Ayurveda originated as oral tradition in 5000-2000 BC and in written form around 1500 BC. It flourished from 1000 BC – 1000 AD and then declined from 1200 AD to 1800 AD due to Muslim invasion and destruction. Ayurveda, the traditional system of medicine is still used in India by over 70% of its population. Ayurveda is a body/mind /spirit or holistic way to achieve health and its practitioners recommend diet and lifestyles changes along with drug therapy. It tried to put medical knowledge on a rational and scientific basis excluding magic, sacrifices and mysticism unlike the Vedic period. Surgery was a major component of Ayurveda till 600 AD but it is seldom used now. The code of ethics for physicians was well developed. The contributions of Ayurveda to modern system of medicine in surgery, herbal medicine, yoga and meditation will be covered. The reasons for its decline were failure to evolve and take up new ideas, close ties with religion. All animal parts, heavy metals, pesticides, microbes and toxins must be eliminated from Ayurvedic preparations. There is a need to prove the safety and efficacy of Ayurvedic drugs in animal models and double blind placebo controlled trials in adequate number of patients. However its low cost, easy accessibility to poor and uneducated communities make it imperative to modernize Ayurveda in the light of advances in science and medicine and incorporate some of its validated and tested ideas into primary healthcare and modern medical practice. TCM has a much larger share of the global market than Ayurveda.
In one of the stories in the Hindu epic, Ramayana, the brother of Lord Rama is saved from certain death by a medicinal herb from the Himalayas. This herb is not known today and might have become extinct. Actually between 30-50% of medicines described in Ayurveda are not known or lost forever. The emergence of drug resistance in micro organisms, emergence of new killer micro organisms like Ebola, Lhassa, revival of plague, resurgence of malaria, tuberculosis, cholera, unexpected adverse reactions and subsequent withdrawal of several high profile drugs like benoxaprofen, phen-fen combination, trogltazone, overuse of pesticides and fertilizers is leading to a counter current movement like return to nature or return to the roots. The rising cost of healthcare is driving it out of the reach of the most vulnerable sections of society like the poor, elderly, children and women. The traditional system of Indian medicine is still used by 70% of population, who do not have access to the Western system of medicine or are unable to pay its very high cost.
|Table 1||Period||Historical Milestones|
|5000 – 2500 BC||Vedic Period||Oral and poetic tradition, divine origin|
|2000 – 1500 BC||Rigveda written version|
|1500 – 1800 BC||Agnivesha (Charaka) Samhita||Sushruta Samhita|
|800 BC – 800 AD||Golden Period of Ayurveda|
|1000 AD – 1945 AD||Dark Period of Decline|
- Transfer of ayurvedic knowledge from Heaven to Earth
- Site of First Ayurvedic Medical Congress
- Source of several Ayurvedic drugs
- Internal medicine, Therapeutics
- Diseases of Eye, Ear, Nose, Throat
- Pediatrics, Obstetric, Gynecology
- Rejuvenation, Promoting therapy
- General principles and philosophy
- Cause of disease
- Nourishment and general pathology
- Anatomy and embryology
- Diagnosis and prognosis
- Divided into 8 sections covering 120 chapters
Basic Concepts in AYURVEDA
Treatment objective is to restore the balance of functions or doshas. Healthy state signifies good appetite, digestive function, proper growth, proper waste product formation and elimination, good sense organs, positive mind and ability to properly adjust to external and internal changes like diet and environment. Good health is favored by regular habits and good food. Dietary overindulgence and irregular or faulty habits are the main causes of disease .
TABLE 6 DECLINE AND SHORTCOMINGS
- A closed system of learning, did not take up ideas from other systems of medicine due to pride of their race and divine origin.
- Original texts written in Pre-Sanskrit grammar style, now forgotten
- Lack of anatomical and physiological knowledge
- No explanation for origin or proof of concept
- No objective way to measure doshas or proof of existence.
- Overkill in sub classification and nomenclature
- Muslim invasions of India and resulting massacre and wiping out of Indian intellectuals and destructions of universities, temples, libraries etc.
- Lack of high quality pharmaceutical standards to assure consistent quality of preparations
- Lack of toxicology and preclinical pharmacology data
- Lack of data about rigorous proof of safety and efficacy by modern standards of clinical trial
- Inability to match dramatic outcomes with antibiotics, antiulcer agents etc.
