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February - March 2007


Health

Authentic Ayurveda - The Real Deal, or is it?

by Anuja Prashar


Among the various countries where Ayurveda has become popular, the status of Ayurveda varies widely. The trade, practice and education of Ayurveda are prevalent in all these countries, but it has not been recognized legally as a Medical system except in India. However, Ayurveda has established its position around the globe as a unique health care system with a holistic solution to many complex health hazards.

The flourish of any system with socio-economic-political global impact, has to be positively channelled to benefit the maximum people with minimum expense. Hence, to retain authenticity and the lowest price in the global political economy of the 21st Century, it is important to have a factual understanding of this rapidly growing health care tradition which is very popular and in public demand. A fair and effective regulation for any medical system can only be designed by experts who have in-depth knowledge of the specifications of the concerned system.

Within the UK, the BAMC (British Ayurvedic Medical Council) is the oldest regulatory body, established to promote and maintain standards for Ayurveda through out Europe. Recently, the Department of Health have founded a new Herbal working group which will monitor and regulate Ayurveda teaching and practise under the banner of Herbal medicine, with a view to westernise these practises and make the whole system consumer friendly for the west. This artiocle attempts to bring together facts about this new development and to gauge the possible implications for consumers, suppliers and the future global sociological engagement with this ancient Vedic medical tradition.

Ancient Vedic tradition

Ayurveda is perhaps the world’s most ancient methodical Medical knowledge system. The earliest doctrines of Indian Medicine, contained in ancient Vedic text written in Sanskrit, the caraka samhita and the suzruta samhita (B.C 1500-1000) indeed show that the art and science of Ayurveda practice was well developed and systematically organised in that period, caraka samhita in the present form is the third generation edition which underwent considerable revisions by caraka and dRDhabala. The concepts of aetiopathology and disease management described in caraka samhita and the anatomical, physiological and pathological considerations of suzruta samhita are unique and quite logical and scientifi for that period of human history.

Suzruta defined health in suzruta samhita sutrasthana, 15/48, as “Health is a bio-physical and physiological state of equilibrium and a contented state of consciousness, senses and mind.” This concept of health which was the purpose of the treatment is more all encompassing and broader than the latest WHO (World health organisation) definition of health, which was re-defined in the 70s as “Health is the state of complete physical, mental and social well being and not merely the absence of disease.” Being a Medical science, Ayurveda views all the aspects which are responsible for the favourable and antagonising effects on the life and longevity of man, the causes for the same and explores the ways to enhance the favourable and eradicate the antagonistic factors.

In the last two decades, official Ayurveda due to its holistic approach using lifestyle modification, healthy diet and safe natural drugs attracted a large population in different countries around the world. Today Ayurveda and Chinese Medicine top the list of the Complementary and Alternative Medicine(CAM)/Traditional Medical(TM) therapies in popularity across the globe.

Policy changes:

The sudden resurgence of TMs, forced Agencies like WHO(World Health Organisation) and NGOs like the National Institute of Health, USA, to develop a new perspective for TM in the scientific and political circles. The WHO Traditional Medicine Strategy 2002-2005 lays guidelines for formulating Policies to integrate TM/CAM into mainstream health care.

The National Institutes of Health opened the National Centre for Complementary and Alternative Medicine (NCCAM) in 1998. They also formulated a five year strategic plan to promote clinical research on CAM, which it examines under five domains -Alternative medical systems, Mind-Body interventions, Biologically based therapies, Manipulative and body-based methods and Energy therapies. The above documents epitomize the scientific and political initiative to regulate the practice of TM/CAM the world over.

The percentage of visits to CAM practitioners increased from an estimated 427 million to 629 million between 1990 and 1997 in US while the Americans using CAM increased from 60 million to 83 million. Visits to CAM practitioners increased by 47 percent, exceeding visits to MDs by 243 million. It has also been observed that Americans spent more money out of their pockets for CAM than for conventional health care. Ayurveda is one of the most popularly used CAM/TM therapies in the World along with Traditional Chinese Medicine. The Healing potential of Ayurveda has opened up a new front of Health Tourism in India where people all over the world come over to India for availing the benefits of Ayurveda therapy for many chronic ailments and also for such diseases where modern medicine has nothing substantial to offer.

The 56th World Health Assembly passed a resolution on its 10th Plenary meeting on 28th May 2003, WHA 56.31.Agenda item 14.10 on Traditional Medicine, urged the member states to promote and support, if necessary and in accordance with national circumstances, provision of training and, if necessary, retraining of traditional medicine practitioners, and of a system for the qualification, accreditation or licensing of traditional medicine practitioners.

