Can Indian Systems of Medicine, such as Ayurveda, Siddha, and tribal medicines, be evidence-based? These questions have come to the fore in the Ramdev Baba Coronil dispute, in which an herbal product was claimed to be a cure for COVID-19 without sufficient scientific evidence.

Many decades ago, in Vietnam, during the war, more soldiers fighting the American army were dying from chloroquine-resistant malaria than American bullets. At the request of Ho Chi Min, China’s Mao Zedong initiated Project 523, sending researchers to scour traditional Chinese medicinal literature to identify herbs for malaria-like symptoms.

The most remarkable outcome was the discovery of artemisinin, a life-saving anti-malarial drug. Tu Youyou and her team, inspired by a 1,700-year-old treatise, discovered artemisinin using modern scientific methods. This breakthrough saved millions of lives and earned her a Nobel Prize in 2015.

Despite initial scepticism, clinical trials and pathophysiological studies confirmed the efficacy of artemisinin in controlling malaria. This robust evidence convinced the global health community and led the World Health Organization to endorse artemisinin. Today, academia worldwide investigates traditional Chinese medicine using modern science tools.

In the past, Indian systems were evidence-based

In ancient Indian philosophy and scientific texts, rationalistic epistemological keywords such as pariksha, anumana, ganita, yukti, nyaya, siddhanta, tarka, and anvesana share space with some form of mythology. According to Narasimha (dated 7th-8th century), the commentator of the Rasavaiseshika-sutra, attributed to Bhadanta Nagarjuna in the 5th-6th century, only two types of evidence count in Ayurveda: pratyaksha (directly observed) and anumana (conjectured/inferred), with no role for ‘belief’ in the sense of blind faith. (Na hy āyurvede pratyakṣārthānumeyārthābhyām āgamābhyām anyacchraddheyārthatvam asti, dṛṣṭaphalatvād iti. -RVSBh 3.45).

Caraka distinguished between Yuktivyapashraya bheshaja (reason-based) and Daivavyapashraya bheshaja (faith-based) therapies, emphasising the process of investigation, ‘pariksha‘, as critical for arriving at scientific truth. He stated that a claim becomes generally acceptable only after it has been thoroughly investigated by several investigators and is supported by robust and rational evidence.

Then why has Ayurveda fallen on the way?

From the sixth to tenth century CE, Ayurveda was a thriving and active field. New medicinal formulas were discovered and added to its extensive corpus. For example, Vagbhata (6th century CE) emphasised the importance of updating medical literature, ‘yuga anurupa,’ and authored new commentaries on Charaka Samhita and Sushruta Samhita. Dalhana (11th century CE) did not deter to amend and add two new iron formulations for anaemia treatment in his commentary on Sushruta Samhita.

“Ayurveda does not derive its authority because it is divined by Brahma; its merit comes simply from the verifiable truths it contains”, according to Vagbhata. However, numerous practitioners of Ayurveda believed that it was attained by ancient ‘rishis’ through their divine ‘yogic’ powers rather than as an experimental and experience-based scientific therapeutic system subject to critique.

“Subservience to the written word and textual authority, reinforced by the societal effects of caste hierarchy and mystical philosophies, gradually replaced the spirit of scientific adventurism and enquiry that characterised the work of Ayurvedic pioneers,” says MS Valiathan, a noted cardiologist and author of the book series Legacy of Charaka, Sushruta, and Vagbata.

In recent history, conservatism and mysticism were reinforced and promoted by the trope formulated by Captain G Srinivasa Murti, a practising medical doctor, to the committee constituted by the Government of the Madras presidency in 1921 under the chairmanship of Muhammad Usman on the question of recognising and encouraging indigenous medical systems. While modern Western science used external aids such as the microscope, telescope, spectroscope, and so on to comprehend things beyond the range of the senses, he asserted that the Hindu sages “sought to effect the same results, not by providing their senses with external aids, but by improving their own internal organs of sense”.

“The general unwillingness of contemporary practitioners of Ayurveda to question the wisdom enunciated in the classical Samhitas is contrary to the teachings of the sages in ancient India who preferred pratyaksha (direct evidence), anumana (inferential evidence), and yukti (logic) over shabda pramana (textual narrations)“ says Subhash C Lakhotia, professor of cytogenetics at the Banaras Hindu University and a pioneer in using the drosophila model to study Ayurvedic biology.

