Can Indian systems of medicine such as Ayurveda, Siddha and tribal medicine be said to be evidence-based? These questions came up in the Ramdev Baba Coronil dispute, where a herbal product was claimed to be a cure for COVID-19 without sufficient scientific evidence.
Decades ago, during the Vietnam War, more soldiers were killed fighting American troops in Vietnam than were killed by American bullets. At the request of Ho Chi Minh, China’s Mao Zedong launched Project 523, sending researchers to scrutinize traditional Chinese medical texts to find herbs that would treat conditions like malaria.
Her most notable achievement was the discovery of artemisinin, a life-saving antimalarial drug. Inspired by a 1,700-year-old paper, Tu Youyou and her team used modern scientific methods to discover artemisinin. This groundbreaking discovery has saved millions of lives and earned Tu Youyou a Nobel Prize in 2015.
Although initially met with skepticism, clinical trials and pathophysiological studies confirmed the efficacy of artemisinin in suppressing malaria. This strong evidence convinced medical professionals worldwide and led to the World Health Organization’s approval of artemisinin. Today, academic communities around the world are investigating traditional Chinese medicine using modern scientific tools.
The Indian system was once evidence-based.
In ancient Indian philosophical and scientific texts, the keyword of rational epistemology is Pariksha, Anumana, Ganita, Yukti, Nyaya, Siddhanta, Talcaand Ambesana According to Narasimha (7th-8th century): Rasavaisheshika SutraIt is attributed to Bhadanta Nagarjuna in the 5th-6th century, but only two types of evidence are given importance in Ayurveda. Pratyaksha (direct observation) and Anumana (speculation/inference), and “belief” in the sense of blind faith does not play a role.Na hy āyurvede pratyakṣārthānumeyārthābhyām āgamābhyām anyacchraddheyārthatvam asti, dṛṣṭaphalatvād iti.-RVSBh 3.45).
Karaka is Yuktivyapashraya Veshaja (Based on Reason) and Daivavyapashraya Veshaja (Faith-based) therapy emphasizes the process of inquiry andPariksha” is important to arriving at scientific truth, he said. Claims become generally accepted only when they have been thoroughly investigated by multiple researchers and are supported by strong and reasonable evidence, he said.
So why has Ayurveda fallen into decline?
Between the 6th and 10th centuries Ayurveda was a thriving field. New medicinal formulas were discovered and added to its vast literature. For example, Vagbhata (6th century A.D.) emphasized the importance of updating the medical literature.Yuga AnurupaHe wrote new commentaries on the Charaka and Sushruta Samhitas. Dalhana (11th century) revised his commentary on the Sushruta Samhita and added two new iron formulas for the treatment of anemia.
“Ayurveda does not derive its authority from being divined by the god Brahma, but its value comes from the verifiable truths it contains,” says Vagbhata. However, many Ayurvedic practitioners believe that Ayurveda is not an experimental, empirical, scientific system of treatment open to criticism, but rather that it was acquired by ancient “rishis” through the power of divine “yoga.”
“Submission to the authority of the written word and texts, reinforced by the social influence of the caste system and mystical philosophy, gradually replaced the scientific adventure and spirit of inquiry that characterized the work of the pioneers of Ayurveda,” says MS Valiasan, noted cardiologist and author of the series, ‘The Legacy of Charaka, Sushruta and Vagbhata.’
In recent history, conservatism and mysticism were reinforced and promoted by an analogy formulated by Captain G Srinivasa Murthy, a practicing physician, at the Committee for the Recognition and Encouragement of Indigenous Systems of Medicine set up by the Madras State Government under the chairmanship of Muhammad Usman in 1921. While modern Western science uses external aids such as microscopes, telescopes and spectroscopes to understand things beyond the reach of the senses, he argued that Hindu sages “tried to achieve the same result not by giving external aids to the senses but by improving our own sense organs.”
