Composed by: “Dr. Shiban Ganju is a consultant specializing in gastroenterology, liver disease and nutrition in hospitals in the greater Chicago area. He is the Chairman, Atrimed Pharmaceuticals and also Founder of Save A Mother Foundation, USA. His commitment to and understanding of how to drive improvements in health outcomes has been nurtured & honed since 1972-73 when he worked in a slum near Delhi and where he helped build a school and dispensary.”
Whatever fell beyond this boundary was probably not considered Ayurveda. In recent years, with newfound pride in its legacy, Ayurveda has regained its vitality to reclaim its rightful place.
In recent times, people seem to have regained interest in discovering different ways to stay healthy for a long time into their old age. In sickness too, people often face a dilemma of choosing treatment from two available systems: modern or alternative. The former has built its foundation on biomedical experiments and the latter has evolved from a lived human experience of centuries. Alternative, which is also known as complementary medicine, includes an array of systems ranging from scientific to folklore. It includes Yoga, acupuncture, traditional Chinese medicine, and AYUSH. The AYUSH systems, which stands for Ayurveda, Unani, Siddha, and Homeopathy, have an established conceptual framework – proven and unproven – about the working of the normal human body, etiology of diseases and their therapy.
Ayurveda, a tradition of India for over 5000 years, reached its zenith around 100 BC by which its earliest stalwarts had created a cogent system, which had a logical strong foundation, a well-constructed edifice, and a demarcated boundary. Whatever fell beyond this boundary was probably not considered Ayurveda. The authors, Charka, Susruta, Vagabhat and others compiled experience, gained over previous centuries, in well-defined texts like Charka Samhita, Susruta Samhita, Ashtang Hridaya and others. Their intuition, observations, logic, and ethics set high standards for the pursuit of knowledge, which guided this tradition for a long time.
The treatises of Susruta and Charaka were translated into Chinese language in the 5th century and into Arabic and Persian languages in the 8th century. The Arabic translation reached Europe by the 12th century. The British showed some interest in Ayurvedic systems but after 1835, with the passage of the English Education Act, they discouraged Ayurvedic and other native systems and gave preference to practice of western medicine. For the past many centuries, the system was not able to maintain original vigor and the knowledge withered or remained static.
In recent years, with newfound pride in its legacy, Ayurveda has regained its vitality to reclaim its rightful place. Many institutions have been working on different paths to reach a common goal: seek the truth in ancient knowledge, preserve what is known and unravel the unknown. After centuries of dormancy, multiple paths are reasserting the relevance of Ayurveda.
The path of the purists and preservationists:
The purists believe in the divine wisdom of Ayurveda, which originated from Brahma who passed it to Prajapati who in turn handed it to Atreya and so on. Among the Vedas, it is Atharva Veda, which describes diseases and therapy in a systemic manner, though there are references to diseases in the earlier Rig Veda. The purists follow the Ashtang (eight-fold) system of Vagabhat, which includes Kaya Chikitsa (Internal medicine), Shalakya Tantra (Head, Eye and ENT), Shalya Tantra (Surgery), Agada Tantra (Toxicology), Bhuta Vidya (Psychiatry), Kaumara Bhritya (Pediatrics), Rasayana (Antiageing therapeutics) and Vajikarna (Fertility, aphrodisiacs). The classic practitioners follow the ancient practices in letter and spirit, which they consider perfect and need no modification.
Traditional practice:
The followers of this path are Ayurvedic doctors who get training from government accredited Ayurvedic medical colleges. Their training includes curriculum like
- anatomy, physiology, and microbiology, which later culminates in learning Ayurvedic texts from ancient masters like Vagabhat. They use traditional Ayurvedic methods and biochemical tests and radiology to arrive at a diagnosis. Many traditional practitioners have no compunction in using western medicines to treat their patients even if they are forbidden.
Commercial:
In recent times people from all societies seem to have rediscovered the benefits of plants and herbs in health and disease. Two reliable market reports estimate that the herbal market size of the world could reach between 168 billion USD and 428 billion USD by 2026. WHO estimates that approximately 3.5 billion people in developing countries use plant-based medicines. At present, half the medicines in the market have natural origin.