Western and Eastern

Not all invoke the divine to refuse scientific scrutiny; some hide behind cultural relativism. They argue that ‘allopathy’ is based on Western science and that Ayurveda is an epistemologically different yet valid knowledge system, which can be validated only using Ayurvedic logic and methods.

According to Ayurvedic physiology and anatomy, shukra (semen) is formed in majja (bone marrow), and urine is formed without the involvement of the kidneys. The text further states that the combination of semen and menstrual blood results in the creation of an embryo. All of these contradict ‘pratyaksha‘, and can these be accepted as alterative ‘ways of seeing’?

Kishor Patwardhan, a Kriya Sharir Ayurveda professor at Banaras Hindu University, explains that Ayurveda’s epistemology aligns with Nyaya Vaisheshika schools of thought, similar to modern science but using simple tools. “In ancient times, pratyaksha meant employing the sense organs to acquire knowledge; today, we use tools like microscopes for the same purpose”, he says.

Clinical trials

Randomised control trials (RCTs) are the gold standard for clinical trials assessing medication efficacy. Allopathy prescribes the same therapy for two people with identical diagnostic assessments.

However, Ayurvedic treatment is individualised based on the constitution (prakriti, agni, samhanana, etc). Due to its complexities, including multiple medications, mid-course correction, therapies, diet restrictions, and lifestyle modifications, the RCT appears to be not feasible for Ayurvedic clinical trials. Some argue that only case studies from the personal experience of Ayurvedic medical professionals are viable.

The situation is not hopeless, however. Recently, methotrexate-based treatment was compared to Ayurvedic intervention in patients with radiological indications of rheumatoid arthritis, proving the viability of double-blind, placebo-controlled trials even for individualised treatments. If there is a will, there is a way.

The elephant in the room

It is frequently argued that modern science gives stepmotherly treatment to studying old medical systems. But this is not the case. Prompted by a fortuitous talk by former President of the Indian National Science Academy, M S Valiathan, on Ayurveda and modern medicine, Naveen Khanna and his team at the International Centre for Genetic Engineering and Biotechnology (ICGEB) discovered a potent antiviral against all four dengue strains, after reviewing Ayurvedic literature. After years of research, they found that a botanical extract of Cissampelos pareira Linn (Cipa) was beneficial against dengue in both in vitro and animal models. Human clinical trials are currently underway.

Similarly, researchers at the CSIR-Indian Institute of Integrative Medicine in Jammu isolated Sinococuline, a bioactive constituent of Cocculus hirsutus, which has a powerful anti-dengue action, and discovered IIIM-290, a botanical medicine with anti-cancer characteristics.

China is investing massive amounts of government funds to revalidate ancient medicine using current evidence standards, by accepting therapies that work while rejecting those that do not. In India, we lack both funding and an unflinching commitment to evidence.

Aura of mystical, the critical hurdle

Sushruta maintains that medical interventions are trustworthy not just because they are effective in his own experience (pratyaksha / phaladarshana) but only because they have been rationally vetted by the community of specialists. He is seeking what is now known as a rigorous peer assessment before the claims are accepted. It is obvious that case studies cannot replace well-designed clinical trials in evaluating efficacy and assessing the underlying pathophysiology of disorders.

Naturally, classical medical texts from centuries ago contain imprecise anatomy and physiology, with outdated theories of pathophysiology and aetiology. Yet, practitioners often claim divine revelation and do nothing to update or change this knowledge. Unearthing the biological basis of this knowledge trove can benefit both the Indian System of Medicine and biology.

Can Indian Systems of Medicine, such as Ayurveda, Siddha, and tribal medicines, be evidence-based? These questions have come to the fore in the Ramdev Baba Coronil dispute, in which an herbal product was claimed to be a cure for COVID-19 without sufficient scientific evidence.

Many decades ago, in Vietnam, during the war, more soldiers fighting the American army were dying from chloroquine-resistant malaria than American bullets. At the request of Ho Chi Min, China’s Mao Zedong initiated Project 523, sending researchers to scour traditional Chinese medicinal literature to identify herbs for malaria-like symptoms.

The most remarkable outcome was the discovery of artemisinin, a life-saving anti-malarial drug. Tu Youyou and her team, inspired by a 1,700-year-old treatise, discovered artemisinin using modern scientific methods. This breakthrough saved millions of lives and earned her a Nobel Prize in 2015.

