Systems Medicine – P4 Medicine – Ayurvedic Understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Systems Medicine is an interdisciplinary field of study which includes systems science and systems biology and works towards providing comprehensive healing to ailments.

Fundamentals -systems medicine

Goals and fundamentals of its functioning –

1. System medicine looks at the systems of the human body as part of an integrated whole. It gives a comprehensive view of health and disease. Eg: In a person having heart and gut diseases, system medicines doesn’t treat his heart or gut ailment separately, but aims at treating the person who has these ailments.

2. It works by incorporating biochemical, physiological and environmental interactions in the causation of the diseases.

3. Systems medicine enables us to understand pathways for personalized treatment – One-to-one approach provides more comprehensive cure to the diseases and enables recovery, since the focus will be on the individual and elements of pathogenesis in him / her. Systems medicine is the first step on the path of personalization of medicines. This is based on computer models. Here, vast amounts of clinical data are used to analyze the health of individual patients.

4. Systems medicine helps in our understanding of disease mechanisms.

5. It helps the medical system or physician to boost the efficacy of treatments. This happens because the patients are addressed individually and personal treatment is administered.

Functioning

How does systems medicine work?

Algorithms form the foundation for systems medicine models – In systems medicine, algorithms are created whose performance improves as they are exposed to more data over time.

Systems medicine aims to achieve multi-disciplinary collaboration. For example, a chronic heart patient usually has respiratory issues. With systems medicine, both these two diseases are treated together. Here, patient is not expected to meet chest and heart specialist separately.

Understanding the working module of Systems Medicine

Systems Medicine aims at establishing a precise, systematic and more personalized approach in medicine. It is also known by different names such as –

• Personalized medicine
• Precision medicine
• P4 medicine which includes predictive, preventive, personalized and participatory medicines

All these share the common goals of making

• improved diagnosis,
• targeted therapy,
• better prognosis and
• prevention

Routes of achieving these goals of systems medicine integration of data from different sources including

• conventional patient data,
• clinical and pathological parameters,
• molecular and genetic data and
• data generated by additional new-omics technologies

This endeavor is achieved by the investigator teams combining the expertise from different disciplines.

P4 medicine

It is a byproduct of systems medicine. They are –

• Predictive
• Preventive
• Personalized and
• Participatory

Objectives of P4 medicine –

• To quantify wellness
• To predict and prevent diseases
• To improve healthcare
• Reduce the cost of healthcare
• To stimulate innovation and new company creation
• Related reading – Application of P4 medicine and systems biology in respiratory medicine

Predictive medicine

By understanding the health of a person at molecular level, the systems medicine will be able to predict an up-coming disease. Eg: Detection of cancer by identifying certain proteins in blood.

Ayurvedic aspect of predictive medicine:
Anumana pramana – By seeing the premonitory symptoms of the disease, the disease which is yet to be manifested can be inferred.
Arishta lakshana – By seeing the ‘death impending symptoms’ the physician can infer / predict the bad prognosis of a disease.
Poorvaroopa – Prodromal symptoms so as to catch the disease in its budding stage.
Nidana – Predicting disease looking into the habits of a person. Eg: Smoker is more likely to suffer from smoker’s cough
Concept of Shat Kriya Kala – This concept is used from ages as diagnostic tools by Ayurveda physicians in early diagnosis of disease and to prevent progression of the disease. When the disease is treated in the early, preliminary stages of disease formation the successive stages of its formation may be prevented. Thus, the knowledge of these stages forms an important tool for predictive as well as preventive medicine.
Sadhya Asadhyata – Concept of prognosis prediction.
Upashaya Anupashaya – Test medicine to diagnose and predict disease.

Preventive medicine

On the backdrop of the knowledge of prediction of disease, the preventive measures for a disease can be taken even before it has occurred.

