Principle of Hot (Ushna) and Cold (Sheeta) and Its Clinical Application in Ayurvedic Medicine.

Hot (Ushna) and cold (sheet) are two fundamental precepts of Ayurvedic medicine reflected variously within the context of health and disease. These are fundamental for being essential attributes of three doshas, namely, Vata, Pitta, and Kapha, forming the very basis of Ayurvedic constructs of health and disease. Ushna is the inherent property of Pitta, symbolizing fire both inside and outside the body. There are pathologies of Pitta where this Ushna property participates in pathogenesis to present the features like burning, sour eructation, and fever. In such cases, the course of treatment eventually focuses on reducing Pitta or reducing the Ushna property of Pitta, in particular. A similar cold association is found with Vata and Kapha, where the pathogenesis is reflected as heaviness, cold and cough, and edema. The treatment of Vata and Kapha diseases eventually focuses upon their reduction or reducing cold-related pathogenesis, in particular. This is evident that these two form an essential and integral component of Ayurvedic understanding of health and disease and are practically applied to make a diagnosis and define the treatment. In this chapter, we are expanding the details of Ushna and Sheeta constructs of Ayurvedic medicine and elaborating on their health and disease application.

Clinical metabolomics investigation of rheumatoid arthritis patients receiving ayurvedic whole system intervention.

BACKGROUND: Arthritis is a common clinical condition seen in Ayurveda clinics. Clinical trials have reported Ayurvedic interventions to be of benefits in many arthritic conditions including Rheumatoid Arthritis (RA). No mechanistic details however are available about how such interventions on their own or as a combination of whole system Ayurveda might be working. OBJECTIVE: The study aims to evaluate simultaneously the clinical outcome of Ayurveda whole system (AWS) intervention in RA patients and identifying the serum metabolic signatures which could be useful for diagnosing the disease and monitoring treatment response. MATERIAL AND METHODS: RA patients (n = 37) simultaneously diagnosed as Amavata fulfilling the specific inclusion and exclusion criteria were recruited in the study and were given Ayurveda whole system (AWS) intervention comprised of oral medicines, local therapy and dietary recommendation for 3 months. The clinical and serum metabolic changes were investigated for pre-treatment RA patients (baseline RA group, n = 37) and post-treatment RA patients (following treatment of 6-weeks (RA_F, n = 26) and three months (RA_T, n = 36). For comparative serum metabolomics analysis, 57 normal healthy control (HC) subjects were also involved and the serum metabolic profiles were measured at high-field 800 MHz NMR spectrometer. The serum metabolic profiles were compared using multivariate statistical analysis and discriminatory metabolic features were evaluated for diagnostic potential using receiver operating characteristic (ROC) curve analysis. RESULTS: A significant reduction in DAS-28 ESR, AAM Score, total swollen joints, total tender joints were observed following AWS intervention. The clinical outcomes were concordant with changes in metabolic profiles of RA patients as these were also shifting towards the normal levels following the intervention. Compared to healthy control (HC) subjects, the sera of baseline RA patients were characterised by increased circulatory level of succinate, lysine, mannose, creatine, and 3-Hydroxybutyrate (3-HB) and decreased levels of alanine. The present study also evaluated the serum metabolic ratios for their discriminatory and diagnostic potential and notably, six metabolic ratios (KHR, KThR, KVR, GHR, PTR and SHR) were found significantly altered (elevated) in baseline RA patients. However, in RA patients receiving AWS treatment, these metabolic changes showed marked convergence towards the metabolic signatures of healthy controls. CONCLUSION: This first of its kind study clearly shows the clinical efficacy of Ayurvedic Whole System (AWS) intervention in the management of Rheumatoid Arthritis (RA), as demonstrated by significant improvements in key clinical parameters. The intervention not only alleviated symptoms but also induced a profound metabolic shifting towards normalization; thus, underscoring the potential of AWS intervention to modulate cellular metabolism in a manner that facilitates a return to homeostasis in RA patients. However, future studies are imperative to confirm these preliminary observations and delineate the underlying mechanisms of action of intervention in cases of RA.

Enhancing amyloid beta inhibition and disintegration by natural compounds: A study utilizing spectroscopy, microscopy and cell biology.

