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Exclusives - 18 May, 2020

COVID19 and Ayurveda: Experience v/s Evidence – By Vaidya M. Prasad

Ayurveda is not a herbal medicine system. It is a theory-based medicine. It has its own style of understanding and explaining health, disease, and treatment… #Coronavirus&Ayurveda

Contradicting the claim of the AYUSH ministry that India is working on four traditional medicine formulations to treat coronavirus infection, renowned Ayurveda doctor Vaidya M. Prasad says that it creates a feeling that India has decided to use Ayurveda to fight the new pandemic. But, he said, in fact it is not so. It is just another herbal drug trial. To the core it has very little to do with Ayurveda.

According to Vaidya M. Prasad:

The Council of Scientific & Industrial Research (CSIR) and the AYUSH ministry have decided to work together to test four Ayurvedic formulations1. It was an attractive piece of news to read. The medicines are ashwagandha, yashtimadhu, guduchi peepli and Ayush 64. The aim of the study is to see their use in battle against Covid-19.

At the outset this creates a feeling that India decides to use Ayurveda to fight the new pandemic. But to the best of the information available, it is not so. Instead, it is just another herbal drug trial. To the core it has very little to do with Ayurveda. It needs some basic understanding about the way in which Ayurveda operates to substantiate this observation.

First of all, one should understand that Ayurveda is not a herbal medicine system. Instead, it is a theory-based medicine. It has its own style of understanding and explaining health, disease, and treatment. In its theoretical framework, it is different from the Western system of medicine, Allopathy.

According to Ayurvedic theory, there are three dosas - Vata, Pitta and Kapha - in the body which are self-regulating functional principles. They are omni-responsive to every stimuli from the environment around. When there is a positive response of dosas, the subject experiences health/wellness. Contrarily, when the response is negative, the experience is disease/illness. In this approach, a disease needs a different set of principles for explaining the finer aspects of a disease including its treatment.  They are the status of the three dosas, the strength of the external stimulus/stimuli, interaction of the involved dosa/s with other body tissues called dhatu and the site of this interaction. The internal channels/pathways involved in this mess and the signs and symptoms that appear are also considered. The capacity of the host to fight against this adverse event becomes critical in the course of the disease and the outcome of the treatment.

Medicines and non-medicinal elements like food, lifestyle etc. are planned and executed according to this. In short, the exercise of generating a prescription is not same in Ayurveda and Allopathy.  Ayurveda, that way, is not an empirical system of medicine. It has its own logic and applied theories in understanding a disease and its management. And that is why authors label Ayurveda as a whole system of medicine.2

COVID 19 and Ayurveda

COVID 19 is a global pandemic caused by a novel corona virus SARS CoV-2, first reported in the Chinese city of Wuhan in December 2019. At present, it has its presence in 215 countries, with a total of 4744516 infected cases and 313713 deaths as on 17th May, 2020.3

India has 91314 infected cases and 2897 deaths in the same period.3   India continues its fight against the epidemic.  It may of interest to note that the Ministry of AYUSH, India, released an advisory with suggestions to prevent novel corona virus in January 2020 itself.4.  

The first cases of novel CORONA virus infection got confirmed in India on 30th January 2020, in Kerala.  On March 6, 2020, when there were only 30 positive cases in India, the secretary of the Ministry of AYUSH, sent a document to the Chief Secretaries and AYUSH secretaries of all States and UTs. That document advised possible AYUSH interventions for prophylaxis/prevention and symptom management of COVID-19, and a program that can be added on to the conventional care.5 

But these inputs were not taken care of. Instead, many quarters alleged that the government is promoting quackery.

Ayurveda is neglected

In general, the major allegation against Ayurveda is that it lacked evidence for its claims. This was in particular on its efficacy to prevent or treat COVID-19. Meantime, different medicines and molecules were getting tried for treating COVID-19. This was against the fact that none of them had any evidence for their efficacy. China had already set precedence in the usage of its traditional medicine (TCM) in its fight against the new virus. Different reports about the use of TCM proposed promising outcomes. One such report said that up to 90% of the patients in China received TCM treatment.6  