The importance of recognizing the role and relevance of developing policies nationally and Internationally for rational and safe practice of Ayurveda. WHO (World Health Organisation) has highlighted the need for regulation of traditional medicines among member states. If the people are to be benefited from any medical system, the system has to be first recognized by the state and then its trade and practice have to be regulated in such a way that safe and quality medicines are provided to the consumers by qualified physicians. This is not possible without understanding the system as such, with all its specifications. Hence, any attempt to regulate Traditional Systems of Medicine like Ayurveda should be firmly grounded on the principles and practices of the concerned system.

Practice

The global profile of Ayurveda can be analysed from three different situations of Practise, trade and Intellectual property. With respect to popular practise, Ayurveda is best identified as a holistic health care system for wellness, integrating the mind-body-spirit trio. The very many Ayurvedic spas and wellness centres where Ayurveda hand in hand with Yoga is offered as a detoxification and de-stressing therapy endorse this fact. The system, which entered global health care arena as a massage system holding the hand of Yoga, started moving on its own. This however should not be confused with authentic Ayurvedic practise as a whole medical system where a practitioner studies for a 5 year degree in India, which includes the study of Sanskrit.

A few committed individuals and institutions have contributed significantly in creating awareness regarding Ayurveda among the various countries of the world. Lately renowned Ayurvedic scholars with scientific background have done a great deal in propagation of Ayurveda in the countries of their influence specially America, Japan, Australia, Italy, Germany etc. There is a significant market for these treatments and the economics of this market cannot be easily ignored.

The key issue, arising from the changing governance structures within the Ayurvedic world in the UK is a challenge to retaining the link between the Hindu philosophy and Ayurvedic practise and teaching practises. This would lead to a dilution of Ayurvedic intellectual property and the lowering of standards of Ayurvedic practise in the west. The new Herbal working group, appointed by the Department of health, is a sub committee of the Council that regulates Acupuncture, Chinese herbal medicine and Traditional herbal medicine. Thus the new herbal working group sits under and not separated from the governance of European and Chinese herbal medicine.

Under the control of the EHPA (European Herbal Practioners Association) chaired by Micheal McIntyre, there are some key players that will now monitor and influence the education and practise, under the current proposed scheme of the UK Health department’s newly appointed Herbal working group. The APA (Ayurvedic Practioners Association) is also identified as key stakeholders for the Department of Health’s proposed Herbal working group. APA recently formed group by Nigel Hubber, is made up of western ayurvedic practioners who do not recognise the Hindu origins of Ayurveda. The AMA (Ayurvedic Medical Association) is another such group run by Mauroof Mohammed Athik and which also does not recognise the Hindu roots of Ayurveda.

European herbal medicine is not equivalent to Ayurveda because European herbal medicine relies upon wholly bio-medical parameters. Where as Ayurveda and the Pancha Tantra system are a holistic approach and completely different in practise and substance. At stake also with these changes is the livelihood of 500,000 Ayurvedic doctors in India, who spend five and half years in training for their degrees, and all the associated herbal suppliers and Ayurvedic industry. The Indian Doctors would be competing with ‘practioners’ who will be able to use the Ayurvedic brand, having acquired diplomas and certificates from a six month study programme, without any authentication from India and the real Ayurvedic practioners in the West, who are all schooled in the authentic Sanskrit and holistic medical system.

The process of establishing Ayurveda in the West has come full circle, from the initial rejection of the benefits of Ayurvedic treatments for Europeans, through to the current situation where Ayurveda is now being considered for the Western markets and thus the education and everyday practises are becoming packaged for European consumption without the root philosophy and original treatments. The shorter Ayurvedic 6 month courses now becoming available or new Degree programmes, such as the University of Middlesex BSc course, without Sanskrit and the whole system approach, will jeopardise the authenticity and value of Ayurvedic practise outside of India in the future. Ayurveda will eventually become diluted and disingenuous.

There is not enough awareness amongst the general public or Hindus at large, about the very nature of Ayurveda systems and practises, and thus the danger of dilution through ignorance would become compounded over time.

Ayurveda drugs are marketed and propagated as neutraceuticals, food supplements, cosmetics, rejuvenatives and aphrodisiacs. In most of the countries, Ayurveda drugs can be seen in general stores as dietary supplements under the label of Ayurvedic Herbal products. These are not classified as drugs and hence are not allowed to have any medicinal claim. There is also no requirement for a qualified Ayurveda physician to prescribe them. Sceptics of Traditional Medicine(TM) have demanded very high standards to accept its efficacy and validity. However the huge costs involved in research of the kind that is demanded by the global scientific community has, in effect, only denied people worldwide access to Ayurveda and other traditional medical knowledge systems in their truly holistic sense.

Today, Ayurveda medicines are largely imported into various countries as ‘Herbal Medicines’, Food Supplements, and Cosmetics etc. These include single herbs, compound herbal remedies and patented drugs which contain non-herbal ingredients. Many of these contain Ayurveda natural mineral and metallic drugs which need strict medical supervision for consumption and for follow up treatment. Since there is no proper mechanism to regulate these drugs, many a times suspected Ayurvedic Drug Regulators spoil the reputation of the Ayurveda system as a whole, where as in most cases it is the irrational use and misbranding of medicines as food, which causes the errors in regulation.