Amyloid proteins and peptides play a pivotal role in the etiology of various neurodegenerative diseases, including Alzheimer's disease (AD). Synthetically designed small molecules/ peptides/ peptidomimetics show promise towards inhibition of various kinds of amyloidosis. However, exploration of compounds isolated from natural extracts having such potential is lacking. Herein, we have investigated the repurposing of a traditional Indian medicine Lasunadya Ghrita (LG) in AD. LG is traditionally used to treat gut dysregulation and mental illnesses. Various extracts of LG were obtained, characterized, and analyzed for inhibition of Aß aggregation. Biophysical studies show that the water extract of LG (LGWE) is more potent in inhibiting Aß peptide aggregation and defibrillation of Aß40/Aß42 aggregates. NMR studies showed that LGWE binds to the central hydrophobic area and C-terminal residues of Aß40/Aß42, thereby modulating the aggregation, and reducing cell membrane damage. Additionally, LGWE rescues Aß toxicity in neuronal SH-SY5Y cells evident from decreases in ROS generation, membrane leakage, cellular apoptosis, and calcium dyshomeostasis. Notably, LGWE is non-toxic to neuronal cells and mouse models. Our study thus delves into the mechanistic insights of a repurposed drug LGWE with the potential to ameliorate Aß induced neuroinflammation.

Development and validation of an ama instrument for assessing the disease activity on the basis of constitutional features in Amavata (Rheumatoid Arthritis).

BACKGROUND: Rheumatoid Arthritis (RA), having a striking clinical resemblance to amavata in traditional Indian medicine (Ayurveda) presents an opportunity to look at disease from two different healthcare perspectives. This differential information may potentially supplement one system with the knowledge of the other for optimal application. This study is the first of its kind, where Ayurvedic concepts of amavata have been adopted to enhance the knowledge about RA where optimal care is still beyond the common reach. OBJECTIVE: The study was conducted to develop and validate a novel ama score based upon constitutional features of ama as depicted in ayurvedic literature as a disease activity indicator in RA. MATERIAL AND METHODS: The study was conducted in two parts comprising development and textual validation of the ama assessment instrument (AAI) followed by its clinical testing. AAI comprising ten items, was developed where each item was provided with a range of scores to offer the assessment close to the patient's observations. The score obtained through AAI was clinically and statistically tested on 79 RA/amavata patients randomly selected for validity and reliability. The score obtained through AAI was tested for its correlation with the DAS-28 score and ESR. RESULTS: Ama Assessment Instrument could find a slight correlation with acute phase reactant ESR (r-value between ESR and AMA at baseline is 0.287, and at 1st, 2nd, and 3rd follow-up is 0.276, 0.276 and 0.160 respectively) and DAS-28 (The r value between DAS and AMA at baseline is 0.231, and at 1st, 2nd and 3rd follow up is 0.218, 0.201 and 0.247 respectively). It however emerged as an independent disease status marker since it could mark the changes in the study population on a time scale more precisely as compared to DAS -28 or ESR. When the ama values at different follow-ups were compared, a significant difference was observed consistent with disease activity marker catching constitutional and GI related domain of the patients. When reducing values of ama score were compared to overall improvements as reported by the patients, a similar trend was observed showing that a change in ama score is reflective of a change in disease status and the impact of the disease on the patient. CONCLUSION: This study provided a quantitative measure for the abstract concept of ama which could be used to mark the disease activity in amavata or RA. The change in ama based scores can be used to assess disease status and the intervention related benefits. The observations prompt for the possible inclusion of AAI in RA composite score to make it more dynamic in terms of disease activity identification in RA.

Prameha purvaroopa as diabetes risk predictor - trends from a retrospective cohort study of newly diagnosed type 2 diabetes patients.

STUDY BACKGROUND: Increasing prevalence of type 2 diabetes has shifted the focus of world from its management to prevention. Life style modifications programs related to diabetes prevention are found to delay the progress of prediabetes into diabetes. Reaching out to community with diabetes prevention program however is still a challenge to meet. OBJECTIVE: Of the study: This study proposed to retrospectively screen the presence of prediabetes symptoms depicted in Ayurveda literature in a newly diagnosed diabetic population and to compare this prevalence with non-diabetic and healthy population. The idea is to put weightage upon prediabetes symptoms as a disease predictor if these are available early in the course of the disease. MATERIAL AND METHODS: A questionnaire based upon detailed literature survey of three Ayurveda classics from the subject area of prameha (identical to diabetes) identified 22 features under the class of prediabetes. A questionnaire was developed to find the presence of these features in selected diabetic population retrospectively before the onset of diabetes. 141 newly diagnosed diabetics were selected on the basis of a defined inclusion and exclusion criteria and surveyed for chronological presence of prediabetes features as identified through the literature search and validated through a validation process. This feature prevalence was further compared with non-diabetic and healthy population. RESULTS: A significant difference (p < 0.001) was observed in specific symptom occurrence in diabetic population comparing to non-diabetic and healthy control for at least 11 of the selected items. CONCLUSION: The study observes that few prediabetes features show their clear retrospective presence in diabetic population comparing to non-diabetic and healthy population. This observation can help formulating a risk calculator for future diabetes on the basis of available pre diabetic features in an individual. A prospective cohort study however would be essential to prove any such realistic relation between prediabetes symptoms and future diabetes development among high risk individuals.