“The general reluctance of modern Ayurvedic practitioners to question the wisdom expressed in the classical samhitas is due to the fact that the ancient Indian sages Pratyaksha (direct evidence), Anumana (inferential evidence), and Yukti (Logic) Above Shabda Pramana (Narration over text) says Subhash C. Lakhotia, professor of cytogenetics at Banaras Hindu University and a pioneer in studying Ayurvedic biology using the fruit fly model.
West and East
Not everyone turns to God to reject scientific scrutiny. Some hide behind cultural relativism, arguing that “allopathic medicine” is based on Western science and that Ayurveda is an epistemologically distinct but valid body of knowledge that can only be verified by Ayurvedic logic and methods.
According to Ayurvedic physiology and anatomy, Shukla It is further written that the fetus is born from the combination of semen and menstrual blood. All these are “Pratyaksha‘, and are these acceptable as alternative “perspectives”?
Kishore Patwardhan Kriya Sharil The professor of Ayurveda at Banaras Hindu University explains that Ayurvedic epistemology is in line with Nyaya Vaisheshika school of thought and is similar to modern science but uses simpler tools. Pratyaksha “In ancient times, it meant using the senses to gain knowledge. Today, tools such as microscopes are used for the same purpose,” he says.
Clinical Trials
Randomized controlled trials (RCTs) are the gold standard for clinical trials evaluating the efficacy of drugs. In symptomatic treatment, two patients with identical diagnostic assessments are prescribed the same treatment.
However, Ayurvedic treatment is individualized based on constitution (Prakriti, Agni, Samhananaetc.) RCTs do not seem feasible for Ayurvedic clinical trials due to its complexity including multiple medications, mid-course modifications, treatment modalities, dietary restrictions, lifestyle changes etc. Some argue that only case studies based on the personal experience of Ayurvedic medical professionals are feasible.
However, the situation is not hopeless. A recent comparison of methotrexate-based treatment with an Ayurvedic intervention in patients with radiological signs of rheumatoid arthritis demonstrated that double-blind, placebo-controlled trials are feasible, even for individualized treatment. Where there is a will, there is a way.
The elephant in the room
It is often said that modern science has treated the research of the ancient medical systems like a stepmother, but this is not true. Prompted by a chance lecture on Ayurveda and modern medicine by MS Valiathan, former president of the Indian National Science Academy, Naveen Khanna and his team from the International Centre for Genetic Engineering and Biotechnology (ICGEB) looked into Ayurvedic literature and discovered an antiviral agent that works against all four strains of dengue. After years of research, they found that a plant extract of Cissampelos pareira Linn (Cipa) is effective against dengue both in vitro and in animal models. Human clinical trials are currently underway.
Similarly, researchers at the CSIR-Indian Institute of Integrative Medicine, Jammu, have isolated sinococulin, a bioactive component of Cocculus hirsutus that has potent anti-dengue activity, and discovered a botanical drug, IIIM-290, with anti-cancer properties.
China is investing huge amounts of government money to reexamine ancient medicines using modern evidentiary standards, accepting treatments that work and rejecting those that don’t. India lacks both the funding and the unwavering commitment to evidence.
Mysterious Aura, Major Hurdles
Sushruta argues that medical interventions can be trusted not simply because they have been effective in one’s own experience.Pratyaksha / Faradalshana) are asserted only because they have been reasonably vetted by a community of experts. He calls for what is now known as rigorous peer evaluation before assertions can be accepted. It is clear that case studies cannot replace well-designed clinical trials in assessing efficacy or the underlying pathophysiology of a disease.
“Not surprisingly, centuries-old classical medical texts contain inaccurate anatomy and physiology, and outdated pathophysiology and etiology. But physicians often claim divine revelation and do not update or modify this knowledge. Unearthing the biological basis of this treasure trove of knowledge could benefit both Indian systems of medicine and biology.”
(The author would like to thank Krishna GL for providing his perspective on the philosophical and epistemological aspects of Ayurveda, especially in his paper “Ayurveda Awaits a New Dawn”)
