Ayurveda

Indigenous Medicine in India

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Indigenous Medicine in India

Shailaja Chandra
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Country’s first Ayurvedic college started in 1889 at Thiruvananthapuram ( Ernakulum) in Kerala

Indigenous medicine denotes the use of traditional health practices by people in different cultures. While the effectiveness of such knowledge and healing skills is generally inexplicable in terms of cause and effect, traditional medicine continues to be accepted for a variety of reasons. From 2010 to 2013, I was commissioned to write two reports on the Status of Indian Medicine and Folk Healing for the Ministry of Health & Family Welfare.This gave me an opportunity to travel to all parts of the country and observe how three indigenous medical systems in particular had developed over time, besides other tribal and folk healing practices. Ranging from well-equipped National Institutions and highly sought-after hospitals and medical colleges for Ayurveda, Unani and Siddha medicine, to the healing practices of a wide variety single practitioners, traditional healers and bone-setters, my study was facilitated by the state Governments but I had the freedom to select whatever I wished to see. These two paradigms represent two entirely different approaches to indigenous medicine.

The first consists of three codified systems of medicine, firmly locked by complex concepts and elaborate treatises. So impressive is the array of this knowledge that six patent offices in the world have treated the stanzas scanned from the ancient texts to be evidence of “prior art” which had been in the public domain for centuries. India’s Traditional Knowledge Digital Library which is available to patent examiners in six UN languages enabled patent examiners to reject patent claims by referring to the textual evidence rendered into a patent compatible format. Over the last decade hundreds of patent applications have been successfully foiled because the World Intellectual Property Organisation has accepted that the description of plants and diseases given in the ancient Indian texts is clear evidence of the knowledge having been in the public domain and in use for centuries.

India is thus the fountainhead of codified indigenous medicine. Ayurveda, which accounts for some 85% of this sector is practiced throughout the Indian sub-continent and is based upon the balance of three doshas (vaata, pitta and kapha) and the certainty that it is the imbalance between the doshas which is the root cause of the disturbance which then manifests as illness. India is perhaps the only country in the world which recognises four drug-based systems under the Drugs and Cosmetics Act. A separate chapter in the Act regulates the licensing and manufacture of Ayurvedic, Unani (a system which had its origins in Yunaan or Greece) and Siddha medicine – (based on another ancient system but confined to Tamil Nadu and parts of Kerala.

The practitioners of these three systems undergo a five and a half year degree course which is governed by registration requirements exactly at par with those set out for allopathic doctors by the Medical Council of India. Homoeopathy, though a system of German origin, is also regulated by independent statutory bodies which govern education, practice and drug manufacture. Taken together with Yoga and Naturopathy (which have no texts or drugs but which greatly enhance good health,) the group of six is widely known by the acronym AYUSH.

Choudhury Brahm Prakash Hospital and college at Kheda Dabur in Delhi
Choudhury Brahm Prakash Hospital and college at Kheda Dabur in Delhi

In 1970, the Government enacted a law that created a body for regulating medical education for the AYUSH sector, making college education with a common syllabus and examinations mandatory. The Act did however permit traditional healers who had passed specified examinations prior to a cut-off date to diagnose, treat and medicate individuals who chose to consult them. Many such non-institutionally trained practitioners are no longer alive today. Their progeny, students and unfortunately a few self-styled practitioners continue to treat patients although the law does not recognise such practice. Due to poor enforcement of the law in many parts of the country, unscrupulous quacks claiming to practice indigenous medicine have often cheated unsuspecting patients, thereby bringing a bad name to the sector and its practitioners.

“India is perhaps the only country in the world which recognises four drug-based systems under the Drugs and Cosmetics Act.”

The hope that laws and institutionally qualified practitioners can stop medical malpractice does however risk losing the last vestiges of classical Ayurveda in its purest form. The Ashtavaidyas of Kerala are an institution in themselves. They are families of highly respected Brahmin scholar physicians who hail from a long lineage of vaidyas who have undergone rigorous scholarship and apprenticeship. That kind of Ayurvedic education once had three distinct parts – five years of textual study in Sanskrit, followed by five years of learning about medicinal plants in the forest, and finally five years of apprenticeship under a guru who tested a student’s perception and skills before he was allowed to come into his own. Those who understand the strength of such tutelage question the wisdom of excluding this time-honoured classical approach in the zeal to set standards and bring uniformity.

