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Friday, June 14, 2013

Scientific Basis for Ayurvedic Therapies -1
























Scientific Basis for
Ayurvedic Therapies 


edited by
Brahmasree Lakshmi Chandra Mishra





This   contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with
permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish
reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials
or for the consequences of their use.

There has been increasing public interest in complementary alternative medicine during
the past decade in the U.S. that led to the establishment of the Center for Alternative and
Complementary Medicine at the National Institutes of Health (NIH), Bethesda, MD, by
the U.S. Congress to conduct scientific evaluation of these therapies. The Ayurvedic system
of medicine (traditional medical system of India) is recognized by NIH as a complementary
and alternative medicine (CAM). Ayurveda has been practiced in India for over 5000 years
and is recognized as a complete medical system comparable with allopathic medicine by
the government of India. In India, Ayurveda has a complete infrastructure, medical colleges,
hospitals integrated with allopathic medicine, research institutes, and scientific
journals devoted to Ayurveda. In addition, India’s Ayurvedic pharmaceutical industry is
governed by the same food and drug laws that regulate conventional drugs. Research in
pharmacology, biochemistry, phytochemistry, and clinical trials of Ayurvedic therapies
currently constitutes a substantial portion of the total research conducted in government
institutes and medical colleges in India.
There has been considerable scientific research effort in Ayurvedic therapies during the
past 50 years. This research has not been adequately disseminated to Ayurvedic students
and physicians. In order to accomplish the assimilation of this research into practice, three
major goals were set for this book: (1) to provide information on pharmacological, biochemical,
and clinical investigations on Ayurvedic therapies; (2) to explore the scientific
basis of Ayurvedic concepts of diseases, diagnosis, and treatments; and (3) to develop new
interpretation of Ayurvedic concepts of therapies based on modern knowledge where
possible.
As editor of the book, I used my combination of medical education in Ayurveda and
research experience in conventional medicinal pharmacy and pharmacology in developing
this text. Disease topics were carefully selected based on the scientific studies available
and the prevalence of a disease. Knowledgeable physicians and scientists in these fields
were selected based on their scientific contributions in the field to review and evaluate
the worldwide literature. In addition, I, along with one Ayurvedic physician, one biochemist,
and one overall expert with knowledge in conventional and CAM research
methods, read each chapter.
General topics such as Ayurvedic disease management,
panchakarma
, Ayurvedic
bhasmas
,
the current status of Ayurveda in India, and clinical research design and evaluation of
typical clinical trials of certain diseases were written by experts in their fields.
It is my hope that the book will prove useful to all Ayurvedic and conventional medicine
physicians, students and scientists, and the general public. In addition, the book is
expected to bring awareness to the community of health-care providers that Ayurveda is
significantly more than a few home remedies, yoga, and meditation. It is a fully established
system of medicine, has a considerable scientific base, and has therapies that can be used
alone or as an adjuvant with conventional health care as practiced in India.
 .
Lakshmi Chandra Mishra

Editor
Lakshmi Chandra Mishra, Ph.D.,
is a professor in the
Research Division of Southern California University of
Health Sciences and an Ayurvedic medicine practitioner
at the University Health Center, Southern California University,
Whittier. He has been conducting research on
Ayurvedic therapies for musculoskeletal disorders at the
university, and stroke in collaboration with faculty at the
University of Southern California, School of Pharmacy.
Dr. Mishra received his Bachelor of Indian Medicine
and Surgery degree from Bundelkand Ayurvedic College,
Jhansi, UP, India, in 1954 and practiced Ayurvedic
medicine for several years thereafter. He received his
bachelor’s and master’s degrees in pharmacy from
Banaras Hindu University, Varanasi, UP, India, in 1958
and 1959, respectively. He conducted phytochemical and
pharmacognostical studies on an Ayurvedic herb for his master’s degree thesis. After
getting his pharmacy degrees, he worked as a pharmaceutical chemist at the Hindustan
Antibiotics Ltd., Pimpari Poona, for 1 year and then as an assistant professor of pharmacology
at Maulana Azad Medical College, New Delhi.
After coming to the U.S. in 1963, Dr. Mishra received his Ph.D. in biochemical pharmacology
from the State University of New York at Buffalo in 1967. Dr. Mishra worked on
cancer chemotherapy research at Roswell Park Memorial Institute in Buffalo for 1 year
before joining Microbiological Associates, Bethesda, MD, where he conducted research on
anticancer agents that was sponsored by the National Cancer Institute, National Institutes
of Health (NIH), Bethesda, MD. He later worked for several federal regulatory government
agencies as a pharmacologtist, toxicologist, and branch chief. Dr. Mishra has served on
many scientific committees in government and industry. He was an ex-officio member of
the National Cancer Advisory Board of the National Cancer Institute, NIH, for 18 years.
Dr. Mishra has extensive background and experience both as a clinician in the traditional
and modern practice of Ayurveda and as a bench scientist. His research expertise includes
pharmacology, toxicology, pharmaceutical chemistry, pharmacognosy, and phytochemistry.
He has authored more than 100 scientific papers, documents, and reports in the fields
of Ayurvedic medicine, pharmacology, toxicology, cancer chemotherapy, and health risk
assessment, particularly cancer and neurotoxicity risk for exposure to environmental
pollutants.


