Experiences with alternative systems of medicine in India
professor rh singh
India is the largest country in South East Asia with many unique social, cultural and economic features. Its population is over 1000 million with notable rising trend and the living settings are more of rural type. The economy is of developing nature and the health sector is one of the major challenges. Although western modern medicine is well developed and is liberally used in India, the population depends to a significant extent on traditional medicine for its health needs. India is a real example of medical pluralism where as many as six systems of medicine are officially practised such as Ayurveda, Unani, Siddha, Naturopathy, Yoga and Homeopathy in addition to the main stream medicine i.e. Allopathy. All systems have their independent working infrastructure in the sector of medical education, practice and research. Ayurveda is the major alternative system of Medicine in India.
Ayurveda is not just a traditional folklore but is a highly evolved and codified ancient life and health science based on its own unique fundamental principles, its origin going back to. the ancient Vedas. Ayurveda makes a holistic approach to life and the universe which exist as interdependent continaum. Ayurveda follows the laws of nature and propounds a number of applied doctrines for the understanding of life, health, disease, diagnostics and cure. Many of these doctrines are valid even today and may throw new light on several unresolved issues of the science of medicine as a whole today. And as such it is considered a treasure of ancient wisdom. The subtle knowledge of the science of ayurveda appears to have been developed through keen observation and intution over the phenomena of nature and its laws by the seers. Full proof theories and their reasonable applications in the field of health and disease were evolved at least few thousand years before. The transmission of the knowledge and transaction of the profession took place through Guru Sisya tradition in Gurukuls. The Ayurvedic classics available today like the Charaka Samhita exhibit a glorious glimpse of this tradition.
The traditional treasures
The original ancient knowledge of Ayurveda has been passed on to the present times through two sets of authentic ancient texts written in Sanskrit, now all translated in many modern languages including English. They are:
Even in the ancient classical period Ayurveda was already a well developed science of medicine and was practised in the form of Astanga Ayurveda Le. medicine with eight specialities viz.:
1. Kayachikitsa (Internal Medicine)
2. Salya Tantra (Surgery)
3. Salakya Tantra (Ophthalmology ENT)
4. Kaumar Bhritya (Paediatrics and Gynaecology)
5. Agad Tantra (Toxicology)
6. Rasayana Tantra (Geriatrics)
7. Bajikarana (Sexology Reproduction)
8. Bhutavdya (Psychiatry)
The present status
During last 200 years trends of institutionalisation began when gradually some Ayurvedic $chools were started. This trend took over a century to reach the present status of institutionalisation and university level education in Ayurveda. Today there are nearly 200 full fledged Ayurvedic colleges spread all over the country afficiated to different leading universities and financed by State Governments providing five and half years degree courses in Ayurveda and specialisation programme. With the growing institutionalisation of education in Ayurveda in the present century need has been felt to launch research and development activities inorder to update it in terms of its understanding and application to the present day needs of the people. Although there are controversies in India about the approach and methodology of research in Ayurveda and about the quantum of utilisation of western modern science for this purpose. However consensus is in favour of utilising all possible aids of modern science and technology to investigate the problems of Ayurveda and to generate evidence for the safety and efficacy of its medications. Thus, research interests are the main feature of ayurveda today in India. As a matter of fact Ayurveda today is an official system of Medicine undergoing fast revival and development on scientific lines towards the need of the nation. Mainstreaming and Globalisation of Ayurveda is the goal of ongoing attempts in India today.
The above perception gave birth to the need of postgraduate education in Ayurveda. During last few decades several Indian Universities have started postgraduate specialisation ourses in Ayurveda leading to MD Degrees of three years duration in as many as 15 specialised branches of Ayurveda. These postgraduate courses provide higher proficiency training and research career to selected scholars. Presently there are over 50 institutions providing postgraduate education in Ayurveda. Faculty of Ayurveda at Banaras Hindu University, National Institute of Ayurveda, Jaipur and Gujarat Ayurveda University Jamnagar are the Apex institutions in Ayurveda in India today.
The education and research in Ayurveda is controlled by two autonomous councils set up by the Government of India by acts of parliament viz., Central Council of Indian Medicine (CCIM) regulates the standard of Ayurvedic education and registration of Ayurvedic Doctors in the country, while Central Council for research in Ayurveda and Siddha (CCRAS) promotes and funds Ayurvedic research. Besides financing individual research projects the CCRAS maintains five central research institutes, seven regional research institutes, ten regional research centres and over 50 research units in Ayurveda fully devoted to research in Ayurveda. The following tables exhibit a summary of the existing infrastructure available in India in the sector of Ayurveda and other indian Indiagenous systems of medicine.
