Traditional medicine in India

India has a long history of traditional medicine, and Ayurveda is the most representative system. Similar to traditional Chinese medicine, Ayurveda is a life science derived from experience. It emphasizes that human health requires both personalized medicine and a holistic approach. This article takes Ayurveda as an example to introduce traditional Indian medicine, hoping to provide readers with a preliminary understanding of the development of traditional medicine in India.

Keywords

Traditional Indian medicine

Ayurveda

Five elements theory

Three humoralisms theory

Introduction

Traditional Indian medicine is one of the oldest medical sciences in the world. Ayurveda, the most widely used system in traditional Indian medicine, emphasizes holistic medicine, which takes the body, mind, and spirit as a whole. It is based on the principle that human beings achieve physical, mental, and emotional health through harmonious coexistence with nature.1

The basic theories of Indian medicine are the five elements theory and the three humoralisms theory. The five elements theory is a natural philosophy in Vedic culture that is used in medicine to explain human physiology. The five elements theory holds that everything in the world is composed of five basic elements—Prithvi (earth), Jala (water), Agni (fire), Vayu (air), and Akasha (ether)—that supplement the corresponding elements in the human body after being ingested. According to the three humoralisms theory, there are three kinds of humoralisms—(Tridosha) gas (Vata), bile (Pitta), and mucus (Kapha)—the balance of which determines the health and disease status of the human body. Disease is caused by internal and external factors leading to an imbalance of the three humoralisms, and the treatment is to restore their balance by means of medicine and diet therapy.2,3 Later, seven kinds of tissues (Saptadhatus) (Rasa, Rakta, Mamsa, Meda, Asthi, Majja, and Shukra—that is, chyle, blood, flesh, fat, bone, marrow, and sperm/ovum) were added, all of which were thought to be derived from food. Others incorporated malas: Purisha, Mutra, and Sweda (i.e., feces, urine, and sweat). In this way, a relatively complete theoretical system has been formed, holding that disorders of humoralism, body composition, and excreta are the sources of disease.4

As an organism, the tissues of the human body are formed by the combination and transformation of these five basic elements. Whether one is healthy or sick depends on whether the whole body system is in balance, including whether all parts of the body are in balance with each other. Both internal and external factors can disrupt the balance of nature and lead to disease. Imbalances can be caused by overeating, bad habits, and ignoring rules for healthy living. At the same time, abnormal seasons, incorrect exercise, improper use of sensory organs, and adverse effects of body and mind will also disrupt the existing normal balance. The basic treatment methods can be summed up as “body cleansing” and “mind cleansing.” By adjusting the diet, the body and mind system can be restored to balance, and bad habits and behaviors can be corrected; or, disorders of the body can be regulated by drugs.

Ayurveda’s diagnosis method

Ayurveda divides diseases into two categories: those suitable for medical treatment and surgical treatment, and those causing mental and physical “pain,” which can be attributed to the abovementioned three reasons. Diagnosis and treatment tend to be human characteristics rather than the disease itself. The age of the patient, the living environment, the social and cultural background, and the constitution of the patient should be considered before the doctor makes the diagnosis. Diagnosis mainly means observing the symptoms and signs of the disease. The tongue coating, skin color, eyes, feces, and urine can all be diagnostic references. The diagnosis and treatment methods are mainly to strengthen the detoxification, medicine, diet, exercise, and health preservation of the body’s function, eliminate the factors that cause the imbalance of the body system and its components, restore the balance, strengthen the physique, and prevent or reduce the occurrence of the disease.5

Ayurveda treatment

Drug therapy

The drugs used are mainly animals, minerals, and marine drugs. In clinical practice, the drugs used are single or compound. The properties of the drugs stimulate the functions of specialized organs, exert the natural activity of medicinal plants, and stimulate the natural healing power of the body. In addition, Indian herbal therapy has a very old history. This therapy mainly uses the oil extracted from herbs to remove toxins from the body and restore the body to a natural balance.

Psychotherapy

Ayurvedic medicine can calm people’s minds and divide mental energy into three types: Satwa, Rajas, and Tamas. The harmony of these three kinds of energy can keep people safe from interference and disease, activate people’s perception, and make people happy to seek peace.5 Indian doctors believe that human health, is, first and foremost, the health of the mind, which directly affects the body. For example, music can make people’s souls enter into the void; music meditation can also bring clear thinking, a healthy body, and harmonious interpersonal relationships.

