LITERATURE REVIEW

Desai (1988) studied Medical Ethics in India. Medical ethics in the Indian
context is closely related to indigenous classical and folk traditions. This article traces the
history of Indian conceptions of ethics and medicine, with an emphasis on the
Hindu tradition. Classification Ayurvedic texts including Carakasmhita and
Susrutasamhita provide foundational assumptions about the body , the self,
and gunas, which provide the underpinnings for the ethical system. Karma,
the notion that every action has consequences, provides a foundation for
medical morality.

Conception, prolongation of one's blood- l in is an important ethical aim of life.

Thus a wide range of practices to further conception are acceptable. Abortion is a more
complex matter ethically. At the end of life death is viewed in the context of
passage to another life. Death is a relief from suffering to be coped with by the
thought of an eternal at manor rebirth

Shankar (2001) conducted a survey of drug use patterns in western Nepal. In

Nepal, traditional health care providers have an important role to play in the provision of
health services. Non-doctor prescribing of allopathic medicines is commonly
carried out by compounders, health assistants and other practitioners. Self -
treatment in which herbal remedies play a large role is also common. Most of the
previous studies have been carried out in the Kathmandu valley. As studies in the
Bokhara valley are lacking the present study was carried out. Methods: The study was
carried out in Bokhara sub-metropolitan city and the surrounding villages in the month of
September 2001 using a semi-structured questionnaire by the health workers of the
community medicine department. The pattern of drug use in the preceding 6 month
period was noted. Differences in the proportion of patients using self-
medication and complementary medicines according to age, place of residence
and socioeconomic status of family were analyzed by the z test of proportions ( p<0. 05).
Findings and conclusions: 112 households were surveyed during the study
period. 120 individuals from these households had been prescribed medications
during the study period. There was a total of 164 encounters
With the health care system. Self- medication was practiced by 39 families
during the study period. Home remedies accounted for 18.9% of the drugs
used 71. 6 % of the respondents using more common among rural households.
Improving accessibility to medicines, improvement of the government health care system and
greater integration of traditional and modern health care systems are recommended.

Ryan (2003) studied the Use of Herbal Medicines in Wound Healing. Healing of chronic lower
extremity wounds is a global problem, especially in the developing world where it is often
only folk and traditional medicine that can be afforded. In the structured health
services of the developed world, there are usually a wider range of possible therapies. In
India, traditional medicines flourish in parallel with Western systems, and those who treat
mounds may use the expertise of more than one system. Ayurveda is a traditional system that
has evolved in India over centuries using especially native plant sources as remedies. Like
many Asian systems, its theoretical basis concerns balance and energy in the individual. In
this perspective paper, the author advocates awareness of plant products
available for wound healing and a study of the extent of their utilization.
They must be developed for safe use and their efficacy reviewed, taking into
account cure well-being and patient satisfaction as well as cost. Developing a list of
products and classifying them appropriately is a beginning for such studies.

Joudrey at al (2004) studied Perceptions of Alternative and Allopathic Medicine. This

exploratory study of student nurses is based on the results of the responses to one question on
an open-ended questionnaire: How would you define the relationship between alternative
medicine and allopathic (conventional) medicine? A specific goal of the study was to find
out how the surveyed respondents conceptualized the relationship between allopathic
and alternative medicine. Three themes were identified: (a) They are not at all alike, ( b)
The two can or should be used together, and ( c) Those who practice alternative
medicine and those who practice allopathic do not get along very well." The
discussion suggests some reasons for these perceptions and considers some implications for
future health care.

Patwardhan at al (2005) discussed that Ayurveda, the Traditional Indian Medicine (TIM)
and traditional Chinese medicine (TCM) remain the most ancient yet living traditions. There
has been increased global interest in traditional medicine. Efforts to monitor and regulate
herbal drugs and traditional medicine are underway.
China has been successful in promoting its therapies with more research and science-based
approach, while Ayurveda’ still needs more extensive scientific research and
evidence base. This review gives an overview of basic principles and
commonalities of TIM and TCM and discusses key determinants of success, which
these great traditions need to address to compete in global markets.