Table-1: Summary of Service Facilities in the Sector of Indigynous Systems of Medicine and Homeopathy in India
The contemporary features
During last hundred years the education and practice of Ayurveda has passed through a fast transition from Guru Sisya tradition to an institutionalised training system and hospital/dispensary based practice both in private and public sector. Thus the practice of Ayurveda as a system of medicine has had an unbroken tradition since ancient times in different forms. The present estimated number of registered traditional practitioners in India is about 50,000. This number is higher than the number of conventional modern doctors in the country. Such practitioners form a huge professional manpower available within the country. If given support and provided time to time training and supplied working facilities, they could prove a big help in national health care delivery system for the masses of this vast developing country which is still facing multifaceted health problems. 70% of the Indian population live in rural areas where western modern medicine is not accessible and practitioners of indigenous systems of medicine are the main help. These systems are working at a very low cost. It may be mentioned that indigenous systems of medicine which provide health care coverage to over two thirds of the population in different ways, share only 2% of the total health budget of the nation. Rest of the budget is spent on facilities for conventional modern medicine. The anomaly is now being examined for taking corrective steps by Government of India.
It is believed that given full support at the level of policymaking and financial input, the indigenous systems of medicine in India have the potential to occupy the role of main stream health care delivery, where conventional modern medicine may limit its role to referrals only.
Ayurveda and other indigenous systems of medicine have two-fold contemporary strength which need to be utilised:
1. In Primary Health Care where Ayurveda has strenght in promotive and preventive Health Care through its time honoured life style measures, dietic regimen and restorative and rejuvenative remedies of Rasayana Tantra.
2. In Tertiary Care of Chronic Intractable Diseases and degenerative disorders where conventional modern medicine has not much to offer. These two are the important sectors of health care delivery system today and in both these sectors Ayurveda and ISM have real strength.
Intergation and mainstraeaming of ISM
Recently with the establishment of a separate department of Indigenous Systems of Medicine (ISM) in the Ministry of Health, Government of India the endeavour to support the growth and to maxi mise the use of ISM has started yeilding results. Integration of ISM with conventional medicine and its mainstreaming is being attempted at all levels. Attempts are being made to start service facilities of traditional medicine specially Ayurveda in major modern medicine hospitals too. A course capsule is being developed to introdude Ayurveda in the formal curriculum of graduate studies of modern medicine in conventional modern medical colleges. The Ayurvedic Colleges have already incorporated Basic Modem Medical Sciences and Diagnostics in the syllabi of Ayurvedic graduate courses. Banaras Hindu University is conducting for many years 3- Years MD Ayurveda courses for modem MBBS graduates besides short term courses in Ayurveda for modern doctors and medical students both on full time and elective patterns open to foreign nationals. Several overseas universities particularly US Universities have shown interest to send their medical students for elective training in Ayurveda. All this is gradually bringing Ayurveda in the mainstream of medicine and is helping its integration. It is hoped that this trend of integration and interdesciplinary development will globalise Ayurveda. However one problem which comes in the way of globalisation of Ayurveda is its distinct uniqueness and the ideological and the linguistic differences from the main stream of medical sciences of today. An international convention on Ayurveda held at the Indic Research Centre of Columbia University, New York in 1994 which was also attended by the author of the present paper, concluded that:
1. The Ayurvedic system of medicine uses a different theoretical construct to describe the human being and the mechanisms of disease than that used by western medicine.
2. The Ayurvedic theoretic construct of human being dictates a significantly different methodology for disease prevention, diagnosis and treatment.
3. A variety of Ayurvedas wide variety of treatment modalities do not have obvious parallels in western medical treatment. Ayurveda also includes a large and sophisticated materia medica based primarily on the use of whole plant substances, although also incorporating significant amounts of animal and mineral products.
4. The challenges of integrating Ayurveda and western medicine are large and complex, yet the potential benefits for health care are significant both in economic savings and in improvement of over all health.
5. Reasonable progress towards an integration of Ayurveda and western medicine will require substantial amount of time and money invested in a broad based cooperative venture involving many people from both traditions.