Despite initial scepticism, clinical trials and pathophysiological studies confirmed the efficacy of artemisinin in controlling malaria. This robust evidence convinced the global health community and led the World Health Organization to endorse artemisinin. Today, academia worldwide investigates traditional Chinese medicine using modern science tools.

In the past, Indian systems were evidence-based

In ancient Indian philosophy and scientific texts, rationalistic epistemological keywords such as pariksha, anumana, ganita, yukti, nyaya, siddhanta, tarka, and anvesana share space with some form of mythology. According to Narasimha (dated 7th-8th century), the commentator of the Rasavaiseshika-sutra, attributed to Bhadanta Nagarjuna in the 5th-6th century, only two types of evidence count in Ayurveda: pratyaksha (directly observed) and anumana (conjectured/inferred), with no role for ‘belief’ in the sense of blind faith. (Na hy āyurvede pratyakṣārthānumeyārthābhyām āgamābhyām anyacchraddheyārthatvam asti, dṛṣṭaphalatvād iti. -RVSBh 3.45).

Caraka distinguished between Yuktivyapashraya bheshaja (reason-based) and Daivavyapashraya bheshaja (faith-based) therapies, emphasising the process of investigation, ‘pariksha‘, as critical for arriving at scientific truth. He stated that a claim becomes generally acceptable only after it has been thoroughly investigated by several investigators and is supported by robust and rational evidence.

Then why has Ayurveda fallen on the way?

From the sixth to tenth century CE, Ayurveda was a thriving and active field. New medicinal formulas were discovered and added to its extensive corpus. For example, Vagbhata (6th century CE) emphasised the importance of updating medical literature, ‘yuga anurupa,’ and authored new commentaries on Charaka Samhita and Sushruta Samhita. Dalhana (11th century CE) did not deter to amend and add two new iron formulations for anaemia treatment in his commentary on Sushruta Samhita.

“Ayurveda does not derive its authority because it is divined by Brahma; its merit comes simply from the verifiable truths it contains”, according to Vagbhata. However, numerous practitioners of Ayurveda believed that it was attained by ancient ‘rishis’ through their divine ‘yogic’ powers rather than as an experimental and experience-based scientific therapeutic system subject to critique.

“Subservience to the written word and textual authority, reinforced by the societal effects of caste hierarchy and mystical philosophies, gradually replaced the spirit of scientific adventurism and enquiry that characterised the work of Ayurvedic pioneers,” says MS Valiathan, a noted cardiologist and author of the book series Legacy of Charaka, Sushruta, and Vagbata.

In recent history, conservatism and mysticism were reinforced and promoted by the trope formulated by Captain G Srinivasa Murti, a practising medical doctor, to the committee constituted by the Government of the Madras presidency in 1921 under the chairmanship of Muhammad Usman on the question of recognising and encouraging indigenous medical systems. While modern Western science used external aids such as the microscope, telescope, spectroscope, and so on to comprehend things beyond the range of the senses, he asserted that the Hindu sages “sought to effect the same results, not by providing their senses with external aids, but by improving their own internal organs of sense”.

“The general unwillingness of contemporary practitioners of Ayurveda to question the wisdom enunciated in the classical Samhitas is contrary to the teachings of the sages in ancient India who preferred pratyaksha (direct evidence), anumana (inferential evidence), and yukti (logic) over shabda pramana (textual narrations)“ says Subhash C Lakhotia, professor of cytogenetics at the Banaras Hindu University and a pioneer in using the drosophila model to study Ayurvedic biology.

Western and Eastern

Not all invoke the divine to refuse scientific scrutiny; some hide behind cultural relativism. They argue that ‘allopathy’ is based on Western science and that Ayurveda is an epistemologically different yet valid knowledge system, which can be validated only using Ayurvedic logic and methods.

According to Ayurvedic physiology and anatomy, shukra (semen) is formed in majja (bone marrow), and urine is formed without the involvement of the kidneys. The text further states that the combination of semen and menstrual blood results in the creation of an embryo. All of these contradict ‘pratyaksha‘, and can these be accepted as alterative ‘ways of seeing’?

