Ayurvedic research and methodology: Present status and future strategies
Abstract
Ayurveda is a science of life with a holistic approach to
health and personalized medicine. It is one of the oldest medical systems,
which comprises thousands of medical concepts and hypothesis. Interestingly,
Ayurveda has ability to treat many chronic diseases such as cancer, diabetes,
arthritis, and asthma, which are untreatable in modern medicine. Unfortunately,
due to lack of scientific validation in various concepts, this precious gift
from our ancestors is trailing. Hence, evidence-based research is highly needed
for global recognition and acceptance of Ayurveda, which needs further
advancements in the research methodology. The present review highlights various
fields of research including literary, fundamental, drug, pharmaceutical, and
clinical research in Ayurveda. The review further focuses to improve the
research methodology for Ayurveda with main emphasis on the fundamental
research. This attempt will certainly encourage young researchers to work on
various areas of research for the development and promotion of Ayurveda.
Keywords: Ayurvedic research and methodology, personalized
medicine, Rasayana, traditional medicine
Introduction
Ayurveda, the traditional Indian medicinal system remains
the most ancient yet living traditions with sound philosophical and
experimental basis. It is a science of life with a holistic approach to health
and personalized medicine. It is known to be a complete medical system that
comprised physical, psychological, philosophical, ethical, and spiritual
health.[1]
In Ayurveda, each cell is considered to be inherently an essential expression
of pure intelligence hence called self-healing science.[2] In
addition, to the self-healing concept, the use of herbal treatment is equally
important in this Indian traditional system of medicine.
According to the World Health Organization, about 70–80% of
the world populations rely on nonconventional medicines mainly of herbal
sources in their healthcare.[3] Public
interest for the treatment with complementary and alternative medicine is
mainly due to increased side effects in synthetic drugs, lack of curative
treatment for several chronic diseases, high cost of new drugs, microbial
resistance, and emerging diseases, etc.[4]
Ayurvedic treatment is although highly effective; proper
mode of action, pharmacology, pharmacokinetics, and pharmacovigilance of many
important Ayurvedic drugs are still not fully explored. Moreover, the
comprehensive knowledge of the basic ideologies of Ayurveda is poorly
acceptable scientifically due to lack of evidence. In the modern time, when the
Western medicinal system is reached almost at the top because of validated
research and advanced techniques, there is an urgent need to validate basic
principles as well as drugs used in the ayurvedic system of medicine with the
help of advanced research methodology. Therefore, advancements in the ongoing
research methodology are highly required for the promotion of Ayurveda.
Why Ayurvedic System of Medicine Lagging Behind?
Undoubtedly, in comparison to allopathic treatment,
Ayurvedic treatment is more effective in most of the chronic diseases. However,
the popularity of Ayurveda is rather lesser as the majority of the global
population prefers modern medicine because of its ability to give fast relief
from diseases as compared to Ayurvedic treatment. Recently, the awareness and
thus fear of toxicity to allopathic drugs and the high cost of healthcare are
causing an increasingly large number of people to seek alternatives. Rather
than competing and veering towards the Western medicine, the Ayurvedic scientists
should work to enhance the core competency of Ayurveda without compromising its
fundamental principles.[5] Some
major points which are responsible for trailing the Ayurveda are as following.
Young Ayurvedic scholars, although enthusiastic, are not
clear about their views on the future of Ayurveda. Moreover, they are not even
very clear that how to expose their valuable research outputs on Ayurveda
Only a few organizations have well-established research
infrastructure for exclusive research in Ayurveda. Experienced researchers with
knowledge of modern technologies are required to conduct advance and quality
research in Ayurveda
There is a lack of cooperation and willingness of Biomedical
Scientists who are often unduly skeptical and carry prejudice
More than a thousand Ayurvedic postgraduates pass out each
year and enter into the streamline of academics and practice. Among them, only
a few choose their profession as researcher in Ayurveda
Neither has the Ayurvedic teaching changed in the last 50
years nor have the textbooks enriched with new research methodologies.
These are some of the following major points those should be
highly needed to consider in the Ayurvedic research for its advancement.