Surgical techniques

There are eight kinds of surgical methods involved in the classic Indian Sushruta Samhita: resection, incision, stab, puncture, extraction, puncture and collaterals, suturing, and bandaging.6

Characteristics of ayurveda

Ayurveda is known as the oldest documented comprehensive medical system in the world. Ayurveda includes eight specialties: internal medicine (Kayacikitsa), surgery (Salya Tantra), otolaryngology (Salakya), gynecology and pediatrics (Kaumarabhrtya), psychiatry (Bhutavidya), toxicology (Agada Tantra), gerontology (Rasayana Tantra), and eugenics and expediting (Vajikarana).7 The treatment methods include Shamana, Shodhana, surgical therapy, and diet therapy. The main feature of Ayurveda is holistic therapy, focusing on the close relationship between the body and the mind, emphasizing that it is more important to keep the balance of all parts of the body than to eliminate external pathogenic factors, using processed natural drugs instead of extracted substances or synthetic chemicals, emphasizing the prevention and treatment of diseases by relying on diet. Ayurveda believes that “the habits of medicine and food are different, but the principles remain the same” and places an “emphasis on eating healthy food.” It is believed that the value of Ayurveda lies in that, as one of the great medical sciences, Ayurveda is useful not only for clinicians and experts but also for housewives.

Ayurveda uses the “Panchakarma” method in its treatment. Panchakarma therapy is applied to various processes of body regeneration, purification, and life extension. Panchakarma consists of five karmas (actions), which are used to remove toxins from body tissues. They are Virechan (purified using powder, paste, or decoction), Vaman (using certain drugs to force vomiting), Basti (using an enema made of medicinal oil), Rakta moksha (bloodletting), and Nasya (using nasal administration, such as decocting, oil, and smoke).7

Clinical treatment advantages of ayurveda

The Rasayana method (rejuvenated method) in Ayurveda medicine can protect and promote health by promoting longevity and preventing or delaying the aging process, while Panchakarma (purification therapy) can completely purify the body of diseases by removing the body’s toxins and waste. Some compounds in Ayurvedic medicine are very effective for various common diseases, such as common cold, fever, excessive gastric acid, ulcer, cough, gastrointestinal problems, diarrhea, amebic dysentery, liver diseases, uterine bleeding, urinary tract infection, arthritis, gout, bronchial asthma, and eye diseases. It also shows good effects in the treatment of some chronic diseases, such as cardiovascular diseases (e.g., hypertension, angina, myocardial infarction, and congenital heart disease), cancer, dengue fever, and inflammatory diseases, kidney diseases. Some studies have shown that Ayurvedic drugs can also help to deal with some emergencies, such as severe diarrhea and vomiting, typhoid fever, delirium, burns, poisoning, threatened abortion, and miscarriage.7

History of traditional Indian medicine

As early as ∼2500 BC, there was an early civilization in the Indus River Basin (i.e., the Halaba culture), with cities, and well-developed handicrafts, such as textile, pottery, and metal processing. During the Vedic era (about 1400 BC to 600 BC), the Aryans who dominated India created a Vedic culture with Brahmanism as the core and also inspired the initial formation of ancient Indian philosophy and natural philosophy. There are four major collections of documents describing various kinds of knowledge, thoughts, and legends in the Vedic era, i.e., the Rigveda, Samaveda, Yajurveda, and Atharvaveda. Among them, the Atharvaveda already contains many medical contents, including information on human structure, physiology, embryos, disease, medicine, and treatment. However, the medicine in this period was not based on the basic theory of naturalism but on a kind of witch doctor.5

From about 1500 BC to 1000 BC, Ayurvedic medicine, as one of the four Upavedas (supplements and deductions of Vedas), was gradually divided into two schools—the Atreya Inner Medicine School and Dhanvantari Surgery School. In the early 100 BC, scholars in these two categories wrote two major books on Ayurvedic medicine: the Caraka Samhita and the Susruta Samhita. Around AD 500, the third important Ayurveda medical work, Astanga Hridaya Samhita, was published, which integrated the views of two medical schools of Ayurveda. From AD 500 to AD 1900, a total of 16 important drug monographs were published one by one as supplements to Ayurveda’s medical classics.