Datta at al (2009) discussed theories and Management of Aging: Modern and Ayurveda
Perspectives. He explained that Aging is a complex phenomenon, a sum total of changes that
occur in a living organism with the passage of time and lead to decreasing ability to survive
stress, increasing functional impairment and growing probability of death. There are many
theories of aging and skin remains the largest organ of the study. Skin aging is described as
a consequence of intrinsic and extrinsic factors.

Gehlot at al (2009) studied the Ayurveda Education in India; How well are the Graduates
Exposed to Basic Clinical Skills? ‘Ayurveda’ is an ancient system of healthcare that is native
to India. At present, in India, there are more than240 colleges that offer a graduate-level
degree (Bachelor of Ayurvedic Medicine and Surgery BAMS) in Ayurveda. Even though the
Central Council of Indian Medicine, the governing body that monitors the matters related to
Ayurveda education, has imposed various educational norms and regulations, the standard of
education has been a cause of concern in recent years. The mushrooming of sub-standard
Ayurvedic colleges is the most important factor that is being held responsible for this kind of
erosion in the standards. The present study is a mailed survey, which was carried out to
evaluate the ‘Extent of exposure to basic clinical skills BAMS course’ as perceived by the
sample groups of students and teachers drawn from 32 Ayurvedic educational institutions
spread all over India. A methodically validated questionnaire was used as the tool in the
study, to which 1022 participants responded. The study indicates that there are some serious
flaws in the existing system of the graduate-level Ayurveda education. Since the Ayurvedic
graduates play an important role in the primary healthcare delivery system of the country,
governing bodies are required to take necessary steps to ensure the adequate exposure of the
students to basic clinical skills. Along with the strict implementation of all the regulatory
norms during the process of recognition of the colleges, introducing some changes in the
policy model may also be required to tackle the situation.

Bhushan Patwardhan (2009) Ayurveda is one of the oldest extant health systems in the
world with fundamental principles and theory-based practices. Literally, the Sanskrit
meaning of Ayu is life and Veda is knowledge or science. Therefore, Ayurveda is also gener-
ally translated as the Science of Life. The theoretical foundations, rational and epistemology
of Ayurveda are based on the six darsanas, mainly the logic of Samkhya and Nyaya-
Vaisesika system of natural philosophy 1. The modern medicine on the other hand, is based
more on Aristolean logic of analytical and reductive life sciences. India has over 600,000
registered practitioners of Ayurveda and other traditional medicine who are close to the
community, just not only in the geographical sense but also in terms of cultural and social
ethos. Due to better accessibility and affordability, these sys-tems enjoy wide acceptance
among large segments of the population especially in India 2. Thus, Ayurveda remains a most
comprehensive and practical medical science that receives acceptance and support of the
public. However, due appreciation from the global scientific and medical community is still
evolving 3. For several reasons scientific research on Ayurveda has been a much debated
issue 4. The Ayurveda fraternity is concerned about the transferability of the current scientific
methods, models and approaches in totality to develop acceptable evidence. The Ayurvedic
community is also concerned about the exploitation and intellectual property protection.
Modern biomedical scientists, on the other hand, have been sceptic of traditional knowledge
techniques, materials and practice. These two polarized points of view do not represent the
whole picture. The axioms of both are important yet distinctly different and logically co-
herent within each system. Therefore, use of identical research approaches may not be
appropriate for inter-system validation. These approaches have been critically reviewed
earlier, rightly emphasizing the need for new standards and methodologies for evaluating
quality, safety and efficacy of traditional medicine 5. Whereas allopathy was being trans-
muted into modern medicine by adopting emergent basic sciences, Ayurveda remained
stagnated and even suppressed. Yet, it survived against the adversity of time especially during
the Mughal and the British period 6. Regardless of this, Ayurveda has made significant
contributions to medical science by providing many leads in natural product drug discovery
7. The epoch-making discovery of monoamines in Rauwolfia serpentina opened up the
floodgates to new vision through Ayurvedic pharmacology 8 . Until then, value of Ayurveda
in medicine and natural product research remained largely unrecognized, understudied and
remained neglected. The discovery of reserpine through traditional knowledge-inspired
approach, known as reverse pharmacology, is now being practiced successfully 9. However,
it is important to ensure that Ayurveda is not reduced to mere drug discovery engine. The
modern research should benefit this ancient science to
become more contemporary and affordable global health care system. Generally, biomedical
scientists have been sceptical on extent, rig our and quality of research on Ayurveda. Even
the House of Lords Committee concluded that Ayurveda was a system lacking in evidence
base 10. until a high level scientific delegation was sent by the Government of India 11 .
However, ironically though, experimental research on Ayurveda had really been limited more
to botany, chemistry and pharmacology of medicinal plants until a decadal vision document
on Ayurvedic biology 12. was put forth. It is satisfying to note that the interest in research on
basic principles of Ayurveda is increasing and of late few studies on genomics have been
published in international peer reviewed journals 13 .More systematic and rigorous studies on
Ayurveda at all the levels of biological organization are necessary to develop interest among
global scientific community. Of course, in doing so, it will be vital to respect and understand
basic concepts of Ayurveda, which should remain the key driver.

