Conventional (western) medicine is a better choice for most such persons.

Origins of Alternative Medicine

For thousands of years, ancient humans have tried looking for treatments for common health conditions. They did it mainly by looking for plant-based treatments. The plant-based medicines they identified, did not have the backing of double-blind studies on random samples of carefully chosen groups, but to call those "non-evidence based" would be a bit of stretch. Many of our common modern medicines from Aspirin to Quinine and Artemisia come from those traditional experiences. Guys looking for the next blockbuster drugs have often stolen the knowledge of plants and herbs from traditional healers. Scientists carry out experiments with synthetic derivatives based on those same plants and herbs and then do scientific trials to show their effectiveness. Many of them call as quacks the traditional healers in villages who are using those same herbs, simply because they base their knowledge on the oral transmission of experiences and tradional learning.

In countries like India, China and Mongolia, people practicing traditional medicine, study in their medical collages just like students studying modern medicine. For example, in Ayurvedic medical collages in India (I have visited 2 of them), students study for their medical degree for 6 years and their curriculum includes all the subjects such as anatomy, physiology, pathology and pharmacology, taught in conventional medical colleges.

However, a part of their studies is based on beliefs which modern science does not accept. For example - the Chinese beliefs about meridians running through the body with the energy points and the balancing of Yin and Yang forces; or the Indian beliefs about the three body humours (vayu, kaffa and pitta); or the homeopathy belief about using "like to counter like" and the power of dilutions of medicines. These beliefs do not fit with the understanding of modern science, because they do not follow the logical-thinking paradigm but follow some other esoteric or intuitive paradigms.

Shaping of Our Beliefs - Personal Experiences

Our beliefs are predominantly shaped by our own life experiences. Scientists say that our experiences are anecdotal evidence and are unreliable and usually biased. So we should only believe in what scientists and experts tell us. However, from personal experience I know that if I have experienced something, I may accept scientific opinions but I will also find a way to keep my own opinion based on my experience, even when the two are contradictory. This seems to be a common human trait.

Let me share a few experiences regarding alternative medicine, which have shaped my ideas on this theme.

My first experience with alternative medicine was with homeopathy in 1980s, when I was a community doctor. I had developed a strong pain in my left shoulder and had difficulty in lifting that arm. For many days I had taken anti-inflammatory and pain-killer medicines. In those days my paternal aunt had high blood pressure and I often visited her house for her check-ups. My aunt's husband, my uncle, had retired and taken up homeopathy as a hobby. He gave free homeopathic medicine to anyone who came to him. During one visit, after checking my aunt's blood pressure, I told my uncle about my shoulder pain and that I was tired of taking pain-killers as they were giving me gastric problems. He asked me numerous questions about the pain and then gave me a small dose of small sweet-tasting pills. He also wrapped in an old newspaper, two more doses of those pills and told me to take them after some hours. In less than 15 minutes after the first dose, my shoulder pain had disappeared and I had no difficulty in raising my arm. It was like a miracle and it changed completely how I felt about homeopathy.

My second experience of alternative medicine was more recent. In 2015, while living in Guwahati in India, I developed a severe knee pain. It became so bad that it curtailed my walking. I stopped going out for walks and took frequent anti-inflammatory and pain-killing tablets. In 2016, back in Italy, I went to an orthopaedic specialist for a few visits. A scan of my knees showed myxoid degeneration of Cruciate ligaments. I was given Hyaluronic acid injections in my knees, wore knee supports and took pain-killers. But nothing seemed to help me. After a few visits, the orthopaedic specialist told me that I had to learn to live with the pain as I was too young for knee replacement surgery. I was also told to reduce weight and do physiotherapy. I shared my scan results with an orthopaedist friend in USA and even his opinion was the same. Talking about it with a Catholic priest, who had become my friend in Guwahati, he suggested that I should try Ayruvedic treatment in a hospital in Kerala.