Research starategis in ISM
Interdisciplinary multi-faceted research is the most important prerequisite for the integrative main-streaming drive of ISM In India lot of efforts are being made in this direction. Researches which are being promoted are designed to generate evidence for the validity of the system and its fundamental principles besides evidence for the safety and efficacy of the medications used as well as new treatment development. The current research dimensions in Ayurveda are:
1. Literary research
2. Conceptual and Fundamental research
3. Clinical research on disease, diagnostics and therapies.
4. Drug development research
5. Medicinal Plants: conservation, cultivation and good use.
Drug research is the hallmark of current Ayurvedic research. Varied strategies have been projected for this purpose. For developing evidence of efficacy and safety of medications one can adopt two approaches:
1. Rapid screening of many herbs of similar expected activity on one screening model in vivo or in vitro in an experimental setting.
2. Clinical evaluation of single or compound drugs in patients with different diseases through open or blind trials, adopting a Reverse Pharmacology Approach in view of the fact that the Ayurvedic/ISM drugs are already in human use by tradition and as such there is no danger in starting direct human trial:
patent regime
The idea of using patents to protect the rights of an inventor is not new. Eversince commercialisation started the use of patent and copy rights also began throughout the world. In the beginning it was more an issue of trust and respect but gradually it became the matter of law, firstly within countries and lately internationally.
In the present times the patent system is an extremely aggressive legal order and the growing trade and commercial temper has created a patent culture in western countries with aggressive tone. The debate on the comparative benefits of the patent regime to developed and developing countries has still not concluded.
The developed countries argue that the patent system will help the developing countries for their economic growth while on the other hand other people believe that the patent regime will benefit more that developed countries like US and will help them to monopolise the world trade and economy.
However the patent regime is to be considered in the present context in the totality of Indian Patent Act, GATT, TRIPs and the issues of intellectual property rights. Ayurvedic medicine and Indian herbs form one of the most vulnerable sectors in the context of patent regime.
A number of known herbs and plant drugs of India have been patented by outsiders on the basis of secondary researches. Neem, Haladi, Sunthi and Ashwagandha are few among any examples. Because of lack of awareness and falacies in the law, patents are being granted to individuals on the basis of minor secondary researches ignoring the obvious traditional knowledge.
In order to promote traditional medicine in any country there is an urgent need to change the Patent laws designed to protect the national heritage of a country which should be considered its intellectual property and should not be allowed to be patented in the names of any individual, national or foreigner. An ancient traditional knowledge claimed to have originated exclusively from a country should be treated as the national intellectual property of that country and that land should be entitled for world patent with exclusive rights of benefit for that nation. There is a need of making necessary legal provisions for national heritage patent. For this, there is a need of nation-wide awareness and national debate. The first task is to precisely define and describe the National Heritage Intellectual Property of the country with substantial proof and textual records. It would be necessary to enlist and to officially register the ancient classical texts and oral traditions historicity-wise which many be projected as National Heritage Record to be used as a document in support of a National claim.
The so registered National Heritage Texts and Traditions should be analysed for their contents viz. ancient concepts and theories, processes and drugs. Such contents which may be possessing potential of commercial utility should be redescribed in a language understandable to the professionals of today and patent administrators. Such a home work and suitable law reform may go a long way in protecting the ancient heritage knowledge of a country from being patented by the foreign agencies.
The respective Governments as well as the individual scientists will have to keep a constant watch on their intellectual properties to prevent any kind of piracy or infringement. The interim strategy should be tilted more towards Protection than to Patent. In view of the prevailing situations the strategy should be Patent or Publish. If one cannot patent his invention due to his limitations, he should publish the same in order to protect it from being patented by others. Certain corners in India have been raising the slogan of Swadeshi to combat the negative impact of globalisation on our nation. But inspite of being a solid reality Swadeshi has so far been used only as a slogan, not as a realistic work strategy.
Only slogans never save unless transformed into action. The new patent regime is to be viewed seriously and more deeply. The issue is not only technoprofessional but is essentially a matter of economic and political activism and is targeted at the rivalary between globalisation and national overeignity. As such the developing countries like India are carrying a big risk which can be overcome only by reasonable defensive strategies and by generating the sense of activism and work culture among our people.
Summary
India is one of the very few countries in the world where traditional systems of medicine are practised on full official footings and are provided with a huge working infrastructure. Serious attempts of integration and mainstreaming are in progress.
Multidimensional research and development on scientific lines is the main feature of Contemporary Ayurveda and ISM in India today. Ayurveda, which has already been a highly evolved and codified system of traditional medicine with an unbroken tradition of practice for thousands of years, is now growing fast in tune with the needs and expectations of present times. The crisis arising out of the new patent regime and IPRs, needs to be addressed to protect the interest of these systems and national heritage claims.
