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Can Ayurveda enter the mainstream healthcare system?

Shivank Mehra
Akash Neel Dey
Varkhede Saurabh Ramesh
Atish Kumar Sinha
Varanya Prakash
Devesh Lohia

“Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity” (WHO, 1946)

-Preamble (Constitution of the World Health Organization)

People usually associate hospitals and doctors with health-care but actually it is beyond than
just medicines and hospitals. On the contrary the ancient practice of Ayurveda is a holistic
system which literally translates to “knowledge of life” (Oxford Dictionary). It is known in the
west as a type of traditional medicine system. The modern medical science looks narrow in
jurisdiction in terms of consistency with the above definition, but Ayurveda covers everything
from philosophy to surgery. At least in terms of its vastness and adherence to the above
definition Ayurveda is far ahead of Modern medical science (WHO, 2010). But, still this
ancient science has failed to make a strong position in the international arena and into the
modern medical textbooks. In this essay all aspects of Ayurveda would be analyzed individually
and then challenges faced by it due to methodology which seems to be incompatible with
modern scientific community and effect of culture would be discussed.

Ayurvedic Philosophy defines perfect health as balanced and dynamic integration between
environment, body, mind and spirit (The Chopra Center, 2016). It teaches a series of conceptual
systems characterized with balance and disorder, health and disease. Disease or health is result
of interconnectedness between the self, personality and everything that occurs in the mental,
emotional, and spiritual being (Center for Health and Healing, 2000). Ayurveda focuses on both
preventive and curative approach. Curative approach seeks to heal an illness by identifying a
person’s ideal state of balance and to determine where they are out of balance and intervenes
using diet, herbs, music, massage treatments, aromatherapy, and meditation to achieve balance.
There is a methodological differences or barrier between Ayurveda and modern medical
science. Early classical texts on Ayurveda discuss certain protocols to study the properties of
drugs, develop new medicines and classify new diseases (Pannikar, 1995; Laurent,2010), but
there is no evidence of organized research work being conducted in Ayurveda during its
evolutionary history. For most part of its history, it was passed on as a tradition through
apprenticeships and universities.

Thousands of research papers have been published on Ayurveda, many of which conclude with
positive findings, yet not a single Ayurvedic drug can be prescribed by a practitioner of modern
medicine. If this seems paradoxical, the reality is that research in Ayurveda so far hasn’t been
systematic and there are few Ayurvedic drugs that have been properly tested in
placebo-controlled clinical trials. Another very serious obstacle to genuine research work in
Ayurveda is the widespread prevalence of fraudulent research. There researches are usually
promulgated by firms that sell over-the-counter Ayurvedic drugs. Thus, it is asserted that the
vast literature on the positive results of the trials of Ayurvedic drugs is simply a ‘mirage’.
(Pulla, 2013)
One set of scientists argue that fervent nationalism has caused Ayurvedic researchers to become
biased. Some of them regard the ancient texts as the last word and don’t consider scientific
endorsement to be important. On the other hand, there are medical scientists who claim that
Western medicine is biased against Ayurveda because its methodology is completely alien to
the West, and they regard it as mere folklore (Pulla, 2013).

That being said, almost seventy percent of drugs are of herbal origin, and there have been quite
a few cases of clinical drugs that developed from Ayurvedic treatments. Thus, despite the poor
condition of Ayurvedic research at present, it appears to have a very promising future (Pulla,
2013).

Ayurvedic drugs don’t enjoy the status as allopathic or mainstream drugs do. Till date only one
ayurvedic drug has been recognized by USFDA(United States Food and Drug Administration)
as a drug and other are sold as supplements instead of being classified as drugs(U.S. Food and
Drug Administration, 2008). The status of Ayurvedic drugs in India is quite different than that
in USA in the sense that it has been given a status above the mainstream drugs. In India it need
not undergo any clinical trials since these drugs have been used for thousands of years. Thus, it
is readily promoted and qualified as a drug and doesn’t require a modern chemist to verify its
claim as argued by government of India.

Internationally any drug before entering mainstream must qualify three phases of clinical tests,
but unfortunately no Ayurvedic drug has ever passed 3​rd​ phase and that only few could even
enter 3​rd​ phase (Pulla, 2013). ICMR (Indian Council of Medical Research) classifies Ayurvedic
drugs into three categories. The first category drugs have been completely described in ancient
text of Ayurveda, second category includes drugs which have been described in ancient text but
are being used for a treatment which these drugs were not originally prescribed for and while
the third category drugs are product of modern day research by ayurvedic researchers. Only
third category of Ayurvedic drugs need to pass the modern 3-phase clinical test (Indian Council
of Medical Research, 2006). There are many reasons why these drugs haven’t passed the
clinical trials and hence not been accepted internationally. Foremost reason is the lack of
motivation of some Ayurvedic practitioner because of their outlook that Ayurveda doesn’t need
validation of modern scientific community and that spending money on something already done
by our ancestors would be a waste of time and money (Pulla, 2013). Surprisingly, this idea is
backed by ICMR but this leads to restriction of Ayurvedic drugs to few countries which believe
in ancient Ayurvedic scriptures (Indian Council of Medical Research, 2006). But, there are very
few countries to put their faith on these ancient textbooks in reality. Other school of thought
claims Ayurvedic drugs are facing difficulties in adhering to modern guidelines due to its
different nature. For instance synthetic drugs are easily monitored and characterized but
ayurvedic drugs are mixture of many pure substance, at times hundreds of them and it’s difficult
to determine which compound of the herb is making it potent and hence the study of the drug
itself. Apart from that the variation and mutation in plants also make standardization of drugs
impossible. Some scientist have even challenged the relevance of 3000 years old catalogue of
plants since the plants might have mutated enough to lose their desired property. (Pulla, 2013)
Noting that the pharmaceutical companies are spending up to $5 billion on a single medicine
(Herper, 2013)as investment to sell patented drugs but for Ayurvedic medicines patents don’t
exist(Press Information Bureau, 2013). Hence this prevents commercial investment which
leaves only the government as the only large scale funding agency. This makes Ayurvedic
research financially unfeasible.

