Abstract
A careful study of the classical literature of Ayurveda provides compelling indications to believe that the practice of building clinical evidence was nurtured in the tradition of Ayurveda. Ayurveda exhibits the characteristics of a knowledge system and requires that observations are validated to be accepted as knowledge. The celebrated textbook on general medicine known as the Charaka Samhita remarks that the outcome of a clinical intervention is to be dismissed as accidental or due to chance if it cannot be substantiated with proper evidence and reasoning. Classical texts of Ayurveda also discuss about self-limiting diseases and the need to distinguish between the true effect and chance effect of a medical intervention. Classical treatments of Ayurveda are multimodal in nature and cannot be studied using conventional methods of clinical research. Appropriate research designs for both observational studies as well as randomized clinical trials need to be developed for meaningful evaluation of clinical interventions in Ayurveda. This chapter will review the gaps in the current approaches to clinical research in Ayurveda and highlight the attempts that have been made to develop methodologies that are appropriate not only for Ayurveda but also such other systems of traditional, complementary, or alternative medicine. An elaborate discussion of the classical approach in building clinical evidence in the tradition of Ayurveda will also be attempted in the process.
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Notes
- 1.
The colophon in the Charaka Samhita—ityagniveshakrte tantre charakapratisamskrte/prapte drdhabalasampurite—itself summarizes the revisions made on the text [2].
- 2.
This verse from the Charaka Samhita describes the process of editing and updating a classical text—samskarta kurute tantram puranam cha punarnavam [2].
- 3.
PubMed search with keywords Ayurveda and Chinese medicine on www.pubmed.com
- 4.
The Charaka Samhita lists the tools for validating knowledge—trividhe tvasmin jnanasamudaye purvamaptopadesajjnanam, tatah pratyakshanumanabhyam parikshopapadyate [2].
- 5.
Chakrapani’s comments on Charaka Samhita explaining the logic of combining herbs and individualizing formulations—yuktih yojana bheshajasya dehadoshadyapekshaya [2].
- 6.
Charaka Samhita emphasizes the need for continuous learning in Ayurveda—na chaiva hyasti sutaramayurvedasya param, tasmadapramattah sasvadabhiyogamasmin gacchet [2].
- 7.
Charaka Samhita lays down the criteria for acceptance of new knowledge—yaschanyopi kashcidvedarthadaviparitah parikshakaih pranitah sishtanumato lokanugrahapravrttah sastravadah [2].
- 8.
The Astanga Hrdayam declares that there is no substance in the world without medicinal property—jagatyevamanaushadham, na kincit vidyate dravayam [9].
- 9.
The Charaka Samhita stresses the danger in using unknown substances and abuse of known substances—aushadham hyanabhijnatam namarupagunaistribhih, vijnatam chapi duryuktam anarthayopapadyate [2].
- 10.
Charaka Samhita explains how poison can also be used as medicine by adjusting the dosage—yogadapi visham tikshnamuttamam bheshajam bhavet, bheshajam chapi duryuktam tikshnam sampadyate visham [2].
- 11.
The Charaka Samhita points out that one must assess the risk-benefit ratio—na tu kinchidadoshanirgunam gunabhuyastvamato vichintyate [2].
- 12.
The Charaka Samhita issues a public warning against physicians who prescribe medicines irrationally—tasmanna bhishaja yuktam yuktibahyena bheshajam, dhimata kinchidadeyam jivitarogyakankshina [2].
- 13.
The Ashtanga Hrdayam recommends testing of toxicity by administering substances to animals—mryante makshikah prasya kakah kshamasvaro bhavet….. [9].
- 14.
Atharva Veda refers to zoopharmacognosy for identification of medicinal plants—varaho veda virudham nakulo veda bheshajam, sarpa gandharva ya viduh ta asma avase huve [10].
- 15.
Chakrapani comments on Charaka Samhita, explaining the chance effect of clinical intervention—yadrcchikasiddhau hi vaidyo na rogapramokshe karanam, kintu ghunaksharanyayena daivagato bheshajasya samyagyoga iti [2].