R Manohar (2012) there is limited access to published research in the field of Ayurveda.
Researchers find themselves groping in the dark to make an assessment of prior research
work. A narrative review of prior research by screening published research papers will lay the
foundation for identifying strengths and gaps in the evidence base that is available to
vouchsafe the safety and efficacy of Ayurveda interventions. It will also facilitate systematic
reviews and Meta analyses in the future. More than 700 research journals on Ayurveda were
accessed through electronic databases like PubMed and DHARA and many journals were
also hand search to compile nearly 8000 citations on Ayurveda research. The research papers
were screened and classified on the basis of the nature of submission, the research approach,
and quality of research, study design, disease conditions, formulations, interventions and
species used. A summarized and classified overview of prior research on Ayurveda could be
sketched on the basis of the comprehensive analysis. Issues in quality of research and
research design could be identified as well as the good and bad practices in research
publication. The key diseases for which evidence is available for recipes and clinical
interventions in Ayurveda could also be identified with an understanding of the level of
evidence and the research gaps. Nearly half of the published research papers on Ayurveda are
review papers. The majority of original research work is in the area of preclinical studies and
drug standardization. Clinical research work is comparatively less and there is scarcity of
research designs and studies that address Ayurveda as a whole system. However, clinical
trials outnumber case studies and case reports. An analysis of the preclinical and clinical
Work done in the field of Ayurveda gives important leads to identify priorities for future
research on Ayurveda.

