Can Indian systems of medicine, such as Ayurveda, Siddha and tribal medicine, be evidence-based? These questions have been raised in the Ramdev Baba Coronil controversy, where a herbal product was claimed to be a cure for COVID-19 without sufficient scientific evidence.
Decades ago, in Vietnam, during the war, more soldiers fighting the US military were dying from chloroquine resistant malaria than from US bullets. At the request of Ho Chi Min, Mao Zedong of China launched Project 523, which sent researchers to search traditional Chinese medical literature to identify herbs for malaria-like symptoms.
The most remarkable result was the discovery of artemisinin, a life-saving drug against malaria. Inspired by a 1,700-year-old treatise, Tu Youyou and her team discovered artemisinin using modern scientific methods. This breakthrough saved millions of lives and earned her a Nobel Prize in 2015.
Despite initial skepticism, clinical and physiological studies confirmed artemisinin’s effectiveness in controlling malaria. This strong evidence convinced the international health community and led to the World Health Organization’s approval of artemisinin. Today, scholars around the world study traditional Chinese medicine using modern scientific tools.
Earlier Indian systems were evidence based
In ancient Indian philosophy and science texts, logical epistemological keywords such as pariksha, Anumana, saw me, yukti, well, siddhanta, multivariateand Anvesana share space with some kind of mythology. According to Narasimha (dated 7th-8th century), the commentator said Rasavaiseshika-sutraattributed to Bhadanta Nagarjuna in the 5th-6th century. century, only two types of evidence are valid in Ayurveda: Pratyaksha (followed directly) and Anumana (guessed/inferred), with no role for ‘faith’ in the sense of blind faith. (Na hy Ayurveda prayaksarthanumeyarthabham agamabham aniacchraddeyarthavam asti, drishtaphalatvad iti-RVSBh 3.45).
Caraka distinguished between Yuktivyapashraya beshaja (based on reason) and Daivavyapashraya beshaja (religious) therapies, with an emphasis on the research process, ‘pariksha‘, as important to the discovery of scientific truth. He said that a claim becomes generally acceptable only after it has been thoroughly investigated by several researchers and is supported by solid and reasonable evidence.
Why has Ayurveda fallen by the wayside?
From the sixth to the tenth century AD, Ayurveda was a thriving and active field. New medicinal formulas were discovered and added to its extensive repertoire. For example, Vagbhata (6th century AD) emphasized the importance of updating medical texts, ‘similar to yuga,’ and wrote new commentaries on Charaka Samhita and Sushruta Samhita. Dalhana (11th century AD) did not hesitate to modify and add two new iron compounds for the treatment of anemia in his commentary on the Sushruta Samhita.
“Ayurveda does not get its power because it is prophesied by Brahma; Its merit simply comes from the verifiable truth it contains,” according to Vagbhata. However, many practitioners of Ayurveda believed that it was achieved by ancient “rishis” with their divine “yogic” powers rather than as an experimental and empirically based scientific treatment system that was subject to criticism.
“Obedience to the written word and textual authority, reinforced by the social influence of caste hierarchy and mystical philosophy, gradually replaced the spirit of scientific adventurism and research that characterized the work of Ayurvedic pioneers,” says MS Valiathan, noted cardiologist and author of the book. the book series Legacy of Charaka, Sushruta and Vagbata.
In recent history, conservatism and mysticism have been strengthened and encouraged by the congregation formed by Captain G Srinivasa Murti, a practicing physician, in the committee appointed by the Government of the Madras Presidency in 1921 under the chairmanship of Muhammad Usman on the question of recognition and encouragement of indigenous systems of medicine. While modern Western science used external aids such as microscopes, telescopes, spectra and so on to understand things beyond the senses, he asserted that the Hindu sages “tried to achieve the same results, not by providing external aids to their senses, but by to improve one’s inner senses’.
