|Year : 2019 | Volume
| Issue : 1 | Page : 3-4
Evidence-based Ayurveda: Way forward......
Ramesh B Devalla
Additional Director, Interdisciplinary Research of Medical Sciences (DMIMS) (DU), Wardha, Maharashtra, India
|Date of Web Publication||27-Aug-2019|
Ramesh B Devalla
Interdisciplinary Research of Medical Sciences (DMIMS) (DU), Wardha, Maharashtra.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Devalla RB. Evidence-based Ayurveda: Way forward...... J Indian Sys Medicine 2019;7:3-4
Redman and Mory defined research in a few words as “systematized efforts to gain new knowledge.” It is a process of systematic collection, analysis, and interpretation of data, leading to new information and finally converting information into knowledge, and knowledge into wisdom. Every science evolves through a rigorous and continuous research, and Ayurvedic science is no exception. The science of Ayurveda has two principle applied aspects, namely preventive and curative health care. In general, the main intention of applied research is to identify, analyze, and bring about the methods and systems for the advancement of human knowledge on a different base of science. The core of any science is in the depth and effort in pursuit for new knowledge through advances in research development of newer applications. In relation to research in Ayurveda, the goal is toward enhancement of human knowledge and not in putting forth contradictory opinions and concepts that is opposite to the already existing knowledge that has witnessed test of time and has served mankind since eternity.
Research in Ayurveda in the domains of literary research, fundamental principles, drug research, and clinical research must be targeted in such a way that it makes profound impact in teaching and clinical practice. The final goal of research and evidence generation in Ayurvedic science must be directed toward its acceptance by the international scientific community leading to its global recognition.
Many institutions from the government and private sector are conducting research in Ayurveda—Academic institutions, Central Council for Research in Ayurvedic Sciences (CCRAS), Indian Council of Medical Research, Council of Scientific and Industrial Research, Ayurvedic pharmaceutical industries, and others. Except in the area of literary research, we could not achieve remarkable progress in the targeted goals in a significant way in the past six decades. Prof. R. H. Singh had observed that Ayurvedic research so far has not strengthened the system, and neither did they benefit Ayurvedic students and practitioners.
The science of Ayurveda is based on its unique principles of health and disease and not on mysticism, magic, and anecdotes. The theories of Ayurveda (Siddhanta) were established by many ancient sages after rigorous testing in several ways and proving the same with reasoning. The concept of evidence was developed on fourfold testing methods, namely direct observation, inferential knowledge, scriptural opinions, and rationally planned experimental evidence. Prof. R. H. Singh opines that in spite of Ayurveda possessing such a strong base, one cannot deny the need to develop supportive new evidence in the wake of new modern language, to make Ayurveda a global medicine. Research in Ayurveda using cutting edge modern scientific tools and thereby creating irrefutable scientific evidence is much more needed to realize the dream of making “Ayurveda” a truly global science. Many research works conducted in Ayurvedic therapeutics so far, in bits and pieces and flaws in many areas have not yielded any noteworthy results. A truly interdisciplinary approach with “truth-trust-teamwork” spirit can only give us fruitful results.
Highly noteworthy research was conducted on Ayurvedic medicinal plants by pioneers such as Col. Ram Nath Chopra, Dr. Sharadini Dahanukar, Dr. Thyagarajan, Dr. Nityanand, Dr. Bhattacharya, Dr. S. S. Handa, Dr. A. B. Vaidya and others. The outcome of such research on medicinal plants may have helped in developing proprietary medicines by the industry, but it did not help in understanding Ayurvedic principles. Nevertheless, they helped to create an interest in modern scientists in understanding and to take up research in Ayurveda.
It is a heartening fact that immense work has been carried out on drug research in Ayurveda in the last six decades; however, these efforts have not transformed into any significant outcome either nationally or globally. Except, the invention of “reserpine,” not much remarkable outcomes have been achieved from such approaches. Currently, even this drug is no more in clinical use due to its adverse effects on chronic use. But, “Sarpagandha” is still used in its traditional formulations. Central Drug Research Institute made a futile attempt to screen more than 2000 medicinal plants for their biological activities. Again, this could not produce any results. It may be said that we could not achieve significant progress in Ayurvedic research because of the lack of understanding and development of modern tools to interpret fundamental principles of Ayurveda, namely Tridosha, Sapthadhatu, Srotas, Agni, Ama, Rasa, Guna, Virya, Vipaka, and so on. Ayurvedic research methodology needs to adopt “whole system testing approach” to scientifically validate its fundamental principles and treatments.
One major challenge Ayurveda needs to address is standardization and quality assurance of its products. The industry has to provide the practitioners with quality products, particularly classical Ayurvedic formulations ensuring desired efficacy resulting in acceptance by the community at large.
The theme of this write-up is evidence generation for which clinical research plays major role. Clinical trials, especially randomized controlled trials, are considered as gold standards, which have very strict and rigid research design and the outcomes are considered to be of high internal validity. In spite of this credibility, the real-life practice of applying this research methodology may be debatable due to its ability to generalize the results in an extended population or clinical setting. It is our general observation that many modern drugs have been withdrawn from market, banning their use in humans due to various toxicities. But, we cannot deny the fact that all such drugs were introduced only after going through rigorous randomized control studies. The philosophy of one-target-one-disease approach is failing as every disease is multifactorial in etiology, and its course and prognosis depends on many factors such as genetics, immunity of the individual, nutrition, and psychological status, which reflects the relevance of Ayurvedic science. Thus, undoubtedly we need to give a serious thought whether we need some fresh approach in research. Opinion of few researchers and policy makers on applicability of the research findings into usable real-life conditions is negative. However, the demand for clinically effective research works is consistently on rise due to increased costs of interventions and health-care services.
The answer for this requirement is pragmatic clinical trials, which are designed in such a way that they are tested in real-life everyday clinical circumstances. The findings of this type of research trials are having significant clinical applicability and generalization. The outcomes from pragmatic trials are mostly patient centered. It appears that the utilization of whole system approach in Ayurvedic research is best suited to validate and evaluate its principles and treatments. Till date, there are no good quality published papers in Ayurveda, which use pragmatic trial design approach. Nikolaos A. Patsopoulos cautiously concludes that the “pragmatic trial design” is an emerging concept, and it is here to stay. However, this process should not be performed at the expense of exploratory trials as there is the need of both concepts to answer the complicated problems lying ahead of us.
The Ayurvedic scientific community, practitioners, and policy makers, as well as health-care recipients, should be oriented to the “pragmatic” concept and should even demand more evidence applicable to real-life settings.
In summary, it is personal view that in order to develop “evidence-based Ayurveda” acceptable to scientific community at large, we need to address and work with all seriousness and sincerity in the following areas:
- Research on fundamental principles (concepts) of Ayurveda has not attracted much attention till date, and this important area should take top priority in research and we need to explore the development of objectively measurable scientific parameters, wherever possible. The pioneering work carried out by Dr. M. S. Valiathan and his team on “Human Dosha Prakriti” correlating with genetics is a guiding spirit in exploring fundamental principles of Ayurveda.
- Though CCRAS has developed research protocols in a few areas, it is desirable we need to develop high quality suitable integrated research protocols involving Ayurvedic scientists, modern basic scientists, and clinicians.
- Ensuring the production of standardized and quality assured drugs.
- Validating Ayurvedic system as a “whole system medicine” using “pragmatic trial design” tool, taking care not to compromise with its basic tenets and philosophy appears as a good alternative in establishing this indigenous medical science globally.
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Conflicts of interest
There are no conflicts of interest.
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