AYUSH medicine. Photo by Nataliya Vaitkevich | Pexels.
Ayurveda, a natural system of medicine, originated in India more than 3,000 years ago. Commonly referred to in India as AYUSH, this acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy represents the six indigenous systems of medicine practiced in India. Join the Lancet Citizens’ Commission on Reimagining India’s Health System for a webinar on December 7 on the role of, and challenges related to, utilizing the AYUSH systems to attain universal health coverage in India.
The Mittal Institute sat down with the event’s keynote speaker, Darshan Shankar, Vice Chancellor, The University of Trans Disciplinary Health Sciences and Technology, who shared more about AYUSH healing.
Mittal Institute: Thank you, so much, Professor Shankar, for speaking with us! How did your interest in AYUSH systems begin?
Darshan Shankar: I have a formal education in basic statistics not Ayurveda. My interest is due to the opportunity to directly observe the functionality of the system in village communities in many parts of India, from Ladakh to Kanyakumari (which uses ecosystems specific plants) and also in Ayurveda clinical establishments. These observations and outcomes narrated by beneficiaries led me to wonder why such an apparently rich, diverse, competent, and, very importantly, a community-rooted knowledge system, was being neglected.
Professor Darshan Shankar, Vice Chancellor, The University of Trans Disciplinary Health Sciences and Technology. Image from TDU.
Mittal Institute: You spent 12 years living in a tribal district after living and teaching in Mumbai. How did that experience impact you? What did you learn that has influenced your thinking about AYUSH systems today?
Darshan Shankar: I was deeply impressed by the fact that the Thakur tribes of Raigad District in the state of Maharashtra coined local names and knew medicinal uses of 500 locally occurring species. I viewed this knowledge as a “People’s Science.” My later interactions with Ayurvedic physicians in a quest to know more about the principles underlying local knowledge (because scientists appeared both ignorant and unaware) convinced me that biological change can be clinically managed and observed at both molecular (by biomedicine) and systemic levels (by Ayurveda). Incidentally, Ayurveda is the Sanskrit term for the English/Latin term “biology,” because both mean “study of change in life processes.”
Mittal Institute: If you had to demystify any myths related to AYUSH, what would they be?
Darshan Shankar: The myth is that there is only one kind of medical science. Ayurveda is viewed as unscientific because it has a non-molecular, systemic way of observing, classifying, and understanding causality and mitigation of biological change. It has a unified theory of bio-regulation, amazing understanding of variability, holistic pharmacology, and pathogenesis. It has an incredibly large repository of over 200,000 brilliant drug formulations (documented by CSIR-TKDL) and effective non-drug interventions that can detoxify impaired physiological processes.
If we actually look at the ground reality, it can be seen that AYUSH is functional and growing exponentially in its acceptance. The growth is reflected in annual turnover of the sector in manufacturing and health services, which is of the order of $18 billion. It services millions of citizens every year. The knowledge framework is theoretically extremely sophisticated.
I witnessed that the system manages simple and complex health conditions, ranging from enhancing wellness (swasthya), to common cold and non-specific fevers and complex conditions, like diabetic wounds, neuro-degeneration, ophthalmology and non-surgical interventions for cancers.
I believe instead of speculating on its strengths, the actual performance of AYUSH services need to be urgently investigated, not by hearsay but from systematic retrospective, longitudinal surveys, using AI and ML of “10 years of real-world clinical practice (practice-based evidence)” from at least a 100 high-footfall clinical establishments in the country.
Many skeptics do not realize that researched evidence derived from analysis of clinical data is directly a function of investment in research. For the last 50 years, research investments by the government of India in extra-mural research have never exceeded Rs 10 crore per year. This is less than sub-critical investment and naturally can yield no substantial data.
Lack of data to demonstrate effectiveness simply means lack of investment. It is a case of data deficiency. which cannot be the basis for assuming incompetence.
[It is a] myth that there is only one kind of medical science. Ayurveda is viewed as unscientific because it has a non-molecular, systemic way of observing, classifying, understanding causality and mitigation of biological change. It has a unified theory of bio-regulation, amazing understanding of variability, holistic pharmacology, and pathogenesis. It has an incredibly large repository of over 200,000 brilliant drug formulations and effective non-drug interventions that can detoxify impaired physiological processes.
Mittal Institute: Could you tell us more about the Foundation for Revitalization of Local Health Traditions (FRLHT) and the Trans-Disciplinary University (TDU) and the goals of these institutions as they relate to traditional medicine?
Darshan Shankar: The goal of both FRLHT and TDU is to evaluate the contemporary relevance of indigenous health science and practice. Our major programs are:
- Accreditation of folk healers based on ISO standards and processes
- Conservation of gene pools of ecosystem-specific medicinal plants
- Building a citizens portal on reliable uses of plants for one’s health
- Research on multiple dimensions of Ayurveda-biology
- Clinical research to understand variability in disease classification
- Designing a strategy for mass personalization of food
Mittal Institute: Your talk on December 7 will address more opportunities and challenges for traditional medicine’s role in achieving universal health coverage in India. What will be some of the key themes that might resonate with other South Asian countries–or maybe even beyond?
Darshan Shankar: I have two key messages. Firstly, the need for radical reimagining of National Health Systems by repositioning the role of both indigenous health sciences and practices and biomedicine, based on analysis of “Practice Based Evidence (PBE).” We need big data from the most reputed 100 or more clinical establishments of “both” systems in the country. The positive results from PBE for Ayurveda should be further researched in trans-disciplinary frameworks like Ayurveda-biology, seeded by Dr. MS Valiathan in 2005 in order to understand concepts, drugs, therapies, and mode of action in a systems-biology framework. The goal of such research is not validation of Ayurveda, but rather for cross-cultural communication and mutual learning across the worlds of indigenous and western health sciences.
Secondly, there is an urgent need to review in parallel the strength of claims of “Evidence Based Medicine (EBM)” in biomedicine. The quality of evidence in biomedicine is a question mark, given the growing realization at the frontiers of biology about the reductionist nature of both experimental (bioassays do not mimic biological complexity) and clinical pharmacology (variability is ignored). This quality of evidence review should also include a hard look at the reliability of regulatory standards that have certified hundreds of subsequently failed, unsafe drugs. An urgent and critical analysis of “PBE” in biomedicine is called for from systematic retrospective, longitudinal surveys, using artificial intelligence and machine learning of 10 years of real-world clinical practice (practice based evidence). The PBE data should guide the repositioning of biomedicine in the health services of the country based on its actual performance of strengths and limitations.