Improvement in research methodology
Research methodology is a way to systematic collection,
analysis, and interpretation of data to solve a research problem. India does
not need to prove the validity of Ayurveda to its people, authorities, and own
scientific community because it is a recognized traditional medical system of
the country. There is a need of fundamental research on Ayurveda to refresh and
upgrade the tremendous knowledge diluted through time particularly during the
British rule. This kind of research will certainly upgrade the fundamental
knowledge of Ayurveda, which will be benefitted not only to Indian but also to
foreign nationals. This will assure Ayurveda to be practiced with its whole
potential and allowed to gain wide recognition. Research is a process that
converts data into information, information into knowledge, and knowledge into
wisdom. In the present scenario, Ayurvedic researches are failing in this
aspect as these are unable to disseminate the knowledge gained from the
exercises.[6]
The glorious past of the research methodology of Ayurveda is
based on the tools of examination known as Pareeksha and inspired
from the philosophical term Pramaana, which refers to the evidence.[7] These
tools of the examination include (i) the direct observation (Pratyaksha), (ii)
the inference (Anumana), and (iii) the authoritative testimonies or literature
(Aptopadesha). The modern day research also depends on these three basic tools
whose efficacy has been augmented by the utility of the scientific and
technological innovative devices. These methods of investigations have been
planned to develop the backbone of the Ayurveda system in the form basic
principles under the fundamental research. The quality researches on Ayurveda
basics with advanced scientific techniques can expand the knowledge and path of
current medical science. Predominantly, drug researches done in the field of
Ayurveda in the last six decades have not enriched the Ayurvedic understandings
or Ayurvedic concepts. However, these researches have created a better
understanding of Ayurveda by the modern medical fraternity.
Now, it is the time to define Ayurveda itself that whether
the use of herbs is Ayurveda or the use of herbs and other treatment modalities
as per Ayurvedic principles is Ayurveda. The research methodology should be
planned and adopted accordingly. At the time of deciding research methodology
in Ayurveda following things should be kept in mind.[8]
Basic differences between Ayurveda and modern science should
be taken into account when designing the research protocols
The main concern must be given to the classical approach of Ayurveda
Research protocols should be designed on the basic concepts
of Ayurveda, i.e., Prakriti, Agni, Dhatu, Srotas, Rasayana, Shatkriyakala, Agnibala, Ojabala, Manobala,
etc.
The research work should involve experts both from Ayurveda
and biomedical specialties
The holistic and integrative approach involving body, mind,
and spirit should be considered for research
Before starting the clinical studies; a complete knowledge
about diagnosis of the disease, materials to be used, process to be adopted,
and accurate dosage form is highly needed
The approach of personalized medicine should be followed
during treatment.
Research methodology in the advancement of Ayurveda varies
with each assignment or project. The major areas of research can be divided
into five major areas, namely, literary, fundamental, drug, pharmaceutical, and
clinical research. Although there is no single way to conduct research, certain
methods and skills can make research efforts more efficient and effective.
Encouragement of research on Ayurvedic fundamentals
Fundamental research needs to be done in the fields of
Ayurvedic physiology, pathology, pharmacology (fundamental and clinical), and
pharmaceuticals. The basic concept of Srotovijnana (knowledge of
channels) as a main matrix of Ayurvedic biology has been highlighted both by
fundamental and applied knowledge.[9] A
living body is a system which comprised innumerable channels designed as an
inner transport system for a variety of functions. The health and disease
depend on the system of Srotas, which is prone to lose its function by
various factors including erroneous food and lifestyle. Ayurveda developed a
therapeutic technology for Samshodhana (biopurification) familiarly
known as Panchakarma therapy. Ayurveda can be better understood
through philosophy and physics rather than modern biology because the study of
the full spectrum of the Srotas can help to define the phenomenon of
relationships in structural and functional biology.[10]
Moreover, the fundamental concept of Ayurveda for a perfect health including
restoration and maintenance can also be understood through quantum theory.[11,12]
The fundamental research in Ayurveda caters demands of the
society and the medical fraternity; the modern scientific research has been
initiated in Ayurveda in the field of basic principles. The aim of basic
research in Ayurveda is to explore the scientific innovations and opportunities
in fundamental concepts of Ayurveda. The fundamental research includes
replacement of faith and suppositions with the scientific reasoning
complimented with the facts and figures. The objectives of the investigation in
the fundamental research are categorized into the human body (Purusha), the
disease (Vyadhi), the medicine (Aushadha), and the right time for action (Kriyakala).[13]
Validation of Ayurvedic drugs with reverse pharmacology
The reverse pharmacology refers to reversing the routine
clinic practice to the laboratory examination for the proper validation of a
traditional medicinal system.[14] It
is an interesting and important scientific approach to develop new drug
candidates or formulations from already known facts in traditional medicines
through sound preclinical and clinical researches.[15]
Previous researches, particularly for the past few decades,
validated a few concepts of herbal drugs by reverse pharmacology, which is
obviously tremendous work for Ayurveda. These researches also supported the use
of crude drugs rather than plant isolates or purified fractions for clinical
trials due to the combined effects of phytoconstituents. Such researches
generated a lot of interest in researchers towards herbal medicines and
consequently, in the last decade a demand of Ayurveda and other traditional
medicines has increased in the medical world.
