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Bridging Ayurveda with evidence-based scientific approaches in medicine

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• Published: 01 November 2014
• Volume 5 , article number  19 , ( 2014 )

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• Bhushan Patwardhan 1  

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This article reviews contemporary approaches for bridging Ayurveda with evidence-based medicine. In doing so, the author presents a pragmatic assessment of quality, methodology and extent of scientific research in Ayurvedic medicine. The article discusses the meaning of evidence and indicates the need to adopt epistemologically sensitive methods and rigorous experimentation using modern science. The author critically analyzes the status of Ayurvedic medicine based on personal observations, peer interactions and published research. This review article concludes that traditional knowledge systems like Ayurveda and modern scientific evidence-based medicine should be integrated. The author advocates that Ayurvedic researchers should develop strategic collaborations with innovative initiatives like ‘Horizon 2020’ involving predictive, preventive and personalized medicine (PPPM).

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Ayurveda is one of the traditional systems of medicine that practices holistic principles primarily focused on personalized health. Originated in India, Ayurveda is one of the ancient yet living health traditions. Ayurveda is commonly referred as ‘science of life’ because the Sanskrit meaning of Ayu is life and Veda is science or knowledge. Charaka Samhita , Sushruta Samhita (~400 BC–200 AD) and Ashtanga Hridaya of Vagbhata are main classics, which give detailed descriptions of over 700 herbs and 6,000 formulations. Madhav Nidan (~800 AD), a diagnostic classic, provides over 5,000 signs and symptoms. Life in Ayurveda is conceived as the union of the body, senses, mind and spirit. The concept of Prakriti or individual nature has a central role in Ayurveda therapeutics. With over 400,000 registered Ayurveda practitioners, the government of India has a formal structure to regulate its quality, education and practice.

Prolonged use of Ayurveda by people has also led to several home remedies for common ailments. Ayurvedic medicines contain sophisticated therapeutic formulations. Ayurveda is also a person-centered medicine (PCM), which deals with healthy lifestyle, health promotion and sustenance, disease prevention, diagnosis and treatment [ 1 ]. The holistic concepts of Ayurveda give emphasis to health promotion, disease prevention, early diagnosis and personalized treatment. There seem to be substantial similarities between the traditional systems like Ayurveda and the innovative approach of predictive, preventive and personalized medicine (PPPM) [ 2 ]. The Horizon 2020 initiative of the European Union rightly considers PPPM as the hardcore of its strategy [ 3 ].

The need for scientific evaluation of Ayurveda has been recognized for a long time [ 4 ]. Ayurveda has personalized approach involving constitutional assessment, which can guide primary prevention, diagnosis and therapeutics. Ayurveda also offers detailed guidance about food, nutrition and diet as per the individual constitution or Prakriti as well as seasons [ 5 ]. The scientific value of basic principles of Ayurveda like Prakriti is being studied in context to biology and genomics [ 6 ].

Ayurveda as an ancient science of life has a long history, and its basic principles may be valid even today. However, essence of any science is a continuous quest for new knowledge through research, development and newer applications. The mode of manifestation of disease has changed. The geo-climatic environment, plants, animals and microbes have changed. Human behavior, lifestyle and genetics have changed. Clearly, classical Ayurveda of yesteryears cannot be blindly practiced without contemporary modifications. Continuous research on safety, quality and efficacy of Ayurvedic drugs and procedures is needed. Systematic documentation and critical analysis of clinical practice are necessary. Sanskrit savvy scholars from India should not be considered as the only custodians of knowledge and practice of Ayurveda. Several Western scholars like Meulenbeld have contributed to emergence of the new Ayurveda [ 7 ]. Many countries in the world especially Germany, Italy, Hungary, Switzerland, United States have institutions where Ayurveda is correctly practiced with respect to traditions and high professional competence [ 8 , 9 ].

Ayurveda was meant to be open for new ideas, principles and knowledge for continuous and systematic progress. However, its progression seems to be stalled during the last several centuries resulting in chronic stagnancy of today. Heritage pride and past glory-based emotional attitudes seem to be predominant among practitioners as against evidence-based quest of scientific research. There seem to be an evident complacency, defensive and dogmatic attitude and often pure sentimentalism rather than a pragmatic scientific outlook. We need to recognize that emotions, experience and evidence are not mutually exclusive. Becoming modern is not a crime; it does not prevent anyone from maintaining cultural identity. No tradition is a static entity; modernity results from evolving traditions. For instance, Charaka would not have ignored technologies like electron microscope if they had been available during his time [ 10 ]. While accepting modern tools and technologies, it is equally important to respect epistemological value of knowledge system like Ayurveda. Embracing modernity by Ayurvedic community does not mean blind acceptance of Western logic and reductive methodologies. In fact, increased recognition to disciplines like systems biology is indicative of modern science moving towards holistic concepts. Therefore, this may be the opportune time to facilitate integration of Ayurveda, Western biomedicine and modern science.

Recently, many experts and critiques have raised concerns that while the popularity of traditional and complementary medicine (T&CM) is growing, this sector is still grappling to discover appropriate models and demonstrate sufficient scientific evidence [ 11 ]. Ayurvedic medicine is no exception to these concerns. However, for understanding Ayurveda from modern terms, one also needs to understand its epistemology.

The objective of any medical research should be to assess health effects, minimize bias, chance effects and confounders. A well-designed rigorous scientific research on medicines and therapeutic practices of Ayurveda is necessary. The Ayurveda sector has to take cognizance of important initiatives like standards for reporting observational epidemiology (STROBE) and consolidated standards on reporting trial (CONSORT) in the methodological domain to develop epistemologically sensitive appropriate methods. Evidence-based Ayurveda needs appropriate blends of modern science, rigorous trial methods and observational studies. Arguably, the nature of evidence in case of Ayurveda may be different from that of Western biomedicine. The status of Ayurveda as an evidence-based medicine is also reviewed here.