There is evidence that Ayurvedic medicine has enriched almost all medical systems in the world. Through sea trade with India, Egyptians learned Ayurvedic medicine; the invasion of Alexander also brought the Greeks and Romans into contact with Ayurveda medicine. Similarly, with the spread of Buddhism to the East, Ayurvedic medicine reached the East.

Development of traditional Indian medicine

Management system

In 1995, the Indian government established the Indian Medical and Homeopathy Bureau under the Ministry of Health and Family Welfare of India. Ayurveda has its own department for management. The highest research institution of traditional medicine is the Ayurveda Central Council. The Indian Pharmacopoeia Committee and Indian Laboratory Committee carry out the standardization and modernization of Indian medicine and specially organize the preparation and printing of traditional pharmacopoeia and other publications, such as the Traditional Indian Pharmacopoeia and the Production of ISM Drugs with Current Good Production Practices.8,9

Policy

Ayurveda focuses on the management, education, regulation, development, and growth of Indian pharmaceutical systems (ISM) in India and abroad. There are few subordinate institutions of the Ministry. There are several autonomous institutions in the form of a research committee, professional committee, pharmacopoeia laboratory, national research institute, academy of sciences, and hospital. In 2002, the state introduced policies on the Indian medical system. The main objectives of this policy are (1) to use Ayurveda to promote good health and to promote healthcare for the local people (mainly those who cannot afford or do not have access to modern medical facilities) by means of prevention, promotion, mitigation, and treatment; (2) to provide affordable, safe, and effective Ayurveda services and medicines; (3) to ensure that the supply and authentic products of APIs meet the Pharmacopoeia Standard requirements to help improve the quality of drugs for domestic use and/or export; (4) to integrate Ayurveda into the medical service system and national planning and ensure the maximum possible use of the huge infrastructure of hospitals, pharmacies, and doctors; (5) to provide full opportunities for the expansion and development of ISM, utilize their potential, and revive their glory.7

Education

The Central Council of Indian Medicine (CCIM) was established by the Central Council of Indian Medicine Act of 1970 and is mainly responsible for managing the teaching and practice of ISM. In 2016, there were more than 125 graduate schools in India (76 Ayurveda, 8 Unani, 3 Siddha, and 40 homeopathy schools) and more than 2700 schools had enrollment qualifications.10 The National Ayurveda Institute of India (Jaipur), National Naturopathy Research Institute (Poona), Ayurveda Graduate Institute of Teaching and Research (Jamnagar), National Unani Medical Research Institute (Bangalore), and National Siddha Medical Research Institute (Chennai) are the top institutions of Indian medical education.

Medical treatment

The population of India is about 1.38 billion, more than 70% of whom live in rural areas. Although the government has established a multi-level network of health institutions in states, counties, districts, and villages, it is estimated that the services provided by the national health system can only cover up to 30% of the total population, and the rest rely on local Ayurvedic medicine. It was in 1970 that India changed its pre-independence policy and recognized Ayurveda and other medical systems to promote the development of national health. Since then, a large number of Ayurveda hospitals and clinics have been established throughout the country, most of which are funded and managed by the national and state governments. In India, Western medicine and traditional medicine are two completely independent systems. In modern general hospitals, there are few traditional medical departments. Traditional medical hospitals generally do not use Western medicine, and doctors in traditional hospitals cannot prescribe Western medicine, which better preserves the localization and independence of Indian medicine.3 According to Minister of State Shripad Yesso Naik, Ayurvedic medicine has 2827 hospitals and 15 520 pharmacies.11

Drugs

In India, about 70% of modern drugs are found in natural resources, and many other synthetic analogues have been prepared from prototype compounds isolated from plants. It is reported that more than 60% of anticancer drugs on the market or in clinical trials are based on herbs. Currently, about 80% of antibacterial, immunosuppressive, cardiovascular, and anticancer drugs come from plants. More than 70% of 177 approved anticancer drugs are based on natural products or imitations. About 25% of the world’s prescription drugs come from plant sources, and there are nearly 121 such drugs in use. It is estimated that Ayurvedic medicine uses about 1200–1800 kinds of plants, and Indian folk therapists use more than 7500 kinds of medicinal plants in different medicines.7

