An Ancient Study: Research Challenges In Ayurveda

Bridging the gap of research in Ayurveda, which had been long languishing in a time wrap, is a herculean task. There is certainly a lot of ground to cover, but it is now on a threshold for a leap, perhaps.

Technology had provided a major impetus to ayurvedic research and would redefine Ayurveda’s impact – just as it redefined modern medicine and is continuing to do so.

There have been certain streaks of excellence happening in many areas in a short time that has put Ayurvedic scientist, Dr Bhushan Patwardhan, among the top 1% of the scientists in the world by Stanford University.

One of the major drawbacks was the lack of documentation. Recognizing these inherent problems, the new crop of physicians have taken progressive steps – documenting clinical practice and certain diseases. 

Covid 19 pandemic was definitely a major trigger for documentation at the clinical level, said Dr V Rajmohan, who was coordinator of the Kerala State Covid 19 Ayurveda Response Cell.

This has led many Ayurveda physicians into studying the various manifestations of the coronavirus disease, particularly the post-Covid 19 rehabilitation. The results have been rather good, he said.

A decade ago, the Chikungunya epidemic had made a major dent in Kerala’s health profile. Even when Ayurvedic practitioners could check the morbidity of the disease with some success, the system never rose to the occasion in documenting it.

When the Covid 19 made landfall, the Ayurvedic practitioners were rueing the lack of documentation as that would have given Ayurveda more acceptance during the Covid 19 pandemic.
When modern medicine leaped ahead with research backings, Ayurveda lagged behind despite some clinical victories. Lack of evidence and research backup had perhaps been a major undoing for Ayurveda relegated to the sidelines.

Even when classical medicines are promoted, allegations continue to bother the proponents of Ayurveda terming them fake. Herbs like Ashwagandha (Withania somnifera), Guduchi (Tinospora cordifolia), Amlaki – the Indian gooseberry, Glycyrrhiza glabra (Yashtimadhu), and Piper longum or Thippali or Pippali are among some of the time-tested drugs in Ayurveda. These along with Ayush 64 were among the drugs that were approved by the Ayush Ministry much later for managing various Covid 19 conditions, but many from the modern scientific community had raised issues of hepatic toxicity against some of these drugs.

Bringing in a researcher’s perspective on these allegations, Dr Rajmohan said toxicity studies are done by using a range of dosages, and in pre-clinical studies when rats were challenged continuously with higher levels of toxicity liver got damaged. However, even then, once the drug is withdrawn, the liver recovers. Nobody reads the last part of the text, he added.
In modern medicine, there have been questionable statistics with Remdesivir, hydroxychloroquine dexamethasone, plasma therapy, and even ventilator therapy for Covid 19, showing just about 20% results, but still, these were recommended for use. However, when it came to Ayurveda, the modern scientific community was extremely biased, said Dr Rajmohan. 

The research was the basis of the old Ayurvedic texts, according to the writings of the late legendary Sanskrit scholar and Ayurveda physician from Kerala Raghavan Thirumulpad. Any medical system is as good as it moves along with times based on contemporary research, he had written. But with little political patronage, especially over 200 years under British rule, Ayurveda faced neglect and was side-lined as modern medicine made its way, wrote Thirumulpad.

The science of anesthesia was the turning point in modern surgery. It was introduced into India as part of modern medicine, and that was perhaps one of the many reasons why Ayurveda shelved its surgical branch and moved ahead, believed the scholar.

Despite the loss of centuries of research, Ayurveda could take the leap with a lot of focus areas, believes Dr Geetha Krishnan, Technical Consultant, Ayurveda, World Health Organisation. A lot of ground needs to be could be covered in the backdrop with fundamental research. Ayurvedic preventive medicine could be a major focus in public health, he said.

Research on drugs had been a key occupation even eons ago, as is evident in various commentaries on the Ayurvedic treatises. The concept of Ayurveda has not undergone any change. It is the diseases and new findings of treating diseases that have got updated in most of the commentaries by various scholars spread over various time frames over the millennia.

While the impact earlier was directly in clinical practice, modern research in Ayurvedic drugs is happening in the industrial sector.

There is a plethora of classical drugs. In fact, there is no need to make new drugs as the classical drugs have not been explored to their worth, said Dr Remya Krishnan, professor in Ayurvedic pharmacology, Ayurveda Medical College, Mahe.