On another plane, families of Hakims who had practiced Unani medicine for generations now face the prospect of ending a family tradition. Hakim Zafar in Sambhal in Western Uttar Pradesh is an example of a traditional healer who sees more than 300 patients every morning prescribing a combination of dried herbs, which are to be boiled and drunk as a decoction. People visit him regardless of age, gender, religion and language and it appeared to me that they came only for a kind word and to collect the special herbs which created a salubrious effect. A research officer who accompanied me on this particular visit observed considerable commonality with herbs used in Ayurveda. He had however never heard of silk cocoons being a part of any potion!

At the other end of the spectrum of indigenous medicine lies a wide variety of tribal and folk healing practices which continue to be the mainstay of millions of people in remote areas. In the North-eastern states and many tribal areas in India, even when regular health facilities are available, the local people rely on local healers. I took the help of the National Institute of Folk Medicine at Pasighat in Arunachal Pradesh and had the folk healing practices in all the states studied. Although the healers are secretive about the plants they use, every state has its band of well-known practitioners who tend to everyday problems with great confidence.

The National Institute of Unani Medicine at Bengaluru
The National Institute of Unani Medicine at Bengaluru

At the family level, reliance on medicinal plants is a part of family tradition almost everywhere in India. “Gharelu nuske” or home remedies are routinely used for dozens of afflictions – even affecting infants, children, pregnant women and the elderly – in fact the most vulnerable members of a family because the safety and healing properties of these home remedies are well known. The use of ginger and holy basil (tulsi) in a tea-based decoction, eating fenugreek (methi) seeds in yoghurt (dahi) and drinking water in which roasted cumin has been soaked overnight are all time-honoured remedies for colds, coughs, an upset stomach, loss of appetite and general fatigue. The surprising part is that with very little variation, such home remedies are used in almost all regions of the country. Decoctions, teas,the use of grape wine (drakshasava) and an application of medicated oils, condiments and spices is commonplace. Even in nuclear families young people have begun checking the properties and dosage of medicinal plants like Ashwagandha (withania somnifera,), tulsi and ginger by combing internet sites. Indigenous medicine then, is no longer the preserve of vaidyas and hakims. A young, modern clientele, including foreigners in search of “natural products” has begun to use shatavari, triphala and brahmi to name only three products from scores that are available over the counter. Indigenous medicine’s time has come but in a guise that one could not have imagined was possible.

A woman buying drugs at a Unani clinic at Pulwama in Kashmir
A woman buying drugs at a Unani clinic at Pulwama in Kashmir

Recent studies are showing another trend with the use of indigenous medicine. Patients are combining modern medical treatment with indigenous medication-believing that this can alleviate symptoms, reduce drug dosage and mitigate the side effects caused by chemical drugs. This is being seen in the treatment of hypertension, diabetes, chikangunya and skin ailments and even tuberculosis and cancer. No one disputes that the drugs manufactured by reputable ASU companies and dispensed by good practitioners have positive effects on quality of life including good sleep, appetite, the most vulnerable members of a family because the improved metabolism and a sense of well-being.

However, self- medication and integration of systems is a new phenomenon largely promoted by literature on the healing properties of plants. There has been little effort to validate this approach and sometimes the positive outcomes baffle both patients and physicians.

Against this backdrop, challenges beset the sector. First,there is the issue of safety and quality. Drugs manufactured by leading companies like Himalaya, Dabur, Charak, and Baidyanath to name just a handful have earned a sound reputation and their products are manufactured, labelled and sold much as modern drugs are. Rarely if ever, are there complaints or questions about quality. The same goes for Unani products manufactured by companies like Hamdard. Family concerns like Dhoot Papeshwar in Maharashtra, Aryavaidyashala in Kottaikal and the Ayurvedic Pharmacy in Coimbatore have a time-honoured reputation built over scores of years – in some cases, the firms have been in existence for more than a century. Some of them have modernised their equipment and processes without compromising on the essentials recounted in the ancient texts. But howsoever good the quality of the products, beyond a point the indigenous systems require a physician who can recognise the signs and symptoms of affliction by diagnosing the constitution or the individual “prakriti “of the patient. That requires patience, skill, insight and experience and naturally the first challenge is to find a practitioner who combines these qualities. Considering the wide range of practitioners and an absence of bench-marking, often this boils down to an individual’s good fortune in finding a competent physician- a factor which deters many from using indigenous medicine. The canvas is much too large and the choice much too varied to find one correct answer.