The evidence in right perspective

In philosophy, evidence is closely tied to epistemology, which considers the nature of knowledge and how it is acquired. Many proponents of T&CM sector argue that inability to measure something using present scientific methods is not a proof of its nonexistence. However, inability of measuring something is certainly not a proof of its existence.

It is also argued that future studies involving comparisons of T&CM systems with modern medicine need to be on the leveled playing field for evaluating outcomes from both an allopathic and a whole-system points of view [ 12 ]. Instead of any hierarchy of evidence, a circular model has been proposed to arrive at pragmatic but rigorous evidence which would provide significant assistance in clinical research [ 13 ]. Appreciably, over a period of time, traditional Chinese medicine (TCM) is starting to create large body of scientific evidence to support safety, pharmacology and clinical efficacy [ 14 ]. Ayurvedic medicine also needs to first discover epistemologically sensitive methods and then build objective scientific evidence with reasonable consistency to justify clinical decision making and therapeutics.

Ayurveda epistemology

The epistemology of Ayurveda is based on the relation between microcosm and macrocosm involving five basic elements ( mahabhoota ), three dynamic principles similar to humors ( dosha ), seven types of tissues ( dhatus ) and many other unique concepts. An introduction to basic concepts may be useful for readers who are not familiar with epistemology of Ayurveda [ 15 ]. In general, Ayurveda is experiential, intuitive and holistic, whereas that of the modern medicine is based more on experimental, analytical and reductive reasoning. The relationship between Ayurveda and modern science is similar to the relationship between the ‘whole’ and the ‘parts’, where the sum of the parts need not be equal to the whole [ 16 ]. Modern medicine is based more on rationalism, reductionism with deeper understanding of molecules, cells, organs or diseases as parts. In the process, however, the sight of the whole person seems to have been somewhat neglected. Integrative, whole system approaches like PPPM and PCM as well as traditional and holistic systems like Ayurveda may need epistemologically sensitive research methodology.

Ayurveda is uniquely patient-oriented where the Ayurvedic physician diagnoses, treats and dispenses medicine to every individual patient. This important principle can form the basis for a form of personalized medicine which will give maximum therapeutic efficacy and high safety to a particular person with a particular disorder, under specified conditions depending on individual constitution, and properties of materials. Prakriti specific prescription may also include supportive therapies, diet and life-style advice so as to regain physiological balance, finally resulting in the removal of the disorder. A decision-support system known as AyuSoft (developed by Center for Development of Advance Computing and University of Pune, Ganeshkhind, Pune India) based on Ayurveda knowledge has been shown to be useful in determination of individual Prakriti and personalized treatments [ 17 ].

The conventional, experimental and diagnostic methods based on pathophysiology mostly rely on limited markers as evidence of health [ 18 ]. Applicability of such restrictive approaches to understand complex systems like Ayurveda has been questioned. Person-centered integrative medicine, which considers the whole person, needs new sets of experimental methodology. Holistic complex systems like Ayurveda may need approaches like the Bayesian theory rather than a classical statistical frequentist approach [ 19 ]; however, no serious experimental efforts have been made to test this hypothesis [ 20 ].

• Evidence-based medicine

Works of famous scientist Archie Cochrane on efficacy and effectiveness [ 21 ] and meta-analysis as a method of summarizing the results of randomized trials [ 22 ] have led to a powerful research and analysis tool in the form of ‘systematic reviews’, which empowered clinicians and researchers decision making. These efforts finally led to the evolution of evidence-based medicine (EBM) as a new approach to bring more rational and analytical evidence for research-backed practice of medicine [ 23 ]. The principles of EBM consider consistency of clinical practice quality and quality of scientific evidence to develop evidence-based practice.

In the following section, we have critically analyzed present situation regarding these two important aspects and have reviewed the status of Ayurveda as an evidence-based medicine.

Evidence base for Ayurvedic medicine

It is very important to review available evidence in the right perspective. In case of Ayurveda, the evidence can be drawn from two main sources. First, source of evidence may be based on historical, classical and present nature of clinical practice. Here, the documentation of practice to support various claims is very crucial. Mere reference to classical texts is not sufficient as evidence for practice. The second source of evidence may be based on scientific research to support various theories, medicines and procedures used in Ayurvedic medicine. A critical situation analysis of present status of clinical practice and scientific research on Ayurvedic medicine may be necessary at this stage.

Clinical practice

Arguably, the clinical practice of classical Ayurveda is rare. Ayurvedic practitioners are reported to adopt allopathic practices for better acceptance in urban settings [ 24 ]. Although, huge knowledge resource and wisdom is available from many Ayurveda classic books, systematic data on actual use and evidence of reproducible outcomes is not available in public domain. Standard treatment protocols for practitioners are not available. Systematic documentation and reliable data on pharmacoepidemiology and pharmacovigilance for clinical practice, safety and adverse drug reactions are not available as open access, although a modest beginning has been made [ 25 ]. The status of professional [ 26 ] and continuing education [ 27 ] as well as attitudes of practitioners towards safety [ 28 ] are also worrying. As per present regulations in India, no scientific or clinical data is required for manufacture and sale of classical Ayurvedic medicines. Technically, sound pharmacopoeia, good manufacturing practices, quality control and pharmaceutical technologies for Ayurvedic medicine are still evolving [ 29 , 30 ]. Issues related to appropriate research methodologies or treatment protocols for Ayurveda have also not been properly addressed. Many critiques are demanding better coordination between stakeholders, continuous dialogue with scientific community [ 31 ] and total overhaul of the curriculum and pedagogy along with the need for crosstalks between different streams [ 32 ]. Recent report on status of Indian medicine and folk healing indicates the need to strengthen research and use of Ayurveda, yoga, unani, siddha, homeopathy (AYUSH) systems in national health care [ 33 ]. The need for innovation is also urged by thought leaders in this sector [ 34 ]. In short, the evidence base to support good clinical practice, guidelines and documentation in Ayurvedic medicine remains scant and grossly inadequate.