Profit drives the followers of this path. The marketing campaigns make generous use of well meaning words like organic, natural, herbal, antioxidant, detox. Market compulsions lead to claims that these products promote health, wellness, strength, cure diseases and are harmless without side effects. Such claims may not be Illegal but are often unsubstantiated.
Currently, India has a small share of the world market, partly because of poor R&D and quality standards. For international acceptance, recourse to clever marketing is essential but not sufficient. Integration with international markets would be possible if Ayurveda pursues intellectually honest research through established scientific methods to establish its veracity. The seekers of truth in ancient times used analytic methods available then and in modern times we should not be reluctant to use the tools of science available now. The integrated R&D could extend to manufacturing to match international quality. This could yield enormous economic benefits.
Public health:
Ayurveda has inherent strength in its philosophy to contribute vastly to public health. Unfortunately, this strength remains underutilized. An Ayurvedic public health system, with its holistic approach, could lead common folks to a healthier lifestyle. With its development and investment, an effective Ayurvedic health system could lead many public health functions: prevention of the preventable diseases, improving nutrition, promotion of physical activity, Yoga, mental health, and rehabilitation of the disabled. A dedicated public health system based on Ayurvedic principles will go a long way to reduce disease burden.
Advocacy:
Activists and believers have pursued this path to persuade the government to become enablers of an AYUSH eco-system. Their efforts have succeeded in opening new organizational structures, institutions, and funding for various avenues of growth. More needs to be done in basic research, standardization of therapy, patent laws, consumer protection and integrated education.
Integrative medicine:
Healthcare will flourish when we harmonize the biomedical system with Ayurveda; for too long these two have been running on parallel and often antagonistic tracks. It helps vested interests to keep the two systems in conflict; it is time to find synergies between them. The results of such merger should be quantifiable, replicable, and verifiable. Making the impact quantifiable avoids inscrutable jargon which is a part of intuitive claims. Two myths prevail about Ayurveda. One held by biomedical doctors, who decry Ayurveda as quackery and the second perpetuated by Ayurvedic practitioners that their treatment has no bad side effects. Both are wrong. Here are two true stories from real life to counter both myths.
A close friend had severe vertigo; his head would swirl unless he lied down immobile. These episodes affected his personal and professional life. He spent a few years in treatment from many modern medicine doctors including one at a reputed academic center but got no relief. Out of desperation, he went to a prominent Ayurvedic clinic and under their therapy he got considerable relief.
In contrast, another friend was treated by an Ayurvedic doctor for abdominal pain, which worsened despite the caring diligence of the doctor. After many months, when she switched to a modern medicine doctor, it was too late. She succumbed to her disease and died soon after, partly due to her disease and partly due to toxicity of the herbal drugs. The implication of these stories is that modern medicine should discard its smug superiority and Ayurveda should shed off its halo of holiness. None of them can claim to be a panacea.
Doctors already in practice could be offered courses both in Ayurveda and modern medicine to enhance their skills.
Integration of the two systems could happen in the medical college or later at practitioner level. Students enrolled in modern medical colleges could take a course in Ayurveda; those who want to specialize could be offered advanced courses following MBBS. Doctors already in practice could be offered courses both in Ayurveda and modern medicine to enhance their skills. Over the long run, the two-track medical education of Ayurveda and modern biomedical medicine could be integrated into a single track; synthesis of the two systems could evolve into a modern Indian system for healthcare delivery. The consumer would benefit if she were not faced with the dilemma of choice.
Biomedical model:
Last two centuries have seen marked advances in understanding health and disease by studying the human body as a biological machine. Investigators of the biomedical model have developed a molecular basis of understanding the normal and abnormal functions of the human body in health and disease. New diagnostic technology has evolved in tandem to understand what was mysterious before. Therapeutic knowledge has exploded in this field of biomedical models so that humans now live longer and healthier than even before in history.