In addition, the reverse pharmacology approach can help in
reducing failure rates of clinical implication of the herbs or their
formulations which are already described in Ayurveda. This approach gives an
opportunity to seek new synergistic combinations and improvements in
bioavailability and innovative strategies that can play a significant role in
drug development. Various previous studies on piperine revealed that its
combination improves the bioavailability of synthetic drugs such as
propranolol, theophylline, and rifampicin.[16]
Day by day, drug industry is facing serious challenges, as
the drug discovery process has become extremely expensive, riskier, and
critically inefficient. Postmarketing failures of blockbuster drugs and a
serious innovation deficit are the major concerns of big pharma companies.
Consequently, there has been a remarkable shift in favor of single to
multitargeted drugs, especially for polygenic syndrome based on the traditional
medicinal knowledge.
Evidence-based benefits of traditional approaches
There are many evidences, which supported Ayurveda
performances better than Western medicine, mainly in case of chronic diseases,
but it needs to validate with advanced scientific procedures. Ayurveda
recommends the use of copper pot for water-purification as copper pot has antibacterial
effect against important diarrheagenic bacteria including Vibrio cholerae, Shigella
flexneri, enterotoxigenic Escherichia coli, enteropathogenic E. coli, Salmonella
enterica typhi and Salmonella paratyphi, which is scientifically
validated.[1,17]
Ayurveda also has the ability of wound healing via a topical route with the
help of various preparations.[18]
Moreover, many Ayurvedic formulations and Rasayanas have
scientifically validated in various in vivo models. In this
connection, Amalaki, an Ayurvedic Rasayana, and Rasa Sindoora,
an organometallic derivative of mercury are effective in longevity,
development, fecundity, stress tolerance, and heterogeneous nuclear
ribonucleoprotein levels of Drosophila melanogaster.[19]
On the other hand, Bhasma, an ash obtained through
incineration of plants and animal derivatives (horns, shells, feathers, etc.),
metallic, and nonmetallic minerals, etc., is another example of traditional
approach in which the starting material undergoes an elaborate process of
purification (Shodhana), followed by the reaction phase, which involves the
incorporation of some other mineral and herbal extracts.[20] Bhasmapreparation
is similar to the present-day nanotechnology having nano-size (25–50 nm)
particles. Although Bhasmas are complex materials, physicochemical
analysis using modern techniques can be most attractive for the standardization
of Bhasma medicines. This can be certainly helpful in building
confidence in the use of such products for medication by ensuring safety,
efficacy, and batch to batch uniformity.[21]
Encouragement of interdisciplinary research
There is a need of involving all basic sciences such as
Physics, Chemistry, Molecular Biology, and Biotechnology together with
Ethnopharmacology, Ayurvedic Drug Discovery, Pharmacoepidemiology, Reverse
Pharmacology and various other areas for the better understanding, and
optimistic outcome of Ayurveda research. In the past few years, the
interdisciplinary concept of research is also introduced in Ayurveda mainly for
integrative medicine.[8]
In Western countries, the multidimensional approach by
combining traditional and modern medicine is growing day by day. The clinical
efficacy of many traditional medications for a variety of diseases has been
found comparatively better than that of modern medicine.[22] The
Ayurvedic system of medicine is very safe that can help in reducing the
enormous burden of mortality and morbidity caused by the various side effects
of conventional prescribed drugs. This traditional system is also found
effective against various diseases where pathogens developed antibiotic
resistance. Thus, interdisciplinary researches are highly needed to fight
against most chronic diseases.
Improvement in quality of herbal drugs
Most of the Ayurvedic Rasayanas (Medhya, Jeevaniya,
and Lekhaniaya, etc.) are based on the herbal products. Many herbs such
as Ashwagandha (Withania somnifera Dunal.), Shatavari (Asparagus
racemosus Willd.), Guduchi (Tinospora cordifolia (Thunb.)