Scientific evidence

Controlled clinical trials are taken as the highest level of evidence. Ayurveda lags far behind in scientific evidence in quantity and quality of randomized controlled clinical trials (RCTs) and systematic reviews. For instance, out of 7,864 systematic reviews in the Cochrane Library, Ayurveda has just one, while homeopathy and TCM have 5 and 14, respectively. Substantial grants have been allocated to ambitious national projects involving reputed laboratories. However, the design, methodology and quality of clinical trial on Ayurvedic medicines seem to lack the expected rigor [ 35 ]. Of course, this does not mean that the RCT model is suitable to clinical research in Ayurveda. RCTs have already been subjected to criticism [ 36 ]. Value of observational studies cannot be ignored. Certainly, there is a need to develop appropriate research methodology for complex whole system, whole-person-centered clinical trials as an alternative to RCTs. Already, scientists are advocating robust clinical study designs based on personalized approach and metabolomics with only one patient [ 37 ]. Thus, non-suitability of RCTs should not be used as an excuse for avoiding rigorous scientific research and clinical documentation.

Few noteworthy attempts related to research and practice include a national program on Ayurvedic biology [ 38 , 39 ], Ayugenomics [ 40 ], whole systems clinical research [ 41 – 43 ], good clinical practices guidelines, digital helpline [ 44 ], decision support system AyuSoft, and systematic reporting standards on lines with CONSORT for Ayurveda [ 45 , 46 ]. Recent efforts to develop robust clinical protocols for comparing effectiveness of complex Ayurvedic and conventional treatments are laudable [ 47 ]. Other notable efforts related to integrative therapy for leishmaniasis have been able to generate sufficient scientific evidence [ 48 ]. Agreeably, many of these efforts could not produce any remarkable products, processes or protocols, and desirable impact on a scientific community is yet to be seen. The need to enhance collaborative culture between Ayurvedic and modern scientific communities has been rightly stressed [ 49 ].

As a result, Ayurvedic medicine continues to remain subcritical in research publications, which is an important indicator of external evidence [ 50 ]. The present scientific evidence in support of Ayurvedic medicine remains extremely poor. The House of Lords and European Union have put several restrictions on Ayurvedic medicines [ 51 ]. Many articles lamenting poor quality of Ayurvedic medicines, presence of heavy metals and other safety compromising substances have been published [ 52 , 53 ]. This situation may lead to further denigration, which can adversely impact the development of evidence base for Ayurveda.

Ayurvedic genomics and epigenomics

According to Ayurveda constructs, doshas are the dynamic principles, which govern a person’s physical, physiological and psychological functions including metabolism. Ayurveda describes three doshas namely vata, pitta, and kapha. The proportional domination of doshas in an individual is expressed as Prakriti , which broadly mean a body type or individual nature. An Ayurvedic physician determines the Prakriti of a patient so as to personalize treatment. The Ayurvedic description clearly suggests that the innate dispositions are represented by individual Prakriti , which represent phenotypes. Classifying humans based on phenotypes still remains a challenge to biomedical science. A number of research groups are now investigating the correlation between Ayurvedic phenotypes and individual human genotypes. A pioneering study showed significant correlation between HLA alleles and Ayurvedic Prakriti type [ 54 ]. Later, it was also hypothesized that different Prakritis may possess different drug metabolism rates associated with drug-metabolizing enzyme polymorphism. In another genotyping study, significant correlations between CYP2C19 genotypes and major classes of Prakriti types have been reported [ 55 ]. A project to study genomic variation analysis and gene expression profiling of human, Prakriti based on the principles of Ayurveda is underway. Now, it is hoped that going beyond genomics is necessary to understand how environment and behaviors can be responsible for inheritable changes when the genome remains unchanged. This science of epigenetics is seen as a future hope to get answers to many puzzles. It is felt that detailed understanding of Ayurvedic concepts like Prakriti may actually facilitate this process. However, no specific genotype has yet been specifically related to a Prakriti type.

Ayurvedic concept and predictive diagnosis

Modern biomedicine recognizes progressive nature of diseases like cancer and diabetes. It is known that slow yet progressive pathophysiological changes result in a transition from a healthy state to diseased state. Ayurvedic concept of shatkriyakaal elaborates a six-stage progressive transition from balanced to unbalanced stage leading to disease manifestation in a person. These six stages are unique and may help early recognition and early diagnosis much before onset of measurable clinical symptoms of diseases. It is possible to undertake a systematic cohort study by stratifying patients in the six categories. Each of the cohorts can be carefully followed up to study pathophysiological, genetic, and epigenetic and metabolomic differences. This may give leads towards the identification of new markers and early predictions, which can then be used for prevention and personalized treatments.

Thus, Ayurveda and PPPM concepts have many similarities, where both do not merely consider concept of disease in isolation but consider the diseased ‘person’. The need to define a common model of health and disease between the western and eastern knowledge systems has been pointed out earlier [ 56 , 57 ]. Therefore, a collaborative project based on concepts of PPPM and Ayurveda may help to better understand disease progression and predictive diagnosis of diseases like cancer and diabetes. In this context, recent efforts to correlate traditional Ayurvedic and modern medical perspectives on cancer are very relevant. In a qualitative study, it was observed that Ayurvedic medicine offers a unique perspective on the biomedical diagnosis of cancer. Due emphasis on restoring wholeness, use of natural remedies focus on emotional health, and emphasis on prevention strategies were found to be unique features of Ayurvedic interventions [ 58 ].

Moving towards evidence base

Several issues need to be addressed for Ayurveda to move towards acceptable evidence base. Concerns related to protocols, problems and potential of Ayurveda in context to evidence-based T&CM have been recently discussed [ 59 ]. Few critiques have opined that basic concepts of Ayurveda should not be distorted to suit convenience or availability of biomedical research models [ 60 ]. Arguably, prevailing pre-clinical methods and clinical models like RCTs may not be suitable to validate Ayurvedic medicine. However, the onus of developing suitable models to build necessary evidence must be voluntarily accepted by the Ayurveda sector. Some efforts in the direction to conduct the whole system clinical trials are already in progress [ 61 ].