'Obesity and arthritis' as the morbid duo: Designing and experimenting a novel strategy for weight reduction at a secondary care ayurveda -arthritis center.

Obesity has been a critical confounding factor in arthritis. Its impacts are seemingly more apparent in conditions like knee osteoarthritis but it affects the net outcome in almost every type of arthritis. Reduction of weight is the obvious first advice by a treating physician in such cases. In the absence of a clear roadmap however to reach the goal, It remains an unmet advise for most arthritis patients. Obesity combined with arthritis, becomes a morbid combination where addition of weight adds to intensity of arthritis and arthritis induced limitation of movements adds to the weight. Weight reduction is much tougher in arthritis due to the physical limitations. Noticing this gap of knowledge between desired and achieved, Ayurveda -arthritis treatment and advanced research center at Lucknow has designed a strategic plan as a real help to such people and executed it through the activities focusing upon educating the obese arthritis patients for causes and concerns of obesity in general and individualized management plan through an interactive workshop. A workshop of its own kind was conducted on 24 April 2022. 28 obese arthritics as participants had offered to understand the real need and feasibility of doing these strategically focused activities aiming at weight reduction. This has come up as a new opportunity of help to the obese arthritis patients by empowering them with practical knowledge and tools to reduce weight suiting to their individual capacities and needs. The feedback of the participants provided at the end of the workshop was highly encouraging and has shown that strategically focused activities to bridge the gaps in clinical practice are highly desired and useful.

Self reported benefits of participating in group prayer in a hospital outpatient setting: A cross-sectional observational study.

BACKGROUND: Prayer had long been used as a tool to bring hope among patients suffering with intractable diseases. Most clinical researches conducted so far on prayer were done upon indoor patients. Effects of prayer involving patients and health care providers in a hospital outpatient setting have never been explored. OBJECTIVES: This cross sectional study aimed to observe the self-perceived changes post prayer among patients and hospital staff involved in the health care delivery and who actually have participated in the prayer sessions. MATERIAL AND METHOD: Survey was conducted with the help of a structured questionnaire on routine OP days at Ayurveda -Arthritis Treatment and Advanced Research Center, Lucknow. Patients visiting the center for OP based consultation and hospital staff who has participated in any prayer session were eligible to participate in the survey. RESULTS: 49 hospital staff and 85 patients have participated in the survey. Among most important self-reported attributes following the prayer sessions in patients were Positive Attitude (84.70%), Optimism about cure (92.90%), Feeling of well-being (95.30%), Optimism about future (95.30%) and Changes in energy level (89.40%). Among hospital staff the important attributes were related to change in energy level (93.90%), increased empathy (93.90%), feeling of universal good (96.00%), less fatigue post prayer (69.40%), sustained effects (81.60%) and healthier feeling (81.60%). CONCLUSION: This observational study suggests that a simple prayer session in outpatient department may be helpful in inculcating hope and building self-esteem among patients and can bring a better self-image, efficiency and connectedness in the hospital staff. Eventually, this may help in improving the outcomes and quality of care being provided at outpatient setting at any hospital.

A survey of patients visiting an Ayurvedic teaching hospital for factors influencing the decision to choose ayurveda as a health care provider.

STUDY BACKGROUND: In a pluralistic health care delivery model, it is important to assess whether the individual's health care choices are based upon evidences of efficacy and safety. Since the essence of medical pluralism lies in the fact that all such systems are equally accessible to a seeker, in such situation, it is highly relevant to check what defines such choices in real life. OBJECTIVE: To identify the factors influencing the health care choices in a subpopulation seeking Ayurveda health care in an Ayurvedic teaching hospital. MATERIALS AND METHOD: The study was an all-inclusive cross sectional survey, done on randomly selected out patients visiting an Ayurveda teaching hospital. The data was collected using a 21 items questionnaire refined through pilot testing from 7.9.2017 to 30.9.2017. RESULTS: The data of 289 respondents who have given their consent were included in statistical analysis. Out of 21 variables studied for their agreement or disagreement in the study population 8 were found to have a significant proportion in favour of agreement. Among these relative safety (Item 9); disease eradicating potential (Item 14); belief (Item 3) and indirect evidences of efficacy (Item 4) were found to have high significance (p < 0.001). CONCLUSION: Participants chose Ayurveda treatment due to its perceived safety and probability of helping in a particular clinical condition. Contrary to the common perception, enabling factors like availability, accessibility and affordability were given less importance by the participants in making health care choices related to Ayurveda.

