Posted On : 27 May, 2020
World Health Organisation suggests that more than 70% people around the world prefer to take one of the other forms of natural medicine for their health conditions. There are over 500 millions people just in India who choose Ayurveda as their primary system of health medicine.
Ayurveda is a traditional health science that originated from India almost 5000 years ago. In today’s modern world, where everything is so fast paced and Hi technology driven, people want to be well informed before making choices. Our social media can be very useful with its pros and cons, as we all know.
As many people around the globe wanting to trial Ayurveda. At the same time some are concerned about its efficacy and want to know more about Ayurveda’s authenticity and its scientific proof. Whether our modern medicine deems it safe or not.
As Ayurveda emerging stronger, Ayurveda Practitioner is also been compelled to prove and validate Ayurveda through Randomised Control Trials (RCT) or publications.
This article helps to explain Ayurveda point of view and not to disregard or critique any other form of medical science.
Western medicine considers that human body is made up of different body parts, like a car has been made of engine, wheels, transmission etc. We all know that, our whole body originates from just one cell. One cell is capable of making 120 trillions cells in our body, but every single cell in the human body is capable of doing all the things that other cells in our human body do.
For example, when one kidney is not working well, the second kidney cell multiply and enlarge in size and perform the work of two kidneys. Same is applicable for cancer cell, cancer cells are our body’s own cells that multiply and behave differently. When we try to offer symptomatically, in Western medicine, one part of the body might superficially improve, but it might cause problem in other part.
Ayurveda main contributor and guru Acharya Charaka in his famous text Charak Samhita has mentioned in sutra sthan, chapter 26 and Shloka 10 (above shloka in sanskrit) that everything is made of five basic elements:
Our body is the mirror image of these five basic elements that form the universe. Every single cell in our body is made of these five elements and form the whole body. So every single cell is capable of adapting to the roles of other parts of the body. So the emphasis should be to heal the whole body and keep the whole body stronger and not to symptomatically treat one organ.
That's what Ayurveda's moto is to treat the whole body, instead of the disease affected organ. As we all have found out by now that most of the allopathic medicines work on one or the other body part, instead of holistic apporach and more or less lead to some sort of side effects or adverse reactions.
Famous Allopathic Doctor and Ayurvedic expert, Dr Hegde once said, “There is no pill for every ill, but there is an ill following every pill.” He added, that leading cause of death in today’s world is not cancer or heart attack, its adverse drug reaction.
The world health crisis is deepening, as we come across new diseases almost everyday. Majority of the world pollution is struggling to have an affordable and equally accessible health care system.
In our modern life, over emphasis on disease/illness and their treatment seems to be becoming top priority, whereas, we should be focusing on health promotion and disease prevention first. Our body has its own medical army inside it and it is called immune system. We need to invest in making it stronger. Thats what Ayurveda teaches us.
The cost and time invested in the research of a new drug, becomes wasted when the same drugs becomes resistant to the same category of microbes in just couple of years. It constantly seems like a cat and mouse chase between the disease and medicine. An antibiotic or antiviral drug created in current year, might not even be effective after five years, as the same bacteria or virus might have mutated and developed a strong version of self.
We humans need to do that do, make a stronger version of ourself, so we are prepared to fight with any disease. Ayurveda has its first and foremost emphasis on making the body stronger and prepare it to fight and win against any future diseases.
People are seeing challenges and risk associated with allopathic medicine and reverting back to their root and following basic fundamental principle of Ayurveda that is maintaining the health of a healthy person, then looking into the treatment of the disease.
The knowledge shed by Ayurveda can be considered safer and cost effective, as it focuses on disease prevention and health promotion, instead of disease cure. Disease prevention can be identified with health education and concept of individual as well as community responsibility towards marinating health. The following points mentioned in Ayurveda are primary concepts of disease prevention:
a. Dinacharya – Daily regimen to be followed by an individual.
b. Ritucharya - Seasonal regimen to be followed by an individual.
c. Samshodhana - Seasonal cleansing of the individual.
d. Adhaaraniya Vegas - Non- retention of the Natural urges.
e. Rasayanas – Intake of Rasayanas.
f. Sattvavijaya - Improving the mental strength with the help of Yoga and Dhyana.
