Scientific evaluation of Ayurvedic drugs - the use of N-of-1 clinical trials.

Despite its ancient roots and prominence in India as an accepted alternative to modern medicine, Ayurveda's growth has been hampered by an inability to carry out clinical studies of its effectiveness and safety using modern scientific methods - while preserving the core of Ayurveda, which is personalised medicine. In this comment, we propose that the N-of-1 trial be used as a practical method to evaluate Ayurvedic treatments, which is simultaneously consistent with the canons of modern medicine and of Ayurveda. We emphasise the importance of doing this as a practical alternative that will benefit patients. We need not wait to resolve the epistemic inconsistency between Ayurveda and modern medicine to take steps in this direction.

Ayurvedic Therapies to Target the Microbiome: Evidence and Possibilities.

Context: The microbiome is a constantly evolving entity, being influenced by diet, lifestyle, age, genetics, medication, and environment; keeping the microbiome in good health is a step toward better health for the body. Ayurveda emphasizes a healthy internal milieu that synchronizes with the circadian and seasonal rhythms, in addition to reacting to other stressors. Objective: The current review intended to provide an overview of Ayurvedic principles related to health and disease and their management and to briefly discuss the current understanding of the human microbiome and explore Ayurvedic herbs and therapies that have been studied for their effects on the microbiome. Design: The team included researchers in India and Canada. A Pubmed search was performed using the keywords Ayurveda therapies, Ayurvedic therapies, Gut microbiome, Panchakarma, Therapeutic purgation, Therapeutic emesis, medicated enema. Results: Research connecting Ayurvedic interventions and the gut microbiome is yet in a nascent stage. Several Ayurvedic herbs have been researched for their potential in altering the gut microbiome. Among the Ayurvedic therapies, virechana (therapeutic purgation) and basti (medicated enema) have been studied for their gut microbiome altering effects. However, the limited number of such studies prevents from drawing categorical conclusions currently, about the effects of Ayurvedic Panchakarma therapy on the human microbiome. Conclusions: Studying where and how the Ayurvedic herbs and therapies can exert their influence on the human microbiome provides a challenging yet novel opportunity and can help address multiple health and disease conditions.

Swarna Bhasma Induces Antigen-Presenting Abilities of Macrophages and Helps Antigen Experienced CD4+ T Cells to Acquire Th1 Phenotypes Against Leishmania donovani Antigens.

In leishmaniasis, the protective immunity is largely mediated by proinflammatory cytokine producing abilities of T cells and an efficient parasite killing by phagocytic cells. Notwithstanding a substantial progress that has been made during last decades, the mechanisms or factors involved in establishing protective immunity against Leishmania are not identified. In ancient Indian literature, metallic "bhasma," particularly that of "swarna" or gold (fine gold particles), is indicated as one of the most prominent metal-based therapeutic medicine, which is known to impart protective and curative properties in various health issues. In this work, we elucidated the potential of swarna bhasma (SB) on the effector properties of phagocytes and antigen-activated CD4+ T cells in augmenting the immunogenicity of L. donovani antigens. The characterization of SB revealing its shape, size, composition, and measurement of cytotoxicity established the physiochemical potential for its utilization as an immunomodulator. The activation of macrophages with SB enhanced their capacity to produce nitric oxide and proinflammatory cytokines, which eventually resulted in reduced uptake of parasites and their proliferation in infected cells. Further, in Leishmania-infected animals, SB administration reduced the generation of IL-10, an anti-inflammatory cytokine, and enhanced pro-inflammatory cytokine generation by antigen activated CD4+ T cells with increased frequency of double (IFNγ+/TNFα+) and triple (IFNγ+TNFα+IL-2+) positive cells and abrogated disease pathogeneses at the early days of infection. Our results also suggested that cow-ghee (A2) emulsified preparation of SB, either alone or with yashtimadhu, a known natural immune modulator which enhances the SB's potential in enhancing the immunogenicity of parasitic antigens. These findings suggested a definite potential of SB in enhancing the effector functions of phagocytes and CD4+ T cells against L. donovani antigens. Therefore, more studies are needed to elucidate the mechanistic details of SB and its potential in enhancing vaccine-induced immunity.

Contention and collaboration: the tenuous encounter of modern Ayurveda and Western medicine in the twentieth and twenty-first centuries.

