Exploring Evidence for

Contemporary Ayurveda

Prof. R. H. Singh

Professor Emeritus

Faculty of AyurvedaBanaras Hindu University

Varanasi, India

Ancient Concept of Evidence for Truth

The Four - Fold Testing for Evidence:

1. Pratyaksa – Direct Observation

2. Anumana – Inferential Evidence

3. Aptopadesa – Scriptural Evidence

4. Yukti – Experimental Evidence

The Contemporary Concept

� Evidence is largely expressed in

terms of the science of today.

� But it also implicates scriptural

and experience-based evidence.

� Evidence for safety & efficacy of

medications seems to be the focus.

� But it also implicates the validity

of principles of Ayurveda.

Dimensions of Evidence Available:

1. Scriptural Evidence.

2. Experience-based Evidence.

3. Current Professional Evidence.

4. Mass Acceptability.

5. New Scientific Evidence.

The Historicity and the Available Ancient Literature

Ayurveda is the most ancient system of medicine, its antiquity going

back to the Vedas, surviving today through two sets of classic texts:

The Historicity and the Available Ancient Literature

Ayurveda is the most ancient system of medicine, its antiquity going

back to the Vedas, surviving today through two sets of classic texts:

Drugs and Herbs1600 A.D.Bhava Misra3. Bhava Prakasa

Medicine1300 A.D.Sarangdhara2. Sarangadher Samhita

Diagnostics900 A.D.Madhavkara1. Madhav Nidana

Philosophy & Medicine1000-700 B.C.Caraka1. Caraka Samhita

Medicine & Therapeutics300-600 A.D.Vagbhatta3. Vagbhatta Samhitas

Practice of Surgery1000-600 B.C.Susruta2. Susruta Samhita

Laghuttrayīīīī - The Three Minor Texts :

Brihattrayīīīī – The Three Major Texts :

SubjectHistoricityAuthorName of Texts

EIGHT CLINICAL SPECIALITIES OF AYURVEDAEIGHT CLINICAL SPECIALITIES OF AYURVEDA

VĀJIKARANA

RASĀYANA

BHUTA VIDYĀ

AGAD TANTRA

KAUMĀRABHRITYA

ŚŚŚŚĀLĀKYA TANTRA

ŚŚŚŚALYA TANTRA

KĀYACIKITSĀ

SEXOLOGY, REPRODUCTION8

NUTRITION & GERIATRICS7

PSYCHIATRY6

TOXICOLOGY5

PAEDIATRICS & GYNAEC4

EYE & ENT DISEASES3

SURGERY2

INTERNAL MEDICINE1

lenks"k% lekfXuÜp le/kkrqeyfØ;% AizlékResfUnz;euk% LoLFkbR;fHk/kh;rs AA

& lqñ lwñ 15%41

lenks"k% lekfXuÜp le/kkrqeyfØ;% AizlékResfUnz;euk% LoLFkbR;fHk/kh;rs AA

& lqñ lwñ 15%41Health is the state of equilibrium of Dosas,

Agnis, Dhatus, Malas and body functions along

with spiritual, sensorial and mental well-being.

Health is the state of equilibrium of Dosas,

Agnis, Dhatus, Malas and body functions along

with spiritual, sensorial and mental well-being.

Definition of Health in AyurvedaDefinition of Health in Ayurveda

Sun

Pitta

Teja

Energy

Oja Biology Prana

Kapha Ecology Vata

Water Air

Tritriangular Eco-genomic Holism, the circle signifying

inherent harmonising equilibrium

WHO Perspective of Global Evidence

1. Key issues in assessment of therapeutic effect :

• Clinical Epidemiology for clinical research.

• Standardization of diagnostic criteria.

• Clinical Trials to assess safety & efficacy.

• Systematic review on literature & clinical research

2. Cross - national evaluations using common Protocols.

3. Weighting the evidence using systematic reviews.

4. Conduct of research in practice - setting.

5. Evaluating information from completed studies.

Local Perspective : HMPC Regulation for

Registration of Herbal Products in Europe

“The rationale behind the actual registration procedure

is to enable products which have been in long standing

traditional use to be registered because their safety and

efficacy can be deduced from their long standing use.