Scientific research

Based on the priority areas of national development and the advantages of Ayurvedic medicine, the Indian Medical Department has set the following key research areas: respiratory diseases, gastrointestinal diseases, geriatric medicine and immunotherapy, metabolic diseases, liver diseases, and malaria. At present, Indian medical research is carried out from multiple perspectives, including basic research, literature research, drug research, and clinical research. For clinical research, the Indian government emphasizes researching traditional medical theories and requires researchers to understand both Indian medicine and Western medicine. There are currently more than 400 research institutions engaged in traditional medicine in India, including the Indian Ayurveda Scientific Research Center, the Central Drug Research Institute (CDRI), and several private research centers, institutions, and universities. From basic research to preclinical or clinical research, from standardized research to ISM development is the current research hotspot. At the same time, the Indian government also supports different research and development (R&D) plans related to medicinal plant research. Over the years, the budget allocation of Ayush Province has gradually increased. In the 12th Five-Year Plan (2012–2017) of India, Indian medicine’s total allocation was 10.44 billion Indian rupees, which is 235% more than the actual expenditure during the 11th Five-Year Plan.7

Industry

In the process of R&D, production, and marketing, India’s large-scale traditional pharmaceutical manufacturers have always been in line with international thinking and have attached great importance to exploring the international market. While going into the world, the Indian government is gradually investing more human and material resources to protect its intellectual property rights to traditional medicine from being infringed upon, which will also promote the development of the traditional medicine industry in India. There are 74 Food and Drug Administration (FDA)-approved drug production bases in India, and India has become the country with the largest number of FDA-approved drug production bases outside the United States. At present, there are two main kinds of drugs produced and sold in the market—traditional preparations of special production and combinations of patent and monopoly drugs—which are consistent with those described in the official books of Ayurveda. India has become the largest exporter of medicinal plants, plant drugs, and value-added products (e.g., essential oils, gum) in the world. There are nearly 9000 traditional pharmaceutical manufacturers in India, and most of them (7744) participate in the production of Ayurveda drugs. It is estimated that 2000 tons of medicinal plant raw materials are needed every year, of which more than 1500 kinds of herbs are also sold as dietary supplements or traditional ethnic medicines; nearly 960 kinds of medicinal plants are in trade, of which 178 kinds consume more than 100 tons every year. The export value of Indian medicinal plants and related products is about 110 billion USD, and the market of health products is about 1 billion USD and growing.7,11

Intellectual property protection

India has 8% of the world’s plant resources, of which at least 44% can be developed into drugs. However, due to a lack of technical means, attention, and awareness of safeguarding rights, many traditional drug patents have been plagiarized. In view of the universality and seriousness of this situation, the Indian government has gradually begun to attach importance to it and has carried out a series of practices to protect and rationally develop traditional medical knowledge—such as the new revision of the patent law, the collection and filing of traditional medicine knowledge, the establishment of a registration and invention patent system, and the establishment of a special investment foundation. Through these means, Indian traditional medicine patents have been well protected.3

Pharmacovigilance system

With the increased recognition of traditional medicine in India, the rate of reported adverse reactions to Ayurveda drugs has also increased dramatically, and the safety of traditional medicine drugs has also received increasing attention. In November 2006, two clinical pharmacologists, Urmilla Thatte and Vaidya Supriya Bhalerao, in Mumbai, India, proposed the idea of establishing a traditional pharmacovigilance system, implemented an Ayurveda pharmacovigilance plan independent of the national pharmacovigilance system, and organized a seminar on “Ayurveda Pharmacovigilance.” In December 2007, a WHO-sponsored seminar was organized at the Institute for Post Graduate Teaching and Research in Ayurveda (IPGTRA) in Ziggurat, Jamnagar, demonstrating the possibility of implementing Ayurveda pharmacovigilance. In 2008, the Traditional Medicine Administration of the Ministry of Health and Family Welfare of India in New Delhi issued the Protocol for National Pharmacovigilance Program for Ayurveda, Siddha, and Unani Drugs (PNPP for ASU) to supervise the safety of the three types of traditional medicines. On January 21, 2009, the National ASU Pharmacovigilance Advisory Committee reviewed the protocol. On February 15, 2010, the Secretary of the National Traditional Drug Administration chaired the evaluation meeting of the ASU pharmacovigilance protocol, which approved the establishment of the ASU pharmacovigilance project. In the same year, the National Pharmacovigilance Program was renamed the Pharmacovigilance Programme of India (PvPI), which was jointly implemented by the Central Drugs Standard Control Organization and the Indian Pharmacopoeia Commission to supervise all types of drugs in India.