Complementary medicine systems are ascending to rapid popularity as the twenty-first century progresses. Often adapted from ancient systems of healing such as Ayurveda, these modern alternative medical movements reappraise millennia-old health traditions that found their inception at the confluence of religious philosophy and herbal healing. Naturally, contemporary global economic forces and a desire to market traditional medicine products in an enticing fashion have characterised how historic traditional medicine systems are presented in the modern context. By establishing a vision of complementary medicine born from ancient traditions, it becomes clear how traditional methods of healing can contend with Western biomedicine-the prevailing standard of care around the globe. The claims made by both sides parry along a line of scientific validity, efficacy and regulatory purview. India, the birthplace of Ayurveda and an epicentre of contemporary medical education, is a prime arena to study the friction between biomedicine and traditional medicine. In this piece, I focus on the modernisation of Ayurveda and how it has found conflict with allopathic medicine. I posit that Ayurveda has re-emerged since the early twentieth century as a key tenet of Indian modernity: and in doing so has found contention with Western medicine. I furthermore argue that despite existing discord, the two medical traditions are not inherently antithetical. They can be synergistic, so long as healthcare delivery and education recognise the limits of each and focus on coaction rather than contradiction.

Of odysseys and miracles: A narrative approach on therapeutic mobilities for ayurveda treatment.

In the past two decades, health care has become a global market and transnational practice. An emerging body of literature examines the astounding variety of drivers, conditions, and experiences. However, the question of how traveling abroad for treatment emerges as an option and takes shape in people's illness trajectories has gained little attention thus far. This article attends to this gap by following the stories of people with chronic conditions who travel to India for Ayurveda treatment out of dissatisfaction with local biomedical health care. This study expands the focus of current research on transnational therapeutic mobilities in three ways: (1) by shifting the attention from being a foreign patient or medical traveler to becoming one, (2) by integrating quests for other-than-biomedical therapies, and (3) by applying a narrative approach to the field. Results show that apart from social, human, and financial resources, it takes certain patient-subjectivities to mobilize patients across borders and healing systems.

Rise of Siddha medicine: causes and constructions in the Madras Presidency (1920-1930s).

This essay aims to situate the emergence of Siddha medicine as a separate medical system in the erstwhile Madras Presidency of colonial India within a broader socio-economic context. Scholars who have worked on Siddha medicine have stressed more on political dimensions like nationalism and sub-nationalism with inadequate attention to the interplay of various (other) factors including contemporary global developments, changes in the attitude of the colonial State and especially to the new promises held by the greater deference shown to indigenous medical systems from the 1920s. If the construction of 'national medicine' based on the Sanskrit texts and the accompanying marginalisation of regional texts and practices were the only reasons for the emergence of Siddha medicine as presented by scholars, it leaves open the question as to why this emergence happened only during the third decade of the twentieth century, though the marginalisation processes started during the first decade itself. This paper seeks to find an answer by analysing the formation of Siddha medical identity beyond the frameworks of nationalism and sub-nationalism. Further, it explicates how material factors served as immediate cause along with the other, and more ideational factors related to the rise of the Dravidian political and cultural movement.

On the earliest descriptions of the uremic syndrome in medical literature.

Uremic syndrome refers to the clinical manifestations of renal failure (acute or chronic) that results from the accumulation of several endogenous toxins normally excreted by the kidneys and can be fatal unless the primary cause is addressed and the toxins removed by dialysis. A historical description of the syndrome is traditionally believed to start in the 18th - 19th century through seminal works in the field of experimental medicine. This account, however, ignores the possibility of clinical apperception of this syndrome in ancient medical literatures. The Sushruta Samhita (SS), a Sanskrit text whose authorship is attributed to the legendary ancient Indian surgeon Sushruta (6th century BC), is well known for its pioneering descriptions of several surgical procedures, even though its contribution to the fields of internal medicine and especially nephrology is detailed. Prameha, a term that first appears in the SS, and subsequently in later historical Ayurvedic (traditional Indian medicine) texts, denotes a multi-systemic disease syndrome impacting the neurological, cardiac, dermatological, and gastrointestinal systems that is recognized through its intimate association with urinary abnormalities such as hematuria, frothy urine, or glycosuria. This construct is highly consistent with uremic syndrome originating from multiple renal disease processes such as acute glomerulonephritis, nephrotic syndrome, diabetes mellitus, etc. Furthermore, medical treatment of prameha, as detailed in the original text, reflects several recently validated approaches to managing chronic kidney disease, supporting the hypothesis that this historical entity may be one of the earliest descriptions of uremic syndrome in medical history.

[Recommendations of the committee on complementary medicine and nutrition in ayurvedic medicine, homeopathy, nutrition and Mediterranean diet]. / Empfehlungen der Kommission Komplementäre Heilverfahren und Ernährung zu ayurvedischer Medizin, Homöopathie, Ernährung und mediterraner Kost.