- 16.
In his comments on Charaka Samhita, Chakrapani coins a term for real effect of clinical intervention—siddhirakhyatiti ukta pratiniyamiki siddhih na yadrchhiki [2].
- 17.
Charaka Samhita explains that a complete and wholesome intervention becomes successful—samyakprayogam sarvesham siddhirakhyati karmanam [2].
- 18.
Charaka Samhita lists the most efficacious formulations—atah siddhataman yogan srnunmadavinasanan [2].
- 19.
Charaka Samhita defines a safe intervention—thus prayogah samayedvyadhim yonyamanyamudirayet, nasau visuddhah suddhastu samayedyanna kopayet [2].
- 20.
Charaka Samhita on strategies for anticipating adverse events and planning their management—samyakprayogam chaushadhanam, vyapannanam cha vyapatsadhanani siddhishuttarakalam [2].
- 21.
Chakarapani’s comments on Charaka Samhita refer to iatrogenic diseases—mithyopachara iti asamyakkaranamasamyagupacharascha [2].
- 22.
Charaka Samhita emphasizes the need to support claims of cure with evidence and rationale—vina tarkena ya siddhih yadrcchasiddhireva sa [2].
- 23.
Students question the role of clinical intervention in the Ashtanga Hridaya—bhedadinam sammato bhaktinamrah papracchedam samsayanognivesah [9].
- 24.
The arguments put forth by skeptics in Charaka Samhita to prove the futility of clinical intervention—yatascha pratikurvan sidhyati, pratikurvan mryate, apratikurvan siddhyati, apratikurvan mryate, tataschintyate bheshajamabheshajenavisishtamiti [2].
- 25.
The arguments in support of the role of clinical intervention proposed by the Charaka Samhita—na hi sarve vyadhayo bhavantyupayasadhyah, na chopayasadhyanam vyadhinamanupayena siddhirasti, na chasadhyanam vyadhinam bheshajasamudayoyamasti [2].
- 26.
Ashtanga Hridya refers to self-limiting diseases—vinapi kriyaya svasthyam gacchatam shodasamsaya [9].
- 27.
Charaka Samhita on diseases that respond to treatment—sadhyasadhyavibhagajno jnanapurvam chikitsakah, kale charabhate karma yattat sadhayati dhruvam [2].
- 28.
Charaka Samhita explains how the mind can influence treatment outcomes favorably—manasorthanukulyaddhi tushtirurjabalodayah, sukhopabhogata cha syad vyadheschato balaksayah [2].
- 29.
Charaka Samhita discusses how favourable factors can induce remission in diseases—iha khalu nidanadoshadushyaviseshebhyo vikaravighatabhavabhavaprativiseshah bhavanti [2].
- 30.
Charaka Samhita emphasizes that all biological events are based on cause and effect relationships—vikarah prakrtischaiva dvayam sarvam samasatah, tadhetuvasagam hetorabhavannanuvartate—Charaka Samhita [2].
- 31.
The Tarkasangraha explains the concept of correlation—yatra yatra dhumastatra tatra vahniriti sahacaryaniyamo vyaptih [3].
- 32.
The Tarkasangraha on establishing causation—vyaptivisishtapaksadharmatajnanam paramarsah [3].
- 33.
The Tarkasangraha explains the method to confirm causation with the help of controls—sandigdhasadhyavan pakshah, nischitasadhyavan sapakshah, nischitasadhyabhavavan vipakshah [3].
- 34.
The Tarkasangraha explains negative and positive correlations between variables—lingam trividham, anvayavyatireki, kevalanvayi, kevalavyatireki ceti [3].
- 35.
The Tarkasangraha on how to establish causation by study of variables—svarthanumitipararthanumityoh lingaparamarsa eva karanam, tasmat lingaparamarsonumanam [3].
- 36.
Padartha Vijnana discusses these concepts in detail [11].
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Manohar, P.R. (2012). Clinical Evidence in the Tradition of Ayurveda. In: Rastogi, S. (eds) Evidence-Based Practice in Complementary and Alternative Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-24565-7_4
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