There are a number of processes as well as product research done by the industry, said Dr Sindhu A, vice president, Technical, Arya Vaidya Pharmacy. In any industrial setup, new product development is the main focus – maybe about 80%, she said. 

Process research is to find whether drugs made out of the slow grinding or slow boiling processes have better efficacy or whether new technological processes are suited to Ayurveda, said Dr Sindhu.

Outside pharmaceutical precincts, there is little fundamental research – using Ayurveda as a methodology or a tool to evaluate health and diseases – happening in Ayurveda, rued Dr M. Prasad, noted clinical researcher and academic in Kerala.
Both fundamental research and a multi-disciplinary approach in Ayurveda are badly missing, especially in Kerala, where there is a social acceptance of the indigenous system and a large number of people seek Ayurveda as the first intervention for many diseases, said Dr Prasad. 

Dr Prasad along with other researchers like Dr P Ram Manohar, director, Amrita Advanced Ayurvedic Research Centre, and Dr Vasudevan Namboothiri, former director of Ayurveda Medical Education, Kerala, had been among the first to conduct an Ayurvedic profile of Covid 19 patients in Medanta Hospital in New Delhi on patients from Italy in 2020, at the beginning of the outbreak in India.

Research methodologies in Ayurveda are different from modern medicine and hence not comparable, but at the same time international standards are being evolved to make Ayurvedic science acceptable on a wider canvas, said Dr Ram Manohar.
Despite the slag, some of national research institutes have built up a body of work. But how much of it has impacted Ayurveda practice needs to be critically analyzed.

The National Research Institute for Panchakarma at Cheruthuruthy in Kerala is one such institute that has built up work over the last 40 years. Earlier the focus was more on clinical research on new drugs and patents while now the emphasis is on evidence creation that will empower the Ayurveda physicians in their clinical practice, said V. C. Deep, assistant director, NRIP.
Documenting the prognosis of the disease in the Out-Patient as well as In-Patient departments with radiological images and physical examination before and after treatment had been one of the major works that have helped create an impact, he said.

Panchakarma is a technique involving various methods of detoxing the body and preparing it for further ayurvedic treatment. Sometimes the detoxing techniques themselves would be enough as treatment. Kerala had preserved the methods of panchakarma in its traditional manner much better compared to any other part of the country. 

The Institute offers training to Ayurveda doctors about the various processes in Panchakarma. The Institute has come out with a booklet on Standard Operating Procedures (SoP) for Panchakarma, which has become a ready reckoner for any Ayurvedic practitioner.

Much confusion prevailed among physicians as to when and how to do each karma, said Dr Deep. The SoP irons out such muddles. 

Another major work of the Institution was a research project titled Documentation of Effective Marma Practices. The outcome was a book titled Marma Chikitsa – Basic Tenets in Ayurveda and Therapeutic Approaches published in February 2021. The work is likely to impact Ayurveda practice in the country as the Ministry of Ayush is planning to make the traditional healing therapy as part of the Ayurvedic practice, making it part of college-level studies, said Dr Deep.

The shortage of medicinal plants is a prime concern in Ayurveda. Pointing out the wide gap in the availability, Dr P Ram Manohar, chief researcher at Amrita, said that, of the 10,000 medicinal plants listed by the Medicinal Plant Board of India, only 300 are actively used. Focus is required to research replacing a herb in a formulation without losing its efficacy or perhaps with better efficacy. Knowledge about abhava dravyam in olden texts indicated by Ayurvedacharyas can thus be furthered with modern research.

An anti-arthritic drug called Rasanaerandi kashayam has an important ingredient called Ativisha – Aconitum heterophyllum, which is an endangered species, hence costing a premium. Research for other plants that could be as effective would be a major breakthrough.

Research methodologies, previously not known to Ayurveda students, have prompted many Ayurveda students at post-graduate level or post-doctoral research, to publish papers, even though it is not mandatory, said Dr Sudhi Kumar, professor, co-ordinating the functioning of the new School of Fundamental Research in Ayurveda, a government initiative under KUHS.
It may take years to build up evidence to make Ayurveda the first preference in preventive medicine. Modern medicine, which had the advantage of technology and patronage of governments has not really brought about outstanding research in the last 250 years. Ayurveda’s modern avatar in Independent India is only about 50 years old.