Q1: What is ISM? Is it a single system?

A1: Ayurveda, Siddha, Sowa Rigpa (Tibetan medicine), and Unani come under Indian System of Medicine (ISM). Although quite close to each other in their theory, each of them have their own systematic ways of treating the patients. Moreover, there is a ministry called Ayush and a medical commission for regulating medical education and practice in each of the systems.

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Q2: If you permit ISMs (Indian Systems of Medicine) to deal with Covid-19, wouldn’t the quacks get a chance to practice and fleece people?

A2: There are quacks who treat in the name of any pathy - but we have to deal with them. Do we ban an entire pathy (medical system) because of presence of quacks? Aren’t patients being fleeced in the name of Allopathy by quacks and some hospitals!

However, we agree that safeguards should be there. The Appeal to PM is asking for treatment by qualified and licensed vaidyas in government hospitals. This ensures that people doing the treatment are not quacks, and the hospital itself is not out to make money using the treatment.

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Q3: In Ayurveda there is no standardized treatment. Each vaidya has his own theory. Wouldn’t there be a total chaos?

A3: It is correct that in Ayurveda there is no single solution given to the patients suffering from the same disease. However, it is not correct to say that therefore, it is arbitrary, or does not have any accepted way of dealing with a disease in a patient.

This is so because even though the broad category of disease may be the same (for example, diarrhoea), the clinical manifestation is always different in subgroups. Today the fact of variability is being understood at the frontiers of biology and medical sciences. Personalized medicine is therefore being projected as the future of health sciences. We are fortunate that ayurveda knowledge system already recognizes and uses variability to provide individualized treatment.

Ayurveda physicians are expected to use a standard logically designed “protocol” (algorithm) for treatment but the actual treatment needs to be individualised. A vaidya looks at different factors or variables, before deciding the treatment to be given to a patient. Based on all these, a vaidya provides individualized (a) medicines, and (b) advice on food and (c) daily work-sleep routine. Further, the vaidya would monitor the health-progress of the patient and vary these as changes occur.

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The point is that even though individualized, the treatment follows the principles of ayurveda as a science, and not the whims of the treating vaidya. It is better to call the treatment as personalized but with replicable logic and principles of treatment.

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Q4: What are some of the factors or variables based on which the treatment is given in Ayurveda, Siddha, Tibetan and Unani medicine?

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A4: A vaidya looks at six or more factors or variables associated with the patient before providing an individualized treatment. The variables include patient’s (i) unique prakriti (phenotype), (ii) manifestation of disturbed tri-dosha (body sub-system analysis), (iii) status of body tissues (seven dhatu), (iv) agni (metabolism or digestive process), (v) awasthaa (disease-stage), as well as (vi) desha and ritu (geographical place and season - as it impacts the patient’s body processes). There are others as well, such as ojas, praana, srotas, etc.

Q5: What is a treatment protocol?

A5: Protocol means the principles and logic to be employed in designing personalized treatment based on factors/variables of the disease and the patient, as explained above. (See Q3 for details.) Different drugs and advice about food and daily routine is given as prescribed by the vaidya.

Q6: Have there been any trials on Ayurvedic protocols? We hear of the rheumatoid arthritis study.

A6: In 2011, there was a study on rheumatoid arthritis (RA) conducted by US doctors (University of Berkeley) and Indian vaidyas (Coimbatore) on patients comparing Ayurveda and Allopathy. The study was funded by National Institute of Health, USA and not a pharma company. The issue of method came up when the US doctors wanted to compare modern drugs with ayurvedic drugs. The Indian vaidyas told them that they choose their drug and its duration based on the patient type, and many other factors. Thus, came the idea of evaluating a “protocol” rather than a molecule. The protocol was documented and the vaidyas participating in the study were told to follow the written protocol in the study, and not any other.

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The above study showed that the ayurvedic protocol (with its individualized drugs and advice) was as effective as modern allopathic drugs, but with lesser side-effects, which were very significant in this disease. We should remember that the proof of the pudding is in eating it!

Q7: How do we evaluate the result of treatment given to a patient?

A7: The result of a treatment of a patient would have to be judged based on whether the condition of the patient improved, whether there were no or lesser side-effects, and finally, whether the long term health became better and not just the immediate improvement in the condition.