Ayurveda co-interventions have supported complete recovery in severe COVID-19 infection with a chest severity score 18/25: A case report.

Severe COVID-19 infection requiring oxygen support is reported to have high mortality. Chest Severity Score evaluated through CT scan has a predictive value about future outcomes in such cases. Score value ∼18 is predicted to have poor outcomes. We are presenting here a case of severe COVID-19 with all predictors suggestive of a bad prognosis including IL-6, D-Dimer, Ferritin and CRP in addition to 18/25 Chest Severity Score. Initially treated under ICU care at a tertiary care COVID hospital for about 14 days, the patient was intervened with Ayurveda on his own insistence seeing the unsatisfactory improvements. Ayurveda intervention for 19 days along with standard ICU care resulted in complete clinical recovery of the patient besides the correction of biomarker levels. Rapid clinical and biochemical correction in this severe COVID-19 case against all odds is highly significant and warrants an urgent search for possibility of instituting the integrative management strategies for all those treated in an allopathic facility. This case also advocates an early institution of Ayurveda interventions in COVID-19 in order to prevent deterioration leading to complications.

Idiosyncratic adversity reported after oral consumption of an ayurvedic formulation containing bhallataka (Semecarpus anacardium): A case report.

Drugs associated adversities are common in health care practice. These adversities are often associated with the dose-related, time-related and methods of drug intake and their rationality in a given condition but can also be unrelated to either of these causes. Such unpredictable drug reactions are highly important from the perspective of safe use of a drug and to prevent complications from any such adversity which is relatively uncommon. The case reported here is a likely case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) like idiosyncratic adversity after oral consumption of an ayurvedic formulation containing Bhallataka (Semecarpus anacardium). DRESS is found associated with many other classes of drugs but its association with ayurvedic drug has not yet been reported. Upon Naranjo probability scale the event scored 6, putting it into the category of probable drug related adversity. This report widens our understanding towards the possibility of delayed and idiosyncratic drug adversities upon the consumption of certain ayurvedic drugs.

Jalaneti as primary intervention in suspected rhino-orbito-cerebral mucormycosis helps improving the recovery: A case report.

The ongoing COVID-19 pandemic has resulted in several opportunistic infections like mucormycosis (MCR) to surface. Although this is commonly afflicting immunocompromised people managed through prolonged ICU care, epidemiological observations suggest that it is also associated with conditions like uncontrolled diabetes. Due to its invasive nature and systemic reach, MCR has high mortality warranting an early diagnosis and treatment. We present here a case of a non-COVID, diabetic patient having acute onset paranasal and periorbital swelling with headache suspected for rhino-orbito-cerebral MCR. The case was innovatively dealt with jalaneti (saline nasal irrigation) seeing a delay in the institution of definitive anti-fungal therapy. Six sittings of jalaneti in four days had been able to give near complete symptomatic relief in paranasal swelling and headache even before the endoscopic nasal debridement and anti-fungal therapy was initiated. Seeing the urgency of diagnosis and treatment in any suspected case of MCR, a simple and self-administrable procedure like jalaneti seems to have a high value for its possible role in reducing the sinus inflammation and reducing the disease intensity in order to find more time for the proper diagnosis and treatment initiation. Negligible cost of jalaneti, its easy administration, and minimal adversity potential are additional advantages for proposing jalaneti as a possible prophylaxis in MCR. More serious clinical research is urgently required to confirm the observations made in this single case report and to extend its benefits to the people suffering with MCR.

COVID-19 pandemic: A pragmatic plan for ayurveda intervention.