Since the establishment of an independent ASU pharmacovigilance system in India, various achievements have been made in the safety supervision of ASU drugs, including the following: (1) A complete three-level supervision system of traditional pharmacovigilance has been formed, and most pharmacovigilance centers have been established in ASU medical colleges, ASU medical institutions, and ASU scientific research institutes, so as to realize the combination of government supervision and technical control of professional institutions. (2) The adverse reaction reporting rate of traditional drugs has increased significantly, the number of adverse reactions/adverse events reported has increased rapidly, and there are detailed adverse reaction reports and causal evaluations. (3) Traditional pharmacovigilance education has greatly improved the content of pharmacovigilance in the curriculum of postgraduates of traditional medicine such as Ayurveda and trained a group of teachers, doctors, and medical assistants engaged in the supervision and research of traditional pharmacovigilance. (4) To improve the safety of traditional medicine registration, the Traditional Medicine Administration of the government of India requires the Drug Registration Agency to take pharmacovigilance as a standard when authenticating new drugs.12

Future of traditional Indian medicine

With more and more people pursuing complementary medicine and worrying about the side effects of synthetic drugs, herbal drugs are gradually moving from the edge to the mainstream market. According to a WHO survey, 80% of the world’s population is optimistic about the development of traditional medicine and is willing to try herbal medicine as their main healthcare drug.13 India has rich herbal plant resources, with more than 3000 types of medicinal plants, and more than 6000 types of herbs are used by people, accounting for about 75% of developing countries herbal species; more than 1000 factories produce traditional herbs. Coupled with Indian medicine’s thousands of years of clinical experience in using herbal medicine, this gives the country the opportunity to become the world’s largest herbal manufacturer.14

Indian medicine has a good background of scientific support and has been recognized by recent research. However, the promotion of herbal medicine still faces many challenges, mainly in developed countries. Before promoting traditional herbal medicine knowledge around the world, the following problems need to be overcome: (1) The identification and quality of medicinal materials are important obstacles affecting the promotion of traditional Indian medicine. For example, the phenomenon of “different things with the same name,” or “different names for the same thing,” is common. There is little talent with professional identification knowledge and experience, the content of mold and heavy metals in herbal medicine exceeds standards, and herbal medicine is often adulterated and deteriorated. (2) Ayurveda doctors do not attach great importance to the side effects of herbs. Although the occurrence and severity of side effects of herbs are far lower than those of synthetic drugs, they cannot be ignored. (3) Due to the government’s neglect of supervision, the area of habitats suitable for the growth of herbal medicines is decreasing. The unscrupulous exploitation of wild medicinal plants by pharmaceutical factories has adversely affected India’s pharmaceutical resources, and some rare medicinal resources are on the verge of extinction. (4) Many herbal medicines in India are not produced and sold in accordance with international market norms, which is another reason they are unable to enter developed Western countries.

Indian medicine is not only a means of medical treatment but also a healthy way of life. However, the use of herbal medicine, along with its association with Indian theology and Buddhism, has been shrouded in mystery. At present, Indian medicine is in an awkward position. Against the medical background of Western medicine occupying the mainstream position, Indian medicine presents two levels of differentiation: In poor areas, people who cannot enjoy Western medicine resources still use Ayurvedic medicine. In upper-class society, meanwhile, the expensive aromatherapy and essential oil therapy of Ayurvedic medicine are very popular. Especially in Europe and America, Indian medicine is regarded as an “alternative” therapy to modern medicine, which makes it attractive.15 Some Europeans and Americans even travel to the hometowns of Indian medicine to take life courses and experience a full Indian medicine regimen, including diet, yoga, meditation, still sitting, massage, and spiritual lectures. This is becoming a new selling point for Indian tourism.

Figuring out how to combine modern technological knowledge with a broader perspective on Indian medicine’s application of medical principles can help traditional Indian medicine gain wider acceptance. To maintain this ancient and valuable medical system as a living tradition, it is necessary to further investigate and demonstrate the scientific basis of Indian medicine.