Kishor Patwardhan, a Kriya Sharir Ayurveda professor at Banaras Hindu University, explains that Ayurveda’s epistemology aligns with Nyaya Vaisheshika schools of thought, similar to modern science but using simple tools. “In ancient times, pratyaksha meant employing the sense organs to acquire knowledge; today, we use tools like microscopes for the same purpose”, he says.

Clinical trials

Randomised control trials (RCTs) are the gold standard for clinical trials assessing medication efficacy. Allopathy prescribes the same therapy for two people with identical diagnostic assessments.

However, Ayurvedic treatment is individualised based on the constitution (prakriti, agni, samhanana, etc). Due to its complexities, including multiple medications, mid-course correction, therapies, diet restrictions, and lifestyle modifications, the RCT appears to be not feasible for Ayurvedic clinical trials. Some argue that only case studies from the personal experience of Ayurvedic medical professionals are viable.

The situation is not hopeless, however. Recently, methotrexate-based treatment was compared to Ayurvedic intervention in patients with radiological indications of rheumatoid arthritis, proving the viability of double-blind, placebo-controlled trials even for individualised treatments. If there is a will, there is a way.

The elephant in the room

It is frequently argued that modern science gives stepmotherly treatment to studying old medical systems. But this is not the case. Prompted by a fortuitous talk by former President of the Indian National Science Academy, M S Valiathan, on Ayurveda and modern medicine, Naveen Khanna and his team at the International Centre for Genetic Engineering and Biotechnology (ICGEB) discovered a potent antiviral against all four dengue strains, after reviewing Ayurvedic literature. After years of research, they found that a botanical extract of Cissampelos pareira Linn (Cipa) was beneficial against dengue in both in vitro and animal models. Human clinical trials are currently underway.

Similarly, researchers at the CSIR-Indian Institute of Integrative Medicine in Jammu isolated Sinococuline, a bioactive constituent of Cocculus hirsutus, which has a powerful anti-dengue action, and discovered IIIM-290, a botanical medicine with anti-cancer characteristics.

China is investing massive amounts of government funds to revalidate ancient medicine using current evidence standards, by accepting therapies that work while rejecting those that do not. In India, we lack both funding and an unflinching commitment to evidence.

Aura of mystical, the critical hurdle

Sushruta maintains that medical interventions are trustworthy not just because they are effective in his own experience (pratyaksha / phaladarshana) but only because they have been rationally vetted by the community of specialists. He is seeking what is now known as a rigorous peer assessment before the claims are accepted. It is obvious that case studies cannot replace well-designed clinical trials in evaluating efficacy and assessing the underlying pathophysiology of disorders.

Naturally, classical medical texts from centuries ago contain imprecise anatomy and physiology, with outdated theories of pathophysiology and aetiology. Yet, practitioners often claim divine revelation and do nothing to update or change this knowledge. Unearthing the biological basis of this knowledge trove can benefit both the Indian System of Medicine and biology.

(The author acknowledges Krishna GL, particularly in his paper ‘Ayurveda awaits a new dawn’, for providing perspectives on the philosophical and epistemological aspects of Ayurveda)

New Delhi:

Patanjali Ayurved co-founder Baba Ramdev; the company’s top executive, Acharya Balakrishna; and the centre were reprimanded by the Supreme Court Tuesday during a hearing on misleading advertisements, including those that disparage modern medicine and medical practitioners.

Ramdev and Balakrishna were rapped for “absolute defiance” after filing improper versions of affidavits demanded by the court, while the centre was asked why it “chose to keep its eyes shut” despite Patanjali claiming Western medicine offered no protection against the COVID-19 virus.

A bench of Justice Hima Kohli and Justice Ahsanuddin Amanullah also asked the Ministry of AYUSH why it had not acted against Patanjali after “shocking” ads belittling contemporary medicine.

“We have questions for AYUSH…COVID was in 2022 and you (the centre) stated these (ayurvedic medicines) were, at best, a supplement to the main (the vaccines)… but this was not publicised… you did nothing to make this known. It was a critical period,” Justice Kohli said sternly.

READ | “Be Ready For Action”: Court To Ramdev In Misleading Ads Case

This is the second time in three months the centre has been rebuked; in February, the Supreme Court said “the government is sitting with its eyes closed” and demanded immediate action against “false” and “misleading” advertisements. “This is very unfortunate…” the court had said then.

The court then also urged the centre to find a remedy to the issue of misleading medical ads.