Introduction
The objective of this book is to explore a scientific basis for Ayurvedic medicine and create
a better understanding of Ayurveda among health-care providers and consumers. Books
published in the West on Ayurveda generally discuss only a few aspects of Ayurveda such
as dietary and lifestyle changes, yoga, breathing exercises, meditation practices, and
aroma, gem-stones, color, music therapy, herbs, and other therapies. In fact, these areas
cover only a small fraction of the body of classical Ayurveda. These areas offer little or
no information about current biochemical, pharmacological, and clinical investigations.
During the past 100 years, several hundred Ayurvedic herbs have been investigated with
respect to plant chemistry, active chemical constituents, pharmacological effects, safety,
and efficacy. However, the basic research on Ayurvedic therapeutic agents has not been
adequately integrated into disease management protocols available to most consumers in
the West.
The origin of Ayurveda is traced back to four books of knowledge called
vedas
:
Rigveda,
Samveda, Yjurveda
, and
Atharveda
(4500 to 1600
B
.
C
.). The information on health care was
subsequently developed by many Ayurvedic practitioners and finally compiled into three
important books known in Ayurveda as the senior triad (
vriddha traya
):
Charak Samhita
,
Sushrut Samhita,
and
Ashtang Hridaya Samhita.
The subsequent three books that are commentaries
on the senior triads are known as the junior triad (
laghu traya
):
Madhava-nidana,
Sarangdhar Samhita,
and
Bhavaprakash Nighantu
. These books contain basic concepts of
health and disease, disease management, anatomy and physiology, hygiene, materia medica,
pharmacology and therapeutics, herbal formulations, pharmacy, and synthesis of
herbo-mineral formulas. Diseases are classified according to organ systems and functions.
Specialties such as internal medicine, surgery, pediatrics, gynecology, obstetrics, eye, ear,
nose, and throat diseases, geriatrics, eugenics and aphrodisiacs, psychiatry, pharmacology,
toxicology, and pharmacy are clearly delineated and discussed in detail in Ayurveda.
1
Although there is no record of pharmacological testing during the time period when
Ayurvedic texts were written, 50 distinct pharmacological categories of medicinal plants
were described. The categories include anti-inflammatory, analgesic, antiallergic, antihistaminic,
antidiuretic, diuretic, antiemetic, emetic, purgative, astringent, antiasthmatic,
antipyretic, and others.
2
Similar to conventional medicine, Ayurvedic medicine has also
benefited from advances in science and technology. These advances facilitated the understanding
of diseases, the development of better pharmaceutical products, and the implementation
of diagnostic techniques. Scientific studies in laboratory animals have now
confirmed the pharmacological properties of many Ayurvedic herbs. The old concept of
accepting the last word of an Ayurvedic teacher without questioning the scientific underpinning
has begun to disappear. A large number of medical schools and medical research
institutions, both private and governmental, are currently involved in Ayurvedic research.
The government of India has established an agency, the Central Council for Research in
Ayurveda and Siddha (CCRAS) under the Ministry of Health and Family Welfare, to
sponsor and conduct research in Ayurveda. The agency has been conducting and sponsoring
Ayurvedic research all over India for more than 30 years in 70 regional Ayurvedic
research institutions. The agency is conducting clinical trials to investigate the effectiveness
of Ayurvedic products as well as basic research. Some of the clinical trials conducted by
© 2004 by CRC Press LLC
Review on Five Diagnosis Categories.” The basic research includes pharmacology, biochemistry,
plant chemistry, product development, the cultivation of medicinal plants, and
manufacturing practices for safe and effective Ayurvedic products.
Basic Concept
Whereas conventional medicine is primarily oriented toward the treatment of disease,
Ayurvedic medicine is oriented toward prevention, health maintenance, and treatment.
In conventional medicine, drugs are developed based on the concept that the elimination
of specific causes of a disease, such as microorganisms, will cure a disease. On the other
hand, the belief in Ayurvedic medicine is that a disease is the product of an imbalance in
the body and mental elements that reduce the body’s resistance to diseases. If the imbalance
is corrected and the body’s defense mechanisms are strengthened by herbal formulas,
lifestyle changes, and diet, then the body will resist a disease with a goal of eliminating
it. Herbal and herbomineral products regularly used in Ayurveda are believed to
strengthen the body’s defenses. Scientific evidence is gradually developing in support of
the Ayurvedic concept.
3
Ayurvedic Physician
Scientific, technical, and engineering advances in the 20th century have been extraordinary.
They created an explosion of new information and understanding in molecular biology,
biochemistry, physiology, antibiotics, vaccines, genetics, mapping of genome, and the
identification of genes responsible for inherited diseases. Ayurvedic physicians have also
benefited from these new medical advances. Scientifically based information is the core
of the preclinical, clinical, residency, and continuing medical education phases of training.
An Ayurvedic physician must be able to understand and appreciate new scientific
knowledge in order to maximize the benefits of Ayurvedic therapies. In order to do so,
an Ayurvedic physician must be aware of the current information on the disease processes,
inter- and intracellular message transmission, membrane transport, protein interactions,
chemical and microbial toxins, autoimmunity, cellular and humoral immunity, and
dynamics of neurotransmitters. A physician needs to know about genetics, congenital
inborn metabolic problems, pharmacological and biochemical research, and the use of
various clinical chemistry data in diagnosis and monitoring disease processes in order to
interpret the clinical data. He must understand the basic principles of toxicology and how
the knowledge can be used in developing protocols for clinical studies. He must also know
how to apply basic science to the Ayurvedic concept of disease management and the use
of modern diagnostic methods involving urine and blood chemistry, enzyme assays,
histology, pathology, radiology, etc. Finally, the Ayurvedic physician must understand the
interaction of spiritual and psychological elements of patients as described in Ayurveda
and be able to earn the patient’s trust through compassionate and holistic care.
the agency are discussed in Chapter 3, “Clinical Research Design: Limited Systematic
© 2004 by CRC Press LLC
Educational Standards
An Internet search revealed a dozen Ayurvedic colleges in the U.S. offering weekend
courses ranging from 1 to 3 years. The curriculums are designed to familiarize students
with Ayurvedic therapies, but are inadequate for actual clinical practice. Because Ayurveda
is currently unregulated in the U.S., there are no standards to meet or pass any state
examination. Because herbs or herbominerals are included under the U.S. Dietary Supplement
Health and Education Act (U.S. DSHEA, 1994), Ayurvedic practitioners in the
U.S. recommend herbal formulas as dietary supplements along with dietary changes, yoga,
and breathing exercises to help remedy certain health problems.
Ayurveda has been recognized as an independent medical system by the government
of India for a long time. The Central Council of Indian Medicine (CCIM), Ministry of
Health (Regulations 1986, Minimum Education in Indian Medicine) regulates Ayurvedic
education and training in India.
4
The curriculum includes 2820 hours of theory and 780
hours of practical and laboratory work over a period of 54 months; this is followed by 1
year of residency leading to a Bachelor of Ayurvedic Medicine and Surgery,
5
formerly
Bachelor of Indian Medicine and Surgery. This is an integrated program that teaches