In January 2017, I went to the Ayurvedic hospital suggested by my friend for a one week of treatment. The treatment consisted of daily massages with oils containing different herbs. After a week's treatment, I was advised to rest for a few days. After that one week of treatment, my knees improved greatly and I could again walk without pain. I went back to that hospital for a week in 2018 and 2019. However, in 2020 and 2021, because of Covid-19, I have not been able to go there and lately, I have again started to have some knee-pain after walking for a few kilometres, though the situation is yet not as bad as it was in 2015. I am hoping to go back for this treatment later in 2022. The image below from 2019 shows Dr Vijayan, the chief Ayurvedic doctor of this hospital, together with his 3 students from the Ayurvedic Medical College who were doing internship with him.

A couple of years ago, I had talked to an orthopaedist friend to explain what had happened, to try to understand why I had responded to the Ayurvedic treatment. His answer was that it was possibly a placebo effect. According to him, another possibility was that the effect of medicines taken in Italy had arrived after a few months.

Perhaps it was indeed a placebo effect, but I would like to know why I didn't have this placebo effect after treatment in Italy and after the injections in my knees? Are traditional treatments likely to induce more placebo effects? If yes, why?

Finally, a friend from Mongolia told me about her experience with traditional Mongolian traditional medicine. We are working together for a project and communicate frequently. Last week she told me that her mother was very unwell due to Biliary colic caused by stones in her gall-bladder. Her mother is quite old and she was in a great deal of pain. However my friend was hesitating to take her to hospital due to Covid-19 fears, so she was visited at home by a doctor and was given pain-killers. He had suggested that if the pain would not pass, they might need to do surgery for removing the gall stones. After 3 days of injections, her conditions had continued to be serious, so the family invited a traditional healer to visit her. The traditional doctor visited her and wrote some herbal medicines. Due to Covid-19 restrictions, it was not easy to buy the traditional medicines but somehow they managed. That night, after taking the herbal medicine her mother slept well after many days of pain. The morning after, it was the day of Lunar new year, she woke up completely pain free - she got up from bed as if she had not been seriously ill till the previous evening. My friend who had been so worried was overjoyed. She said that it was like a miracle. Once again, I am sure that if we ask, most doctors in the hospital will explain it as placebo effect or some kind of psychological effect.

These are all anecdotal stories without any scientific value, they do not prove anything. But if any of these had happened to you, will you be able to forget them? Such experiences illustrate why so many persons, especially in traditional and rural societies, continue to go to traditional healers even when experts tell us that there is no proof regarding their usefulness.

For persons like me, strongly anchored in the Western Medical Paradigm, alternative medicine may not be the first line of treatment for any problem, but I will seek it if modern medicine are not able to resolve my health condition.

A Role for Traditional Medicine

Even for persons who feel that alternative medicine is not effective or is illogical, I feel that in today's world there are some functions for which it can be very suitable. For example, think of illnesses like flu and viral fevers. Doctors say that these should be given only some symptomatic treatment and not treated with antibiotics because they are not useful. Still a large number of people take antibiotics for such conditions. I think that taking alternative medicines for such illnesses is a good strategy to discourage the antibiotic abuse.

There are so many chronic non-infective conditions accompanied by pain, like the ones I had in my knees or in my shoulder, where long-term treatment with conventional medicines can have many side-effects. So if persons can feel better with alternative medicines, why not encourage them to try?

When modern medicines can do little because we have not found treatments for some conditions, I feel that people should be given the option of trying alternative medicines. The image below shows a modern pharmacy plant for making Ayurvedic medicines based on herbs and oils in India.

I know the situation in India - alternative medicine is usually cheaper and is much more accessible to persons. Unless it is a life-threatening condition, often alternative medicine can provide psychological support and even serve as placebo and reduce suffering. In many villages, traditional medicine is all they have because modern medicine is costlier and located far away.

I feel that demonising alternative medicine as fraud and quackery and to think of people preferring it as gullible or stupid, is not the right approach towards it.