Photo gallery of interviews with the healers and patients

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At one end of the spectrum stand the National institutions for Ayurveda, Unani and Siddha medicine (located at Jaipur, Bengaluru and Chennai respectively) where high standards of teaching and clinical practice are pursued while following a syllabus set out by the Central Council of Indian Medicine which has been patterned on the Medical Council of India. In the process, the Guru-Shishya parampara – personalised, teaching and learning under the tutelage of a teacher has been given up entirely. Almost all Indian medicine a doctor and starting practice has overtaken the need the National Institutes have modelled themselves on allopathic medical colleges and the need to standardise and modernise has replaced the individualised approach which had been the mainstay of traditional medicine for centuries.

The Southern States like Kerala, Tamil Nadu, Andhra Pradesh and Karnataka have some fine institutions which taken together with the Gujarat Ayurvedic University at Jamnagar, the Benares Hindu University at Varanasi and the Choudhury Brahm Prakash Ayurved Charak Sansthan at Kheda Dabur Delhi, still produce practitioners who are confident of practising their system without falling back on allopathic drugs for quick results. This however, is not a uniform story when one goes to the second and third rung of colleges and hospitals across the country where the goal of becoming a doctor and starting practice has overtaken the need to master the classics and diagnostic techniques.

Finally, there is the future of integration at the tertiary level. Towards the end of 2012 when I was completing the second report, I was astounded to find that Medanta a super-speciality conglomerate in Gurgaon had an Ayurvedic doctor working collaboratively with an oncologist, a robotic surgeon and even the cardiologists. The experiences of these super-specialists have been captured in an exhaustive seminar which was organised at the India International Centre in Delhi and is available on you-tube at – https://over2shailaja.wordpress.com/2013/05/05/panel-discussion-at-india-international-centre-on-status-of-indian-medicine-folk-healing-part-ii-on-22th-april-2013/ Medanta’s difference is in catapulting integration to the tertiary level. Ironically, it is here that physicians from two different systems talk to and treat the patient according to his preferences. It is happening on a small but impressive scale but could be the harbinger of things
to come if patients remain satisfied.

During my visit to Bengaluru, I was pleasantly surprised to find an Ayurvedic doctor treating infertility cases referred by a London trained gynaecologist working in one of the city’s speciality hospitals. The gynaecologist, to whom I spoke, could not explain how the Ayurvedic doctor had succeeded in helping some 10 couples to beget a child out of 80 cases referred by her. Examples like this give the hope that barriers can be broken through traditional medicine approaches but the diversions on the way are often daunting.

Traditional & Folk Healing Practices in Manipur

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Most people identify Ayurveda as being synonymous with body massage, the slow stream of oil relaxing and cooling the brain and as a process of detoxifying and rejuvenating the body. The five star hotel and spa massages embellished with soothing aromas and rose petals are a miniscule part of the panchakarma regimen which involves over 16 different procedures which are used to treat patients suffering from paralysis, mental affliction, arthritis and spinal injury. Such panchakarma treatment can be observed in every Ayurvedic hospital in the country but it is quite different from the relaxation techniques used for rejuvenation of healthy people. Both fulfil a felt need as it should be.

Although India has achieved a lot, there remains immense scope to rise as a world leader. The way indigenous medicine has adapted itself to modern times has been remarkable. It is time to build on these strengths – not for the survival of practitioners or to meet narrow sectoral interests, but to preserve a heritage which is undeniably unique, efficacious and entirely indigenous. The day that happens indigenous medicine will come into its own!

Traditional and folk Healing Practices in Mizoram

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STATUS OF INDIAN MEDICINE AND FOLK HEALING, Part I

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With a focus on benefits that the systems have given to the public


CONTENTS


Shailaja Chandra
Former Secretary, Government of India
Ministry of Health & Family Welfare
Department of AYUSH
and
Former Chief Secretary, Government of Delhi

Under the aegis of
Department of Ayurveda, Yoga & Naturopathy,
Unani, Siddha and Homoeopathy (AYUSH)
Ministry of Health & Family Welfare
Government of India
AUGUST 2011

Medical Pluralism and the truth about Ayurveda.

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Manik was suffering from a hacking cough triggered by an unidentified allergy. A long list of prescribed drugs had left her heavy-headed and lethargic. It was her good fortune that she found a fine Ayurvedic doctor who gave her talishadi powder. Honeyed over, the paste soothed her hoarseness and she was her normal self soon enough, minus any side-effects.