Ayurvedic and alopathic courses so that therapeutic options for patients may be maximized.
Reasons for the Current Interest in Ayurveda
The great therapeutic success of synthetic antibiotics, hormones, and vaccines has created
an expectation that conventional medicine will be able to discover a cure for every ailment.
This expectation has been only minimally met for many diseases (e.g., cancer, arthritis,
autoimmune diseases, and AIDS) even after spending hundreds of billions of dollars in
research worldwide over the past 30 years. In addition, the synthetic antibiotics and
steroids sometimes result in serious adverse effects, such as immunosuppression, gastrointestinal
bleeding, and ulcers, after prolonged administration. Ayurvedic therapies
generally provide relief without such adverse effects even after prolonged administration.
Some formulas known as
rasayanas
are believed to improve the body’s defense mechanisms.
For example, in one short study for 90 days with
chyawanprash
, a
rasayana
, the
following improvements were observed: increased stress tolerance; improved endocrine
functions (adrenal and testicular); positive nitrogen balance as indicated by increased
serum protein level; and a decrease in urinary levels of nitrogen, creatinine, mucopolysaccharide,
and hydroxyproline. The general well-being of the volunteers improved and none
of them complained of any physical disorder.
3
Ayurvedic herbs and formulas often have a wide spectrum of therapeutic activity. For
example,
guggul
is recommended in Ayurveda for 25 or more ailments (e.g., inflammatory
diseases, a variety of infections, muscle spasm, cough, bronchitis, anemia, endometritis,
neurological diseases, skin diseases, urinary system disorders, obesity, osteoarthritis, and
rheumatoid arthritis). The reason for this wide spectrum of activity is that
guggul
has antiinflammatory,
anticoagulant, hypolipidemic, and antibacterial activity; it can be beneficial
in many health ailments associated with inflammation, infection, obesity, or blood clotting.
Additionally, pharmacological activities of herbs may not be confined to one specific
chemical constituent.
Guggul
was found to have anti-inflammatory activity in both polar
© 2004 by CRC Press LLC
and nonpolar solvents, indicating that several chemical constituents present in it may have
anti-inflammatory activity.
5
Similarly, herbs showing neuropharmacological activity
in
vitro
did not have the activity concentrated in any one solvent extract. This indicates that
several constituents with different chemical physical properties may have the same neuropharmacological
activity.
6
Ayurvedic therapies are known to be relatively economic. For example, a 1-month dose
of an Ayurvedic formula for arthritis may be obtained at this time for about $20, which
is often the co-payment for brand name prescription drugs for many health insurance and
health maintenance organizations. Other alternative nondrug complementary therapies
may be even more expensive.
The relative safety of Ayurvedic medicine is another reason for its popularity. Ayurvedic
formulas are time tested for safety. These formulas contain vitamins; minerals; biologically
active steroids, alkaloids, glycosides, and tannins; and a variety of antioxidants in a natural
state. A single herb extract or a pure active chemical constituent may cause some adverse
effects under certain conditions and dose levels. For example,
guggul
extract has been
shown to produce some anticoagulant effect under certain conditions.
7,8
Ayurvedic text
formulas containing
guggul
may be safer than the
guggul
extract; the formulas that have
guggul
in relatively small amounts, along with many other herbs, act as synergists and
possibly counteract some of the side effects.
Quality of Ayurvedic Formulas
In order to assure quality of Ayurvedic formulas, the government of India, Ministry of
Health, amended the Drugs and Cosmetic Act of 1940 in 1964 to include Ayurvedic drugs
(Ayurvedic herbs and herbal formulas). The Act requires the raw materials to be genuine
and adequately identified; the formulas must contain ingredients listed on the label and
manufacturing must be conducted under prescribed good manufacturing practices conditions.
CCRAS developed a formulary of Ayurvedic text formulas called
The Ayurvedic
Formulary of India
published in 1978. CCRAS conducted research to establish enforceable
standards for Ayurvedic formulas similar to allopathic drugs and promulgated the standards.
The book
Pharamcopoeial Standards of Ayurvedic Formulations
was first published in
1976 and subsequently revised in 1987. This effort was followed by the development of
The Ayurvedic Pharmacopoeia of India
in 1989. The pharmacopoeia contains the popular
names; macroscopic and microscopic description of herbs; and limits for foreign matter,
total ash, acid-insoluble ash, alcohol-soluble extractive, water-soluble extractive, and
heavy metals in the same way as prescribed in allopathic pharmacopoeias. It also gives
the levels of known chemical constituents, therapeutic uses, and doses.
Organization of the Book
Only a few diseases are selected based on the scientific data available on Ayurvedic
therapies. Specialists in treating each disease searched the worldwide literature, critically
reviewed the information on the basis of their expertise, and summarized the information
in an understandable and easily usable form. Ayurvedic description and therapy of a
disease are first described followed by a discussion using current knowledge. Available
at  
pharmacological, biochemical, and chemical studies on herbs used in the management of
the disease are evaluated to determine if there is an adequate scientific basis for their use.
Finally, the overall management strategy of the disease, commonly used therapies, and
scientific data are presented.
An attempt is made to first use the English translation or meaning of the Ayurvedic
word, followed by the Ayurvedic word in parentheses as often as possible to make the
chapters easy to read and understand. In addition, a list of Ayurvedic words is provided
and addresses of the manufacturers of Ayurvedic formulas, and a list of journals publishing
articles on Ayurvedic therapies. The words
Ayurvedic texts
or
Ayurveda
refer to the
senior and junior triads in all chapters.
The book is organized to give a global picture of Ayurveda and to show that these
therapies are relatively safe, effective, and have supporting scientific data. It is intended
to provide better understanding of Ayurvedic medicine so that wherever appropriate, the
integration of these therapies by the health-care providers may become possible.
References
1. Mishra, L., Singh, B.B., and Dagenais, S., Ayurveda: a historical perspective and principles of
the traditional healthcare system in India,
Altern. Ther. Health Med
., 7(2), 36–42, 2001a.
2. Mishra, L., Singh, B.B., and Dagenais, S., Healthcare and disease management in Ayurveda,
Altern. Ther. Health Med
., 7(2), 44–50, 2001b.
3. Udupa, K.N. and Singh, R.H.,
Clinical & Experimental Studies on Rasayana Drugs and Panchkarma
Therapy
(monograph), Central Council for Research in Ayurveda and Siddha, New Delhi,
India, 1993.
4. Central Council of Indian Medicine (Minimum Standards of Education in Indian Medicine)
Regulations, 1986, New Delhi-110055, 13 July, 1989, in
Abstracts of the Gazette of India
, Part III,
Section 4, August 5, 1989.
5. Gujral, M.L., Sareen, K., Tangri, K.K., Amma, M.K.P., and Roy, A.K., Anti-arthritic and antiinflammatory
activity of gum (balsamodendrone mukul hook),
Indian J. Physiol. Pharmacol.
, 4,
267–273, 1960.
6. Misra, R., Modern drug development from traditional medicinal plants using radioligand
receptor-binding assays,
Med. Res. Rev
., 18(6), 383–402, 1998.
7. Bordia, A. and Chuttani, S.K., Effect of gum guggulu on fibrolysis and platelet adhesiveness
in coronary heart disease,
Indian J. Med. Res.
, 70, 992-996, 1979.
8. Mester, L., Mester, M., and Nityanand, S., Inhibition of platelet aggregation by “guggulu”
steroids,
Planta Med.,
37, 367–369, 1979.



