As per present regulations in India, no scientific or clinical data is required for manufacture and sale of classical Ayurvedic medicines. Technically, sound pharmacopoeia, good manufacturing practices, quality control and pharmaceutical technologies for Ayurvedic medicine are still evolving [ 29 , 30 ].
Issues related to appropriate research methodologies or treatment protocols for Ayurveda have also not been properly addressed. Many critiques are demanding better coordination between stakeholders, continuous dialogue with scientific community [ 31 ] and total overhaul of the curriculum and pedagogy along with the need for crosstalks between different streams [ 32 ]. Recent report on status of Indian medicine and folk healing indicates the need to strengthen research and use of Ayurveda, yoga, unani, siddha, homeopathy AYUSH systems in national health care [ 33 ].
The need for innovation is also urged by thought leaders in this sector [ 34 ]. In short, the evidence base to support good clinical practice, guidelines and documentation in Ayurvedic medicine remains scant and grossly inadequate. Controlled clinical trials are taken as the highest level of evidence. Ayurveda lags far behind in scientific evidence in quantity and quality of randomized controlled clinical trials RCTs and systematic reviews.
For instance, out of 7, systematic reviews in the Cochrane Library, Ayurveda has just one, while homeopathy and TCM have 5 and 14, respectively. Substantial grants have been allocated to ambitious national projects involving reputed laboratories. However, the design, methodology and quality of clinical trial on Ayurvedic medicines seem to lack the expected rigor [ 35 ]. Of course, this does not mean that the RCT model is suitable to clinical research in Ayurveda.
RCTs have already been subjected to criticism [ 36 ]. Value of observational studies cannot be ignored. Certainly, there is a need to develop appropriate research methodology for complex whole system, whole-person-centered clinical trials as an alternative to RCTs. Already, scientists are advocating robust clinical study designs based on personalized approach and metabolomics with only one patient [ 37 ].
Thus, non-suitability of RCTs should not be used as an excuse for avoiding rigorous scientific research and clinical documentation. Few noteworthy attempts related to research and practice include a national program on Ayurvedic biology [ 38 , 39 ], Ayugenomics [ 40 ], whole systems clinical research [ 41 — 43 ], good clinical practices guidelines, digital helpline [ 44 ], decision support system AyuSoft, and systematic reporting standards on lines with CONSORT for Ayurveda [ 45 , 46 ].
Recent efforts to develop robust clinical protocols for comparing effectiveness of complex Ayurvedic and conventional treatments are laudable [ 47 ]. Other notable efforts related to integrative therapy for leishmaniasis have been able to generate sufficient scientific evidence [ 48 ]. Agreeably, many of these efforts could not produce any remarkable products, processes or protocols, and desirable impact on a scientific community is yet to be seen.
The need to enhance collaborative culture between Ayurvedic and modern scientific communities has been rightly stressed [ 49 ]. As a result, Ayurvedic medicine continues to remain subcritical in research publications, which is an important indicator of external evidence [ 50 ]. The present scientific evidence in support of Ayurvedic medicine remains extremely poor. Many articles lamenting poor quality of Ayurvedic medicines, presence of heavy metals and other safety compromising substances have been published [ 52 , 53 ].
This situation may lead to further denigration, which can adversely impact the development of evidence base for Ayurveda. Ayurveda describes three doshas namely vata, pitta, and kapha. The proportional domination of doshas in an individual is expressed as Prakriti , which broadly mean a body type or individual nature. An Ayurvedic physician determines the Prakriti of a patient so as to personalize treatment. The Ayurvedic description clearly suggests that the innate dispositions are represented by individual Prakriti , which represent phenotypes.
Classifying humans based on phenotypes still remains a challenge to biomedical science. A number of research groups are now investigating the correlation between Ayurvedic phenotypes and individual human genotypes. A pioneering study showed significant correlation between HLA alleles and Ayurvedic Prakriti type [ 54 ]. Later, it was also hypothesized that different Prakritis may possess different drug metabolism rates associated with drug-metabolizing enzyme polymorphism.