Methods of complementary and alternative medicine (CAM) are appealing for many patients with rheumatic diseases. The scientific data are currently characterized by a large number of publications that stand in contrast to a remarkable shortage of valid clinical studies. The applications of CAM procedures are situated in an area of conflict between efforts for an evidence-based medicine and high-quality therapeutic concepts on the one hand and ill-founded or even dubious offers on the other hand. In 2021 the German Society of Rheumatology (DGRh) launched a committee for CAM and nutrition, which aims to collect and to evaluate the current evidence for CAM applications and nutritional medical interventions in rheumatology, in order to elaborate recommendations for the clinical practice. The current article presents recommendations for nutritional interventions in the rheumatological routine for four areas: nutrition, Mediterranean diet, ayurvedic medicine and homeopathy.

Exploring the Role of Mentha in Gut Microbiota: A Modern Perspective of an Ancient Herb.

Gut microbiota includes the microbes present in the gut; these microbes are an essential component in maintaining a healthy gut. Gut microbiota has a wide range of functions, including effects on colonization, pathogen resistance, intestinal epithelial maintenance, metabolizing food and pharmaceutical chemicals, and influencing immunological functions. Every disease associated with the gut starts due to a disbalance in the composition of the gut microorganisms and can be managed by balancing the composition of gut bacteria using various herbal remedies. Mentha herbs are a variety of perennial herbs that are grown commercially in various parts of the world. Mentha is a potent herb that shows anticholinergic action and can block PGE2 and GM1 receptors and interact with cholera toxins; it is used traditionally in different systems of medicines to treat various gastrointestinal diseases associated with the gut. Mentha herbs have potent bactericidal, viricidal, and fungicidal properties. Mentha has been used to cure stomach and digestion issues as well as to treat a variety of disorders. This review article summarizes diseases associated with the gut, the composition, and function of gut microbiota, and mentha's effectiveness along with its extraction methods and traditional uses. Research findings revealed that mentha could be an essential source against a wide range of diseases, especially gastrointestinal disorders. From its ayurvedic claims to its present use, various confirmed its clinically effective for human health. The present work also describes the mechanism of action along with the bioactives present in this well-known herb from Ayurveda.

Overlooked contributions of Ayurveda literature to the history of physiology of digestion and metabolism.

Ayurveda is a traditional system of healthcare that is native to India and has a rich documented literature of its own. Most of the historians agree that the documentation of core Ayurveda literature took place approximately in between 400 BCE and 200 CE, while acknowledging that the roots of its theoretical framework can be traced back to a much earlier period. For multiple reasons many significant contributions of Ayurveda literature to various streams of biological and medical sciences have remained under-recognized while recounting the historical milestones of development. This is true in the context of the physiology of digestion and metabolism too. In this communication we try to reconstruct a picture of the processes of digestion and metabolism as had been understood by ancient Ayurveda scholars. Though this understanding was primitive and insufficient in many ways, we argue that this deserves to be documented and acknowledged. To help with grasping the importance of these contributions, we juxtapose them with the corresponding insights pertaining to this subject reported by prominent western scientists. The major contributions of Ayurveda that have been recounted in this paper are those related to the description of three distinct phases of digestion (Avasthapaka), multiple sets of transformative entities acting at different levels of metabolism (Agni), and the roles ascribed to various internal and external factors in executing these physiological functions.

"Confessions of an Ayurveda professor" - A wake up call.

Kishor Patwardhan's 'confession' in this journal [1] has initiated the expected debate, which I hope leads to some good developments for the teaching and practice of Ayurveda. Before, commenting on this issue, I should myself confess that I am neither formally trained in Ayurveda nor practising it. A basic research interest in Ayurvedic biology [2] led me to learn about the "fundamental principles" of Ayurveda and to experimentally examine effects of some Ayurvedic formulations using animal models like Drosophila and mouse at organismic, cellular, and molecular levels. During the past 16 to 17 years of my active engagement with Ayurvedic Biology, I had multiple opportunities to discuss the principles and philosophies of Ayurveda with formally trained Ayurvedacharyas and others who have an interest in this classical healthcare system. These experiences enhanced my appreciation of the wisdom of ancient scholars that led them to methodically compile the elaborate details of treatment for various health conditions in the classical Samhitas and, as noted earlier [3], gave me a "ring-side" view of Ayurveda. Despite the above limitations, an advantage of the "ring-side" view is the possibility of comprehending the philosophies and practices prevalent in Ayurveda in an unbiased manner and weighing them against contemporary practices in other disciplines.

Do Ayurveda students need a course in Medical Astrology?

Ayurveda is based largely upon two classics - Charaka-Samhita, representing the school of medicine, and Sushruta-Samhita representing that of surgery. These two texts mark the historic switch in the Indian medical tradition, from faith-based therapeutics to its reason-based variant [1]. The Charaka-Samhita, which acquired its present form in circa 1st century CE, uses two remarkable terms to designate the distinctness of these approaches: daiva-vyapashraya (literally, dependence on the unobservable) and yukti-vyapashraya (dependence on reason) [2].

Ayurvedic medicine for the treatment of chronic rhinosinusitis: a systematic review of randomized and non-randomized trials.