Many integrated health practitioner like Dr Kavitha Chinnaiyan MBBS, MD Cardiologist in US, have also shed some light on this particular topic of evidence based Ayurveda. She in conjunction with Ayurveda scholar Dr Sumit Kaserkar BAMS Ph.D Ayurveda, mentioned the importance of evidence based Ayurveda. They have emphasised that on the fact that Ayurveda is very different from allopathy in several aspects, as mentioned earlier, so its is not ideal to compare an Ayurvedic medicine with an allopathic medicine.
When we try to develop a randomised controlled trial for an allopathic medicine for particular disease and expect the similar trial to happen for an Ayurvedic medicine and expect similar results, we are already developing a biased opinion in favour of allopathy, as Ayurveda is a huge system of medicine, that incorporates significant number of factors before administering any medicine to someone.
A randomised trial, itself means it is given to a random group. An Ayurvedic practitioner, following ayurvedic treatment principles, must incorporate the Ayurveda body type, the person’s digestive strength, their level of ama or toxin accumulation, their mental and emotional tolerance and well being, their overall immunity, level of exercise, current season and age etc, then only the correct Ayurvedic medicine can be decided. Ayurveda is completely contrary to randomisation, it is very much person specific instead.
So how can one expect to show similar results, even when a similar category of drugs is chosen? For example, when an RCT is performed on group of people with Diabetes. Metformin (a famous allopathic blood sugar lowering agent) is compared with Ayurvedic herb called Gymnema sylvestre (also lowers blood sugar levels), it may show that they both lowers glucose level, but still that result is not satisfactory from an Ayurvedic point of view, as an Ayurvedic physician may not prescribe this herb to all the people with diabetes as first line of treatment.
The ayurvedic doctor might prefer to prescribe another ayurvedic herbs to its diabetic patients as he wants to treat the person as a whole and knows that this person has a compromised metabolism etc. He may choose a combination of Ayurvedic herbs that increase (of the diabetic person’s) digestive fire and improve elimination of toxins primarily and have secondary effect on lowering the blood sugar levels, by increasing the ability of digestive system to absorb and eliminate better.
In modern medicine, this type of Ayurvedic doctor will fail to prove his efficacy, as he did not even prescribe a blood sugar lowering agent, but in actual world, if we don't judge his methodology, he still managed to show results based on Ayurvedic science. As he tried to work on the root cause of diabetes that could be poor metabolism, that might take a bit longer but eventually shows promising results. Practically these people will generally be able to maintain those results for much longer duration with improved diet and lifestyle and without needing regular medicine.
We all know that diabetes can affect multiple organs down the track, like kidney, eye and heart etc. In Modern medicine a nephrologist, an ophthalmologist and cardiologist would treat those complications, but in Ayurveda, one Ayurvedic doctor will treat those. He or she will encourage you to be patient, as you may not show any changes in the body for the first few days, as the ayurvedic medicine is trying to work on the root cause and body may take time to balance the doshas, but once we get a step closer to balancing it from an ayurvedic principles, it usually last longer and may show reduction of complication.
Ayurveda is a conceptual health science that takes the person as a whole and always emphasise on treating the body holistically, rather than focusing on a particular organ alone. That is one of the reasons, Ayurveda does not label every single disease and rather categories it into syndromes or clusters or complications of doha’s imbalance, Chronic diseases are like diabetes, heart diseases, obesity, arthritis or even depression etc. Around 70% of the people using Ayurveda services are suffering from a chronic disease and most of them would have tried some or the other forms of health treatments before approaching Ayurveda. As initially when people find out that they have a particular disease, they want to treat it quickly and want to see faster results.