World community is facing an unprecedented pandemic of novel corona virus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV- 2). The disease has spread globally with more than 1.43 million confirmed cases and 82,100 deaths as of April 8, 2020. Despite worldwide efforts to contain it, the pandemic is continuing to spread for want of a clinically-proven prophylaxis and therapeutic strategy. The dimensions of pandemic require an urgent harnessing of all knowledge systems available globally. Utilization of Traditional Chinese Medicine in Wuhan to treat COVID-19 cases sets the example demonstrating that traditional health care can contribute to treatment of these patients successfully. Drawing on the Ayurveda classics, contemporary scientific studies, and experiential knowledge on similar clinical settings, here we propose a pragmatic plan for intervention in India. We provide a plan for graded response, depending on the stage of infection among individuals, in a population. Notwithstanding the fact that no system of medicine has any evidence-based treatment for COVID-19 as yet, clinical interventions are required to be put in place. Therefore, pragmatic strategy proposed here for Ayurveda system of medicine requires immediate implementation. It will facilitate learning, generate evidence and shall be a way forward.

Telemedicine for Ayurveda consultation: Devising collateral methods during the COVID-19 lockdown impasse.

COVID-19 pandemic and subsequent measures to mitigate it have presented the world with certain unprecedented situations. Lockdown with effective closure of all services including routine health care services has tested the nerves of health care providers for finding novel ways of providing services without getting into the risk of exposure. Telemedicine had been an ideal option for such situations allowing all channels of communication that leverage Information Technology platforms, including voice, audio, text and digital data exchange as a help to diagnosis, prescription and follow up evaluation. Unfortunately this versatility of Telemedicine as a patient -physician interface could not be harnessed well for its technical complexities and unpreparedness of institutions and individuals. Smartphone based video calling using whatsapp messenger has been proposed as a feasible Telemedicine application to provide outpatient services in this scenario. A pilot run of outpatient services during lockdown period through whatsapp facilitated video calling at Ayurveda Gathiya Clinic, State Ayurvedic College and Hospital, Lucknow has shown a way forward of running such services with a mass appeal, ease of operation and high interface gratification among users and service providers. Within its limitations related to the quality and quantity of information sought, this comes as a viable method of patient -physician interfacing during the phase of lockdown.

Time when a physician turned out to be a patient: A case study on how an Ayurvedic physician cured himself from COVID-19.

Medical literature continues to get enriched through various researches and observations related to SARS-CoV-2 infection leading to COVID-19. Case reports play crucially to understand a novel clinical condition where much is yet to be known. Current pandemic is unique for the reason that its impacts upon front line health care workers (HCWs) are much higher than general population. In this situation, how an Ayurvedic physician has handled his own case leading to a cure from COVID-19 may furnish important information regarding mitigation and cure from the disease. This is also an unprecedented writing in medical literature as a physician reporting his own case is a rare phenomenon in medical history. This case report puts strongly the prophylactic and disease modifying potential of Ayurvedic interventions in COVID-19.

Sustainable traditional medicine: taking the inspirations from ancient veterinary science.

Rapid reduction in natural resources as a consequence to the expanded urbanization, global warming and reduced natural habitat posed a considerable threat to the sustainability of traditional medicine. Being completely dependent upon natural resources like herbs, minerals and animal products, traditional medicine would possibly rank first in order of extinction of heritage if an alternative way is not considered well in time. In reference to the use of animal products, Ayurveda presents some unique examples where animals are used without causing harm to them and so without posing a threat to their existence. In the current context, when natural resources are facing a threat to their existence, a revisit to these ideas may give us a new insight to refine our look at natural resources used in traditional medicine.

Evaluating the Impact of a Pragmatic Nutrition Awareness Program for Expectant Mothers upon Birth Weight of the Newborn.

Poor maternal nutritional status and substandard antenatal care, which result in increased women's risk, low birth weight and stillbirth, afflict many countries with weak or emerging economies even today. Studies that address the effect of extending nutrition awareness among pregnant women to the net outcome of pregnancy remain scarce. We aimed to compare and contrast the effect of a pragmatic nutrition awareness program for expectant mothers (NAPEM) on birth weight of the newborn with a control group who received no such nutrition awareness activity. The effect of variables of mode of newborn delivery, associated complications at birth, and APGAR score of the newborn were also assessed. A pragmatic intervention trial of an antenatal care (ANC) program that consisted in nutrition awareness was conducted involving 53 pregnant women. Awareness was given through one-to-one interview and through informational literature provided to the participants in the local language. A hospital registry for deliveries undertaken during the study period was screened for identification of variables. A control group of matched pregnant women (n = 53) was obtained from the same hospital registry from preceding years, when the nutrition awareness program was not executed. A statistically significant improvement in birth weight of the newborn was observed in the intervention group, where expectant mothers were made aware about desired nutrition during pregnancy. A reduced incidence of complications associated with pregnancy was also observed in the intervention group. Providing awareness about nutritional requirements during pregnancy and suggesting the pragmatic ways to meet them was shown to be one possible effective measure to deal with pregnancy-related undernutrition. We show the efficacy of the intervention for underprivileged regions of India marked by inadequate health care delivery and lower socio-economical standards. We discuss our findings in the context of available evidence-based guidelines.