Miers), Amalaki (Embellica officinalisGaertn.), and Bhallataka (Semecarpus
anacardium Linn.) are well-known Ayurvedic Rasayanas, which are
proven immunomodulators. Adjuvants are required for many of weak immunogenic
vaccines, and Ayurvedic rasayanas may offer better and safer immune
drugs that can be used as adjuvants in such vaccines and also in cancer
treatment.[23]
Herbal extracts of therapeutic relevance are of great
importance as reservoirs of structural and chemical diversity. Interestingly,
more than 120 distinct phytochemicals from different plants have capability as
lifesaving medicines. These compounds have been achieved through chemical and
pharmacological screening of only 6% of the total plant species.[24] The
National Institute of Health has already started extensive research for
anti-inflammatory compounds from turmeric, ginger, and Boswellia with
the aid of Ayurvedic knowledge. The screening of numerous herbs for treating
cancer has been done using traditional knowledge on such herbs.[25]
Moreover, a variety of drugs of immunomodulating capacity from traditional
medicine can provide newer opportunities to improve therapeutic spectrum.[26]
In case of herbal drugs, consistency in the chemical
composition and bioactivity are essential requirements for their safe and
effective use because the quality is the primary need for safety and efficacy of
plant-derived medicines. In case of Ayurvedic preparations, most of the drugs
are polyherbal formulations, and proper quality control is still a serious
issue. Consequently, till the date, the acceptability of Ayurvedic drugs in the
international market is very poor. There must be some procedures and techniques
to analyze these drugs (extracts or formulations) for their composition and
strength.[27]
Thus, there is a need to insure the standard quality of Ayurvedic products.
Active involvement of government
The government should be prepared a timeframe roadmap for
the progressive development of Ayurvedic education and research. Science-based
approaches may be promoted, utilized, and inculcated in the education of
Ayurveda like traditional Chinese medicine (TCM). It is most appreciable that
China has about 95% of Department of Traditional Medicine in their government
hospitals. That is why their traditional medicinal system got global
recognition and acceptable everywhere.[28]
Recently, Youyou Tu, has won Nobel Prize in Medicine for discovering
Artemisinin, a drug that has significantly lowered mortality rates from
malaria, based on a TCM remedy.[29]
India has to develop similar type of policies in the healthcare system for the
development of Ayurveda.
Development of Ayurvedic pharma sector
The drug manufacturing industries and other supporting
industries play important role in the development of Ayurvedic medicine. The
whole supporting system, i.e., raw material collectors, dealers, processing and
manufacturing industries, Ayurveda practitioners, and consumers must be
encouraged. Around 1100 medicinal plants are used as medicine and among them at
least 60 plants are of great demand.[30]
Today, as the demand for herbal products is increasing day by day, enough
availability of raw materials with reasonable prices is a big challenge for the
industries. Hence, some strict steps must be taken by the government as well as
industries itself to fulfill the supply and meet market demand. There is a need
to ensure correct raw materials for the medicine and for this purpose, it is
important to carefully monitor entire cycle of raw material collection such as
harvesting, processing, transportation, and storage before their use. Moreover,
selection of the correct germplasm using modern DNA fingerprinting and
chemoprofiling techniques be used taken on priority basis.[31]
Upgradation of Ayurveda literature
Ayurveda is continuously facing constraints and difficulties
from regulatory authorities and the scientific community, which is coming in
the way of its global acceptance.[32] The
available literature on the use of Ayurveda for the treatment of diseases is
still not evidence based. There is a need of more evidence-based researches in
this area to make the literature adequate. In this connection, Digital Helpline
for Ayurveda Research Articles provides a first of its kind resource to access
research articles on Ayurveda must be improved and updated. More than thousands
of articles indexed in renowned PubMed every year, unfortunately, out of them a
very few belong to Ayurveda research. However, the articles based on TCM cover
around 12% of total published papers.[33]
Therefore, Ayurvedic literature has to make its huge contribution in PubMed for
the international recognition.
Revalidation of clinical trials
The clinical trials on Ayurvedic medicines must be
revalidated to find out better treatment modalities by improving scientific
procedures, dose forms, and side effects of any given drug. The development of
a method to allow placebo controls for changing and individualizing therapies
is an important step in providing the basis for a meaningful comparison of not
only classic Ayurveda but also other traditional medicinal systems with
allopathic treatment in ways acceptable to Western standards. This approach
also shows that double-blind, placebo controlled, randomized studies are
possible when testing classic Ayurvedic versus allopathic medications. Larger
trials are needed and are clearly possible.[34] The
Ayurvedic clinical trials must follow consolidated standards of reporting
trails statement for global recognition.
Combination of Ayurveda and Western medicine
No doubt, Indian system of medicine has already received
much attention in academic fields. The popularity of Ayurveda is mainly due to
its therapeutic efficiency against most chronic diseases where modern medicines
are ineffective.[35] The
Western medicine, on the other hand, introduced in Asian countries in early 16th century,
when travelers from Western countries began to settle and found themselves in
greater contact with native people.[36] This
medicinal system got high popularity within a very short period due to its fast
action over traditional medicinal systems.