There is usually a myth that goes around with Ayurveda that it is slow in showing desired results, but clients with chronic health conditions who try Ayurveda for the first time, also need to consider that the disease in their body has been developing for a long duration, months or years, before it started showing any sign or symptoms, so it will also take time for the body to revert the root cause and start healing.
It might be couple of months, before people with chronic health conditions show noticeable results with Ayurvedic medicine, but those results are not symptomatic fixing, those results are visible after the body has started to heal from the root.
Somik Raha, an Independent Researcher in California, USA, has also mentioned in his research that although Double-blind randomised controlled trials are viewed as the golden standard of drug research in Western medicine, however, RCTs are far from “golden” in many respects. They are impractical for many therapies, such as for surgeries and complex lifestyle changes.
They encourage a one-size-fits-all approach to medical treatment that fails to address the huge diversity among individual patients in terms of their physical and emotional symptoms, social and cultural upbringing, and other factors. These things that gets missed out from RCT are actually the fundamental basis of Ayurvedic treatment.
To guide a fare search for an alternate model of medical research, the principles mentioned in Ayurveda, epistemology: Inductive learning, whole systems thinking, and individually optimised therapy should be considered.
To understand the Ayurveda clinical trials or research more, Ayurveda has mentioned its own way of doing clinical studies. It has already mentioned in the Ayurvedic texts that how an Ayurvedic doctor or researcher should perform clinical trials on their clients and various treatment therapies.
So let's discuss and clarify these Ayurvedic principles of clinical trials. We have also mentioned the original Sanskrit Shlokas from Ayurveda text called Charak Samhita. It is translated in English for your convinience.
Shloka Reference: Charak Samhita, Sutra Sthan Chapter 11, Shloka 17
Ayurvedic epistemology, mentions four forms of validity, known as pramānas (“means of knowledge”) in Sanskrit.
Principles of Evidence and clinical Judgement mentioned in Ayurveda. Ayurveda talks about four types of evidence in its study.
Shloka Reference: Charak Samhita, Sutra Sthan Chapter 11, Shloka 18-19
Apta: Knowledgeable, unbiased person, who is bereft of any bias in cognition or expression of truth. This type of information is considered un-doubtful and should be considered on the top of the hierarchy of Ayurveda clinical research. Although lot of modern day research might think otherwise.
Shloka Reference: Charak Samhita, Sutra Sthan Chapter 11, Shloka 20
Pratyaksha or Perception: Objective confirmation by direct perception by senses. This is the most common and widely accepted type of clinical evidence, as it is obvious to the researcher.
Shloka Reference: Charak Samhita, Sutra Sthan Chapter 11, Shloka 21-22
Anumana or Inference: Involves a conclusion reached on the basis of estimation, by sufficient knowledge or evidence. It can be for past, present or future. Example, once a seed implanted, under favourable circumstances one day it will become a plant. Similarly a bad diet or lifestyle, under favourable circumstances will eventually cause a dosha imbalance and hence a disease.
Shloka Reference: Charak Samhita, Sutra Sthan Chapter 11, Shloka 25
Yukti or Reasoning: Pragmatic application of gained knowledge and innovative thinking to novel situations and confirming the truth. For the approach of Yukti pramana, a capacity to think ‘out of the box’, an aptitude for learning newer sciences and a deep motivation for synthesis of ideas/evidence are most essential. This part of clinical trials suggested by Ayurveda, is obviously open to adapt experimental methodology to develop further reproach in the field of Ayurveda.
Modern Medicine describes various forms of clinical trials and research methodology. Commonly divided into four level of hierarchal evidence based Practice;
Randomised Controlled Trials: RCTs are the gold standard of clinical trials. In modern medicine, highest level of clinical evidence is accepted through RCT. Researches take a group of people, divided into two group. In a medicine case, it will be usually to compare a drug A with drug B or placebo. As the name suggest it is randomised and non-biased to particular group of people. the they come to the conclusion whether that drug works or not!