A critical review and analysis indicate that the present Ayurvedic medicine is severely deficient in scientific evidence related to clinical practice and scientific research. Ayurveda sector needs to go beyond mere scholarly recitals, reviews and defensive interpretations, which are abundant in current literature. Ayurveda needs to be studied and experimented with help of new models based on modern science and biology. Ayurvedic medicine needs more rigorous scientific research for evaluating safety, quality and efficacy [ 62 ]. Many lessons learned in the past may guide our quest for evidence-based Ayurveda in the future [ 63 ]. It may be worthwhile to learn from collaborative research networks like IN-CAM from Canada [ 64 ] and CAMbrella from Europe [ 65 ]. Ayurveda sector needs to get connected with Indian and global scientific networks not as a bureaucratic process but for scientific and professional pursuits.

Conclusions

This review and analysis is carried out with a caveat that the methods and evidence approach of biomedicine may not be directly applicable to Ayurveda. However, either Ayurveda has to discover its own methodology and approach for evidence or should face the critical analysis as per the conventional approach of EBM. Avoiding any critical appraisal under the pretext that it is a holistic system and that the present methods like randomized controlled trials are not applicable may not sustain for a long time.

The Ayurvedic sector should urgently recognize and address the need for scientific evidence [ 66 ]. Systematic documentation, appropriate methodology and rigorous experimentation in accordance with good practices coupled with epistemologically sensitive approaches will remain crucial to move towards evidenced-based Ayurveda. Key factors crucial for Ayurveda to move towards evidence-based scientific approaches related to quality of drugs and practices are portrayed in Figure  1 . The question of epistemologically sensitive methods is relevant only to biomedical laboratory and clinical research. The good agricultural practices for procurement of raw materials and good manufacturing practices for Ayurvedic drugs must be in accordance with the globally accepted norms.

Key factors for evidence-based Ayurvedic medicine.

Integration of PPPM and Ayurveda

The new philosophy of health care is moving from illness to wellness, from treatment to prevention and early diagnostics and from generalized approach to personalized medicine. As discussed in this review, there are several similarities between the concepts of PPPM and Ayurveda. Search of novel models for integrative medicine indicates the need for collaborations between traditional systems like Ayurveda and contemporary western biomedicine [ 67 ]. Agreeably, many concepts from Ayurveda have not yet been validated with help of modern science. Therefore, it is felt that collaborative efforts between scientific researchers from Ayurveda and PPPM seem to be a mutually beneficial proposition. Such integration bringing the best of the western biomedicine and eastern traditional knowledge systems like Ayurveda may lead to high impact projects. Suitable industry collaborators can also be roped in from both respective regions. Thus, the three dimensional priority of ‘Horizon 2020’ can be effectively addressed through integration of PPPM and Ayurveda. Such integration certainly has contemporary significance and will help to address societal challenges presently faced in the global health care sector.

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Acknowledgements

I thank Gururaj Mutalik and Girish Tillu for their valuable inputs and research assistance. I gratefully acknowledge open access support especially from Google Scholar, Pubmed, and Cochrane Collaboration. Financial support from Board of College and University Development, Savitribai Phule Pune University is gratefully acknowledged.

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Patwardhan, B. Bridging Ayurveda with evidence-based scientific approaches in medicine. EPMA Journal 5 , 19 (2014). https://doi.org/10.1186/1878-5085-5-19

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Ayurvedic research and methodology: Present status and future strategies

Affiliations.

• 1 Department of Biotechnology, Faculty of Biomedical Sciences, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.
• 2 Department of Phytochemistry, Faculty of Biomedical Sciences, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.
• 3 Vice Chancellor, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India.
• 4 Department of Pharmaceutical Sciences, Tshwane University of Technology, Pretoria, South Africa.
• PMID: 27833362
• PMCID: PMC5041382
• DOI: 10.4103/0974-8520.190699

Ayurveda is a science of life with a holistic approach to health and personalized medicine. It is one of the oldest medical systems, which comprises thousands of medical concepts and hypothesis. Interestingly, Ayurveda has ability to treat many chronic diseases such as cancer, diabetes, arthritis, and asthma, which are untreatable in modern medicine. Unfortunately, due to lack of scientific validation in various concepts, this precious gift from our ancestors is trailing. Hence, evidence-based research is highly needed for global recognition and acceptance of Ayurveda, which needs further advancements in the research methodology. The present review highlights various fields of research including literary, fundamental, drug, pharmaceutical, and clinical research in Ayurveda. The review further focuses to improve the research methodology for Ayurveda with main emphasis on the fundamental research. This attempt will certainly encourage young researchers to work on various areas of research for the development and promotion of Ayurveda.

Keywords: Ayurvedic research and methodology; Rasayana; personalized medicine; traditional medicine.

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Integration of Ayurveda and allopathic medicine: Opinion of experts who participated in the working group meetings for the preparation of the WHO benchmarks for the training and practice of Ayurveda

Berra, Jorge Luis

Fundación de Salud Ayurveda Prema, Buenos Aires, Argentina

Address for correspondence: Dr. Jorge Luis Berra, Santa Fe 3373 6 B (1425) Buenos Aires, Argentina. E-mail: [email protected]

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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The World Health Organization (WHO) has recognized the importance of integrating traditional systems of medicine, including Ayurveda, with conventional medicine, and has taken several initiatives to promote this integration. The Ministry of AYUSH, Government of India, agreed to host two WHO Working Group Meeting that took place at National Institute of Ayurveda (2018) and at Institute of Teaching and Research in Ayurveda (2019) for developing the WHO Benchmarks in Ayurveda with the participation of 27 experts from the six regions of World Health Organization. These WHO Benchmarks on Training and Practice of Ayurveda were published in March 2022. Excluding the author, 23 (89%) of the experts which participated in the said meetings answered a questionnaire about the integration of Ayurveda and allopathic medicine. A very significant majority of these experts (95%) considered that Ayurveda can make important contributions to conventional medicine and are in favor of the integration of Ayurveda and allopathic medicine. There is also a majority consensus that conventional physicians should have training in Ayurveda at both the undergraduate and graduate levels and that they should have training in Ayurvedic remedies. A large proportion of the experts consulted consider the prevailing view in the Ayurvedic government and official environment in India to be in favor of integration with allopathy, and a significant but somewhat smaller number appreciate this same trend in the Ayurvedic academic field of India. It is significant that almost two thirds believe that in the West, Ayurveda should be a specialty within conventional medicine.