Contributions to Modern Medicine
Some of the concepts first mentioned in Ayurveda have stood the test of time and been incorporated in modern practice (Tables 7-9). The contributions of Sushruta to plastic surgery are well recognized. Plastic surgery arose in India because cutting off nose and ears was a common punishment. The concept of chronomodulation of drugs, mind-body interactions, treatment of mental disease, holistic treatment and slowing of the ageing process are universally accepted. The use of amputation and artificial eyes and limbs must have been a great step forward at that time. The story of a baby saved from its dead mother by opening of her womb must have caught the imagination of mankind 3500-4000 years ago as it does today. This technique, we know today as cesarean, is routinely used when normal delivery of the baby is difficult.
Similarly opening of the bladder to remove kidney stones was a historic event as was the cataract operation. Lack of sterile or lack of knowledge about anatomy and physiology was made up by keen naked eye observations. Even if very few of these patients survived, there was hope of a cure. No records exist of these early surgeons, about their success or failure rate or their follow up of patients. Medicine progressed by documenting and learning from mistakes. It must have happened during ayurvedic period.
Besides yoga and meditation, the area of herbal drugs still in use today can be considered as a real contribution. In India, there are 1500 Ayurvedic drugs on the market, sourced from around 800 medicinal plants. There is a separate Ayurvedic pharmacopoeia, standards for Ayurvedic drugs, and the drug controller need not insist on safety and clinical trial data for approval of new or existing Ayurvedic drugs. The ayurvedic system of medicine has been recognized since 1959 and over a hundred ayurvedic colleges were set up. There are over 500,000 registered practitioners of Ayurveda in India today. The total worldwide 2009 market for traditional medicine was around 50 billion US dollars, out of which Ayurveda accounts for 20%. TCM has a dominant position. 
Ayurvedic drugs are extensively used in India for hepatoprotection, diabetes, memory enhancement, health promotion, skin diseases, obesity and lipid disorders, ageing, and prostate enlargement. Turmeric in medicated oils or ghee was used at that time for wound healing. Recent studies have shown that semi liquid salted boiled rice (as in Ayurveda) is more effective in cases of severe diarrhea than oral salt mixture. Some of the current uses of these drugs are different from those mentioned in the original text. Like Rauwolfia alkaloids were used in Ayurveda for insanity and insomnia in contrast to their more recent use in cardiovascular diseases.
There is a need to conduct globally acceptable clinical research in ayurvedic therapeutics. The gold standard is a double blind placebo controlled clinical study in hundreds of patients, drug interactions studies and special impaired patients. Selection of appropriate drug, non-drug and/or drug combination, identification of objective outcomes, adequate placebo controls, double blinding, bias, duration of trials, adequate number of patients, dose optimization should be reviewed.. There is a need to establish reasonable safety and adverse event profile of ayurvedic therapy. A recent survey found wide range of clinical and in vivo studies for many of the plant-based therapies utilized in the Ayurvedic system. Of the 166 plants investigated, 72 (43%) had at least one or more human studies and 103 (62%) had one or more animal studies. Most of these studies in small number of patients and often lack double blinding or a placebo control group. 
The Central Drug Research Institute CDRI has pioneered new drug discovery in India. 11 drugs mostly herbals have been discovered/developed by CDRI. Six new drugs developed by CDRI have been commercialized and marketed for CVS & CNS disorders (Gugulipid, Memory Plus), malaria (Arteether, Aablaquin). In addition, several new drugs like Consap, Picroliv and 80/574, herbal remedy for diabetes etc, are in development. 
The first active drug to come out of India in the early 1960s was Reserpine.
In India, practitioners of traditional Ayurvedic medicine have long used the herb Coleus forskohlii to treat asthma, heart disease, and a range of other ailments. The active ingredient forskolin, available in supplement form, is commonly recommended for treating hypothyroidism and obesity.. Forskolin is believed to stimulate the release of thyroid hormone, thus relieving such hypothyroidism symptoms as fatigue, depression, weight gain, and dry skin. Forskolin activates an enzyme that raises levels of a key cell-regulating substance called cAMP (cyclic adenosine monophosphate). This compound is considered to be an invaluable tool for proper understanding of cyclic AMP-dependent physiological processes. It has been reported that forskolin reduces preload and after load of the heart due to myocardial contractility arising from its positive inotropic action without affecting myocardial oxygen consumption. Sabinsa Inc. has recently taken out a US patent for its use as a weight loss agent.