In another genotyping study, significant correlations between CYP2C19 genotypes and major classes of Prakriti types have been reported [ 55 ]. A project to study genomic variation analysis and gene expression profiling of human, Prakriti based on the principles of Ayurveda is underway. Now, it is hoped that going beyond genomics is necessary to understand how environment and behaviors can be responsible for inheritable changes when the genome remains unchanged. This science of epigenetics is seen as a future hope to get answers to many puzzles. It is felt that detailed understanding of Ayurvedic concepts like Prakriti may actually facilitate this process.
However, no specific genotype has yet been specifically related to a Prakriti type. Modern biomedicine recognizes progressive nature of diseases like cancer and diabetes. It is known that slow yet progressive pathophysiological changes result in a transition from a healthy state to diseased state.
Ayurvedic concept of shatkriyakaal elaborates a six-stage progressive transition from balanced to unbalanced stage leading to disease manifestation in a person. These six stages are unique and may help early recognition and early diagnosis much before onset of measurable clinical symptoms of diseases. It is possible to undertake a systematic cohort study by stratifying patients in the six categories.
Each of the cohorts can be carefully followed up to study pathophysiological, genetic, and epigenetic and metabolomic differences. This may give leads towards the identification of new markers and early predictions, which can then be used for prevention and personalized treatments.
Scientific Basis for Ayurvedic Therapies - Google Книги
The need to define a common model of health and disease between the western and eastern knowledge systems has been pointed out earlier [ 56 , 57 ]. Therefore, a collaborative project based on concepts of PPPM and Ayurveda may help to better understand disease progression and predictive diagnosis of diseases like cancer and diabetes. In this context, recent efforts to correlate traditional Ayurvedic and modern medical perspectives on cancer are very relevant. In a qualitative study, it was observed that Ayurvedic medicine offers a unique perspective on the biomedical diagnosis of cancer.
Due emphasis on restoring wholeness, use of natural remedies focus on emotional health, and emphasis on prevention strategies were found to be unique features of Ayurvedic interventions [ 58 ]. Several issues need to be addressed for Ayurveda to move towards acceptable evidence base. Few critiques have opined that basic concepts of Ayurveda should not be distorted to suit convenience or availability of biomedical research models [ 60 ].
Arguably, prevailing pre-clinical methods and clinical models like RCTs may not be suitable to validate Ayurvedic medicine. However, the onus of developing suitable models to build necessary evidence must be voluntarily accepted by the Ayurveda sector. Some efforts in the direction to conduct the whole system clinical trials are already in progress [ 61 ].
A critical review and analysis indicate that the present Ayurvedic medicine is severely deficient in scientific evidence related to clinical practice and scientific research. Ayurveda sector needs to go beyond mere scholarly recitals, reviews and defensive interpretations, which are abundant in current literature. Ayurveda needs to be studied and experimented with help of new models based on modern science and biology. Ayurvedic medicine needs more rigorous scientific research for evaluating safety, quality and efficacy [ 62 ].
Many lessons learned in the past may guide our quest for evidence-based Ayurveda in the future [ 63 ]. Ayurveda sector needs to get connected with Indian and global scientific networks not as a bureaucratic process but for scientific and professional pursuits. This review and analysis is carried out with a caveat that the methods and evidence approach of biomedicine may not be directly applicable to Ayurveda.
However, either Ayurveda has to discover its own methodology and approach for evidence or should face the critical analysis as per the conventional approach of EBM. Avoiding any critical appraisal under the pretext that it is a holistic system and that the present methods like randomized controlled trials are not applicable may not sustain for a long time. The Ayurvedic sector should urgently recognize and address the need for scientific evidence [ 66 ]. Systematic documentation, appropriate methodology and rigorous experimentation in accordance with good practices coupled with epistemologically sensitive approaches will remain crucial to move towards evidenced-based Ayurveda.
The question of epistemologically sensitive methods is relevant only to biomedical laboratory and clinical research. The good agricultural practices for procurement of raw materials and good manufacturing practices for Ayurvedic drugs must be in accordance with the globally accepted norms. The new philosophy of health care is moving from illness to wellness, from treatment to prevention and early diagnostics and from generalized approach to personalized medicine.