Introduction

The World Health Organization (WHO) has recognized the importance of integrating traditional systems of medicine, including Ayurveda, with conventional medicine and has taken several initiatives to promote this integration. The WHO Traditional Medicine Strategy 2014–2023 emphasizes integrating traditional and complementary medicine, including Ayurveda, into national healthcare systems. The strategy includes recommendations for promoting research, regulation, and training in traditional and complementary medicine. [ 1 ] The initiatives from WHO aim to promote the integration of Ayurveda and other traditional systems of medicine with conventional medicine to improve access to safe and effective health care for all.

The Ministry of AYUSH, Government of India, agreed to host the WHO Working Group Meeting

for developing the WHO documents, Benchmark for Practice in Ayurveda, Benchmark for Practice in Unani, and Benchmark for Practice in Panchakarma at the National Institute of Ayurveda, Jaipur, from September 17 to 19, 2018. [ 2 ] The Ministry of AYUSH and WHO organized the International Experts Consultation Meeting for developing the WHO documents Benchmarks for Practice in Ayurveda, Benchmarks for Practice in Unani, and Benchmarks for Practice in Panchakarma and Updating the Benchmarks for Training in Ayurveda, and Benchmarks for Training in Unani which was held at IPGTR&A at Jamnagar, India, November 26–29 2019. After meticulous review processes, in March 2022, they were presented at the Geneva headquarters with the participation of Dr. Tedros Ghebreyesus, General Director of WHO, and Vd. Rajesh Kotecha, Secretary of Ayush, the “WHO Benchmarks for the training of Ayurveda” and “WHO Benchmarks for the practice of Ayurveda.” The “WHO Benchmarks for the Training of Ayurveda” is an update of its previous version published in 2010. [ 3 ]

It could be helpful and relevant to consult the opinion of experts from the six WHO regions about different aspects related to the integration of Ayurveda and conventional medicine.

Materials and Methods

The Ayurveda experts who participated in these meetings have answered a questionnaire related to a Ph.D. research project about “Trends, contributions and challenges in the integration between Ayurveda and allopathic medicine.” The questionnaire was answered on the spot by 21 experts, while two others sent their responses by mail.

Twenty-seven experts participated in the two meetings; eight participated in both meetings, six only in the first and another 13 only in the second. Three people did not answer the questionnaire, and the author of this paper was also excluded from the investigation. The responses of 23 experts who have the following characteristics were considered:

• Place of residence: 10 resided in India, 2 in the USA, and another 2 in Malaysia, while only one expert per country attended from Spain, Germany, Italy, Latvia, Mauritius, Switzerland, Tanzania, Russia, and the UAE.
• Sex: 17 males and six females
• Average age: 52 years
• Original training: Ayurveda 16, Allopathy 5, Ayurveda and Allopathy 1, Heilpractitioner 1

Training time in Ayurveda: More than 20 years 18; between 11 and 20 years 2; between 1 and 5 years 1; without training in Ayurveda 2 (members of regulatory offices in their countries of origin) [ Table 1 ].

Today’s globalization allows different visions of health to come into contact. Integrating Ayurveda and allopathic medicine is a complex and highly topical reality that arises both in India and the West. It is of great importance to know, through the verification of authorized opinions, the trends to draw conclusions that may be useful in different countries.

A significant majority of experts favor integrating Ayurveda and allopathic medicine, considering that both medical systems must take measures to promote this process. The almost unanimous opinion emphasizes that Ayurveda can make outstanding and vital contributions to conventional medicine and that its knowledge by doctors would help improve patient care outcomes. There is also a majority consensus that conventional physicians should have training in Ayurveda at both the undergraduate and graduate levels and that they should have training in Ayurvedic medicines. A large proportion of the experts consulted to consider the prevailing view in the Ayurvedic government and official environment in India to favor integration with allopathy, and a significant but somewhat smaller number appreciate this same trend in the Ayurvedic academic field of India. There would be a current favorable to the integration on the part of the Ayurvedic doctors of India, but opposing opinions are appreciated on the part of the allopathic doctors of India. Significantly, almost two-thirds believe that in the West, Ayurveda should be a specialty within conventional medicine.

The integration of Ayurveda and allopathy has several potential advantages, including:

• Holistic approach: Ayurveda focuses on the holistic approach to health, which includes physical, mental, emotional, and spiritual well-being. Integrating Ayurvedic principles into allopathy can help to provide more comprehensive and personalized health care.
• Prevention: Ayurveda emphasizes the importance of preventing disease before it occurs through lifestyle modifications and the use of natural remedies. Integrating Ayurvedic principles into allopathy can shift the focus from treating disease to preventing it.
• Safety: Ayurvedic interventions are generally considered safe and have fewer side effects compared to some allopathic medicines. Integrating Ayurveda with allopathy can help to reduce the risk of adverse reactions to conventional medicines.
• Cost-effectiveness: Ayurvedic interventions are often more cost-effective than allopathic medicines. Integrating Ayurveda into conventional health care can reduce healthcare costs and improve access to healthcare for all.
• Complementary approach: Integrating Ayurveda with allopathy can provide a complementary approach to health care. By combining the strengths of both systems, patients can benefit from a more holistic and personalized approach to health care.