However, the fact that Ayurvedic drugs couldn’t pass clinical trials doesn’t prevent the rise of a
global commercial ayurvedic industry concentrated in Indian sub-continent. These medicines
are also present in countries like USA as complementary and alternative medicine (U.S. Food
and Drug Administration, 2008).Ayurveda as an alternative form of medicine is blooming in the
West because of recent trend of people opting for more organic and natural products. The
erstwhile Hindu nation of Nepal is dependent on ayurvedic drugs for more than 75% of their
medicinal needs (WHO, 2001, p. 137), attributing to its religious nature. Being a part of ancient
Hindu text it was promoted by the Hindu state. This argument was recently strengthened by the
fact that in Pakistan another traditional system of medicines “Unani” is popular (WHO, 2001, p.
79).

Although Ayurveda is seen as mainstream medicinal system in Indian subcontinent, but due to
barrier in international trade is restricted to domestic market of respective countries. Chief
reason being absence of standards and large firms which can commercialize these products and
export it. Other problem is the ambiguous treatment given to these medicines and absence of
patents and clinical testing. The USAFDA has issued warnings against exported Ayurvedic
drugs stating that these drugs haven’t passed any clinical tests and labelled as supplements by
FDA which must be used with caution (U.S. Food and Drug Administration, 2008). The
concern raised by FDA cannot be perceived as solely due to cultural bias towards the East but
backed by tests carried by FDA which concluded that about 21% these drugs contain detectable
amount of heavy metals and cases of lead poisoning in pregnant woman by ayurvedic drugs has
been documented(​Centers for Disease Control and Prevention, 2012​).

It is estimated that the entire Ayurvedic production of India is valued at around $1 billion
(​Dharmananda, n.d.​). Companies such as Dabur and Himalaya in addition to drugs are now
selling consumer goods like ayurvedic Food items, Beverages, toiletries etc. One of the recent
large brand in this segment is “Patanjali Ayurved” which has launched a range of Ayurveda
based medicines and fast-moving consumer good(FMCG) which includes almost every FMCG
ranging from stress busting medicines to detergents. In other words these companies have
expanded the domain of Ayurveda as until recently nobody could imagine the launching of
noodles under the banner of “Patanjali Ayurved” (​Saha, 2016​).

Surgery is a branch of medicine that involves operating on body parts to diagnose, prevent or
cure an illness. Initially it was considered risky “art” rather than science. But only after
advances in this field it became branch of modern medicine.
History of surgery can be traced back to Ayurveda, particularly “Sushruta Samhita” (​Wujastyk,
2003​) (Sushruta’s compendium), one of the foundational texts of Ayurveda. “Shalya chikitsa”
which specializes in surgery (​Kerala Home of Ayurveda,n.d.​) is one of the eight branches of
Ayurveda. Sushruta is considered as the “founding father of surgery”. “Sushrita Samhita”
describes procedures for many surgeries such as rhinoplasty, plastic surgery (Saraf ​et al.​, 2006),
labiaplasty (​Kumar​) and cosmetic surgery. Sliding graft, rotation graft and pedicle graft methods
are also described in Sushruta Samhita (Thompson,n.d.).

Ayurveda greatly emphasizes preventative and healing therapies along with various methods of
rejuvenation. It can thus guide every individual in the prevention of disease and helps in
maintenance of health. Panchakarma Therapy is prescribed for the cleansing of body toxins
(Volunteering India, 2006). Rasayana, the science of rejuvenation has been reputed to
strengthen body’s immune system and slows down the ageing process. Scientific evaluation
Ayurvedic treatments have shown that Rasayanas can protect the body against the damaging
effects of ageing process by enhancing its ability to fight pathogens by activating immunity
non-specifically unlike antibiotics who have specific action and do not aim at enhancing the
immune system. Many Rasayana herbs contain antioxidants which prevent damage caused by
free radicals. Rasayanas are known to be responsible for bringing about proper nourishment,
growth and function of all seven tissues (Dhatus) (McIntyre, 2007). There are many
rejuvenating foods and herbs like kitchari, Ashwagandha, Shatavari, Pippali, Triphala, Amalaki
etc. Further there are a set of activities that promotes health and happiness classified under
behavioral Rasayans.