1.1 Introduction
It is a universally accepted fact that good health plays an important role in human
development. According to the concepts of Ayurveda, good health is based on the equilibrium
of
dosha
(humor),
agni
(digestive fire),
dhatu
(seven body tissues: lymph, blood,
muscle, adipose tissue, bone, bone marrow, semen), and
mala
(feces, urine, and other waste
products). Furthermore, in Ayurveda there is clear-cut emphasis on maintaining physical,
mental, and spiritual well-being as part of good health.
1
The World Health Organization
(WHO) defines good health as a state of complete physical, mental, and social well-being
and not merely an absence of disease or infirmity,
2
which is in close approximity to the
definition of good health mentioned in Ayurvedic classics. Creation of the infrastructure,
generation of requisite human resources, and framing of appropriate policies required to
meet the health-care needs of its citizens are accepted as some of the main and fundamental
responsibilities of a modern state. Every country in the global fraternity aspires to meet
the health-care needs of its people through an appropriate and cost-effective approach.
CONTENTS
© 2004 by CRC Press LLC
2
Scientific Basis for Ayurvedic Therapies
The contributions of Traditional Systems of Medicine (TSM) for global health care in
the past and their importance for the health-care needs of the present and the future are
well recognized. The traditional systems of India, which are now called Indian Systems
of Medicine (ISM), have a very strong conceptual base and have been practiced uninterruptedly
for a very long time; hence they are considered as independent medical systems.
Ayurveda, Siddha, and Unani are the three important traditional systems practiced in
India. Ayurveda is the oldest and the most widely practiced system among the three. It
takes into consideration all aspects of health including mental, physical, and social components.
Considering the comprehensive manner in which all matters related to health are
addressed in Ayurveda, it has potential to become a global medical system. However, to
achieve this status, some of the shortfalls that are perceived to hinder its progress must
be rectified. In the following pages the present status in different subsectors of Ayurveda
are reviewed and some of the steps required for further development in the future are
suggested.
The matters that require consideration are national policy for the development of
Ayurveda in India; role of Ayurveda in the country’s health-care delivery; regulatory
mechanism to control and regulate manufacturing and utilization of the drugs manufactured
in this sector; and facilities available for the generation of trained manpower, including
clinical and paramedical personnel, research and development aspects, and
globalization of the system.
1.2 National Policy on ISM in India
One of the most important requirements for any system to play a meaningful role in the
health care of a country is for that system to receive due recognition from the government.
In India, the highest policymaking body regarding the matters concerned with health and
family welfare is the Central Council for Health and Family Welfare, set up under Article
226 of the constitution of India. It consists of central health ministers, state health ministers,
eminent health experts, nongovernmental organizations with an interest in the health
sector, and officials of the central and state governments. It strongly advocates systematic
use of the ISM in the primary and secondary infrastructure. In its last meeting, the Council
recommended that at least one physician from the ISM and Homeopathy (ISM & H) should
be available in every primary health center. Further, it was also resolved to introduce
systems in the existing state and district level government hospitals.
The government of India has taken up the matter quite seriously and drafted a national
3
provides comprehensive coverage of different sectors. Feedback and suggestions have
been collected from concerned organizations. This will form the basic material to frame
the National Policy after completing the process of consulting different state governments
and different ministries of government of India. Some highlights of the draft policy are
as follows:
• It addresses the system in the areas of current relevance while at the same time
delineating the immense opportunities that lay ahead.
policy on traditional systems practiced in India (www.indianmedicine.nic.in). The policy
special treatment centers for ISM & H in rural hospitals and to create a wing for these
© 2004 by CRC Press LLC
Ayurveda — A Potential Global Medical System
3
• It plans to build upon the positive features of ISM & H, which are their modest
cost, low level of technological input, and growing popularity. There is a possibility
of expansion of activity in a wide range of related fields. To maximize
utilization of this opportunity a range of strategies has been recommended.
• It seeks to revamp the curriculum of the educational institutes to reorient the
approach of the practitioners of these systems to increase their relevance, credibility,
and professionalism.
• It strongly advocates enforcement of good manufacturing practices (GMP) by
placing acceptable levels of regulation and enforcement covering manufacture
and certification of drugs.
• Several measures have been mentioned for the scientific and sustainable utilization
of the medicinal plant-based resources of the country. It advocates adoption
of a collaborative approach. Emphasis has been placed on utilizing the experience
and scientific base available in the research councils of the country; for example,
the Central Council for Scientific and Industrial Research (CSIR), the Indian Council
for Agriculture Research (ICAR), and institutes under the Department of Science
and Technology.
• To protect the intellectual property rights (IPR) of the resources of this sector,
creation of an extensive database and a traditional knowledge digital library
(TKDL) has been advocated.
• It also highlights the importance of utilization of local health traditions in the
national health-care programs. It seeks to provide support of the operational
research studies and efficacy trials for this purpose.
• The policy encourages propagation of Ayurveda and other ISM throughout the
world, especially in areas where there is special interest in these systems, through
Indian missions abroad. This policy will promote creation of a larger constituency
for the practitioners of these systems. Promoting ISM as part of health tourism is
being planned. Other approaches include international collaboration and academic
exchange between interested groups.
• It has been strongly recommended that there should be an increase in the share
of ISM in the national health budget.
• The policy also seeks to involve and promote the importance of ISM physicians
in various national health programs.
• It seeks to establish and build the credibility of the ISM sector by encouraging
certification and establishment of quality marking of products to allay the concern
expressed in some quarters about the quality, safety, and efficacy of the products
used.
• It recommends effecting policy changes to cover nutraceuticals and food supplements.
The Drugs and Cosmetic Act would be amended to cover intermediates
and partially processed plant-based products. The enactment of the ISM Product
Information Promotion and Regulation Act is under consideration.
• There will be policy support and taxation incentives to promote high standards
of manufacture.
• It seeks to support evidence-based research to determine the efficacy of ISM drugs
and therapies, generation of data on safety and efficacy, along with standardization.
• There will be strong encouragement for undertaking research on basic principles
of Ayurveda and the medico-historical approach.

