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Optimizing the Old and Generating the New Evidence

In tune with the ayurvedic classical dictum of managing diseases which call for replenishing the deficits, depleting the excess and maintaining the balance (Tripathi 1983c), it is proposed that a similar strategy could also be adopted for research in Ayurveda to generate evidence. One of the expectations that modern science has from Ayurveda is that its practitioners must produce translational benefits from books to bedside. This may prove to be particularly difficult in the case of matters like aphorisms and dictums which have been used to guide the practice of ayurvedic medicine. On the contrary, it may be argued that these dictums are actually the result of a translational effort, which has reduced complex observations in textbooks to easily remembered rules of practice. Such dictums already stand proven, since they have passed the test of time (Rastogi 2012).

Although research has been conducted in Ayurveda for the past many decades, these largely failed to give a reasonable reshaping of Ayurveda in the contemporary world and also could not help improve its clinical practice to a great extent. Ayurvedic practitioners, by and large, remain unclear about the possibility of their prescriptions to work in a given case. What has been missed by ayurvedic research done in the past decades is their contextual appropriation to link the discrete pieces of knowledge available to form a single compact and comprehensive knowledge having practical utility. Designing appropriate models to test if ayurvedic fundamentals work is also an important task. However, it seldom reached beyond its status from debate to practical designing (Patwardhan 2012).

Optimizing the Old: Re-Appropriation, Revalidation and Research Synthesis

Ayurvedic classical texts are full of information that is generic and are related to health maintenance, causes of diseases, diagnostic methods and treatment approaches. Ayurvedic literature is found following a temporal pattern of textual compilations, moving from the complex to the simpler narrations. Eventually the oldest texts of Ayurveda comprising the classical triad like Caraka Samhita and Susruta Samhita are found to be the most complex, in regard to their contents, whereas latter-day texts, including their commentaries, have become much simpler for their easy comprehensibility and acceptability among vaidyas of average intellect. This simplification of classical texts without diluting their principles was the ancient translational approach of Ayurveda, to make it widely acceptable, by offering ease in understanding and practice. Presentation of knowledge in a compact form (siitra), although facilitating its memorization and allowing the practitioner to have their contextual inference by applying their own wit (yukti), also proved limiting by creating a rigid grid around the knowledge and its application, which is not the case in contemporary medical learning and practice, which is more descriptive and elaborate. The difference in learning in Ayurveda and modern medicine is so large that the interpretation of knowledge and its application is highly subjective in Ayurveda, whereas it is highly objective in modern healthcare. It is for this reason that there is little space for variability in modern healthcare where the responses may be highly predictable. This is the opposite in Ayurveda, where it is highly variable, and the responses are rarely predictable. Continuous research in contemporary science is regularly incorporated in the texts allowing the readers to update them about evolving knowledge and to modify their practice in tune with the emerging knowledge. This approach of research synthesis is largely missing in Ayurveda.

Re-appropriation in this context stands for revisiting the classical knowledge of Ayurveda and finding if they seem appropriate in the contemporary context. There can be references to traditional contexts of living styles, which may not be truly appropriate in the current context. Such references may be re-appropriated. Looking at the causative factors of vatarakta elaborating a bumpy ride on a fast-moving animal (camel or horse) as the cause of the disease, seeing that such causes are actually not existing any more despite a sustained presence of the disease in the population argues for finding the re-appropriation of such causes in newer contexts. A motorcycle ride may be a re-appropriated cause of vatarakta in the modern context. Drug formulations and their dosing schedules may also require a similar contextual re-appropriation, focusing upon the drug dose as well as its scheduling. The time required for a pancakarma procedure may also need a similar re-appraisal.

Revalidation studies are vital in order to revive the evidence which has been accumulated through millennia in Ayurveda. These are again referring to the cues contextual to the cause of a disease and its cure by various means and modalities of Ayurveda. Without questioning their validity in the time when they originated, it is genuine to ask if these are still valid since the application of this knowledge has spanned a gap of over five millennia. The question of revalidating Ayurveda does not seem absurd, as we see old technologies getting replaced by new ones which are better productive and less expensive. The couching technique of cataract surgery originally described by Susruta in 500 B.C. has no place in today’s ophthalmology, except for its historical value (Kansupada and Sassani 1997). The same is the case with the laparotomy method recommended by Caraka in the case of intestinal obstruction or perforation (Shastri and Chaturvedi 2009). The ancient diagnostic technique of pouring a drop of oil into the urine (Tailabindu panksa), which had been a practical examination technique of finding the amount of bile salts in the urine and so to judge a clinical condition, has much better, accurate and reliable alternatives today, with ease and swiftness of operation (Kar et al. 2012). Ayurvedic drug formulary and pharmaceutics had largely been relying upon organoleptic techniques of drug identification and quality of finished products. There are remarkable advances made in the area of drug development and standardization in the recent past. Whether we really need today the techniques which had been described in Ayurveda many thousand years ago, is a question hard to be ignored. Revalidation is largely required in Ayurveda to understand its philosophy first, then its applications which may be the derivations of its fundamentals. A revalidation is also required to filter in Ayurveda what is still valid and what may have only historical importance. In the past century, China has been able to successfully do such a revalidation for its traditional Chinese medicine, though the process still goes on with divided opinion on the endpoints of such a process. It is India’s turn now to do it for Ayurveda.