Government of India recently opened Ministry of AYUSH to promote Indian system of


medicine (Ministry of Ayush, n.d.). It also helps teaching and research in Ayurveda. 25% posts
of public health officers are reserved for Ayurveda doctors (Hindustan Times, 2010). Even
though Ayurveda is considered a pseudoscience (Semple ​et al.​, 2013), Indian parliament passed
the Indian Medical Central Council Act (1970) to standardize qualifications for Ayurvedic
doctors (Government of India, 1970). Indian government has always promoted Ayurveda and
its study at both national and state level. Ayurveda doctors (Bachelor of Ayurvedic Medicine
and Surgery (B.A.M.S.) have recently been given permissions to prescribe allopathic drugs and
perform surgery in the state of Maharashtra. Secretary of Indian Medical Association (IMA) of
Maharashtra has said. “We will challenge government's decision in court”. He also said that
“this will hamper practice of medicine” (The Indian Express, 2014). The question of
competency of BAMS doctors to perform surgeries was raised when a surgery by BAMS doctor
lead to death (Hindustan Times, 2010). Modern medical science has been included in the
curriculum of Bachelor of Ayurvedic Medicine and Surgery (B.A.M.S.). BAMS degree holders
are allowed to perform basic surgeries and they are also allowed to do major surgeries after
proper additional training (Deccan Herald, 2012).

Ayurveda is more than 3000 years old but suffered from some sort of bias and discrimination
only by English as even Mughal rulers promoted Ayurveda consistent with their image as
patron of arts and science. Although Ayurveda could have been suppressed by Unani
(Medicine's Greco-Islamic system) but the rulers wanted to unify both Ayurveda and Unani
(​Shane, 2013)​. Hendrik van Rheede, a Dutch colonial governor and naturalist was among few
European who were not insensitive towards Indian culture collected data on approximately 800
medicinal plants and their properties and published it as 12 volume set called Hortus
Malabaricus in Amsterdam (​Shane, 2013)​.But the English Education act of 1835 discarded
vernacular education and imposed western education system on India also affected Ayurveda.

Though initially the English completely discarded Ayurveda, but after 1857 were cautious in
not intervening with cultural matters of the native and were also unable to set up a system of
western healthcare. As result a hierarchy was created among physicians in which those trained
in western medicine were considered superior to those trained in Ayurvedic medicine(​Freidson,
1994)​ and this was the starting of downgrading of status of Ayurvedic who were mainstream
physicians for more than 3000 years(​The Times of India, 2014)​.

After independence the government promoted and supported Ayurveda but the efforts of
government couldn’t restore the lost glory of Ayurveda. The stagnation in Ayurveda during
18th and 19th century and exponential growth of western medical science helped the English to
reduce Ayurveda to its present status. Even when government is promoting Ayurveda
Medicines the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy only gets 3% of total budget sanctioned for the Ministry of Health and Family
Welfare (​Economic Times, 2014)​.

Among general public nowadays Ayurveda isn’t given due respect instead seen as cheap, slow
if not ineffective, unprofessional and secondary system of healthcare. People tend to use
ayurvedic cough syrup, or opt for simple herbal remedies for minor health concerns, but never
consider Ayurveda even as a viable option when it comes to critical health issues or more
importantly surgery. On the other hand some patients are known who after allopathy treatment
fail to get the desired results, take up Ayurveda as the last resort. This shows the reputation of
ayurveda as secondary medicinal branch.

"Just saying that our things are best will not do anything. We need to present our technology to
the world in the language they understand," –Mr. Narendra Modi (February 2014) at National
Ayurvedic Summit at Mahatma Mandir.

This statement captures the debate on Ayurveda as to conclude whether Ayurveda can be
accepted as science by the modern scientific community and be used as primary medical
system, those who belief in Ayurveda or want it to be recognized must provide evidence
compatible with modern scientific methodology instead of citing ancient textbooks. Despite this
fact Ayurveda as a secondary medicinal system is flourishing in India and abroad.

Word Count
Total words in main body=2,517 words
Total words of in text references=100 words (approx.)
Total words in main body without in text references=2417 words (approx)

Appendix A

It says everyone is born with a specific constitution, called “prakruti” which is viewed as a
unique combination of physical and psychological characteristics throughout his/her life and
affects the way an individual functions. However, it is constantly influenced by various internal,
external and environmental factors like seasonal changes, diet, lifestyle choices etc. Three
fundamental energies or “Doshas” govern our inner and outer environments: Vata (Wind) for
movement, Pitta (Fire) for transformation, and Kapha (Earth) for structure. Each individual has
a different quantities of each “Dosha” and there is a certain configuration of all the “Doshas” in
his balanced state. Any deviation from his unique configuration leads to onset of imbalance.

Appendix-B (Concept Map​)


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Word Count
Total words in main body=2,517 words
Total words of in text references=100 words (approx.)
Total words in main body without in text references=2417 words (approx)