Scientific Basis for Ayurvedic Therapies
There is a feeling that formulation of a national policy has been delayed inordinately;
however, the fact that a comprehensive draft has been prepared and is being circulated
among all the agencies involved in its implementation indicates that the matter has been
taken seriously and there will be a discernible change in the Ayurvedic sector for the better
in the future. The fact that such a detailed draft policy has been prepared and the government
of India has initiated steps to enforce GMP in the ISM drug-manufacturing sector
clearly indicates that it is earnest in its desire to develop and ensure mainstreaming of the
ISM sector and its practitioners. The expenditure in this sector has gradually and significantly
increased from Rs. 21683.60 million (US $433.66 million) in 1996–1997 to Rs.
40792.60 million (US $815.95 million) in 2000–2001.
1.3 Role of Ayurveda in India’s Health Care
Ayurveda is quite popular, being practiced throughout the country including tribal and
remote areas where other modes of therapies are not readily available. Though it does not
have as an elaborate organized structure as its modern counterpart, it plays a major role
in meeting the health-care needs of a large section of India. There are separate directorates
of the ISM & H in 18 states. Though Ayurveda is popular in all these states, this system
is more prevalent in the states of Kerala, Himachal Pradesh, Gujarat, Karnataka, Madhya
is prevalent.
At present there are 611,413 practitioners of TSM, 26,032 hospitals/dispensaries, and
approximately 8,500 Ayurvedic drug manufacturers in the country. There are more than
190 Ayurvedic colleges turning out more than 7,000 Ayurvedic graduates and around 700
the resources and is taking steps to integrate ISM in primary health care and national
health programs. This growing attitude change is demonstrated by the drafted national
policy mentioned above.
1.4 Academic Role of Ayurveda in Future Health Care
The concepts of proper lifestyles, dietary habits, and daily and seasonal routines followed
in Ayurveda can be adopted with suitable modification to different countries in different
TABLE 1.1
Summary of Medical Care, Medical Manpower, and Facilities Available under ISM as of 1 April
1999
Facilities Ayurveda Unani Siddha Yoga Naturopathy Homeopathy Total
Hospitals 2,258 196 224 8 21 297 3,004
Beds 40,313 4,872 1,811 101 733 12,836 60,666
Dispensaries 14,416 970 363 42 56 7,155 23,028
Registered
practitioners
367,528 41,221 12,915 — 388 189,361 611,413
postgraduates every year (Tables 1.1 and 1.2). The government of India is well aware of
Pradesh, Rajasthan, Uttar Pradesh, and Orissa. In the state of Tamilnadu the Siddha system