(An earlier version of this post was first published on my blog in 2021)

Bonsai & the Life in the Plants

Last month I visited a Bonsai exhibition at the Jaquard gardens of Schio. The sight of tiny plants looking like a miniature version of full-grown trees reminded me of a nature-visit in Bologna some years ago. This post is about two different ways of thinking about the life-forces in the plants. At the same time, it is also a reflection about the relationship between humans and nature. (Click on the images for a bigger view)

Indian Ideas About Nature

Let me start briefly with some of my ideas about nature, which are influenced by my growing up in India. Hinduism is full of Gods and Goddesses, each of whom is linked with an animal and a plant species. There are many mythological stories that teach one to respect all the beings as a part of the respect for the sacred.

There are different stories linked with plants in the Hindu mythology. Like the story of the sacred Tulsi plant (Indian Basil), which represents a pious prostitute. Thus, people believe that this plant should not be kept inside the house, but must be planted in the courtyard where the families can pray to it at dawn and sunset by lighting a lamp near it. The 1960's Hindi film Parakh had one of my all time favourite songs, Mere Man ke diye (The lamp of my heart), in which Sadhana lights a lamp and prays to Tulsi plant. According to Ayurveda, Tulsi is an important medicinal plant. Such myths and sacred stories, are ways to remind the communities about the importance of different species of plants and animals, and to safeguard the biodiversity.

I remember my grand-mother once telling me to not to pluck the leaves of a plant at night because "the plant was sleeping". I think that such a way of thinking illustrates the popular understandings of life in the plants among Indians. While in the cities, people have a more transactional ideas about nature (for example, that it is good for breathing and well-being, it is relaxing and stress-busting), in the smaller towns and villages of India, I feel that there is still a lot of respect and traditional knowledge about these ancient understandings of nature.

Bonsai Plants

Literally the term Bonsai means "planted in a vase". The aim of growing a Bonsai is to create a realistic representation of nature through a miniature tree.

An exhibition of Bonsai plants was held at the beautiful 19th century Jaquard garden in the centre of Schio. It is a small garden but is very beautiful, with an old theatre and a green-house. The exhibition presented the plants grown by the Bonsai students of Schio under their teacher Dr. Ennio Santacatterina.

I spoke to Ennio to understand about Bonsai. He explained that he had discovered his passion for Bonsai after his retirement. His school is a part of the Bonsai Art School and its classes are held in a local plant shop called Garden Schio.

Ennio sees Bonsai as a part of the Zen traditions from Japan, in which it is fundamental to understand kamae, the basic and essential nature and characteristics of each plant. He cites the Bonsai guru Aba Kurakichi and says, "We must conserve all the specificities of the nature of each plant because Bonsai is a life-art." This means that each plant will develop according to its own characteristics and the Bonsai-maker must know how to enhance its individuality and highlight its beauty by selecting the appropriate style, branches and spaces.

I think that it means that a Bonsai is not created but rather it is nurtured, grown and gently guided. It is an exercise in mindfulness, in which the Bonsai-maker searches for a connection with the plant through silence and meditation, to understand its nature and develops a vision of how it should grow. Then, with patience and mindfulness, the maker helps the plant to achieve that vision.

Free-Growing Nature

While Bonsai speaks the language of Zen, meditation and mindfulness for creating a connection with plants, it seems as if the plant is moulded into an idealised vision of how it should look. It reminded me of another encounter about plants - in 2011, I had an opportunity to meet Mr. Marco Colombari, a gardener and plant-lover from Bologna, who had some very radical ideas about the plants.

Marco had guided us in the discovery of a forest, talking to us about how to observe and "see" the plants. A century ago, this forest was an "aviculture centre", an area for developing and growing different species of birds. Then it had become a hunting laboratory and a honeybee cultivation centre. In the 1980s, surrounded by multi-story apartment buildings, this area was supposed to be used for building more condominiums. However, the local residents had started a campaign to save it as a natural area. It is now managed by an association called Oasi dei Saperi (The Knowledge Oasis), which promotes it as a site for the conservation of biodiversity. It is known as the Forest of St. Anna and is located in the Corticella area of Bologna.