The judgement is not based on what sophisticated instruments were used, how much costly drugs were given, or which health science was used. Ultimately the question is whether the patient got better and recovered from the illness, and developed good sustained health in the long term.

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Q8: What have been the results of ISM in treating Covid-19?

A8: The real life evidence and results of treating Covid-19 by Ayurveda, Siddha, etc. appear to be quite positive. Based on case studies which have also been published in journals of standing, the results look very good for prevention and treatment of mild and moderate conditions, and for post-covid conditions. See the Appeal to PMfor the references.
One significant observation seems to be that patients receiving ayurvedic treatment right from the beginning did not become critical.

Q9: Shouldn’t one wait for results of controlled trials before taking any steps using ISM?
 

A9: In the context of Covid, no pathy has a proven cure for the disease today, moreover there is urgency for treating the large number of patients affected by the disease. In such times, one starts based on the safety record of already practiced therapies in the respective disease areas, such as respiratory health, fevers, etc. The long standing experience of treatment given by ISMs, gives confidence that the ISM therapy is working well and has not produced any harmful effects.

The ayurveda physicians are licensed medical practitioners. Their interventions not only for covid but for dozens of conditions are legally sanctioned by Govt of India because they are in practice for hundreds of years. Drug regulators in all countries assess traditional practices in use for at least 15 years, without the same kind of trials as required for new experimental drugs.

This also brings in another question. Several expensive medicines used in allopathic treatment turned out to be useless. There were public announcements by the authorities about the withdrawal of advisories which were recommending their use. Perhaps there was not even this much evidence for benefits from these drugs, compared to what is available for Ayurvedic treatment protocols today. This suggets that we are following double standards as far as use of ISMs is concerned.

The Appeal to the PM is asking for ISM treatment to be made available to patients, as an option to those who desire it, and the conduct of large scale controlled clinical trials in government hospitals. (One should know that keeping patient documentation let alone doing control group studies, is extremely difficult for an individual practitioner. Controlled group trials require support to individual practitioner or an institutional setting.)
This can help india to share knowledge of ayurveda, siddha, etc. and the performance outcomes outside the country as well.

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Q9a: I am not opposed to Ayurveda, as well as other systems of medicine, having benefited from taking Ayurvedic medicines for colds and such ailments myself. However in a high stakes situation like Covid needing hospitalization, what can be done? (Question from allopathic doctor.)

 

A9a: A doctor in any pathy is trained in how to deal with extremely ill patients, and also recognize when he/she is not able to do much for a patient in a condition. Any competent and ethical Ayurvedic doctor would know their limits as well. This is why we are asking tha modern life-saving facilities be made available to patients whether they are being treated by allopathy or ISMs. This can be done when integrative hospitals are there with the choice left to the patient as to which pathy he/she wants to be treated by. And in case of emergency, life-saving facilities are available to the patient irrespective of how he/she was being treated.

Q10: What is prejudice in science?

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A10: Prejudice means not looking at real life data or evidence, and going by one’s private opinions, whether there is any basis for them or not.

In the case of Covid-19, there are several ayurvedic studies across the country which have shown promising results, three of which are mentioned in the Appeal to PM. Their results are published in journals of standing. Should they just be ignored and not even be tried systematically on a large scale? The appeal is asking for precisely this to be done.

Refusing to look at the data and refusing to do any further study is prejudice, what else is it? The appeal is asking for treatment and evaluation of treatment data in government hospitals, based on Indian System of Medicine.

Q11: Who is stopping the vaidyas to treat their Covid-19 patients?

A11: In some states, arrests have been made of vaidyas who were giving Ayurvedic treatment to their Covid-19 patients. In some cases, the police even sealed their clinics. They were told that they have to give only allopathic medicines (according to WHO guidelines). Unbelievable but true! After the intervention of public or some higher authorities in the respective states that they were released, and were permitted to use their clinics.

In any case, there is very little financial support for Ayurvedic treatment for Covid-19. Small in-patient public facilities, a weak distribution network for ayurvedic medicines, etc. Most importantly, there are hardly any funds for doing systematic research on patients getting Ayurvedic treatment.