Ayurveda — A Potential Global Medical System

parts of the globe after giving due consideration to the cultural milieu existing in each
country and also the constitutional profile of each population. Attempts can also be made
to utilize the medicinal plant resources of these countries for meeting the health-care needs
of their people after categorization of the plants according to Ayurvedic concepts. Drugs
used in ISM can be used as adjuvant to the main drugs used in conventional medicine.
Therapeutic approaches such as
Panchakarma
,
Ksarasutra,
etc. can certainly be integrated
into other health systems, broadening the choices available to physicians and patients.
1.5 Education and Training
At present, more than 190 undergraduate Ayurvedic colleges in India offer a curriculum
for a Bachelor of Ayurvedic Medicine and Surgery (BAMS) degree. This program takes
5
1
/
2
years to complete and runs according to the standards of the Central Council of Indian
Medicine (CCIM), which is a statutory body that regulates the ISM education in the
country. During the 5
1
/
2
years of education, the student must go through internship for
a period of 1 year. The 10 + 2 (10 years of school education followed by 2 years of predegree
study) students with Science Group are eligible to take admissions in the degree course.
This is similar to the requirement for the admission to the MBBS (allopathy) degree
program. In fact, in many states there is a common entrance test to admit candidates to
these courses. BAMS contains many modern subjects in its course material; however,
nothing is taught in MBBS colleges about Ayurveda or any other ISM. This is a paradox,
as many modern medicine graduates prescribe Ayurvedic drugs — especially in difficultto-
cure diseases like hepatitis — without any training in Ayurveda. The Department of
ISM, being perceptive of this situation, has prepared course material containing basic
concepts and fundamentals of ISM & H for incorporation in MBBS curricula. This has
been forwarded to the Medical Council of India for appropriate action. In most states,
e.g., Uttar Pradesh, Rajasthan, and Gujarat, Ayurvedic colleges are state supported.
Because it is necessary that Ayurvedic graduates understand modern advances in medical
diagnostic methods, medical technology, and drug treatment, the present curriculum
contains about 50% conventional medicine, and clinical and preclinical subjects. The
CCIM, which is the apex body in matters related to the education and practice of Ayurveda
in the country, is initiating steps to revise the curriculum to suit the present-day requirement
by placing emphasis on practical-oriented teaching. Furthermore, at present there
is no facility to impart training in some of the important disciplines, like
Vriksha
Ayurveda
(a subdivision of Ayurveda that deals with matters related to cultivation of plants) and
Pasu
Ayurveda (Ayurvedic veterinary science), at the undergraduate level. Steps have to
be initiated to include them as subjects for study at the undergraduate level.
TABLE 1.2
Number of Undergraduate and Postgraduate Colleges and Institutions In India (1 April
1999)
Facilities Ayurveda Unani Siddha Total
Undergraduate colleges 196 40 2 238
Admission capacity 7070 1280 150 8500
Postgraduate colleges 49 3 2 54
Admission capacity 645 35 70 750
Source: www.indianmedicine.nac.in-; Annual Report 2000–2001.
© 2004 by CRC Press LLC
6
Scientific Basis for Ayurvedic Therapies
1.5.1 Postgraduate Education
Postgraduate education is available in over 30 research institutes and offers specialization
in 16 clinical and preclinical Ayurvedic specialty areas such as medicine, surgery, pediatrics,
pharmacology, pathology, pharmacy, and
Rasa Vigyan
. Besides the mainstream institutes,
the National Academy of Ayurveda, run by the government of India, was established
to impart intensive training in different specialties for graduates and postgraduates of
Ayurveda under the guidance of eminent scholars (similar to the traditional custom of
Guru Shishya
Parampara; interested readers can obtain more information from the Web
site of the Department of ISM as well as a CD released by the department
3–5
).
At the present time, Gujarat Ayurvedic University is the only university exclusively
devoted to Ayurveda and allied sciences in India. Its constituent institutes include the (1)
Institute for Postgraduate Training and Research in Ayurveda financed by the government
of India, (2) Shri Gulabkunverba Mahavidyalaya funded by the Gujarat State, (3) Institute
of Ayurvedic Pharmaceutical Sciences, (4) Institute of Ayurvedic Medicinal Plant Sciences,
(5) International Center for Ayurvedic Studies, and (6) Mahrishi Pananjali Institute for
Yoga and Naturopathy Education and Research. The last three institutes are self-financed.
The Gujarat Ayurvedic University has signed the Memorandum of Understanding (MOU)
with nine Ayurvedic institutions functioning in Japan, Australia, the Netherlands, Italy,
Argentina, and Germany to coordinate and facilitate the globalization of Ayurveda
through academic collaboration. Earlier, Medical (Ayu) Institute of Russia had signed the
MOU with the government of India, in which the Gujarat Ayurvedic University is also
one of the implementing authorities.
The Ayurveda Faculty of the Institute of Medical Sciences, Banaras Hindu University,
Varanasi, Uttar Pradesh, which is under the Central Government administration, also has
similar programs. It has excellent facilities for imparting postgraduate training in different
disciplines of Ayurveda. It is collaborating in international research programs and attracting
graduates for training and research in Ayurveda, conducting basic research and publishing
in international journals. It has an advantage of sharing the research facilities and
clinical research with the medical institute’s research program. National Institute of
Ayurveda, Jaipur, Rajasthan also has an excellent research facility and similar training
programs and collaborations. The other postgraduate research centers also have very good
facilities and are involved in various important research collaborations.
1.5.2 Para Ayurvedic Staff
At present there is only one institute attached to Gujarat Ayurved University that conducts
courses in Ayurvedic pharmacy. There is an urgent need to establish many such institutes
to generate requisite manpower for the Ayurvedic drug manufacturing and dispensing
sector. This can be facilitated by formulating a national policy making it compulsory after
an initial grace period to appoint only qualified persons in the Ayurvedic manufacturing,
dispensing, and drug regulatory sectors. There is also a dearth of institutions to impart
training in Ayurvedic nursing. There is a need to open many such institutes and the present
practice of recruiting nurses trained in modern medicine has to be phased out. If such
persons are recruited, they should be made to undergo orientation training in Ayurveda.
Many special therapeutic approaches like Panchakarma, Ksarasutra, and Marmavidhya
are of great importance in Ayurveda.
© 2004 by CRC Press LLC
Ayurveda — A Potential Global Medical System

