Ayurveda – A potential global medical system

The Government of India has recently drafted a national policy on traditional systems practiced in India. Shashank Sandu, Executive Director, Sandu Brothers, provides a few action points for the government to make ayurveda a global healthcare system

Good health plays an important role in human development. Ayurveda emphasises on maintaining the equilibrium and happiness at spiritual, physical, mental and social status of an individual. This concept of health is in close proximity to the definition of good health mentioned by the World Health Organization (WHO).

Unlike other medicinal systems, ayurveda advocates restoration of health and prevention of disease more than cure of disease. Ayurveda is a philosophy of life, which leads to long, happy, healthy and prosperous living.

Contributions of Traditional Systems of Medicine (TSM) and their importance for the healthcare needs of the present and the future are well recognised worldwide. Ayurveda has the rich heritage of time-tested traditional medicines with consistent scientific and evolving approach. The comprehensive manner in which all matters related to health are addressed in ayurveda, it has the potential to become a global medical system.

National policy on Indian Systems of Medicines (ISM) in India

Every country in the global fraternity aspires to meet the healthcare needs of its people through an appropriate and cost-effective approach. In India, the highest policymaking body regarding the matters concerned with health and family welfare is the Central Council for Health and Family Welfare. It strongly advocates systematic use of the Indian System of Medicine-ISM, consisting of Ayurveda-Yoga-Unani-Siddha-Homeopathy, and known as AYUSH, in the primary and secondary infrastructure. The Government of India has taken up the matter quite seriously and drafted a national policy on traditional systems practiced in India. Some highlights of the draft policy are as follows:

• It seeks to revamp the curriculum of the educational institutes
• It strongly advocates enforcement of good manufacturing practices (GMP)
• It encourages protection of the intellectual property rights (IPR) of the resources of this sector
• The policy encourages propagation of ayurveda and other ISM throughout the world, especially in areas where there is special interest in these systems, through Indian missions abroad. Promoting ISM as part of health tourism is being planned. Other approaches include international collaboration and academic exchange between interested groups.
• It has been recommended to increase the share of ISM, in the national health budget.
• It recommends effecting policy changes to cover nutraceuticals and food supplements.
• There will be policy support and taxation incentives to promote high standards of manufacture.
• It seeks to support evidence-based research to determine the efficacy of ISM drugs and therapies
• There will be strong encouragement for undertaking research on basic principles of Ayurveda

Efforts at government level to promote ayurveda

Ayurveda is quite popular, being practiced throughout the country including tribal and remote areas where other modes of therapies are not readily available. Though it does not have an elaborate organised structure, it plays a major role in meeting the healthcare needs of a large section of India.

• Academics
  Post graduate education in ayurvedic medicines is available in over 30 research institutes and offers specialisation in 16 clinical and preclinical ayurvedic speciality areas. The Gujarat Ayurvedic University has signed a Memorandum of Understanding (MoU) with nine Ayurvedic institutions functioning in Japan, Australia, the Netherlands, Italy, Argentina, and Germany to coordinate and facilitate the globalisation of ayurveda through academic collaboration.
  Earlier, Medical (Ayu) Institute of Russia had signed an MoU with the Government of India, in which the Gujarat Ayurvedic University is also one of the implementing authorities.
• Medicinal plant resources
  The drugs used in the AYUSH, are mainly plant based, in addition to mineral and animal origin. The Government of India has set up a National Medicinal Plant Board (NMPB), which has been given the responsibility of coordinating all matters related to medicinal plants. The Planning Commission set up a task force, to inter alia provide policy directives on –

1. Conservation and sustainable use of medicinal plants
2. Growth of domestic and foreign trade
3. Development of an equitable market system
4. Regulation of this sector to maintain quality control
5. Protection of IPR of medicinal plants

• Trading of ayurvedic herbs and herbal compound formulations
  Ayurvedic medicines are marketed in various forms. They may be traded in simple form of cultivated and harvested plant parts, or may be in form of traditional dosage forms like juice (swaras), decoction (kwath), and naturally preserved thru fermentation, products (asava-arishta). In addition, many patent drugs are sold in modern drug dosage forms like syrups, granules, creams, lotions, etc., which constitute around 65 per cent of the market share.
  There are more than 8500 manufacturers of ayurvedic drugs in the country.
  Manufacturing of ayurvedic medicines is governed by local FDA body through enforcement of the Drugs and Cosmetic Act (1940) and Rules (1945) of the country.
  Manufacturers must comply with the rules mentioned under this act.
• Research and development
  There are research councils and institutes functioning throughout the country on different aspects of ayurveda. The Central Council for Research in Ayurveda and Siddha (CCRAS) is an apex body for the formation, coordination, development, and promotion of research on scientific lines in ayurveda and the siddha system of medicine. The research activities in various fields can be broadly categorised as follows:

