Opinion: Why isn’t Ayurveda mainstream?

The historical references of Ayurveda are as old as 5,000 years or even more. In Nepal, studies show it is being used by at least 80 percent of the population in some form. The total number of Ayurveda doctors in the country, with five and a half years of medical school training, is less than 1,000 and the total number of consultants in various Ayurveda specialties are around 100.

Till date, there are five medical colleges which run undergraduate Ayurveda courses in Nepal. With a history as long as the regime of Amshu Verma (605-620 AD), Ayurveda health services have reached almost all districts. Even with its antiquity and accessibility, Ayurveda is still not a mainstream medical system and left out as a complementary and alternative medical system.

Four years back, when I started my Ayurveda medicine training, I wrote a column in the same newspaper suggesting pilot study to report indigenous uses of medicinal plants in Nepal, development of standard guidelines and protocols for Ayurvedic treatment of different diseases, discourage quackery and malpractices in the field, and bridge the ancient knowledge with the modern science.

Four years down the line, the challenges and problems within the Ayurveda field remains the same. While India is able to upgrade its Ayurveda department into a full-fledged AYUSH ministry, Nepal’s counterpart institutions are barely managing to function. Although few progresses are made even with the tortoise’s speed, the field significantly lacks decisive leadership in its institutions and clear vision as to make use of the available resources and improve the public health services.

Ayurveda mainly has two domains of practice – first the preventive aspect and second the curative practices. The first aspect usually involves recommendations for daily regimens, seasonal regimens, and lifestyle modifications to promote the health of healthy individuals. The latter domain of the Ayurveda practice mostly involves the uses of drugs and therapies including yoga, lifestyle changes, and dietary modifications for the management of medical ailments. While Ayurvedic interventions are widely used in the management of chronic and non-communicable diseases namely diabetes mellitus, hypertension, thyroid disorders, depression, and anxiety among others, the efficacy of Ayurveda in the management of acute conditions are also very encouraging.

Today, the world’s leading academic institutions like Yale, Harvard, Arizona, Jefferson, Boston in the United States, RMIT, UTS, Western Sydney in Australia have established separate departments and centres of integrative medicine promoting the evidence-based approach to medical systems like Ayurveda and others. This has opened doors for Ayurveda to get in touch with the west and pass on the knowledge and skills instructed in the classical texts. However, most of the Ayurvedic clinical practices happening today have completely left out the classical instructions – from the diagnosis to management.

For example, the use of sodhana (purification) treatment, to what the classics refer to as an essential process to be performed before beginning any drug therapy, is avoided by the doctors either due to reluctance or due to unavailability of resources. Similarly, Ayurveda classics have set out its own clinical methods to examine the patient and diagnose the ailments, but Ayurveda doctors deliberately neglect this. These are very few examples of how Ayurveda doctors are delineating from their core principles today.

At certain times, few doctors make prescriptions through an injudicious and unjustifiable approach, which not only increases the expense on the patient’s end but also raises concerns about the patient’s prognosis and adverse drug reactions. The governing bodies should publish standard treatment guidelines to streamline the clinical practice, ensure rational prescribing and dispensing of the drugs. The utter inactiveness of the governing and regulatory bodies in issues such as rampant quackery, injudicious prescriptions, drifting the practice to their non-specialties, inadequacy of the infrastructures in the medical colleges is really disappointing.

The backbone of the Ayurveda is medicinal plants. Although more than 800 species of medicinal plants are reported in Nepal, the cultivation and production doesn’t meet the demands of pharmaceutical companies in the country. Also, very few Ayurveda drug manufacturing companies in the country has WHO’s good manufacturing practices, leaving a room for questions in their product’s quality, safety, and efficacy.

Because of the small market, the medicines are not readily available and most of the imported medicines, which make up a significant portion of prescriptions, are unaffordable and expensive. This is one of the reasons why many patients, especially with chronicity, discontinue their treatment in Ayurveda resulting in poor prognosis. The long-term solution is to widely cultivate medicinal plants, establish processing centres and run GMP certified Ayurveda pharmaceuticals to meet the market’s demand. The coverage of Ayurveda therapies and consultations by insurance schemes is also an effective policy to decrease the financial burden of the patients and promote medical tourism in the country.

There are also some issues of solidarity within the Ayurveda doctors. Even with the human resource as low as five percent of the country’s human resources in the western medicine, Ayurveda doctors are apparently divided and do not maintain the unity even when it comes to solving the problems and progress of the fraternity. The fraternity should be vigilant to keep Ayurveda out of political and religious influences. For example, at multiple times, Prime Minister KP Sharma Oli used Ayurveda to claim that Nepali’s immune system against COVID-19 is strong due to the use of spices such as turmeric and other herbs in their kitchen, defending his inefficiency and incompetence in managing the pandemic.

Although this sparked public and intellectual debates, Ayurveda fraternity could hardly raise a common voice, whether in support or in opposition, because of the political stratification and moral dilemma within. The fraternity needs to be clear that our access to politics should be used for the development and prosperity of Ayurveda instead of individual benefits. For example, the political access should be used to bring out our genuine woes such as inadequate allocation of budget by the donor-driven Ministry of Health, lack of physical infrastructures in the districts for comprehensive service delivery, and institutional condescension during federal adjustments, among others.

In Nepal, there is no appropriate documentation or scientific collection of the cases with positive outcomes from Ayurveda drugs and therapies. There is a very widespread impression that the holistic and individual-based treatment approach of Ayurveda makes its clinical practice difficult to translate into the paper. Even though this is partially correct, this is more of a surreal excuse. With rapid advancements in science and technology, there is no such boundary.

Scientific evidences should be adequately generated to make it comprehensible to all the scientific community for its wider acceptance. In this current situation, rigorous scientific methods should be followed both by the Ayurveda or western medicine to claim the prophylaxis or management of COVID-19. The fraternity needs to accept that without scientific validity or appropriate classical references, the claims and marketing of Ayurveda’s success will be termed as “unproven” and become counterproductive.

There are dozens of international, indexed, peer-reviewed journals that specifically focus on Ayurveda and complementary medicines. But only a handful of doctors have started documenting their clinical outcomes properly. This is mostly because Ayurveda doctors trained in Nepal do not have adequate knowledge of research methods. The curriculum for the undergraduate course Bachelor of Ayurvedic Medicine and Surgery (BAMS), unrevised since 1995, doesn’t have elements of research methodologies and information technology. Consequently, a large section of the Ayurveda doctors lack the ability to apprehend and appreciate scientific knowledge that would in turn maximise the benefits of Ayurveda drugs and therapies.

With changing times, Ayurvedic doctors should use newer tools and methodologies to establish their clinical outcomes and document the evidence. It is the responsibility, especially of the newer generation, to decide whether to let the proponents of western medicine label Ayurveda as a pseudoscience or to establish this traditional practice as an evidence-based system of medicine. With faith in the classical texts, acceptance of science, and utmost professionalism, the newer generation in Ayurveda can definitely change the status quo and drive the practice into the mainstream.

Acharya is the President of Nepal Ayurveda Medical Students’ Society