Experiment: Experimental or Exploratory trials include a small number of patients or healthy subjects and expose them (over a short period of time) to a low dose of an investigational medicinal product.
Observation: In observational trials, researchers do not assign participants to a treatment or other intervention. Instead, the researchers observe participants or measure certain outcomes to determine health outcomes.
Experience: Research study the experience of people about certain medicine or treatment. It may also mean the experience of the researcher in the field of work.
So, comparing and understanding the difference approaches of clinical trials in Ayurveda and modern medicine and trying to bring them to same platform, we need to change our approach and think broadly.
This hierarchal approach of clinical trials is not ideal for Ayurveda and its principles. So many Ayurveda scholars suggest that we should accept all the four types of reproach as equivalent and recognise them as the part of a moving wheel, as they all contribute equally, rather than a hierarchal pyramid
So just to say that we need a scientific evidence for Ayurveda, would not be a simple case of an RCT. Instead there are thousands of clinician trials done of Ayurveda these days, but most of them are to prove that had already shown results for centuries, rather than trialing an herb for a particular disease for the first time. It is sometimes also labelled as reverse engineering, which means, researchers are just trailing and re-confirming and validating the efficacy of information that has already been mentioned in Ayurveda.
For example, in the treatment of rheumatoid arthritis, Ayurveda mentions an Ayurvedic medicine that is infused with small amount of purified gold. A recent research in lab has also found that injecting a small amount of gold in the Rheumatoid arthritis affected knee, helps in regenerating the knee joint.
Another example of reverse engineering is the “Brain and gut brain phenomenon”. Ayurveda has being saying from the beginning that all the diseases are somehow result of imbalance of doshas and that imbalance usually starts in the gut, especially when our digestive fire is not performing optimal.
That’s why, despite eating the best quality organic healthy food, some people still become sick, as the gut brain or our digestive fire is not responding well to that food and eventually leads to malabsorption of good quality food and lead to leaking and depositing of ama (known as bad food or toxins in Ayurveda) in the various parts of the body, resulting in various diseases. Ayurveda knew about this leaky gut phenomenon and said that gut brain is independent and not controlled by so called “main brain” in our head.
Contrary to that, modern medicine has always believed that we only have one brain known as “central nervous system” that resides in our head and it controls the rest of the body, including the nerves sent to gut “enteric nervous system”. They did not call it gut brain, but referred it as the part of the main brain.
Now as there has been more and more reproach on how diseases originate and why people who look alike and eat same food, get different disease, modern medicine is also agreeing with the principles of Ayurveda that there are two independent brains in our body, one in the head and one in the gut and they don’t control each other, in fact some modern researches like Dr Kulreet Chaudhary MD medicine and neuroscientist from US, have highlighted the importance of gut brain that it might be the main brain and it can even control the brain in our head.
Ayurvedic medicine has unique qualities as compared to modern medicine, as their effect can vary based on their Anupaan (liquid taken to ingest a medicine). Commonly mentioned anupaan in Ayurveda are hot water, lukewarm water, cold water, buttermilk, milk, yoghurt, rice water, honey, ghee etc. One medicine can show different effects in the body when taken with different anupan and time. For example an Ayurvedic medicine called “Ichabhedi Ras” is used to treat chronic constipation, when taken with cold water, but same medicine can be taken with warm water in the case of diarrhoea or runny stool.
To offer a reassurance to our community, Ayurveda lovers can confidently say that there is a lot of research done on Ayurveda these days. Some examples of these worldwide research references are as follows:
https://www.ccras.nic.in/ The Central Council for Research in Ayurvedic Sciences (CCRAS) is an autonomous body of the Ministry of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy), Government of India. It is an apex body in India for the formulation, coordination, development and promotion of research on scientific lines in Ayurveda and Sowa-Rigpa system of medicine..
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Ayurveda stads for extensive and elaborate clinical examination to understand thenature of the disease