Coleus Forskolin Reduces the Risk of Blood Clots Formation
Tylophorine from Tylophora indica has a marked stimulating effect on both the striped and unstriped muscles, and a distinct depressing effect on the musculature of heart. The roots of the plant have a sweetish taste turning acrid, pleasant aromatic odour, and a brittle fracture. They possess stimulant, emetic, cathartic, expectorant, stomachic and diaphoretic properties and are used for the treatment of asthma, bronchitis, whooping cough, dysentery and diarrhoea; they are reported to be given in rheumatic and gouty pains. The roots and leaves are used in hydrophobia, dried leaves are more uniform and certain in their action than the roots. In large doses, the dried leaves may cause fatal poisoning. The dried leaves are used to treat certain forms of allergy.
Brahmi (Bacopa monnieri) has been in use since ancient times as a potent nerve tonic for rejuvenating mental health and promoting intellect and memory and is mentioned in Charak Samhita written in the 1st century A.D., where this brahmi is prescribed as a cure for mental retardation leading to psychosis. Implicit in the pharmacological properties ascribed to brahmi is the cognitive enhancing and anxiolytic effects of this plant. The other classical Ayurvedic treatise Sushruta Samhita precisely describes brahmi as efficacious in loss of intellect and memory. —CDRI’s decided to develop the plant as an herbal remedy. As a result a quality herbal preparation has been developed from B. monnieri, standardized in terms of bacosides contents. (Web site, Table 10)
Gugulipid, a hypolipidaemic drug has been developed from the plant Commiphora mukul after obtaining the lead from Ayurveda.
Gugglu, the gum from the tree Commiphora mukul has been recommended in Ayurveda for the treatment of gout, arthritis, rheumatism and lipid disorders. The establishment of promising hypolipidemic activity in a non-toxic fraction of guggulu led to the identification of the active constituents, gugulsterones. Guggulsterone, the active constituent of gugglelipid, blocks the action of a cell receptor, called FXR, which helps regulate a body’s cholesterol level.
Gugulipid passed through all the three phases of clinical trials successfully and was found to possess hypolipidemic activity comparable to Clofibrate. The use of Gugulipid led to the average reduction in serum cholesterol and triglycerides by 24% and 22% respectively and there were 80% responders in a group of 330 hyperlipidemic patients. (Web site, Table 10)
Picroliv It is a fraction prepared from roots and rhizome of the plant Picrorhiza kurrooa. The major constituents of the fraction are iridoid glycosides (Picroside I and Kutkoside). Picroliv has shown preventive and curative hepatoprotective and anticholestatic activities in animal studies. It also possesses promising activity against Hepatitis B virus and significant immunostimulant activity and is devoid of any adverse pharmacological or toxic effects, as revealed by detailed studies. Advanced clinical trials in cases of acute viral hepatitis have been concluded at and results are encouraging. (Web site, Table 10)
TABLE 7 MEDICINAL PLANTS
Forskolin (Coleus forskohlii)
TABLE 9 CONTRIBUTIONS TO MODERN MEDICINE
Charaka Samhita is full of general statements about qualities of an ideal ayurvedic physician and warns against quacks. Some of these statements are about ethics and conduct expected from Ayurvedic specialists. The ethical code was very similar to Hippocratic Oath (Table 11). 
In India, there has been a variable and flexible code of medical ethics based on local, lingual, regional, religious, folk and caste basis. Besides Hindu, there are Muslim, Christians, Buddhists, Jains, Sikhs and untouchables and tribes. Each of these religions has its code of ethics. The Hindu medical ethical code as mentioned in Ayurvedic books, the four Vedas and scriptures is quite flexible. The Hindu religion is quite heterogeneous, due to the lack of a central supreme authority, which can resolve conflicts or issue guidelines. The early practitioners of Ayurveda were saints or learned scholars and were recognized as well wishers of the society. This tradition still continues in rural communities, where Ayurvedic doctors are sought after for health care and general social problems of the family. 
The main ethical issue in India today is how to deliver modern healthcare and make it accessible to all. It is a moral dilemma that even 50 years after Independence, India is not able to educate all its children or provide an efficient health care to the poor sections of its population or eliminate misery and poverty. Ayurveda defines death as respiratory failure and mentions that life begins at conception. The belief in reincarnation in a way denies that death has taken place. A Hindu is duty bound (Karma) to have children in particular males. Thus ancient scriptures and Vedas can be used to justify some of the current practices in reproduction like sperm donation, surrogate mothers etc. Similarly abortion in mentioned in ayurvedic texts when the life or honor of the mother is in danger.
Some selected Internet Sites for ayurveda:
- http//www. well-being.com