Synthesizing and amalgamating the existing research to a meaningful conclusion is yet another fascinating area having high relevance to Ayurveda. Modern biology synthesizes the research findings through meta-analysis and systematic reviews which are not of much relevance to traditional medicine. What makes more sense to Ayurveda is to see what research material is meaningful, to understand it more explicitly, whether it is done by Ayurveda scientists or not. There are a number of researches conducted across the world having great significance to Ayurveda. Such research may require screening and if needed, to be viewed in a new ayurvedic perspective, keeping the inferences obtained from the primary research as pilot observations. The amalgamation of researches conducted in Ayurveda is also needed, even though these may not be rigorous studies. A combination of a few weak studies, when put together through data pooling, may come out to be a strong study. This can have high applicability in Ayurveda.

Generating the New: Priority Areas for Clinical Research in Ayurveda

Compared to the clinical research in biomedicine, Ayurveda presents its own unique requirements of clinical research pertaining to its specific needs. These needs are in addition to the usual efficacy and safety-related researches needed in Ayurveda or any other system of healthcare. The following examples may be considered as the priority areas for clinical research in Ayurveda, although it should not remain limited to those listed here, and, therefore, many other novel areas not listed may subsequently be added to the list. It is further emphasized that clinical research in Ayurveda may be carried out by adopting various models using Ayurveda either as a stand-alone therapy or integrating it with modern medicine in various proportions (Box 7.1).

BOX 7.1 MODELS OF RESEARCH IN AYURVEDA

  • 1. Stand-alone model
  • 2. Integrative model

a. Primary modern care followed by Ayurveda care

b. Primary Ayurveda care followed by modern care

c. Simultaneous care by due adoption of both systems at the same time

Areas of Priority of Clinical Research in Ayurveda

Areas Relevant to Contemporary Healthcare Needs

Areas where conventional effective care is not available, accessible or affordable can be the first priority research area in Ayurveda. This area may include the diseases of high prevalence, morbidity and mortality, having a high economic burden or requiring highly complex care not easily accessible to everyone. Ayurveda may find its research-based role here to ease the situation by extending its helping hand as a complementary, adjunct or supportive therapy along with the modern healthcare currently practiced.

Areas Where Ayurveda Has Proven Strength

These are certain clinical areas where Ayurveda anecdotally and conventionally is believed to have an edge over modern medicine. Hepatobiliary diseases, joint diseases, skin diseases and gastrointestinal diseases are such areas where Ayurveda is preferred by common people on the basis of the response observations in the segment. Developing these areas further through research and experimentation to maximize the benefits and to make the interventions highly specific, dependable and cost-concerned is highly desirable. The ultimate objective of research in these areas should be to develop Ayurveda as first-line therapy in specific conditions where it may dependably be considered as a primary therapy (Chauhan et al. 2015).

Taking Cues from Clinical Observations

While practicing Ayurveda, we find many unexpected observations which have not been seen and reported before. These observations may be related to various domains of clinical knowledge e.g. the cure of a rare disease, symptomatic relief in an intractable disease, side-effects of a relatively safe medicine or some other observations which may be of significance to other clinicians in practice. All such observations may become the subject of more detailed inquiry through systematic clinical researches.

Areas of Textual Strength in Ayurveda

Many areas are elaborately described and praised in Ayurveda, but are not used in contemporary practice. Such practices, which have a theoretical basis, but are not practiced, may be explored to prove the relevance and translational possibility of such descriptions. Rasayana, vajTkararia, various dincarya and rtucarya rituals and preventive pancakarma are classical examples of this knowledge which needs contemporary reappraisal.

Areas Important to Establishing Standards in Ayurvedic Clinical Practice

Many fundamental questions which are important from an ayurvedic perspective are required to be taken as a priority in clinical research. These are typically related to the development of practice guidelines, cost-effectiveness analysis, determination of dose and duration of therapy on the basis of primary and secondary endpoint observations and establishment of long-term safety of ayurvedic interventions in the conditions where a prolonged therapy is required.

Ayurveda in Vulnerable Population

Ayurveda is still required to prove its worth in marginal populations having special healthcare needs. Ayurveda may be required to find a clear role in pediatric and geriatric healthcare needs and also need to establish its safety and utility in pregnancy and lactation. Such research work is essential to establish a firm ground for Ayurveda since it involves over half of the population requiring medical care.

 
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