The long tradition of the medicinal product enables to

waive requirement for clinical trials, insofar as the efficacy

of the medicinal product is plausible on the basis of long-

term use and experience. The preclinical tests do not seem

necessary either, where the medicinal product on the basis of

the information on its traditional use proves not to be

harmful in specified conditions of use.”

Priorities in Ayurvedic Drug Research

� Standardization and quality control of

in-use Ayurvedic medicines with

necessary GMP.

� New drug / formulation development

through a “Reverse Pharmacology

approach”.

Lead Areas in Drug ResearchLead Areas in Drug ResearchLead Areas in Drug Research

1. Antistress, adoptogens and memory enhancers.

2. Immuno-enhancers and Anti-Aging remedies.

3. Hypolipidemics and Cardioprotectives.

4. Hepatoprotectives.

5. Antidiabetics and Anti-arthritics.

6. Cytostatic and Anticancer Drugs.

7. Nutraceuticals and Antioxidents.

8. Cosmetics and Cosmetic base materials.

1. Antistress, adoptogens and memory enhancers.

2. Immuno-enhancers and Anti-Aging remedies.

3. Hypolipidemics and Cardioprotectives.

4. Hepatoprotectives.

5. Antidiabetics and Anti-arthritics.

6. Cytostatic and Anticancer Drugs.

7. Nutraceuticals and Antioxidents.

8. Cosmetics and Cosmetic base materials.

Plants with New Evidence for Specific Effect

Antiviral/HBV

Antifilarrial

Antidiabetic

Antihistaminic

Anti-inflammatory

Antiseptic, Antifungal

Hypolipidemic

Immunomodulater

Hypolipidemic

Antistress

Antiparkinsonism

Memory enhancer

P. amarus

S. asper

P. marsupium

A. lebek

C. longa

A. indica

A. sativum

T. cardifolia

C. wighti

W. somnifera

M. pruriens

B. monniera

Bhumyamalaki

Sakhotaka

Vijaisar

Sirish

Haridra

Nimba

Rasona

Guduchi

Guggulu

Ashwagandha

Kpikachu

Brahmi

Some Leading Phytochemicals & Their Uses

Anti inflammatory Glycyrhiza glabraGlycyrrhizin

HypolipidemicAllium sativumAllinin

AdaptogenWithania somniferaWithanolides

Nootropic Bacopa monnieraBacosides

DiureticBoerhaavia diffusaPunarnavine

Anti-spasmodic Atropa bellodonaAtropine

Neuro stimulntNuxvomicaStrychnine

Anti-asthmatic EphedraEphedrine

Hepatoprotection Picrorhiza kurroaKutakin

Anti cancerVinca rosiaVincristicine

Anti-diabetic, Anti Cancer

Anti-inflammatory

Curcuma longaCurcumine

Parkinsons DiseaseMucuna pruriense Levo Dopa

CardiotonicDigitalisDigoxine

Bio- enhancer Piper longam Piperine

HypertensionRauwolfia serpentinaReserpine

Therapeutic UseMedicinal PlantsPhytochemicals

Cytostatic Anti Cancer Activity of the Extracts of Some

Plant Drugs against COLO 320 Tumor Cells

<10-CISPLATIN10.

> 100LeavesNIRGUNDI (Vitex nigundo)9.

10 – 100FruitsKANTAKARI (S. xanthocarpum)8.

< 10FruitsBHALLATAKA (S. anacardium)7.

> 100Branches CHITRAK (Plumbago zeylanica)6.

> 100CortexSIGRU (Moringa oleifera lam.)5.

10 – 100Fruits MAHANIMBA (Melia azadarach)4.

10 – 100GlandulaKAMPILLAKA (M. philippinensis)3.

< 10FlowersARKA (C. procera)2.

> 100Rhizome VACA (A. calamus) 1.

IC50µg/mlPart UsedAyurvedic Name (Botanical Name)Sl.No.