Namenda Bhatt (2012) The World Health Organization - WHO has estimated that major
percentage of the population in developing countries depends primarily upon herbal medicine
for basic health care. [1]The traditional systems of medicine, commonly referred to as
‘Complementary and Alternative Medicine’ (CAM) are widely used and looked upon for
possible and safe solutions to present day health and medical problems. [2] Ayurveda, the
Indian system of medicine practiced today has its roots in the Vedic thinking. Ayurveda
follows its own unique philosophy and methodologies to address issues of health care. [3,4] It
prescribes variety of simple therapies as also certain complex treatments that could comprise
of single ingredients, poly-ingredient formulations and combination of drugs, diet, lifestyle
changes and therapies like massages, fomentation therapies, enemas and several other
cleansing procedures as well.[5] These treatments, oral medications or a combination of both
are individualized in nature and ideally meant to be administered only after proper
understanding of the ailment as per Ayurveda diagnostics or Indian. [6] Since last 4-5
decades major changes have occurred in Ayurveda education, practice, research and
manufacturing of Ayurveda products. Research in Ayurveda that began with search for new
compounds from Ayurveda plants and formulations based on pharmacological assertions and
chemical moieties has come a long way with recent advances in biomedicine and technology.
Research as part of learning and essential postgraduate training is expected to contribute
towards overall growth of the sector. [7] It is believed that drifting away from the
fundamental principles and concepts had negative impact and therefore integration at the
basic level of development of hypothesis of research is felt necessary. [7] Much research is
being carried out on single herbs, poly-herbal formulations or herb-mineral compounds,
pharmaceutical products, combined treatments and disease specific therapies. However, the
path remains uncertain in terms of standardization of products along with safety and efficacy
for universal acceptance. Though the protocols for clinical studies in Ayurveda treatments by
Indian Council of Medical Research – ICMR had been prepared in consultation with
Ayurvedists, looking at those protocols however, it’s evident that either the consulted
Ayurvedists were not clear about needs of Ayurveda or their opinions were not accepted.[8]
Focus of research that was mainly directed at isolating active ingredients from Ayurveda
medicinal plants for drug development seems now to be shifting towards scientific
understanding of basic physiological concepts and disease processes as outlined in Ayurveda.
This is an engaging task. It is possible that such a quest for biodynamic mechanisms can
generate new disciplines in life sciences. [9] There is increasing interest and eagerness to look
for solutions from CAM to treat difficult and chronic diseases. There definitely exists an
anxiety about the quality and reliability about CAM. Evidence based research is being
examined for its processes, relevance and implication to CAM. [10] Validation of products or
treatments and their safety aspects are crucial for acceptance of specific therapeutic claims.
Most of implicit scientific studies with negative results on otherwise beneficial claims
warrant a serious reconsideration about the approach of research and about the methodology
applied for research. It is believed that ongoing research is proceeding in such a way that it is
of more value to modern medicine than Ayurveda. It does not strengthen Ayurveda and
Ayurveda practice. [11] A question arises whether the understanding of the conventional
medicine or developments in biomedical research methodology could be applied for the
understanding of Ayurveda system of medicine? Many serious researchers find current
research approaches to be inappropriate and feel need of a major paradigm shift for research
oriented and based on principles of Ayurveda. There is an urgent need to understand
Ayurveda principles of treatment and search for inclusive solutions to design clinical studies
Methods for validation of natural products or CAM are areas of increasing academic
interest.
[13] In India majority of the clinical studies on Ayurveda treatments, products or therapies,
form part of institutionalized research. These studies are published mainly in Ayurveda
journals. A detailed analysis of clinical research activities carried over a period of time would
provide an insight into the research methodology followed therein and the applicability of this
research for the progress of Ayurveda or health sciences in general. This is a primary review
of papers that were published in three well established Ayurveda journals with more than 15
years of regular publication that were available with private clinic library of authors. The
purpose of this exercise was to examine different approaches taken for clinical studies and
methods applied therein. Initially a quantitative assessment with an established method of
scoring was considered but the idea was dropped in view of its non-applicability due to
multiple poorly defined variables observed in most of studies. The study was limited to
articles published in only three but highly used journals as available in the private clinic
library. Currently applied standard scales14were considered for objectivity but could not be
applied due to lack of availability of relevant data. Similarly a critical quality analyses could
not be undertaken for reasons of insufficient details. This review therefore is restricted to
subjective parameters only. These journals are popular within Ayurveda discipline in India.
This review covers earlier period and does not reflect changes that might have occurred in
recent times. The authors opted to capture and analyze basic and preliminary data as available
for the benefit of faculty, students and researchers of Ayurveda fraternity. After preliminary
observations a format – data sheet - was evolved to compile information under several
categories and to examine different criteria in terms of design of study, diagnostics,
treatments and outcome. Several variables that contribute to design of a clinical study were
considered during compilation of the data. The data was classified as per the treatment or
drug te sted against disease condition and diagnostic criteria used in the study as of
conventional (modern) medicine or Ayurveda diagnostics –Indian. The compiled data
included Ayurveda treatments used along with specifics of name and type, name of single
ingredient or plant or compound, compound formulations, coded drugs if any, nature of
indoor or ambulatory treatment, details on measure of dose and administration (route), study
design, sample size, treatment period, clinical, diagnostic and or laboratory investigations
carried out, inclusion and exclusion criteria, report of adverse events or side effects,
effectiveness of treatments offered and observations or recommendations on outcome
including need for further evaluation. The objective was to compile data that will give a
broad idea about each of the clinical study conducted and the approach taken by
investigator/s and to examine its relevance for therapeutic outcome.