1. Clinical research
2. Drug research
3. Literary research
4. Family welfare research

   Existence of the ‘therapeutic gap’ in modern medicine is well known. Though tremendous progress has been made in the treatment of many dreaded diseases, remedies are yet to be found for treating diseases like tuberculosis, cancer, rheumatoid arthritis, hepatitis, AIDS, etc. In these areas ayurvedic drugs and procedures may have beneficial effects. Similarly, ayurvedic drugs are proving to be beneficial in the treatment of iatrogenic disorders like Parkinsonism and to attenuate drug-induced toxicity when administered as adjuvant. Intensive research efforts are required to explore these possibilities.

Globalisation of ayurveda

Globalisation of ayurveda has gained momentum. Many active groups have been formed in many parts of the world, including developed countries, to spread the concept and practice of ayurveda. Following reasons make ayurveda a trustworthy medical system across the globe:

1. The holistic approach advocated by ayurveda in therapeutic practice
2. It has one of the most extensive and profound conceptual bases among the traditional system of medicines of the world, and
3. It has survived for more than 4000 years as a vibrant medical system.

Academic role of ayurveda in future healthcare

Facilities have been established in many countries like the US, Australia, the UK, Brazil, New Zealand and Japan to impart training in Ayurveda.

The concepts of proper lifestyles, dietary habits, and daily and seasonal routines followed in ayurveda can be adopted with suitable modification to different countries in different parts of the globe after giving due consideration to the cultural milieu existing in each country and also the constitutional profile of each population. Attempts are being made to utilise the medicinal plant resources of these countries for meeting the healthcare needs of their people after categorisation of the plants according to ayurvedic concepts.

Research at the international level

The department of AYUSH Govt of India has signed an MOU with the University of Mississippi’s department of Pharmacognasy, and established the National Centre for Natural Products Research, where scientists are researching the efficacy of many Indian plants and herbs.

A recent review points out that more than 13,000 plants have been investigated during past five years. A number of medicinal plants (like Curcuma longa, Boswellia serrata, Picrorhiza kurroa, Terminalia chebula, Emblica officinalis, Bacopa monnieri, Phyllanthus niruri, Ocimum sanctum, Gymnema sylvestre, Momordica charantia, Commiphora mukul, Tribulus terrestris, Withania somnifera, Tinospora cordifolia, and Terminalia arjuna) have been shown to possess important pharmacological activities in preclinical testing; however, the generated leads have not been adequately followed up with double-blind, placebo-controlled clinical trials.

One of the main lacunae that becomes apparent for any reviewer of this sector is that most of the studies are undertaken on an individual pharmacologic-effect basis. These studies need to be organized and reviewed. Such a review of these studies is likely to provide scientific basis to the traditional usage of ayurvedic therapies.

Furthermore, many more studies are required to be undertaken on compound (multicomponent) formulations and assessment of synergistic effects of the combination of herbs, possible drug interactions with concomitant use of modern drugs, etc. should carried out.

Action points for the government

Ayurveda has an exceptional potential to become a global healthcare system, government policies should be focused on following action points to make the path of its globalisation hassle-free:

• The first requirement is to undertake globalisation of ayurvedic education to generate high-quality, competent manpower with the requisite communication skills to teach the principles and practice of the system.
• The second requirement is to globalise ayurvedic practice and marketing of ayurvedic drugs. There are many obstacles to achieve this. A two-pronged strategy is required to overcome this problem.

  a) The first one is to undertake multicentric collaborative studies on internationally acceptable guidelines to prove therapeutic utility and safety of ayurvedic drugs and practices.
  b) The second one is to establish ayurvedic clinics and hospitals in countries where there is no such barrier.

• Standardisation of ayurvedic drugs and formulations should be given top priority — without this it would not be possible to promote the utilisation of Ayurvedic drugs at the global level.
• Another aspect that needs to be taken into consideration is the possibility of existence of constitutional differences (Prakruti) among different races and communities as per the concepts of Ayurveda, therefore an ayurvedic concept based epidemiology linkage is necessary.
• It is also necessary to explore the possibility of utilisation and integration of locally available flora into ayurvedic practice of the particular country or region.