Finally, what happens if an ayurvedic patient becomes critical? Is life systems support available for such patients in associated hospitals?

All the above become possible if there is an integrated facility. The appeal is to create integrated facilities and referral links so that emergency care can be managed by allopathy. And at the same time, data on efficacy of the treatments by Allopathy and Ayurvedic treatment has to be collected and analyzed. This is what the Appealis asking for.

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Q12: How do you look at advances in modern medicines, it has done wonders with its instrumentation in diagnostics and surgery.

A12: Modern medicine should be encouraged, but without preventing holistic, safe, systemic interventions by other health systems. Integrative health care in line with National Health Policy 2017, needs to be encouraged. Whereever prima facie evidence of safe covid management is available from a recognized system of medicine, it should be actively persued in public interest.

Q13: What does philosophy of science tell us about experimentation and verification of theories?

A13: There are more ways than one to look at the reality. For example, there are many ways to evaluate the medical intervention in case of a disease. The obsession with evaluating a “single” molecule or drug as the only method, is wrong and limiting. (See evaluation of treatment, or Q7 in this FAQ.)

By being limited in our thinking, we rule out better ways of intervening. Tomorrow, if there is “individualized” medicine using genetics, the drugs for treating the same disease would be different for different people. In such a case, how would you evaluate a single drug? It would be much better to evaluate the whole protocol of treatment.

Practice of modern medicine bases itself today largely on the cellular or molecular approach, whereas ISMs base themselves largely on the systemic level. For example, Ayurveda functions by examining and evaluating the factors in a disease, which are at systems or macro level. Allopathy functions today largely by looking at pathology and radiology.

Surely in future, the two would meet. But till then, we should adopt the approach based on what results are delivered in providing relief, or the effect on health of the patient today and in the long term.

Some of these decisions have to be clearly left to the patient as to which treatment/therapy they want to choose. But in a country with a mature legacy of legally sanctioned Indian Systems of Medicine, choices must be made available by both government and private sector as part of disease management policy.

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Additional Questions & Answers
(Questions mainly from interested allopathic doctors)

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Q14: What is “herbology" view of Ayurveda?

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A14: Herbology is a European term. It, alongside herbalism, refers to the use of herbs as medicine. Herbology is not recognized in any country as a complete system of medicine. Modern allopathic physicians unfamiliar with the depth of ayurveda knowledge system, have a “herbology" view of Ayurveda. What this means is the following:

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• I have diagnosed the disease,

• I know all about the disease and its prognosis,

• I have worked out the treatment plan,

• Can you give me a natural herb to supplement treatment?

 

This is not Ayurveda, this is “herbology"! By itself, herbology might still do some good as the herbal medicines might have lesser side-effects, but it is not Ayurveda.

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Most allopathic doctors are not aware of the alternative view/theory in Ayurveda regarding human body, about its illness and how to treat the patient. (See Q3 and Q4 in this FAQ.)

 

Q15: It is said that there are alternate views of body. How can there be two views of the same reality?

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A15: One way to understand the two views of reality is in terms of depth or levels of understanding. For example, common understanding in allopathy is that ghee causes obesity (fattiness). However, in Ayurveda, ghee is given in large amounts (25 ml to 100 ml) to patients in early morning on empty stomach for shodhanam (or cleansing) which may cause weight loss.

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It is the same human body (or reality), however, the body is complex. It behaves differently based on what processes are being activated. Unless there is an understanding of these “larger" processes, one might reach different, even opposite, conclusions. To resolve whenever such issues arise, is through careful experimentation and observation over a long period of time, at the systems level and not just at the cellular level.

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(Differences also appear in the results of therapeutic interventions tested in lab models like isolated cell lines or small animals and organisms versus what happens in the actual highly complex and interconnected human biological system. That is why, many drugs that appear promising in lab studies fail when applied in human trials, and some show adverse effects after several years of use, even after having been approved by regulatory bodies with due scientific testing.)

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Q15a: I do think that the ISMs are forms of medicine that are worthy of promoting but only once they adopt solid, comprehensible forms of communication of etiopathogenesis, mechanisms of action of their treatments, methods of measuring, monitoring illness/ treatment, as well as strategies to deal with acute/ emergent situations or crises.