It is highly likely that the publication of the benchmarks by the WHO, along with the actions taken by the Ministry of Ayush in India, as well as academic and research initiatives undertaken by renowned Ayurvedic institutions, and the growing interest in Ayurveda observed in the majority of countries, will stimulate a fruitful dialogue between these two medical systems that undoubtedly will benefit patients and the general population.

The sample was representative of the experts invited by the WHO and Ministry of Ayush to prepare the Benchmarks on Ayurveda. Although the response rate was good for a survey instrument, the sample was small, and it cannot be ensured that the experts’ answers represent the majority opinion on the subject. Since the study is cross-sectional rather than longitudinal, we do not have information on the actual attitude change over time. Due to the study’s limitations, it is necessary to carry out more representative studies of the opinions on the subject in the different WHO regions.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Ayurveda; WHO benchmarks; integrative medicine

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The Significance of Ayurvedic Medicinal Plants

1 University of Duisburg-Essen, Essen, Germany

Gustav J. Dobos

Thomas rampp.

Traditional Indian medicine (ayurveda) is becoming increasingly popular, with many chronic conditions responding to it well. Most patients begin to take conventional medications as soon as their diagnoses are made, so ayurvedic treatments are usually undergone alongside and/or after conventional medical approaches. A detailed knowledge of the action of food, spices, and medicinal plants is needed in order to understand their potential influence fully. While societal use of ayurvedic plants and Indian spices is commonplace, without ill effect, the use of more concentrated products made from single plants, often in the form of teas or tablets, is of more concern. The mechanisms by which polyherbal drugs and their extracts act differ in many respects from the actions of single substances or synthetic drugs. Despite the fact that ayurvedic medicines are based on natural herbal materials, their safety depends on their method of administration, taking into account individuals’ needs and their specific disease conditions.

Traditional Indian medicine (or ayurveda) is becoming increasingly popular in Europe, with many chronic conditions responding to it well. While conventional medicine dominates many fields in this market, it does not always outperform traditional ayurvedic approaches. Conventional medicine frequently relies on lifelong medication, on which patients come to depend. Many medications have side-effects, and withdrawal symptoms that, if the medications are later discontinued, can become problematic. In such circumstances, ayurveda has much to offer. Patients generally respond well to ayurvedic treatments, experiencing a reduction, and sometimes even a cessation, of their symptoms. Most patients begin to take conventional medications as soon as their diagnoses are made, so ayurvedic treatments are usually undergone alongside and/or after conventional medical approaches. Patients therefore tend to experience ayurveda once their conditions have progressed. Despite this, much can be done to minimize conditions’ symptoms and control their progress. Ayurveda can help improve patients’ symptoms by reducing their cortisone and analgesic usage, thereby enhancing their quality of life.

The public constantly seeks out new health care approaches. In this situation, ayurveda is an easy target for bogus health claims. Many of the available books are inauthentic—a product of unqualified authors’ ideas and fantasies. Short-term courses similarly vary greatly in the quality of the teaching provided and the qualifications thereby obtained. While ayurveda is becoming increasingly popular, which is a positive development, care must be taken against its mismanagement, especially given the vast array of spurious “ayurvedic” products currently on the market.

Concepts Underpinning Ayurvedic Medicine

Traditional Indian medicine, or ayurveda, is based on a traditional medical system, in the same way as traditional Chinese medicine, with both being developed in their respective geographic regions. Ayurvedic practice is around 3000 years old, with a long history of managing disease. The 3 basic principles, called doshas ( vata , pitta , and kapha ), are derived from 5 elements of Indian philosophy. Ayurveda’s doshas can be identified as regulatory control factors for fundamental physiologic processes in living systems that maintain their identity throughout biologic history: vata and its subdoshas regulating input/output processes and motion; pitta and its subdoshas regulating throughput, turnover, and hence energy; and kapha and its subdoshas regulating storage, structure, and lubrication. 1

Factors such as food, activity, the climate and stress can, however, disrupt or destroy these functions. Ayurveda seeks to normalize body functions with varied techniques including advice on food and activity, internal herbal preparations, purification treatments ( panchakarma ), and surgical methods ( shalya chikitsa ).

Oral administration routes play a major role in influencing individuals’ doshas , via the ingestion of food, spices, and medicinal plants. These elements are influencing doshas in different ways: stabilizing, disturbing, and supporting the body’s healthy state. A detailed knowledge of the action of food, spices, and medicinal plants is needed in order in to understand their potential influence fully.

Ayurvedic Medicinal Plants

Ayurveda first seeks to diagnose patients’ conditions before treating them with internal preparations, diet, and habit restrictions. Plant-based preparations play a major role in the ayurvedic healing process. In broad terms, there is no substance in the world that cannot be used as a potential medicine. 2 Traditional ayurvedic texts warn against the use of substances that are not adequately understood. 3 Any plant, animal, or mineral substance can be incorporated into the ayurvedic pharmacopeia, but only if it is understood fully, in terms of its nomenclature, identity, properties, and applications. 4 The texts also warn against the abuse of well-known medicines, emphasizing the point that even poisons can have medicinal properties when used appropriately, whereas the best of medicines can be harmful if improperly used. 3 Of nearly 10 000 plants used for medicinal purposes in the Indian subcontinent, only 1200 to 1500 have been incorporated into the official ayurvedic pharmacopeia in more than 3000 years. All plants must be studied thoroughly before becoming part of the ayurvedic pharmacopeia. 3

Actions of Foods, Spices, and Medicinal Plants

The role of food.

Food plays a major role in ayurvedic practice by supporting the body’s healing processes. Metabolic diseases and diseases of the gastrointestinal tract are directly influenced by food. Food can also indirectly affect diseases of the skin, muscles, and joints, as well as neurological, gynecological, and psychological disease.