1.6 Research and Development
There are research councils and institutes functioning throughout the country on different
aspects of Ayurveda. In 1971, the government of India established a research council, the
Central Council for Research in Indian Medicine, Homoeopathy & Yoga (CCRIMH), which
was subsequently developed into four independent councils in 1978. The Central Council
for Research in Ayurveda and Siddha (CCRAS) is an apex body for the formation, coordination,
development, and promotion of research on scientific lines in Ayurveda and the
Siddha System of Medicine. The council has 89 field units under it, and they have been
reorganized into 30 institutes and units including the Headquarters Office (List 2 in this
chapter). The research activities in various fields can be broadly categorized as follows:
Clinical research
, encompassing clinical studies and programs in survey and surveillance,
community health, and tribal health.
Drug research
, encompassing medico-botanical surveys, cultivation of medicinal
plants, pharmacognostical studies, and phytochemical profiling of plants used in
Ayurveda, plant tissue culture, pharmacological and toxicological studies, and
drug standardization. It also has a breeding program for musk deer, which is the
source of the well-known drug Kasturi
.

Literary research
, encompassing publication of rare and classical manuscripts of
Ayurveda and Siddha, monographs on the basis of the studies undertaken by the
council, scientific journals and bulletins, newsletters featuring activities of the
council, and pamphlets on research findings; and preparation of video films on
various research achievements.
Family welfare research
, including studies on family welfare such as antifertility.
Besides CCRAS, research activities are carried out in other postgraduate institutes as
part of an M.D. dissertation and Ph.D. thesis. Research studies on Ayurvedic drugs and
therapies are carried out throughout the country in many conventional medical colleges
and research institutes, giving MBBS degrees — though not from an Ayurvedic perspective
but as part of conventional drug research. However, some institutes have done important
research work on Ayurvedic herbs. The major institutes conducting research on medicinal
plants are Seth GS Medical College (Mumbai), Central Drug Research Institute (CDRI,
Lucknow), Regional Research Laboratory (Jammu), National Institute for Pharmaceutical
Education and Research (NIPER, Mohali), Tropical Botanical Garden and Research Institute
(TBGRI, Trivandrum), Central Institute of Medicinal and Aromatic Plants (CIMAP,
Lucknow), National Botanical Research Institute (NBRI, Lucknow), pharmacology departments
attached to the Institute of Medical Sciences, Banaras Hindu University (Varanasi),
KG Medical College (Lucknow), SPARC (Mumbai), University Department of Pharmaceutical
Sciences, Punjab University, etc. In-house research activity is undertaken by some
of the large Ayurvedic drug manufacturers like Himalaya Drug Company, Dabur Research
Center, Zandu Research Foundation, etc. (Lists 1 and 2 in this chapter).
The present research approach, especially in the area of drug development and therapeutics,
needs to consider single plant as well as Ayurvedic concepts and text formulas.
Research protocols are often prepared without giving due consideration to the Ayurvedic
conceptual base that underlies employing a drug in a particular disease or clinical condi-