In the European Union, there had been an agreement that all countries would have their herbal industries and products under identical medicines controls by the end of year 1992. The only major country to achieve tight control was UK in the course of which most of the efficacious herbal products ceased to exist. Germany, France, Italy and Spain all had different degrees of light control and their product ranges actually grew. No unified market existed in January 1993 and no progress has been made towards it in the last decade. Of all EU countries, UK leads in the matter of legislative control for Herbal Medicines.

Since the introduction of the Medicines Act 1968, Herbal Medicines (Manufactured) are all supposed to be Licensed as Medicines but Herbal Medicines made of pure herbs and prepared by a Herbalist for patients are exempted under Section 12 of the act. This situation led to confusion, dating from 1975, and many manufactured products were and are being sold under section 12 exemption.

Holders of Official Authorisations for Herbal Products objected to the 12(2) amendment made in early 1990s and have been fighting the 12(2) exemption ever since. They want the Directive to clear the anomalous products from the market.

Maintaining the products in the market needs huge financial resources, which the herbalist sector could not afford. It is not just a question of producing one set of documents per product, but maintaining their validity on five-year review when extra data is always needed. Same purity criteria were imposed on Herbal medicines as for the synthetic (allopathic) drugs. Hence, by 1992 the UK market showed a marked decline with regard to the Herbal medicines.

A vast majority of Ayurveda products uses raw materials other than herbs as active ingredients. Hence, they cannot be called herbal. By being classified herbal, many of the popular Ayurveda drugs will be prohibited from being sold as Traditional Drugs without authorisation. They will not be considered for traditional Use Registration either since they are not purely herbal. Further only very few Ayurveda products can be safely dispensed as Over The Counter products, especially among a public who is uninformed regarding the indications, actions and reactions and antidotes in case of ADRs. In short, this clause excludes the whole range of Ayurveda products that are required for a proper Ayurveda treatment by an authentic Ayurvedic Practitioner. It denies the European public the freedom of choice for Ayurveda medicines for their treatment purposes and poses threat to the existence of many small-scale Ayurveda drug companies in India, who are exporting these drugs to EU.

Knowledge / Intellectual property

The third and perhaps the most recent trend is the promotion of Ayurveda education. Ayurveda is studied from different angles abroad. There is a purely academic approach to study Ayurveda, an exercise in which medical anthropologists, historians, philologists and sanskritists are engaged. Then there is the category called Complementary and Alternative Medicine, which looks at Ayurveda as part of a spectrum of alternative approaches to healing but not as an independent system of medicine. Compared to the first approach, the concept of CAM recognizes a certain amount of practical relevance for systems of medicine like Ayurveda. Thirdly, there are the promoters of Ayurveda who believe in its identity as an independent system of medicine. In this group there are a few who have a genuine understanding of Ayurveda - who desire to promote Ayurveda truly for the well-being of the global community.

The eminent Ayurveda practitioners in India have lots of case studies documented as to benefits of Ayurveda in Medical practise. An example is that one of the formulations by Vaidya Balendu Prakash, an eminent Ayurveda practitioner from Dehradun, India, has been accepted by European and US patent authorities for Leukaemia patients. Data are available also for certain forms of cancer with more clinical data on acute leukaemia. Some other diseases that are successfully treated in Ayurveda are Chronic inflammatory disorders like Pancreatitis, hepatitis, bronchitis, colitis, cystitis, dermatitis, gastritis, duodenitis, rheumatoid arthritis, sinusitis, metabolic disorders like chronic headache, childhood asthma, urticaria, insomnia, chronic fatigue syndrome, backache and anaemia.

Today, there are many institutions in India offering Ayurveda courses to interested foreign nationals. Many Western scholars have gone to India and do a formal Ayurveda education out of sheer love and interest in the subject. Many Modern doctors in the west also are keen to understand Indian holistic health care systems better. The main barrier in acquiring formal Ayurveda education in India was the lack of authentic texts and capable teachers who can convey the subject in depth in English. However, this is no longer the case in India where Ayurvedic studies are available in English. There is also the Europe Ayurvedic University in London, which is addressing the need for authentic Ayurvedic education in it’s degree programme, which is also affiliated to reputable Ayurvedic teaching institutions in India, and has produced a raft of authentic Ayurvedic graduates. The University is currently undertaking steps to have it’s degree programmes certified by the Indian Government. This type of institution needs to be supported and empowered further to meet the growing need for the authentic Ayurvedic practitioners outside of Indi, who will retain the links with the ancient Vedic roots and the holistic world view which has made Ayurveda and its associated Yoga practices so popular in the 21st century.

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