Anti-stress effect of some Ayurvedic drugs in

terms of Ed50and Antistress Unit Activity

25.2 ± 2.318.0 ± 1.624.7 ± 2.224.1 ± 2.115.0 ± 1.844.0 ± 3.89. P. Ginseng

46.1 ± 1.414.3 ± 1.115.9 ± 1.315.8 ± 1.412.5 ± 1.222.2 ± 2.18. E. centicosus

28.5 ± 2.525.0 ± 2.027.8 ± 2.526.4 ± 2.217.0 ± 1.346.3 ± 4.2 7. Bimbi

(C.indica)

27.5 ± 2.421.0 ± 1.926.0 ± 2.625.6 ± 2.416.3 ± 1.248.8 ± 4.06. Nilotpala

(N. stellata)

23.5 ± 2.117.0 ± 1.726.6 ± 2.021.6 ± 1.614.8 ± 1.841.5 ± 3.75. Kutaki

(P. kurroa)

22.9 ± 2.216.4 ± 1.223.2 ± 2.426.6 ± 2.314.3 ± 1.340.3 ± 3.84. Tinduka

(D.perigrina)

19.1 ± 1.915.6 ± 1.320.6 ± 2.118.3 ± 2.213.7 ± 1.627.4 ± 2.43. Aralu

(A. excelsa)

14.9 ± 1.515.9 ± 1.816.0 ± 1.814.5 ± 1.513.0 ± 1.415.0 ± 1.32. Ashwagandha

(W.somnifera)

13.7 ± 1.315.3 ± 1.213.4 ± 2.013.0 ± 1.512.0 ± 1.613.3 ± 1.21. Tulsi

(O.sanctum)

Antistress

Unit

Activity

Prevention

of Restraint

Induced

Ulcer

Prevention of

Increase of

Adrenal

Cortisol

Prevention

of Adrenal

Ascorbic

Acid

Prevention

of Increase

of Adrenal

Wt.

Swimming

Performance

Test

Plant Drug

Screened

Jyotismati (Celastrus paniculatus)

Effect of Jyotismati in cases of Depressive illness in terms of HDRS

± 2.47± 2.45± 3.72

1.8910.0011.89Placebo

n = 9

± 1.75± 2.19± 2.49

6.007.7913.79Jyotismati added on

n = 14

p<0.02± 1.69± 3.71± 3.54

2.824.179.6113.78Jyotismati alone

n = 18

Unpaired ‘t’ test

d Mean±SD

AT Mean±SD

BT Mean±SD

Trial Group

Kapikacchu (Mucuna pruriens)

0 5 10 15 20 25

2nd Followup

1st Followup

Initial Values

Changes in HDRS Scores in Cases of Depression Treated with Kapikacchu

Total Cases No. 44

React. Depression

No. 23

Endo. Depression

No. 21

Pancakarma Pancakarma TherapyTherapy

Samsodhana or Biopurification of the body

using five-fold therapeutic technology of

Pancakarma is an important component of

classical Ayurveda. Some of these practices

have shown notable effect in clinical settings

viz., Vamana in treatment of bronchial asthma

and allergies, Vasti in the treatment of

neurological diseases, Snehana-Swedan in

treatment of arthritis, Sirodhara in treatment of

headaches, anxiety and insomnias etc.

Kshara Sutra Treatment

Application of standardised medicated

thread in treatment of fistulla-in-ano has

shown notable success and acceptability.

Gradual cutting and simultaneous healing of

fistullar tract by Kshara Sutra has over-

whelming advantage over conventional

surgery for this purpose. There are

convincing published data as evidence-base

for this technique.

ConclusionAyurveda is one of the most ancient systems of medicine and has

enjoyed an unbroken tradition of practice in India for thousands of

years till now. Because of its growing popularity and spreading global

usage, a need has been felt to explore evidence-base for Ayurveda and its

medications.

The concept of evidence in this context is still vague. WHO while

recognizing its scriptural and experiential evidence has suggested to

gather also new scientific evidence. The last five decades have made

commendable efforts in this direction which needs to be documented to

identify leads for further research.

Besides, there is a greater interim need to standardize the in-use

medications for quality assurance through due GMP in order to

strengthen the ongoing practice of Ayurveda in the hands of over

5,00,000 registered Ayurvedic practitioners who could play a significant

role in National Health Care Program specially for rural masses.

“Inspite of the fact that the ancient Hindu Medicine practised in India in the

earliest times was an equally developed scientific discipline as any other contemporary system in the world, Its influence on the western society was small.

Hence, most of the current writings in history of medicine do not have an appropriate mention of the contributions of ancient Indian medicine”.

Welch, C.S. 1968

Thank You