“The general willingness of contemporary Ayurveda practitioners to question the wisdom expressed in the classical Samhitas is contrary to the teachings of the sages of ancient India who preferred Pratyaksha (direct evidence), Anumana (inferential proof), and yukti (logic) over shabda pramana (textual narratives),” says Subhash C Lakhotia, professor of cytogenetics at Banaras Hindu University and a pioneer in using the drosophila model to study Ayurvedic biology.
West and East
Not everyone invokes the divine to reject scientific observation; some hide behind cultural relativism. They claim that “allopathy” is based on Western science and that Ayurveda is an epistemologically different but still valid system of knowledge, which can only be confirmed by Ayurvedic logic and methods.
According to Ayurvedic physiology and anatomy, thank you (semen) is formed in the majja (bone marrow) and urine is formed without the involvement of the kidneys. The text also states that the combination of sperm and menstrual blood leads to the formation of an embryo. All this contradicts ‘Pratyaksha‘, and can these be accepted as alternative ‘ways of seeing’?
Kishor Patwardhan, a action body An Ayurveda professor at Banaras Hindu University, explains that the epistemology of Ayurveda conforms to Nyaya Vaisheshika schools of thought, similar to modern science but with simple tools. “In ancient times, Pratyaksha meant using the senses to acquire knowledge; today we use tools like microscopes for the same purpose,” he says.
Clinical trials
Randomized controlled trials (RCTs) are the gold standard for clinical trials that evaluate the effectiveness of drugs. Allopathy prescribes the same treatment for two individuals with the same diagnosis.
However, Ayurvedic treatment is individualized based on constitution (prakriti, particle, samhananaetc). Due to its complexities, including multiple drugs, mid-course corrections, treatments, dietary restrictions, and lifestyle changes, an RCT does not seem feasible for Ayurvedic clinical trials. Some argue that only case studies from the personal experience of Ayurveda practitioners are realistic.
However, the situation is not hopeless. Recently, methotrexate-based therapy was compared with Ayurvedic intervention in patients with radiological evidence of RA, proving the feasibility of double-blind, placebo-controlled trials, even for individual therapy. If there’s a will, there’s a way.
The elephant in the room
It is often argued that modern science gives a stepmotherly treatment to the study of ancient systems of medicine. But this is not the case. Sparked by a chance speech by the former president of the Indian National Science Academy, MS Valiathan, on Ayurveda and modern medicine, Naveen Khanna and his team at the International Center for Genetic Engineering and Biotechnology (ICGEB) discovered a potent antiviral against all four dengue strains, after reviewing Ayurvedic literature. After years of research, they found that a herbal extract of Cissampelos pareira Linn (Cipa) was beneficial against dengue in both in vitro and animal models. Human clinical trials are currently underway.
Similarly, researchers at the CSIR-Indian Institute of Integrative Medicine in Jammu isolated Sinococuline, a bioactive substance in Cocculus hirsutus, which has potent anti-dengue activity, and discovered IIIM-290, a herbal medicine with anticancer properties.
China is investing huge amounts of government money to revalidate ancient medicine using current evidence standards, accepting treatments that work but rejecting those that don’t. In India, we lack both the resources and an unwavering commitment to evidence.
The aura of the mystical, vital barrier
Sushruta argues that medical interventions are reliable not only because they are effective in his own experience (Pratyaksha / phaladarshana) but only because they have been intelligently examined by a community of experts. He seeks what is now called rigorous peer review before agreeing to the demands. It is clear that case studies cannot replace well-designed clinical trials in evaluating efficacy and assessing underlying disease pathology.
Naturally, classical medical texts from centuries earlier contain inaccurate anatomy and physiology, with outdated theories of pathophysiology and etiology. Yet practitioners often recite divine revelation and do nothing to update or change this knowledge. Unearthing the biological basis of this body of knowledge can benefit both the Indian system of medicine and biology.
(The author acknowledges Krishna GL, especially in his article ‘Ayurveda Awaits a New Dawn’, for providing perspective on the philosophical and epistemological aspects of Ayurveda)
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