On November 19, a government notification listed out specific surgical procedures that a postgraduate medical student of Ayurveda must be “practically trained to acquaint with, as well as to independently perform”. The notification has invited sharp criticism from the Indian Medical Association, which questioned the competence of Ayurveda practitioners to carry out these procedures, and called the notification an attempt at “mixopathy”.
The IMA has planned nationwide protests on December 8 against this notification, and has threatened to withdraw all non-essential and non-Covid services on December 11.
How far is surgery part of Ayurveda?
It is not that Ayurveda practitioners are not trained in surgeries, or do not perform them. In fact, they take pride in the fact that their methods and practices trace their origins to Sushruta, an ancient Indian sage and physician, whose comprehensive medical treatise Sushruta Samhita has, apart from descriptions of illnesses and cures, also detailed accounts of surgical procedures and instruments.
P Hemantha Kumar, professor and head of the department of general surgery at the government-run National Institute of Ayurveda in Jaipur, claims that at least 1,000 major surgeries are performed every year at his hospital. “There would be many more minor surgeries being done,” he said.
There are two branches of surgery in Ayurveda — Shalya Tantra, which refers to general surgery, and Shalakya Tantra which pertains to surgeries related to the eyes, ears, nose, throat and teeth. All postgraduate students of Ayurveda have to study these courses, and some go on to specialise in these, and become Ayurveda surgeons.
Nandkishore Borse, head of the department of surgery at Tilak Ayurveda College and Tarachand Hospital, a semi-government facility in Pune, said for several surgeries Ayurvedic procedures almost exactly match those of modern medicine about how or where to make a cut or incision, and how to perform the operation. There are significant divergences in post-operative care, however.
“The only thing that we do not do is super-speciality surgeries, like neurosurgey. For most other needs, there are surgical procedures in Ayurveda. It is not very different from allopathic medicine,” Hemantha Kumar said.
Before the notification, what were the regulations for postgraduate students?
Postgraduate education in Ayurveda is guided by the Indian Medical Central Council (Post Graduate Education) Regulations framed from time to time. Currently, the regulations formulated in 2016 are in force. The latest notification of November 19 is an amendment to the 2016 regulations.
The 2016 regulations allow postgraduate students to specialise in Shalya Tantra, Shalakya Tantra, and Prasuti evam Stree Roga (Obstetrics and Gynecology), the three disciplines involving major surgical interventions. Students of these three disciplines are granted MS (Master in Surgery in Ayurveda) degrees.
Ayurveda practitioners point out that students enrolling in Ayurveda courses have to pass the same NEET (National Eligibility-cum-Entrance Test). Their course runs for four-and-a-half years, followed by one year of internship, six months of which are spent at an Ayurveda hospital, and the remaining six months at a civil or general hospital, or a primary health care centre.
Postgraduate courses require another three years of study. They also have to undergo clinical postings in the outpatient and In-patient departments at hospitals apart from getting hands-on training in Ayurvedic treatment procedures. Medico-legal issues, surgical ethics and informed consent is also part of the course apart from teaching Sushruta’s surgical principles and practices, said Dr Vinayak Temburnekar, National President of National Integrated Medical Association (NIMA).
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So, what is new?
Ayurveda practitioners say the latest notification just brings clarity to the skills that an Ayurveda practitioner possesses.
“The surgeries that have been mentioned in the notification are all that are already part of the Ayurveda course. But there is little awareness about these. A patient is usually not clear whether an Ayurvedic practitioner has the necessary skill to perform one of these operations. Now, they know exactly what an Ayurveda doctor is capable of. The skill sets have been defined. This will remove question marks on the ability of an Ayurveda practitioner,” Hemantha Kumar of the Jaipur-based National Institute of Ayurveda said.
The notification mentions 58 surgical procedures that postgraduate students must train themselves in, and acquire skills to perform independently. These include procedures in general surgery, urology, surgical gastroenterology, and ophthalmology. 📣 Follow Express Explained on Telegram
What are the IMA’s objections?
IMA doctors insist that they are not opposed to the practitioners of the ancient system of medicine. But they say the new notification somehow gives the impression that the skills or training of the Ayurveda doctor in performing modern surgeries are the same as those practising modern medicine. This, they say, is misleading, and an “encroachment into the jurisdiction and competencies of modern medicine”.
The fact that Ayurveda institutions prescribe textbooks from modern medicine, or that they carry out surgeries with the help of practitioners of modern medicine, is not reason enough to allow this encroachment, said K M Abul Hasan, chairman of the IMA Junior Doctors’ Network.
A statement from the IMA said it condemned the “predatory poaching on modern medicine and its surgical disciplines” by CCIM (Central Council of Indian Medicine, which functions under the Ministry of Ayush). “This is another step to legitimise mixopathy,” it said.
Avinash Bhondwe, president of the Maharashtra chapter of IMA, said the CCIM had claimed that all these modern surgeries are actually Ayurvedic procedures, and have Sanskrit names. “All the common procedures in all the surgical specialities have been included in the notification. They have notified these as Ayurveda procedures. They should also explain, with proof, how each of these procedures mentioned in Ayurveda literature is equivalent to the modern surgical procedures,” Bhondwe said.
The IMA is also upset with the recent decision of NITI Aayog to set up four committees for integrating the various systems of medicine in medical education, practice, public health, and administration, as well as research. It says such an integration would lead to the death of the modern system of medicine.
The IMA has demanded that the notification as well as the NITI Aayog move towards ‘One Nation One System’ be withdrawn. “If the government does not accept our demands, IMA will file a petition in the Supreme Court,” said R V Asokan, Secretary-General of IMA.
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