OBJECTIVES: This article provides a comprehensive systematic review and qualitative analysis of the current research investigating Ayurveda chronic rhinosinusitis (CRS) treatment. CONTENT: PRISMA guidelines for systematic reviews was followed and our search utilized MEDLINE, Embase, Ayush Portal, and Cochrane Library databases. Articles published prior to March 2022, 10 or more patients that investigated Ayurveda as a treatment for CRS in humans were included. This resulted in thirteen articles meeting inclusion criteria. Ayurvedic treatments included herbal medications for oral consumption, nasal instillation, and steam inhalation used alone or in combination. All studies concluded that Ayurvedic therapy led to improvements in subjective CRS symptoms and objective radiographic and hematologic criteria. However, all 13 studies had a significant risk of bias due to study design and statistical methods utilized. SUMMARY: Ayurvedic therapy may be a useful CRS treatment for some patients and overall appears to be well tolerated. However, definitive recommendation for when Ayurvedic treatments would be beneficial in the treatment of CRS remains not possible. OUTLOOK: Given the overall positive effects shown in the current published evidence and growing interest in complementary and integrative therapies, Ayurvedic treatments for CRS deserve further investigation in the form of well-designed controlled trials.

Some thoughts on the undergraduate Ayurveda curriculum.

In his reflective piece in this issue, Kishor Patwardhan has exposed the hollowness of the Ayurvedic curriculum in some approaches to anatomy and physiology [1]. Being a teacher of Ayurvedic physiology at the Banaras Hindu University (BHU) and a widely published researcher, his views should be heeded by those responsible for designing the curricula of the Bachelor of Ayurvedic Medicine and Surgery (BAMS). His paper is not a one-off lament. Patwardhan and several others have been writing for over 10 years on the contradictions between recognised medical science and what is professed in the Ayurvedic curriculum [2, 3]. Having himself subscribed to such subterfuges in the past, he now warns that to "superimpose modern science over classical references (is) unscientific," adding that "such misinterpretations could lead to clinical misapplication, misjudgement" and "smother innovation" [1].

Is delayed regulation of yoga and naturopathic medicine in India breeding quackery?

The combined discipline of Yoga & Naturopathy (Y&N) constitutes one of the official indigenous medical systems under the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homoeopathy (AYUSH), Government of India (GoI). The GoI has recently regulated all the systems under AYUSH, except Yoga & Naturopathy, through the National Commission for Indian System of Medicine (NCISM) Bill, 2020 [1]. However, Y&N has been left out from the NCISM Bill, despite the recommendations of the Department-related Parliamentary Standing Committee on the National Commission for Indian System of Medicine Bill, 2019 [2: p 20], and NITI Aayog [3: p 15]. On the contrary, GoI has proposed a board for regulating Y&N without defining its statutory value or timeline.

Confessions of an Ayurveda professor.

In this essay, I narrate my experiences of teaching Ayurveda physiology through an approach that involved laborious re-interpretation of ancient literature using the recent advances in the field of medical physiology. Though this approach made the ancient concepts and theories appear modern and relevant, it did not contribute much except for apparently reducing cognitive dissonance among students. I cite examples describing the processes of formation of shukra (semen) and rakta (blood) to show how we often overinterpret Ayurveda concepts to make them sound rational by proposing ad hoc conjectures. I illustrate why my previous writings were faulty by applying the falsification principle proposed by Karl Popper. I further explain how this approach made these concepts only verifiable but not refutable, and hence, non-falsifiable. I argue that instead of using such re-interpretation to prove obsolete concepts, they can be dropped altogether from the curricula of Ayurveda programmes. There is a need to develop a reliable method to identify such outdated content.

Nano-ayurvedic medicine and its potential in cancer treatment.

Nano-ayurvedic medicine is an emerging field in which nanoparticles are functionalized with active principles of potent ayurvedic herbs to enhance their efficacy and target-specific delivery. Scientific advances in the past couple of decades have revealed the molecular mechanisms behind the anticancer potential of several ayurvedic herbs, attributed chiefly to their secondary metabolites including polyphenols and other active substances. With the advancement of nanotechnology, it has been established that size-, shape-, and surface-chemistry-optimized nanoparticles can be utilized as synergizing carriers for these phytochemicals. Nano-ayurvedic medicine utilizes herbs that are commonly used in Ayurveda to functionalize different nanoparticles and thereby enhance their potency and target specificity. Studies have shown that the active phytochemicals of such herbs can be coated onto the nanoparticles of different metals, such as gold, and that they work more efficiently than the free herbal extract, for example, in inhibiting cancer cell proliferation. Recently, an Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)-based clinical trial in humans indicated the anticancer potential of such formulations. Nano-ayurvedic medicine is emerging as a potential treatment option for hyperproliferative diseases.