As discussed in this review, there are several similarities between the concepts of PPPM and Ayurveda. Search of novel models for integrative medicine indicates the need for collaborations between traditional systems like Ayurveda and contemporary western biomedicine [ 67 ]. Agreeably, many concepts from Ayurveda have not yet been validated with help of modern science. Therefore, it is felt that collaborative efforts between scientific researchers from Ayurveda and PPPM seem to be a mutually beneficial proposition. Such integration bringing the best of the western biomedicine and eastern traditional knowledge systems like Ayurveda may lead to high impact projects.
Suitable industry collaborators can also be roped in from both respective regions. Such integration certainly has contemporary significance and will help to address societal challenges presently faced in the global health care sector. I thank Gururaj Mutalik and Girish Tillu for their valuable inputs and research assistance. I gratefully acknowledge open access support especially from Google Scholar, Pubmed, and Cochrane Collaboration. National Center for Biotechnology Information , U. Published online Nov 1. Received Jul 19; Accepted Sep This article is published under license to BioMed Central Ltd.
This article has been cited by other articles in PMC. Abstract This article reviews contemporary approaches for bridging Ayurveda with evidence-based medicine. Ayurveda, Traditional, complementary and integrative medicine, Epistemology, Evidence-based medicine, predictive, preventive and personalized medicine, PPPM. Review Ayurveda is one of the traditional systems of medicine that practices holistic principles primarily focused on personalized health. The evidence in right perspective In philosophy, evidence is closely tied to epistemology, which considers the nature of knowledge and how it is acquired.
Ayurveda epistemology The epistemology of Ayurveda is based on the relation between microcosm and macrocosm involving five basic elements mahabhoota , three dynamic principles similar to humors dosha , seven types of tissues dhatus and many other unique concepts. Evidence base for Ayurvedic medicine It is very important to review available evidence in the right perspective.
Clinical practice Arguably, the clinical practice of classical Ayurveda is rare. Scientific evidence Controlled clinical trials are taken as the highest level of evidence. Ayurvedic concept and predictive diagnosis Modern biomedicine recognizes progressive nature of diseases like cancer and diabetes. Moving towards evidence base Several issues need to be addressed for Ayurveda to move towards acceptable evidence base.
Conclusions This review and analysis is carried out with a caveat that the methods and evidence approach of biomedicine may not be directly applicable to Ayurveda. Open in a separate window. Key factors for evidence-based Ayurvedic medicine.
Bridging Ayurveda with evidence-based scientific approaches in medicine
Integration of PPPM and Ayurveda The new philosophy of health care is moving from illness to wellness, from treatment to prevention and early diagnostics and from generalized approach to personalized medicine. Acknowledgements I thank Gururaj Mutalik and Girish Tillu for their valuable inputs and research assistance. Footnotes Competing interests The author declares that he has no competing interests. Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine-person-centred medicine.
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Chapter 7 Diabetes Mellitus Madhumeha. Chapter 8 Ayurvedic Therapies for Thyroid Dysfunction. Chapter 21 Diarrhea Atisara and Dysentery Pravahika. Chapter 22 Gastroduodenal Ulcers. Chapter 23 Alzheimers Disease. Chapter 25 Psychiatric Disorders. Chapter 26 Parkinsons Disease Kampa Vata. Chapter 27 Male Reproductive Dysfunction. Chapter 28 Raktaja Krimis Dermatophytes. Chapter 9 Obesity Medoroga in Ayurveda.
Chapter 10 Rheumatoid Arthritis Osteoarthritis and Gout. Chapter 11 Ayurvedic Therapies of Sciatica Gridhrasi. Chapter 12 Allergic Reaction. Chapter 13 Bronchial Asthma. Chapter 14 Hepatic Disorders. Chapter 15 Antimutagenic Effect of Ayurvedic Therapies. Chapter 17 Indigestion Ajirna. Chapter 18 Constipation Vibandha. Chapter 19 Hyperacidity Amlapitta. Chapter 20 Irritable Colon Grahani.