That India accepts medical pluralism and five drug-based systems-Allopathy, Ayurveda, Unani, Siddha, Homeopathy- are all covered by the Drugs & Cosmetics Act (D&C) 1940 is not commonly known. These systems have been in regular use for centuries but were given statutory recognition more than four decades ago. All medicine (unless prepared by an individual Vaidya or Hakim) has to be li censed and follow the pharmacopoeial standards and quality control regulations set out in the D&C Act. But it is also true that barring some twenty renowned Ayurvedic companies, hundreds of concoctions making wild claims and skirting quality control regulations are marketed in all states with shifting degrees of enforcement. This naturally deters a discerning public from using the Indian systems, unsure both about the presence of essential ingredients and the absence of impurities.

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Click for PDF View

Government institutions like Banaras Hindu University, the Gujarat Ayurvedic University and the Tilak Mahavidyalaya, Pune among others conduct the finest Ayurvedic teaching and practice but like most government institutions, unless one knows an insider, inefficiencies abound. Family concerns like AVS Kottakal, AVP Coimbatore and Shree Dhootapapeshwar (some more than 100 years old) manufacture high qualitquality drugs that adhere to the original Ayurvedic classical recipes. Some run excellent hospitals which draw patients from round the world. A score of other corporate ventures have engaged excellent vaidyas, invested in R&D and gained country-wide respect quality of their proprietary products. But finding the physician-bridge continues to present a challenge for the consumer, particularly one who has had no family tradition of using Ayurveda.

Responding to this situation, companies like Himalaya, Dabur and Charak erected a bridge to the consumer by adopting the “ethical marketing” route. Sales representatives educate the modern medicine doctor about the constitution of the drugs, their therapeutic action and indications and contra-indications- exactly as they do for modern drugs. Regular CMEs are organised for special therapeutic segments and publications in quality journals shared with practitioners. Experience has shown that once they see the treatment data, modern medicine doctors add Ayurvedic items to the prescription to alleviate symptoms. All such items are in any case freely available without prescription.

Peoples’ health-seeking behaviour is also changing. Consumers are opting for medication that is natural and free from synthetic substances .Ayurvedic treatment is increasingly being used as adjuvant therapy because it restores good health while often reducing the dosage of strong medicine. Concerned about the side-effects of allopathic drugs it is natural for consumers to repose greater faith in formulations which are ninety percent plant based. But once again a bridge is needed – one which is reliable but also conversant with modern diagnostics and clinical findings.

In response to this,in 2010, Medanta a multispeciality hospital in Gurgaon erected that bridge by establishing a Department of Integrative Medicine. Here Ayurvedic treatment is offered on par with specialised allopathic treatment even as the rooms for panchakarma (a complex protocol for de-toxification) are located alongside other clinics as for dialysis and endoscopy.

At Medanta, the Departments of respiratory and sleep medicine, cardiothoracic surgery, critical care, bone and joint disorders, neurosciences and minimally invasive thoracic surgery have been the most receptive to the concept of integrative medicine. As the Head of Integrative Medicine at Medanta Dr Geethakrishnan puts it, “the first step was to educate the bio medical doctor. Creating databases of authentic clinical outcomes made the process of integration that much easier. The hospital opened that opportunity.”

Contemporary Ayurveda then is a response to public demand for gentler, safer remedies. But building bridges to modern medicine has ruffled many feathers backed less by concern for the consumer but more by commercial pulls. Lobbies are furiously at work to prevent an allopathic doctor from suggesting an Ayurvedic packaged formulation although it is available off –the –shelf to any citizen. As a result the public could be denied access to formulations which physicians in scores of countries prescribe freely for their patients. The patient’s consumer rights are being fettered because of larger commercial interests which are at stake.

This situation would not have arisen had the Ayurvedic graduates stuck to their own system. The extent of modern medicine practiced by Ayurvedic doctors has taken away from the shine of an ancient and time-honoured system. It has confused the public and accounts for much of the distrust that surrounds Ayurveda and other Indian systems of medicine. We need competent and committed practitioners who can satisfy a modern, internet savvy public. That in turn requires published research undertaken by multi-disciplinary teams to tell people not just that Ayurveda is effective but how its therapies and drugs stimulate the nervous system.