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A15a: Ayurveda does have sophisticated etiopathogenesis but asking the Ayurvedic physician to explain their diagnosis and treatment in allopathic terms is not only being arrogant but also does a disservice. There are alternative ways, particularly systemic ways, of viewing and understanding the disease. In fact, many times the alternative ways are superior in treating the disease leading to long term benefits, rather than only short term solutions. One will have to put in effort and understand its etio-pathogenesis, which will lead to further progress in integrative medicine. (See Q3, Q4 and Q15.)

 

Q16: What else is there in Ayurvedic understanding other than “herbs"?

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A16: The materia-medica of Ayurveda comprises of around 2500 plants, around 300 animal products, and about 70 metals and minerals. These day animal products are not in active use, due to wild life restrictions.

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These natural products are used as whole fractions, based on an understanding of their systemic pharmacology (Dravya-Guna Shastra). The Ayurvedic pharmacology studies the action of natural products (fractions with multiple molecules) on key systemic functions (doshas) like anabolism, catabolism, bio-transmission. Allopathic pharmacology on the other hand, usually considers single active molecules and studies their effect on cellular functions. A simplistic way to understand the difference of “systemic" understanding versus “cellular" understanding, is to differentiate between macro- vs. micro-understanding of biological change. The two should complement each other because changes in a part impact the whole and vice-versa, but the correlation can only be discovered by new integrative cross-cultural discipline like Ayurvedic-Biology.

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The differences in outlook when not cooperatively reconciled result at times in controversy. For example, allopathy till recently held the view that dietary cholestrol is a major cause of heart diseases, and therefore advised that one should consume less fats, for example, ghee.

Ayurveda believes that the body naturally produces substances like cholestrol (recent studies also indicate that 85% of the serum cholestrol is produced by the body), therefore it holds that avoiding fats in diet is not so critical for health. In the Ayurveda view, ghee is considered essential for metabolic, cardiac and neurological functions. Based on these two alternate understandings/theories, the treatment and the approach to management of health is different.

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(Today it is recognized that Cholestrol, whether produced by the body or taken from outside, is NOT the cause of cardiac diseases! This assumption in allopathy has been found to be erroneous after being widely practiced in the allopathic world for a better part of the last century. Some have termed it as the scam of the century. Anyway, the drug companies have benefitted enormously from this mistaken assumption. See the latest findings on it in USA including retraction of advisories. Incidently, allopathic doctors have routinely used it to debunk Ayurvedic treatment based on cow ghee. (See "Dietary Cholesterol and Cardiovascular Risk: A Science Advisory from the American Heart Association" AHA Journals, Vol.141, 3, Dec, 2019, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000743.) )

 

Q17: Ayurvedic medicines are not subjected to the same level of testing as allopathic medicines.

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A17: The above is false.

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World Health Organization (WHO, UN) prescribes three key parameters for quality assurance of any drug. These are safety, quality and effectiveness. The International regulation regarding two parameters viz safety and effectiveness of traditional medicines in public use for periods in excess of 15 years, do not require same testing as required for new molecules which have not been used on humans before. However, the parameter of quality of medicine, irrespective of traditional use, does need regular testing.

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Sometimes, not all brands of medicines, whether in Ayurveda or in Allopathy, undergo the same level of testing for quality due to laxity of regulatory bodies NOT because of requirements of regulation. The consumers then rely on reputation of manufacturers. Fortunately, there are highly reputed companies on whom consumers can rely upon both in allopathy and ayurveda. but there are also few black sheep. The implementation of regulation needs to be strengthened by State and Central governments to weed out the black sheep. (Also see Q9.)

(Prepared by Prof Rajeev Sangal and Vaidya Shefali Sangal – with inputs from Ashok Jhunjhunwala, Darshan Shankar, JK Bajaj and AV Balasubramanian)

See PPST (Patriotic and People-oriented Science and Technology)
https://www.ppstindiagroup.in/covid-and-ayurveda Email: ppstindiagroup@gmail.com

7 September 2021 (version 2 with additional questions Q14 to Q17, and Q9a)
(Original version 1 released on 27 July 2021)