The court today also ripped into Ramdev and Balakrishna for the causal manner in which an affidavit – offering an unconditional apology for the ads – was filed last month. A furious court called the affidavit “indefensible” and “humbug”, and even suggested Patanjali Ayurved could be guilt of perjury.

READ | Patanjali’s Apology Day After Court Summons Ramdev In Ads Case

“You should have made sure the solemn undertaking should have been in letter and spirit. We can also say we are ‘sorry’… for not accepting it (the apology)… it is more of a lip service,” the court said.

The court was angered that Patanjali had, prima facie, continued to run ads ruled as misleading last year. The claim that the company’s media unit was unaware of the court order was dismissed.

“…every order passed by courts across the country has to be respected. This is absolute defiance,” a bench of Justice Hima Kohli and said, after Patanjali Ayurved’s lawyer folded his hands in apology.

“You have to abide by every undertaking given to the court… and you have broken every barrier,” a clearly displeased court told both Ramdev and Balakrishna, who were ordered to be present.

Responding to the court’s strong words, Solicitor-General Tushar Mehta acknowledged “what has happened should not have happened”. “It appears (that) the way the affidavits should have come… it has not come,” he told the court, underlining, however, that the centre could not take sides.

READ | Yoga Guru Ramdev Summoned By Court Over Patanjali’s Misleading Ads

“What I am suggesting is… if Your Lordships permit… then I can sit with the counsel (for Patanjali) and (decide) what can be done,” he continued, to which the court said, “We will decide that.”

Ramdev and Balakrishna have been given “one last chance” and must file the affidavits, in a proper manner, in one week. They must also present when the court hears this matter next – on April 10.

The top court is hearing a contempt case against Patanjali Ayurved over publication of advertisements making false claims about its products and their medical efficacy.

On February 27 the court had directed Patanjali to stop all electronic and print ads giving misleading information, with immediate effect.

READ | Court Warns Ramdev, Patanjali, Tells Them To Stop “Misleading” Ads

The case began last year after the Indian Medical Association filed a petition claiming a smear campaign by Baba Ramdev against the Covid vaccination drive and modern medicine.

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New Delhi:

The Supreme Court today came down heavily on Patanjali Ayurved’s co-founder Ramdev and Managing Director Balakrishna for their “absolute defiance” in not filing proper affidavits over the company’s misleading advertisements.

“Not just the Supreme Court, every order passed by the courts across this country has to be respected. This is absolute defiance,” the top court said.

The top court observed that advertisements issued by Patanjali are in the “teeth of law” of the land. ” Be ready for action,” the Supreme Court told Ramdev.

A bench of Justices Hima Kohli and Ahsanuddin Amanullah also refused to accept an apology tendered by Patanjali last month after the top court rap during the earlier hearing. “We are not happy with your apology,” Justice Kohli said.

“You should have made sure that the solemn undertaking should have been in letter and spirit. We can also say that we are sorry for not accepting it. Your apology is not persuading this court. It is more of a lip service,” the Supreme Court said.

After which, Ramdev’s lawyer said both Ramdev and Balakrishna are ready to personally apologise in the court. “We want to apologise and are ready for whatever the court says,” Senior advocate Balbir Singh told the court with folded hands.

The bench granted last opportunity to Ramdev and Balkrishna to file their affidavits in the matter in one week.

The Supreme Court also pulled up the Centre for not taking action and said they were sitting with their eyes shut. “We are wondering why the government chose to keep their eyes shut ,” the bench had said.

The Supreme Court has asked Ramdev and Balkrishna to be present in the court on April 10 – the next date of hearing in the case.

The Supreme Court last month had severely criticised Patanjali for failing to obey its directives and directed Ramdev and Balkrishna to be personally present before the court today.

On February 27, the top court had directed the company to stop all electronic and print advertisements of its medicines giving misleading” information with immediate effect.

The case began in November last year when the Supreme Court, while hearing a petition filed by the Indian Medical Association (IMA), cautioned Patanjali Ayurved against making “false” and “misleading” claims in advertisements about its medicines.

IMA had referred to several advertisements which allegedly projected the allopathy and the doctors in poor light, saying that “disparaging” statements have also been made by firms, engaged in the production of ayurvedic medicines, to mislead the general public.

These commercials say that the medical practitioners themselves are dying despite taking modern medicines, the counsel for the IMA had said.