Infrequent consumption is unlikely to cause a problem, but frequent consumption of inappropriate foods will cause disease or worsen existing disease. Advice on food depends not only on the disease but also on the disease condition and the dosha involved. Because of this, food advice may change throughout the course of a disease, depending on the stage reached. Interactions between foods and medicines are a major issue. The advice given with regard to food must take account of the medicines prescribed, otherwise potential interactions may worsen patients’ conditions.

The Action of Indian Spices

The second strongest influence on patients’ doshas , after food, is spices. Many spices are strong by nature. Spices are obtained from the roots, flowers, fruits, seeds, or bark of plants or herbs. Spices are native to warm, tropical climates. Coming from woody or herbaceous plants, spices have a different active principle, which gives them specific characters. These active principles have specific functions within the body. The phytochemicals within spices are secondary metabolites, which serve to protect the plants from damage by insects, animals, fungi, pathogens, and parasites. Before consumption, most spices are dried to degrade these chemicals. Drying also increases the resulting spices’ shelf life and potency.

The action of spices within the body differs according to the ways that they are used. Spices are mostly used for their natural flavor and aroma in processing food. In addition to adding taste, some spices (cumin, ginger, coriander) also have preventative effects, aiding digestion through the production of digestive enzymes. When mixed with digestive juices, these substances aid absorption. Such spices have individual effects, their actions depending on the constitution of the person concerned and their disease. Indian food is becoming increasingly popular and is often seen as healthy. From an ayurvedic perspective, healthy food is food that is used in a healthy way. From this viewpoint, spicy and pungent foods are not necessarily “good” foods. Indian food is not automatically ayurvedic, because the latter insists that individual’s health situation be taken into account. People with gastric hyperacidity or gastric or intestinal inflammation may find their health worsened by exposure to some Indian spices.

Approximately 90% of ayurvedic preparations are plant based. Ayurvedic plants have a stronger action on the body than either food or spices. Such actions enable the plant to reverse pathophysiological processes and stabilize the doshas . For this reason, one should use such plants with caution. Classical ayurvedic preparations, made from such plants, are known as “yoga” in Sanskrit. Yogas have developed following years’ of practical experience combining plants to get the optimal effect.

Polyherbal combinations have also proven lastingly effective than single herbs. In ayurveda, most of the classical preparations are polyherbal, with a combination of 3 to 30 plants involved. These constituents are combined accurately, in such a way that the formula is balanced and reproducible. One or two of the plants in these combinations will be active and the others will play a supporting role. The supporting herbs will each have different actions, acting as catalysts to help proper absorption, transportation, and to reduce toxicity. If an ideal combination is delivered, then the result can be excellent, but such outcomes are based on thorough plant knowledge (see Figure 1 ).

Concept of the increasingly intense influence of food, spices, and medicinal plants on the body.

Ayurvedic Plants: Misuse and Self-Medication

While societal use of ayurvedic plants and Indian spices is commonplace, without ill effect, the use of more concentrated products made from single plants, often in the form of teas or tablets, is of more concern. Ayurvedic plants are generally seen as safe and free from side effects, which is not always true. Table 1 lists some undesirable effects of improper use of ayurvedic herbs. Some of the common plants sold in the market are tulsi ( Figure 2 ), guduchi ( Figure 3 ), and pippali ( Figure 4 ).

Effects and Side Effects of Commonly Propagated Ayurvedic Herbs in the Market.

Tulsi ( Ocimum sanctum ).

Guduchi or amrut ( Tinospora cordifolia ).

Pippali ( Piper longum ).

Ayurveda Branding as Teas

Classified as vata , pitta , or kapha teas, these products are marketed for their supposed beneficial effects on individuals’ corresponding dosha problems. From an ayurvedic perspective, diseases certainly seem to arise from the improper function of these 3 doshas . Ancient texts list 80 vata diseases, 40 pitta diseases, and 20 kapha diseases. The more recent recognition of new diseases should make this number even higher. The complex pathophysiology of modern disease means that the symptoms that individuals experience are always a combination of 2 or 3 doshas . This complexity means that ayurvedic preparations must be equally complex. In the classics, 63 major combinations of doshas have been listed and this complexity needs to be considered to elicit therapeutic effects. For example, migraine, low back pain, or arthritis of the knee can occur from vata imbalance. These diseases have different pathophysiological mechanisms, manifesting themselves in different body regions. To treat these conditions, drugs that act on the selected region are chosen. Compounds made from groups of plants are then combined in prescribed ways to achieve the desired effects. This means that undifferentiated concepts of vata -, pitta -, and kapha -related teas are nonsensical. Most of the above-mentioned teas contain a variety of nonspecific, commonly used, spices. While these teas can certainly be consumed for refreshment purposes, they will not cure disease.

The Rationale for Ayurvedic Formulations and Actions

Ayurvedic products are mainly composed of herbal combinations. 16 In certain parts of India, ayurvedic formulations also contain heavy metals. Traditional texts such as Charaka Samhitha , Susrutha Samhitha , and Ashtanga Samgraha do not describe the use of heavy metals—clearly this is a later development. Heavy metals are toxic and are not permitted at any level in modern pharmaceuticals. By contrast, in ayurvedic preparations, metals may be added for their perceived therapeutic effects to form rasausadhies (herbo-bio-mineral metallic preparations). In ayurveda, the use of metals and minerals as medicines have been recommended only after purification ( shodhana ) and that with recommended low dose, with specific vehicle ( anupana ), for a particular period and obeying dos and donts in relation to diet, activities, and environment. Ayurveda has also described the toxic effect, complications, and diseases caused due to ingestion of raw or improperly processed metallic preparations. Researches have revealed the metal content in a number of ayurvedic rasausadhies and toxicity cases due to ayurvedic herbal consumptions have been reported throughout the last decade, especially those sold through the Internet. 17 Such metals are not found in pure herbal ayurvedic preparations. 18