But India did not try Ayurveda. Ever since the number of cases increased, AYUSH is trying to push Ayurvedic treatment methods, both as prophylaxis and as symptom management. Teams of Ayurvedic experts designed many treatment guidelines across the country. Later, Govt. of India formed a task force to look into the possibilities of interdisciplinary research in Ayurveda and other systems. There were more than 2000 research proposals received as a response. The proposed study of 4 Ayurvedic formulations is an outcome of the efforts of that task force. But all the studies proposed are to look into the antiviral and/or immuno-modulatory effects of these combinations and not for their Ayurvedic utility. The authorities may call it as a repurposing of the medicines. Considering the resistance that the task force had in pushing the proposals through, no doubt, this effort is commendable. The words of the Chairman of the task force Prof. Bhushan Patvardhan tell the story very well. In a recent interview, he called the refusal to accept the empirical evidence in support of Ayurveda “unethical”. His point was very clear.   “There is no modern medicine intervention available today to increase immunity. As far as COVID-19 is concerned, modern medicine and AYUSH are on the same level of playing field. None is superior or inferior, because everyone is experimenting. In that case we are raising the question, when everything is new, when everybody is experimenting, why AYUSH interventions are not becoming mainstream for COVID-19 management?”7. 

This is a valid question from him which deserves an answer from the authorities.

Inevitable deaths?

People are dying by COVID. After every fatal incident, we hear that it happened ‘in spite of the best human efforts’. Is that true? How can one say that these deaths were inevitable? We have not even tried a precious resource with us called Ayurveda. How can one say that these deaths happened in spite of the best human efforts? One should not forget that Ayurveda has traversed through a time period of more than 5000 years. It may be the only traditional system of medicine on the planet which is in active practice in the original form. It has vast experience in the management of diseases, infectious or otherwise. The pharmacopeia of Ayurveda is rich and diverse. For every disease by name or symptoms, Ayurveda has hundreds of medicinal preparations. 

A book popular among the Vaidyas of Kerala called SAHASRAYOGAM has thousand medicinal compounds for different clinical conditions. Kerala may have half a dozen of books of the same type. And each State of the country may have similar works in their practice. So the treasure is quite vast and precious.  It does not mean that Ayurveda is complete by all means.  There are many lacunae in it. Like any other system of medicine, it has its limitations. It is not a panacea. But it is time-tested. It has a track record of a few million years. It is still active in all parts of the country. Above all, it is a recognised system of medicine in India. It has well-set measures to regulate its teaching and practice in the country.

Experience v/s Evidence

In traditional systems, clinical practice is not always based on research evidence. This is, to the core, because of the fact that the orthodox research methodology does not fit to the way in which traditional systems work. In short it is not the fault of the system of medicine.  We have to work hard on that part.  But we cannot wait for the evidence to come to save the lives.  We are in a deep crisis.  We have to bring all our resources into the field.  This is an hour of need. If we are reluctant to use our traditional resources now when will we do that? We have to design our strategies from our experiences. Evidence will follow.

 References:

Various print and visual media reports including www.inquest.org.in Ram Manohar P., “Defining Ayurveda as a whole medical system: Examples of clinical encounters in real life situations”, Forschende Komplementarmedizin (vol. 20(S3). p. 4, 2013. 17.5.2020. www.worldometers.info/coronavirus https://pib.gov.in/PressReleasePage.aspx?PRID=1600895# https://www.ayush.gov.in/docs/125.pdf https://news.cgtn.com/news/2020-03-27/Traditional-Chinese-Medicine-used-on-at-least-90-of-COVID-19-patients-Pcpt6ZhT3y/index.html https://sputniknews.com/india/202005151079309687-refusal-to-accept-empirical-evidence-in-ayurveda-unethical-says-indias-covid-19-task-force-chief/

(Vaidya M. PRASAD, MD (Ay.) is Principal & Medical Superintendent of Ashtamgam Ayurveda Chikitsalayam & Vidyapeedham, Vavanoor, Palakkad; Director & Honorary Physician, Sunethri Ayurvedashram & Research Centre, Thrissur; Member, Board of Examinations, Kerala University of Health Sciences; Trustee, Vaidyabhushanam K.Raghavan Thirumulpad Foundation for Ayurvedic Studies, Chalakudy; Managing Trustee, Sunethri Foundation; Former Member, Board of Studies (UG-Preclinical), Kerala University of Health Sciences.)

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