Scientific Basis for Ayurvedic Therapies
tion. The tendency is to treat medicinal plants used in Ayurvedic therapeutics as a source
material for drug prospecting for a single herb or chemical constituent and not for a drug
formulation. Ayurveda has a very well-developed discipline of Ayurvedic pharmacy and
drug formulation called
Bhaisajya Kalpana
, which deals in great detail with different methods
of drug preparations, use of adjuvant, maintaining ideal conditions, collecting and
processing drugs in a particular season at a particular stage and site, and others. There is
urgent need to study the impact of changes made in drug formulation and manufacturing
processes on the expression of biological activity and therapeutic efficacy.
Existence of the “therapeutic gap” in modern medicine is well known.

Though tremendous
progress has been made in the treatment of many dreaded diseases, remedies are
yet to be found for treating diseases like tuberculosis, cancer, rheumatoid arthritis, AIDS,
etc
.
In these areas TSM drugs and procedures may have beneficial effects. Similarly, TSM
drugs could be beneficial in the treatment of iatrogenic disorders like parkinsonism and
to attenuate drug-induced toxicity when administered as adjuvant. Intensive research
efforts are required to explore these possibilities.
1.7 Medicinal Plant Resources
The drugs used in the ISM are mainly plant based, in addition to a few materials of mineral
and animal origin. Thus the therapeutic efficacy of the drugs used in these systems is
greatly dependent on the use of pure and genuine raw materials in their preparation.
According to the estimation of the Department of ISM,

about 1100 medicinal plants are
estimated to find use in ISM & H drug preparation, and 500 of these are more commonly
used.
There are many problems in ensuring a constant supply of drugs; avoiding overexploitation
of medicinal plant resources; and also ensuring the quality of raw drugs and the
conservation, cultivation, and preservation of medicinal plants. To look into these matters,
the government of India has set up a Medicinal Plant Board, which has been given the
responsibility of coordinating all matters related to medicinal plants. The Planning Commission
set up a task force under Dr. D.N. Tewari, to
inter alia
provide policy directives
on (1) conservation and sustainable use of medicinal plants, (2) growth of domestic and
foreign trade, (3) development of an equitable market system, (4) regulation of this sector
to maintain quality control, and (5) protection of IPR of medicinal plants.
1.8 Ayurvedic Herbs and Herbal Formula Manufacturing
Ayurvedic medicines are marketed in various forms. They are available in the classical
forms like
gutikas
(tablets),
churnas
(powder),
asavas
and
aristas
(fermented products),
ghritas
(medicated ghee), and
kashayams
(decoctions). For topical use, drops, creams,
lotions, liniments, and ointments are available. Dried plant extracts in capsule form are
also in use. In addition, many patent drugs are sold in other modern drug presentation
forms like syrups, granules, creams, lotions, etc., which constitute around 65% of the
market share. There are more than 8500 manufacturers of Ayurvedic drugs in the country,
of which the annual return of 10 firms is more than Rs. 50 crores (approximately US $5

million — $1.00 is roughly equal to Rs. 48 crores), of 25 firms is between Rs. 5 and 50
crores, of 965 firms is between Rs. 1 and 5 crores, and the remaining is very small with
an annual turnover of less than Rs. 1 crore. The market share of Ayurvedic drugs is around
Rs. 3500 crores and that of Siddha drugs is around Rs. 5 crores.
3
Ayurveda is covered by the Drugs and Cosmetic Act (1940) and Rules (1945) of the
country, and the manufacturer is expected to comply with the rules delineated under
this act. In 1960, Chapter IV and other related chapters were added. Chapter IV deals
with the manufacture, sale, and distribution of drugs and cosmetics; Chapter IV-A,
which was subsequently added, deals with provisions related to Ayurvedic, Siddha, and
Unani drugs. In this chapter, 19 sections dealing with different aspects have been
described. All the drug manufacturing and dispensing activity in the country is covered
under this act. According to Clause 3(a) of this act, the definition of Ayurvedic drugs
includes all medicines intended for internal and external use for or in the diagnosis,
treatment, mitigation, or prevention of disease or disorder in human beings or animals
and manufactured exclusively in accordance with the formulae prescribed in the authoritative
texts of Ayurveda (which have been specified in the First Schedule of the act).
Clause 3(h) describes patent and proprietary medicines. This refers to formulations
prepared utilizing the drugs listed in the formulae mentioned in the authoritative texts
and mentioned under Schedule I but excludes drugs administered by parenteral route
and formulations mentioned in the books in the First Schedule.

 






Om Tat Sat
                                                        
(Continued...) 


(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)

1 comments:

Unknown said...

Good information about ayurveda

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