Marco's point was that every plant is a living being and has its own characteristics. He felt that people decide about planting trees and plants without really thinking about those natural characteristics. Thus, every time we cut the branches of a tree for making it fit into our urban landscaping, it is like closing an animal or a bird inside a cage. In the forest, he had shown us parts of the trees where the branches had been cut, making us look at the seeping liquids from the cut surfaces and drawing parallels with injured animals.

Besides the natural forest, St. Anna Forest also has some other areas including a botanical garden for growing medicinal herbs, a small pond which was used in the past for jute production and a group of ash trees with old artificial nests which were used for keeping birds when it was an aviculture centre.

Some Reflections

Listening to Marco had a very strong impact on me. Reflecting on his words and coupled with the philosophy in the Indian sacred books of Upanishads, I feel that it is the same life-force flowing inside the trees and plants which flows in every living being.

How do I reconcile this understanding with our daily business of living? There is a proverb in Hindi which says "If the horse becomes the friend of the grass, what would it eat?" I think that this proverb sums up the basic dilemma of our life - the impossibility of avoiding violence, if we wish to live.

Thus, I think that all life in the world is inter-connected and there is no way we can avoid eating other life forms, till the time comes for us to die when we return back to the earth, turn into our basic elements and become a part of the never-ending cycle of life, death and decay. To me it means respecting nature and all forms of life, which I translate as avoiding giving unnecessary suffering to my fellow creatures. Thus, I feel that individuals can decide if they wish to eat meat or they prefer to be vegetarian or vegan - it is a matter of choice linked with personal convictions.

However, I think that keeping animals to be used for their meat (chicken, ducks, sheep and cows) in narrow spaces, which do not allow them to move, and making them eat food laced with hormones and antibiotics so that they can fatten quickly, or hurting them unnecessarily, are wrong.

It means being kind to the animals and birds that we keep as pets. It means, taking care of the nature so that our biodiversity is maintained and strengthened. It means that if we have a zoo or a circus, we shall ensure dignified spaces for keeping the animals and treat them with care. I think that zoos and wild-life parks can play an important role in saving species close to extinction and in teaching young people about the importance of safeguarding nature and biodiversity.

Some people would completely separate humans from other animals because they see all human-animal interactions as basically evil and unwelcome for the animals. They are against keeping pet animals, they don't like zoos, they do not want any experiments involving animals - I feel that it is an extreme view and does not help the animals or the nature.

I hope that science and technology would soon progress so that one day we can have all kinds of food, including meat and fish, grown in cell-cultures. In the meantime, I would like more humane conditions for the animals we keep for meat.

Conclusions

Coming back to the plants, does making the plants grow as miniaturised Bonsai trees means that the plants are being forced into unnecessary suffering? Probably Marco Colombari would say yes. I don't think so. I feel that Bonsai practice, by helping us to seek a connection with the plants through mindfulness and meditation, is another path to recognising the importance of nature.

The evolution has made different life-forms co-dependent on each other. We have biomes inside each of us, made of billions of bacteria and viruses - every time we are ill and take medicines, we are killing millions of them. Life, death and decay are a part of a never-ending cycle going around us all the time and there is no way we can say that we don't want to be a part of this cycle.

This reflection about the life in the plants, makes me think of Shiva, the Hindu God who controls the never-ending cycles of creation and destruction in the universe. I think that Shiva is a metaphor of the life and death which connects together all the organic and inorganic matter of the universe. It is the life-force moving the particles composing the atoms, which combine to make the molecules of different elements, the building-bricks of everything in the universe. Life and death are illusions, because those atoms and the forces moving their particles, they do not die and will continue to combine and create new forms all the time.

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