Traditional ayurvedic texts note that quality-assured ayurvedic compounds are strong and potent enough to combat disease. The parts of the plants chosen for use are also important. Depending on the plants concerned, and the medical combinations involved, the leaves, flowers, seeds, bark, roots, or skin of the plant may be chosen. The particular combination chosen results from extensive practical experience of the constituents needed to achieve the maximal effect. The mechanisms by which polyherbal drugs and their extracts act differ in many respects from the actions of single substances or synthetic drugs. 19 , 20

Polyherbalism has its roots in the earliest texts of ayurveda like Caraka Samhita , Susrutha Samhitha , Ashtanga Hrudaya , which systematizes the pharmaceutical procedures. The traditional Ayurvedic text Sarangdhar Samhita , which dates from 1300 AD, highlights the concept of polyherbalism in this ancient medical system. 21 Most ayurvedic formulations are polyherbal. 22 , 23 While the active phytochemical constituents of individual plants are well established, they are usually present only in minute amounts and are, thus, insufficient to achieve the desired therapeutic effects. 18 Recent research shows that combining plants of varying potency enhances their effect, both when compared to individual plant use and also to the sum of their individual effect. This phenomenon is known as synergy. Some pharmacological actions, from the active constituents of some herbs, have proven to be significant only when potentiated by those of other plants, but are not evident when used alone. 18 Two mechanisms have been proposed for these actions: pharmacokinetic synergy and pharmacodynamic synergy. 24 The former is based on herbs’ perceived ability to facilitate the absorption, distribution, metabolism, and elimination of other herbs. The latter concerns the synergistic effect of active constituents with similar therapeutic actions targeting similar receptors or physiological systems. Most diseases are caused by a multiplicity of factors, leading to both visible and invisible symptoms. A combination of herbs may act on multiple targets at the same time to provide thorough relief. 25

There is a misconception that ayurvedic preparations, being natural, are always safe. This is untrue. Charaka Samhita notes that ayurvedic medicines have adverse effects when prepared and/or used inappropriately. 26 Ayurvedic Pharmacopoeia of India sets standards of drugs/ingredients mentioned in different formulations of Ayurvedic Formulary of India. There are also 56 referral texts described under the Drugs and Cosmetics Act. Apart from these, there have been several other ayurvedic texts written during 1000 BC to 19th century. The numbers of medicinal plants have gradually increased from the Vedic period to modern era inducting more number of indigenous medicinal plants as well as exotic plants. The Charaka Samhita stresses the factors to be considered when selecting formulations’ constituents, including plants’ habitat, the season in which they grow, the prevailing harvesting conditions, the selected method of storage, and the chosen method of pharmaceutical processing. 27 However, herbs are natural materials, and their constituents may vary due to differing geographical locations, climatic conditions, environmental hazards, harvesting methods, and collection protocols. Such factors make it difficult to standardize or reproduce the quality of the end product. 28

The concept of bioavailability is broadly defined as the absorption and utilization of a nutrient. 29 The degree and quantity of penetration of a herbal drug, or its active ingredients, is determined by its bioavailability. 30 , 31 Bioavailability can depend on the chemical complexity of an herb, due to the synergistic and antagonistic actions of its constituents, in promoting absorption. A drug’s hydrophobic properties determine its ability to cross the luminal wall, as do the gut microflora, patients’ liver function, and the chemical modifications made by the herbal constituents. Herbal drugs must cross the blood-brain barrier if they are to affect the central nervous system, but there is a dearth of literature on Indian herbs, especially ones with potential antioxidant-stimulating properties, on this important topic. 32 The synergistic interactions of herbs can play an important role in their bioavailability. Long pepper, black pepper, and ginger can all increase the bioavailability of some compounds. 33 Person-to-person variation in gut micro flora and hepatic activity also play a role in systemic absorption. 34

Methods of Drug Administration in Ayurveda

Drug administration methods differ in ayurveda and conventional modern medicine. In the latter, most medications are synthetic; their administration influences the stomach and intestine. Most conventional medications are thus administered after food. Ayurveda has narrated timings of medication according to the patient’s nature, disease, and the condition of disease. Ayurvedic preparations are also administered on empty stomach. As the latter preparations are plant-based, they are slow-acting. The absorption of ayurvedic plant preparations occurs as part of normal metabolism. Ayurvedic preparations must be broken down for digestion in the gastrointestinal tract and has to get digested in the stomach and intestine, before getting into blood circulation and before reaching the target organ and bring about treatment action. For ayurvedic physicians, patients’ digestive strength is thus important. Ayurvedic preparations must undergo many digestive processes before being absorbed as part of normal metabolism. Ayurvedic physicians therefore analyze their patients’ metabolic state before treatment, as a matter of course, aiming for optimal stability and the least gastrointestinal damage.

Ayurvedic medicines exist in different formats, including decoctions, powders, pastes, fermented products, tablets, and medicinal butters (ghees). The formats used, whether liquids, pastes or tablets, are linked to preparations’ efficacy. If the format is changed, then the desired effect may be lost and potential side effects created. The parts of the plants used as ingredients are also very important. Sometimes, ayurvedic preparations are administered alongside other natural products, such as honey, salt, or milk, to get specific actions, according to the disease condition experienced. In Sanskrit, these natural products are termed Anupana . These natural products also help minimize any side effects. The timing of ayurveda preparations also varies according to the specific disease and its condition.

From the above discussion, it is clear that many factors must be considered in prescribing or taking ayurvedic medicine. Despite the fact that ayurvedic medicines are based on natural herbal materials, their safety depends on their method of administration, taking account of individuals’ needs and their specific disease conditions. The unguided consumption of ayurvedic preparations, in the mistaken belief that spices and herbs will necessarily be safe, may lead to serious health issues. A thorough awareness of these plants’ actions is needed for their safe selection and consumption.

Authors’ Note: The article was written at the office of Syal Kumar with the guidance of Prof Gustav J. Dobos and Dr Thomas Rampp.

Author Contributions: SK collected the data, references, pictures, and wrote the article. GJD and TR verified the article.

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval: As no human subjects were involved, this study does not require ethical approval.