There are groups of investigators, who are diligently using modern tools to unravel the ancient knowledge. Some excellent work has been published in scientific journals and can be searched in medical knowledge data banks like PubMed and others. To globalize the knowledge and products of Ayurveda, we should meet international standards of research and product approval. The current gold standard is publication is a high impact peer reviewed journal and approval from the FDA, USA. A serious inquiry into the ancient may reveal kernels of truth and some fallacies. We should be bold to discard the fallacies and welcome the truth.
Like many others in this field, our group, Atrimed (Named after sage Atreya, teacher of Charaka and Susruta) has also been working on an integrated Ayurvedic-biomedical model. Since 2003 we have been investigating the molecular basis of ancient therapeutics. We believe that plants, which have evolved for over 2 billion years, can inspire new drug discovery. Plants are factories of nature. Phytochemicals and secondary metabolites can lead to new bioactive compounds.
In the last two decades, Atrimed group has diligently built a library of all previously published Phyto-molecules and established a repository of real extracts from plants mentioned in Ayurveda. Atrimed also experimented in preserving endangered plant species in tissue culture. The virtual and real library could possibly be one be the largest in the world.
Such research necessitates the use of trans disciplinary teams to use technology from many labs. Some examples are recombinant technology to produce target protein; molecular biology to study biological reactions; tissue culture to study the effect of investigational molecules on living cells. Atrimed uses computational chemistry and a docking software to study these phytochemicals and has developed a software to predict absorption, distribution, metabolism, excretion, and toxicity. To understand the therapeutic value of nutrition we are developing software to see the effect of food at molecular level, which may help in understanding the poly-pharmacology of various Ayurvedic drugs. Atrimed has also succeeded in developing plant molecules with verifiable anti-viral activity both in lab and clinical setting.
Atrimed has collaborated with many reputed institutions. Some of them are Rajiv Gandhi Institute of Technology, Bangalore Bio-innovations Center, Rastriya Vidyalaya College of Engineering, Nitte center for animal studies, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Institute of sciences Bhubaneshwar, Regional Center of Biotechnology Faridabad. Our company Atrimed has been awarded by Biotechnology Industry Research Assistance Council (BIRAC) and recognized by many government and private organizations.
The work of the Atrimed group has led to development of over one hundred effective products, which meet international standards of safety. Some products have been retested for safety in European labs to ensure they are free from toxic metals and pesticides. Manufactured in C GMP or FDA approved facilities, some of the products have been registered with FDA. As a result of high-quality work, Atrimed products are selling in India and many countries abroad.
Regulators and consumers:
The recent Ayurvedic resurgence forms but a minuscule part of the health and wellness universe. The private and public initiatives can expand only if enabled by the government and accepted by the global consumer. From the regulatory authorities in becoming enablers to people becoming informed consumers, all intermediary stake holders need to participate in rejuvenating this tradition. The regulators could help evolve the market with a multi-pronged initiative, which would include new laws for intellectual property, new integrated medical training, funding of original research and controlling fake claims in marketing.
The growth of Ayurveda also requires an informed consumer who is equipped to utilize Ayurvedic or modern medicine. As many diseases are self-limiting, either one may suffice but the decision is critical when the disease demands an expert’s help for recovery. Ideally, the treating physician would keep the patient’s best interest foremost and guide her towards the best available treatment. But it gets muddled due to financial incentive the physician gets by providing treatment. In both modern and AYUSH systems, the practitioners range from altruistic to commercial, from competent to charlatans. Perhaps the ethics of ancient physicians are as important as modern technology. Ethical partitioners and empowered consumers probably provide are the best guardians for reinvigorating Ayurveda.
In our euphoria of novel discoveries, the ancient wisdom has been, unfortunately, relegated to an inferior status because of perceived low utility. But discarding ancient wisdom of our inheritance may be inimical to achieve the target of a healthier and happier human life. The rejuvenation of Ayurveda needs a new impetus, which integrates the traditional intuitive method with the analytical reductionist method of western science. The tradition of Ayurveda deserves neither derision nor worship; it needs honest investigation to establish its validity globally.