Ayurveda education in India: Addressing the human resource barriers to optimize the delivery.

Ayurveda currently is passing through a phase of global renaissance. Its growing popularity however is not matching with quality driven human resource development to meet the growing expectations. Teachers holding the responsibility of inspiring the newer generation for their adherence to quality are often de-motivated for various reasons and eventually fail to deliver optimally. Although promoting Ayurveda by increasing its visibility is a priority approach in policy and planning, much is desired to be done on the fronts of its actual delivery. Not much is done to ensure the quality driven human resource development in Ayurveda, accounting for a major cause of its dismal show on the fronts like education, practice and research. Ayurveda in India in general is still striving to achieve the minimal standards in these key functioning areas. Uncertain career opportunities, poor recruitment and discriminatory promotional policies, erratic salary structures, meager opportunities for early and mid-career advancements and negligible resources for in job skill enhancements are prominent reasons of de-motivation among Ayurveda teachers. An identity crisis of being unfit in the larger community of higher or medical education further adds to the misery as the advantages given to these communities are not generally shared with Ayurveda teachers. The outcome of an education imparted by a demotivated teacher can have its far reaching and diverse effects on the society. A poor performance of Ayurveda in the country of its origin has its roots in the inappropriate handling of its key functionaries like teachers. Ayurveda teachers playing the role of service providers and educators can create the foundation of quality driven education and health care in Ayurveda, if they themselves are harnessed well for their potential. The teachers are essentially the spine of any step related to qualitative benchmarking of Ayurveda and hence their miseries and misappropriations are needed to be accounted and addressed. Ayurveda teachers also deserve to be nurtured well to bloom to their fullest potential so to serve Ayurveda with all their strength and capacity.

Emanating the specialty clinical practices in Ayurveda: Preliminary observations from an arthritis clinic and its implications.

Despite their historical praise, specialty studies and practices are not generally seen in current Ayurvedic education and practice. Current Ayurvedic education by and large is devoid of training programs focusing upon specialty based health care delivery. This makes many disappointed who look at Ayurveda for a focused and specialized health care. The consequences of this gap in demand and supply are alarmingly obvious. With its unfocused health care approach, the Ayurvedic health care remains generic for large section of its delivery. There are no referral settings in Ayurveda to get a higher level of care better than the one offered at a primary health care setting. This apparent lack of expertise care in Ayurveda shifts it as an alternative health care used only on the instances of failure of other trusted options. Specialty clinical practices in Ayurveda seem highly important in order to build the trust and to enhance its quality of health care delivery. Our preliminary observations from a deemed arthritis clinic at an Ayurveda teaching hospital, visited by a diverse joint disease population carves a path in this direction and proposes the possibilities of using it as a template for the qualitative improvements in Ayurvedic health care delivery in the country in various clinical areas.

Making ASU ethics committees more productive: Responsible research needs more than developing the guidelines.

Ethics has been an integral component of health care research. Various guidelines have been developed globally to ensure ethical conduct of research. Ethics committees (EC) at research organizations have been instituted and empowered to oversee the research conduction in an ethical context. Traditional Indian health care research involving AYUSH systems (particularly drug based systems including Ayurveda, Siddha and Unani - ASU), also come under the broad ethics purview since it involves human or animal participation. Although assigned with a greater responsibility of ensuring and promoting responsible research in the campus, ECs at ASU institutions are yet to be positioned as the promoters of ethics and integrity in research. There had been anomalies in EC structure and function and there had not been the observance of SOPs about considering ethics in research. Poor understanding about their role and function in EC by individual members and poor appreciation of their role in building a responsible research culture across the institution holds much behind suboptimal EC performance. Central Council of Indian Medicine's (CCIM) recent note of the situation and initiation to make a separate guideline for EC functioning in ASU is a welcome step in this regard. However, it may not be the most appropriate step for its possibility of diluting the research standards in favor of ASU. What seems more appropriate is to empower the ASU ECs with knowledge about global standards of ethics and integrity in research to optimize their role in building a responsible research culture in ASU. Naturally, they may need initial help to get evolved subsequently as accountable stakeholders able to care for their own research needs while making attempts to make their benchmarks similar to the global standards.