Opinion Bringing Ayurveda into the mainstream: Is the ancient system equipped to meet the modern challenges of health and disease?

A note on the WAC organised by the Ministry of AYUSH on the ‘Whole Government Approach’ (WGA) to foster and strengthen the research ecosystem for AYUSH systems quoted the PM as saying that “to transform the healthcare system of the country and to develop a healthy society, there is a need to think holistically and integrate the TM and modern medicine system (MM)”. Chairing the session, Vaidya Rajesh Kotecha (Secretary, AYUSH) described an elaborate plan to fulfil the PM’s vision. Essentially, several high-level inter-ministerial committees will proactively sanction, monitor, and expeditiously complete AYUSH-centric research projects. The goal is to develop integrative medicine (IM) as a futuristic medicinal system for India and the world.

The concept of WGA is in consonance with the “Whole System Approach” (WSA). WSA encompasses integrated and network participation of several stakeholders ( including patients and the community) for better solutions (treatment outcomes) in a challenging and complex situation. IM is an important component of WSA in the current context.

In this regard, K M Gopal also described several proactive and real-life measures being promoted by NITI Aayog with reference to policy using WSA/IM in the health and medical care sector (H & MC). NITI Aayog set up a multidisciplinary expert committee in August 2021 to formulate a futuristic policy on integrative H & MC and the draft document is almost ready.

However, what evidence exists to support the notion that TM modalities (such as Ayurveda or homoeopathy) can scientifically align with MM for a better outcome? Two clinical models were presented at the WAC. These were primarily based on clinical practices at the Centre for Rheumatic Diseases, Pune (CRD) and the National Institute of Mental Health and Neuroscience (NIMHANS).

A recently established Department of IM in NIMHANS continued to show remarkable success in treating difficult neurological diseases with a team of Ayurvedic and MM physicians and carefully planned and monitored IM strategy.

Modern rheumatology practice in the CRD model includes critical elements of TM and Ayurveda, which have shown unequivocal evidence in CRD research projects (multicentric, pan-India, several PhD programmes, and mostly published) from 1995 to date. Gaps in knowledge and therapy outcomes were initially identified in 17 arthritis population surveys. Several controlled protocols-based evaluations of standardised Ayurvedic drugs and other TM modalities (such as diet, exercise, yoga, and counselling), often in conjunction with MM, in arthritis patients, were completed. Rheumatoid arthritis (RA) is a severely painful crippling lifelong autoimmune condition, mostly seen in women, and universally acknowledged as difficult to treat. Supervised and monitored IM intervention (including Ayurvedic drugs) over several years showed a consistently superior and sustained clinical improvement in patients suffering from active RA. There was a measured improvement in arthritis, functionality, health and well-being. In several cases, potent MM (including steroids) was reduced and even stopped for prolonged periods. Comprehensive medical records of over 30,000 RA patients are currently maintained in the CRD e-database.

A standardised Ayurvedic drug showed excellent efficacy at par with standard MM in the treatment of osteoarthritis under the auspices of a GOI (CSIR) NMITLI research programme and received a prestigious global award in clinical research excellence in 2013.

Several AYUSH drug trials of repurposed Ayurvedic drugs for Covid-19 were recently designed using an IM approach and coordinated by the CRD team and showed significant efficacy and safety. AYUSH 64 (a proprietary Ayurveda formulation) was a success story. A large sample size-based ongoing multicentric study will evaluate the additional benefits of combining Ashwagandha with Covid vaccination. AYUSH intends to use the IM platform also for a major thrust in the public health domain.

It is noteworthy that IM outpatients now operate in several premiere medical institutions including AIIMS New Delhi, and AYUSH is proactively engaged in collecting “big data” on IM.

Undoubtedly, the current global scenario of the H & MC sector seems chaotic. The pandemic has exposed several chinks in the MM armour. Despite the overwhelming success and global acceptance as the mainstream system, MM often fails to improve the health and lives of people. Despite extended longevity, people live with poor quality of life. The drug side effects and toxicity (MM) are often life-threatening and unacceptable. The burden of drugs per se is often worrisome and scary in the case of several chronic diseases such as painful arthritis and diabetes. TM and IM are likely to make an important impact in the latter domain.

AYUSH systems include Ayurveda, Homeopathy, Unani, Siddha, and other TM. AYUSH systems and MM differ radically in several ways — or so it seems. Modern scientific research in Ayurveda is often at variance with classical Ayurveda. Unlike MM, TM has at its core a personalised approach. MM is dominantly reductionist. The ambitious futuristic programme of TM and IM by AYUSH is well-intended and in the right direction. There are several pertinent and vexing questions. What is the need for research and evidence when Ayurveda has been in popular practice for over a millennium? Will TM and Ayurveda lose their identity in an IM system? Is classical ancient Ayurveda equipped to meet the modern challenges of health and disease?

The answers may seem nebulous but the questions merit action. TM and Ayurveda need to respond to the new world order, which has changed substantially recently. It is reasonably certain that MM and TM in the current format will continue to treat several medical disorders and altered health states. But evidence-based medicine will become the new mantra. Also, informed and empowered patients and people will continue to make the right choices.

The writer is a rheumatologist, physician-scientist, and Director, Centre for Rheumatic Diseases, Pune. He is also National Coordinator for AYUSH CSIR Research Projects in Covid-19 and International Coordinator for WHO COPCORD