Evidence-Based Ayurveda - Challenges

Evidence-Based Medicine (EBM) is a pillar of healthcare. EBM has three components: the best available scientific research evidence, clinical expertise, and patients’ values and preferences. It took more than 300 years to evolve into present-day EBM. Why does Ayurveda need EBM? Clinical practice in Ayurveda depends on acquired clinical training, textual knowledge, and clinical experience gained through practice. Hence, individual differences can occur in patient care. Of the three modalities of treatment mentioned in the Caraka Samhita - Daivavyapashraya Chikitsa (faith-based), Yukthivyapashraya Chikitsa (experimental), and Satwavajaya Chikitsa (mind-controlling) - Yukthivyapashraya Chikitsa can be considered a primitive form of evidence-based medicine, as it is experimental or rationale-based. It developed beyond faith-based medicine during the Samhita period. Ayurveda has more historical evidence than well-documented clinical evidence at present. Even though Ayurveda research started in the Vedic period, it lacks empirical evidence and scientific research. There may be many reasons, starting with the reluctance of practitioners to accept research evidence. Other reasons include limitations in high-quality research, inadequate training in research methodology, difficulty in translating Ayurvedic concepts into biomedical terminology, difficulties in designing clinical trials, lack of standardisation and quality control of raw materials, process standardisation, product standardisation, infrastructure, regulation, and funding. Despite these challenges, several developments such as reverse pharmacology, network pharmacology, omics-based research, and proteomics, which help mechanistic studies, are helping Ayurveda move towards evidence-based practice. By overcoming these challenges, Ayurveda will become evidence-based in the near future with the support of WHO and the Government of India.