If India hopes to be a front-runner in the practice of integrative medicine, resting on a few good examples will not suffice. It will take much more than rhetoric to convince a discerning public that a combination of therapies can in fact heal faster and better.

Post DU, Ayush moots longer course

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Monday, 20 May 2013 | Archana Jyoti | New Delhi
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Amid the hullabaloo over the four-year DU course, a Government report prepared by Shailaja Chandra, former health secretary (Ayush) has recommended a 10-year MBBS/MD/PhD in integrative medicine as a long-term measure to boost alternate medical system in the country.

The essentials of all major healthcare systems can be incorporated, says the extensive report “Status of Indian Medicine and Folk Healing in India” prepared by Shailaja Chandra, former health secretary, Ayush Department in the Health Ministry.

The report extensively focus on the current status as well as gaps that need to be bridged with the aim of improving public awareness and access to identified health benefits that each system offers.

The recommendations also include strengthening postgraduate education both quantitatively and qualitatively and to increase a requirement for rigorous and independent research the quality of which needs to be judged by publications in reputed journals.

“Instead of leaving the students to find their own feet, it would be better to expose them in the very first year to the work of good practitioners so that they understand how the public is accessing ASU medicine and for what conditions.”

“It would be useful to send the students to visit reputed ASU teaching institutions and private clinics so that they observe actual treatment in progress,” the report says.

The four-year degree course introduced by Delhi University from the new academic session beginning July to replace the existing three-year BA/BSc (General/Hons) course has sparked a major controversy with the DU faculty splitting into two factions.

The report recognises that both under National Rural Health Mission (NRHM) and by virtue of special orders issued by certain State Governments, ASU practitioners are permitted to prescribe modern medicine; but no one has spelt out whether that includes prescription of all Scheduled drugs and other interventions.

“Since there is no domain expertise on the functional requirements of Ayush available with the NRHM managers there is a recommendation to use the extensive human resource capacity available in the existing non-NRHM facilities to provide oversight for the NRHM related Ayush work,” the report says.

Likewise, the need for supervision of Ayush drug supplies which were found to be universally in short supply has been dwelt upon. The near absence of interaction between modern medicine and AYUSH doctors has been described bringing out what is essentially needed if the patient’s welfare is to be kept uppermost in view.

Referring to a recent case of an injured and incapacitated NSG commando who was paralyzed and received

Ayurvedic treatment but failed to get reimbursement for the expenses incurred, the report has stressed on the need for the Department of Ayush to convince all ministries to reimburse medical expenses on AYUSH treatment of employees.

Panel Discussion at India International Centre on “Status of Indian Medicine & Folk Healing, Part II” on 22th April 2013

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Integrating Ayurveda with Modern Medicine.

Brief Background of the Speakers & Commentators   

Ms Shailaja Chandra

Ms Shailaja Chandra is the author of this Status Report which was commissioned by the Department of AYUSH, Government of India in 2010. She was Secretary of the Department of Indian Systems of Medicine & Homeopathy, Ministry of Health &Family Welfare (1999-2002).

Dr Naresh Trehan

Dr. Naresh Trehan, Chairman & Managing Director, Medanta – The Medicity on “Why Integration?”

Dr. Tejinder Kataria

Dr. Tejinder Kataria, Chair, Radiation Oncology, Medanta .

Dr. Ali Zamir Khan

Dr. Ali Zamir Khan, Consultant Thoracic Surgeon, Medanta

Dr. G Geeta krishnan

Dr. G Geeta krishnan, Head, Dept. of Integrative Medicine, Medanta

Dr. K. Muraleedharan

Dr. K. Muraleedharan, Medical Superintendent and Chief Physician, Arya Vaidyashala Hospital & Research Centre, Kottakkal .

Commentators

Dr. Srinath Reddy

Dr. Srinath Reddy, President of the Public Health Foundation of India.

Dr. Ranjit Roy Choudhary

Dr. Ranjit Roy Choudhary, Emeritus Scientist, National Institute of Immunology, New Delhi

Prof Shakir Jamil

Prof Shakir Jamil, Director General, Central Council for Research in Unani Medicine

Dr. K. K. Agarwal, Volunteer Commentator

Dr. K. K. Agarwal,Senior Consultant Physician, Head Cardiology and Dean of the Board of Medical Education Moolchand Medcity, New Delhi

Click for Report page Part I

Click for Report page Part II