Ayurvedic aspects of preventive medicine

• Maintenance of health and prevention of disease have been the two main objectives of Ayurveda.
• Dinacharya – daily regimen helps in preventing many diseases. For example, Abhyanga keeps arthritis away, regular teeth brushing keeps oral germs away.
  Ratricharya Sandhya charya – Ayurveda believes, like sun, moon also has his impact over mind and body. Healthy night regimen to upkeep health 24 hours.
• Ritucharya – Healthy seasonal regimen to adjust the body to the changing weathers and seasons.
• Sadvrutta – Healthy code of conduct for a disciplined lifestyle.
• Swasthavrutta – Concept of health and hygiene.
• Achara Rasayana – Behavioral therapy. It enumerates various behaviors which when practiced daily and throughout the life will have an effect of Rasayana i.e. rejuvenators / immune modulators. Since the activities included under achara rasayana have immune modulator effects, they are helpful in prevention of diseases.
• Pathya Apathya – Wholesome diet and prevention of unwholesome diet and activities.
• Panchakarma purifying treatments – Elimination therapies so that the body is detoxified from time to time.
• Traya Upastambha – food, celibacy and sleep regimen to maintain health and prevent diseases.

Personalized medicine

Assessing the nature of the person by DNA analysis and developing a personalized strategy for treatment.
The conventional system of modern medicine had much believed and followed the concept of generalized medicine wherein ‘one medicine fits all’ was believed to work every time. Of course it took lot of researches to generalize the medicine so that it could fit most health seeking clients and most clients fit into the shoes of this constant. To an extent it works, but most often it fails because every human being is a different individual. What suits other need not suit the other essentially. This includes food choices, lifestyle preferences, dressing and lot more.

Ayurvedic aspects of personalized medicine:

Concept of Prakriti and personalization of medicine  
Prakriti means constitution, body type or personality types. Ayurveda tells that each of us derive our personality from the moment we were conceived in out mother’s womb. It is unique to all of us, just like our fingerprints and cannot be changed or erased till our last breathe.
For example, a Vata prakriti person is prone to Vata type of Jwara, when all causes of Jwara are common.
Excessive consumption of ice cream is more like to cause Kapha increase in a Kapha person than in Vata person.

Concept of samanya lakshanas and vishesha lakshanas i.e. generalized and dosha specific symptoms of a disease in relation to personalization of medicine.
Example, Kapha type of diabetes / urinary disorders are said to be easily curable than the pitta and vata types.

Concept of Dashavidha Pariksha i.e. tenfold examination of patient and personalization of medicine

Concept of Rajavaidyas and personalization of medicine

In ancient times, the kings, wealthy people and nobles used to have their personal doctors. They were called as rajavaidyas or royal physicians. They were personal physicians to these wealthy people and would make diagnosis, prognosis and treatment protocols individually for only the concerned people. This was the earliest evidence of having a personal or family doctor. This would definitely build up the trust factor between the physician and the king / nobility. The treatment and advices also worked on trust factor and the healing would be comprehensive. More importantly the patients would be treated in their own preferable living places and conditions. The concept of the physicians visiting the home of the patients is also described in Ayurveda in the context of dootadhikara in the Indriya Sthana of Charaka Samhita.

Concept of Kuti Praveshaka Rasayana and Jentaka Sweda i.e. in-home rejuvenation therapy and cottage sudation in relation to personalization of medicine

Kuti praveshaka rasayana i.e. taking the rejuvenation therapy by living isolated within the three chambered cottage specially constructed for therapeutic purposes and Jentaka Sweda, one of the sudation treatments wherein the patient needs to stay within a specially constructed sudatorium or cottage and take the sudation treatment. In these instances, Ayurveda has emphasized to construct separate cottages or sudatoriums for every new patient. After the treatment, those constructions are not used for providing treatments to other patients. These two are perfect examples of personalized approach of treatments and earliest evidences of personalized medicine.

Participatory medicine

Taking the patient into confidence and actively involving him in the healing process. Counselling the patient and his relatives so that all stake-holders work in unison with the doctor and patient in effective treatment.

Ayurvedic approach of participatory medicine
Chikitsa Chatushpada – Four limbs of treatment – physician, medicine, nurse and the patient – all the four should work in unison for effective treatment. Lack of one component among these makes the disease difficult or impossible to cure.

The doctor should encourage the patient to follow healthy daily regimen, seasonal regimen, diet as per the disease. This makes the patient, part of the solution. Thus the burden of responsibility of healing will be shared equally among doctor, patient and his kin.

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