Sanjeev Rastogi (2007) A medical prescription is the proposed intervention plan drafted by
the concerned physician, aiming to deal with certain kind of illness of a person [1]. It forms
the prime document for medical procedure or intervention to execute. Despite the differences
among healthcare systems or underlying specialty, medical prescriptions have few common
generic features. They usually contain the basic details of the patient and prescriber
identification followed by the details of the medications including its dose, intake schedules
and total duration of drug consumption. Seeing this, it is obvious to infer that the prescription
is primarily written for the intermediary staff including nurse or pharmacist responsible for
healthcare delivery in a hospital setting or for individual patient in an OP setting [2]. Besides
this primary role, a prescription has its expanded role in many other domains. It acts as a
piece of evidence when the illness and the treatments are linked with some legal issues. It can
play the role of evidence of past illness, past treatment and past adverse events related to the
drug intake and can also act as the ground paper for second opinions [3]. For the physician
himself who has generated the prescription, it acts as a record to evaluate the role of
interventions during follow ups. Needless to say, a good prescription also becomes the spine
of evidence- based medical practice as it may lead to a good case report if the records are
reported meticulously [4]. Importance of writing a good prescription in legible hand writing
is beyond doubt [5]. Even a carefully drafted prescription can lead to execution problems if it
is not readable. Besides legibility, there can also be other issues related with prescription
writing which may eventually lead to poor execution of treatment plan or adversities in worst
possible cases. Errors of omission or commission are two broad passes through which an
undesired functioning of the prescription may creep in. The former one addresses the missing
components of a prescription whereas the latter emphasizes the over stressed components [6].
This is a common observation that missing an instruction in the prescription makes it labile to
subjective interpretations. Prescription errors are little different than prescribing errors. In the
former, the focus remains on the basic format of the prescription for the ease of its execution.
In the latter however, the individual components of the prescription are critically analyzed for
their optimality as per the disease condition [7]. As prescriptions are the sole instruments
ensuring the successful management of a disease if the treatment is executed as per the initial
plan of the physician, it is mandatory to ensure what information it should contain. A poor
elaboration of the plan or an unreadable plan can lead to number of morbid eventualities.
Similarly missing some essential component in a prescription can also open a wide array of
unforeseen erroneous happenings in future. Prescription Quality Index (PQI) was initially
proposed as a mean to identify the prescription related errors in order to improve them
further. Various PQI tools have been developed in clinical medicine addressing the
prescriptions related to the type of illness or clinical specialty. These tools have been
validated and are in regular use as a measure to improve the prescription quality in Allopathy
[8]. Prescription quality is obviously and equally important in other systems of healthcare
dealing with medicine and procedures. Ayurveda offers healthcare to its patients through
variety of means including herbs, minerals, metals, animal products and also a variety of bio
cleansing procedures included under panchakarma. Adversities due to Ayurvedic drugs are
well reported in medical literature and at occasions these adversities are reported to occur due
to wrong medication, overdose, or poor quality of medicine [9]. A wrong medicine can well
be the result of a clumsy prescription. In the conventional format of prescription, disease
diagnosis and a brief description favoring the arrival of the diagnosis is always mentioned.
This description generates an understanding about pathogenesis and helps physician choosing
most appropriate medicine for a given condition. As Ayurveda has its own understanding
about the pathogenesis and derives the treatment plan on the basis of such understanding, this
is obvious to advocate a mention of such findings in the Ayurvedic prescription. Poor
quality of Ayurvedic prescriptions is an undercurrent observation not brought into
notice frequently [10]. Ayurvedic practice of medicine is largely criticized for not
utilizing its own concepts of disease diagnosis and management but rather borrowing
and imposing the modern concepts of pathogenesis and treatments upon their own
treatment principles [11]. There have not been serious efforts to improve the quality
of practice, education and research in Ayurveda. It is for this reason, despite of a
turning around of the world towards Ayurveda; it does not seem ready to utilize the
opportunities coming in its way [12]. PQI can come up as a measure to delineate the
unexposed errors of prescription quality in Ayurveda with a long term goal of
eliminating such problems through educating the prescribers about the importance of
various components of an Ayurvedic prescription. With the help of a thorough
literature review, a comprehensive prescription quality index pertaining to Ayurveda
was thus attempted to be developed, validated and subsequently pilot tested upon
sample prescriptions at a secondary care Ayurveda teaching hospital. The index
development was able to propose many constituents of Ayurvedic understanding of
disease management thought important for their inclusion in a prescription. Similarly
the pilot test was also able to reveal many underlying limitations in contemporary
Ayurvedic prescription writing. The study has many future implications. At one point
it identifies the existing gaps in contemporary Ayurvedic clinical practice and can
help finding the measure to meet such gaps. At the same time, the index also
proposes to act as a tool of prediction of the net outcome on the basis of quality of a
prescription judged upon the basis of PQI.