Interestingly, there are certain examples of Ayurveda and
Western medicine work well when used in combination. For example, rheumatoid
arthritis, a chronic and immune-mediated disease that causes pain and
inflammation are not well treatable in modern Western medicine. Present,
methotrexate achieves a response in 40–60% patients which cannot say
satisfactory at all. Furthermore, methotrexate is associated with distressing
and potentially serious side effects. As a result, 68–94% of arthritis patients
use complementary and alternative medicine therapy including Ayurveda.[34]
Therefore, Ayurveda and Western medicine should be considered as two sides of a
coin, and they must come together to work for humankind.
Resolution of controversies in Ayurvedic drug
It is not always the case that Ayurvedic medicines do not
show adverse effects. In a random sample of commercially prepared Ayurvedic
drugs purchased online via internet, it has found that nearly 21% contained
detectable levels of lead, mercury, and arsenic. The Rasa shastra medicines
were more than twice as likely as non-Rasa shastra medicines to contain
detectable levels of such metals which are said to be highly toxic for the
body.[37]
Such reports are to be addressed appropriately, so that the concerns can be
answered in time preventing further damage to the heritage. These Ayurvedic
formulations must have to critically standardized before their marketing.
Improvement in personalized medicine with modern technology
The concept of Ayurveda treatment is broad, which heal the
human being as a whole whereas Western system of medicine has traditionally
operated from only a cure model. Now, the time has come to create a new model
of the medicinal system by combining both healing and cure models. The value of
health care could be increased tremendously through personalized medicine that
could be helpful to predict disease risk, prevent progress of disease, and
manage treatments more efficiently. Moreover, the developments in the area of
pharmacogenetics and pharmacogenomics can help the practitioner to achieve the
target of personalized medicine.[38] A
personalized medicine does not mean just the right drug for the right
individual but the right drug for the specific disease affecting a specific
individual.[39] This
concept will surely make clinical trials more efficient by reducing the cost
usually raises due to side effects, and prescription of drugs those are not
effective in certain genotypes.[40]
The concept of personalized medicine is very old and used as
long as people have been practicing medicine.[7] In
recent time, the personalized medicine is all about DNA while single nucleotide
polymorphism and epigenetic factors influence drug response and form the basis
of personalized medicine.[41]
Hence, the personalized medicine must be improved with the help of modern
scientific techniques to promote Indian system of medicine.
Conclusion
Today, the cost of health care is constantly rising, and
affecting people's ability to afford health coverage. Drug-based medicines are
being unaffordable for economically poor countries like India and problematic
in the Western countries due to numerous side effects. The drug should be the
last rather than first mean of treatment, beginning with the natural healing
method like Ayurveda. One of the Ayurvedic treatment modalities such as Panchkarma can
remove disease before its manifestation. Having all the above beauties,
Ayurveda is still lagging behind because of the lack of scientific evidence in
many cases and poor research methodology.
The development of guidelines for methodology in Ayurveda
requires a huge professional work both by academicians and practitioners who
must have the necessary knowledge and motivation for this task. Otherwise,
Ayurveda will gradually lose its identity and will become a history of
medicine. Although the process of research is time taking but it is the only
way to overcome the difficulties in the promotion of Ayurveda worldwide. The
work in a coordinated and well-organized manner with no bias can improve
Ayurveda. Nevertheless, it also a bitter truth that modern researches have not
been very rewarding for Ayurveda itself as most of these researches is being
used Ayurveda to extend modern bioscience. Hence, there is an urgent need to
design advanced research methodology for the validation of Ayurvedic
fundamentals as well as its treatments.
There is a huge difference in the approach of allopathic and
Ayurvedic medicines. Ayurveda has evolved as a holistic system having an
understanding of physiology enabling it to maintain and restore health with a
few side effects and will focus rather on health, while allopathy whose
analytic understanding of physiology leads mainly to suppression of symptoms
with many side effects. Similarly, there is a great contribution of allopathy
in the fields of emergency medicine, diagnostic techniques, and surgery where
the existing practice of Ayurveda cannot compete. Thus, both systems have to
complement each other in the benefit of ailing. Ayurveda requires more
researches in the areas of fundamental principles and diagnostic tools in place
of drug research. In the present scenario, the research methodology of Ayurveda
is not good enough, which needs further advancements in the development and
promotion of Ayurveda.
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