Discuss the role of AYUSH and the traditional systems of medicine in health care.

Ayush and Traditional Systems of Medicine

• The systems in brief:
• Ayurveda — the indigenous Indian system based on the tridosha theory of vata, pitta and kapha, with emphasis on diet, lifestyle, seasonal regimen and herbal and mineral preparations
• YOGA and naturopathy — drugless systems using posture, breathing, meditation, diet and natural agents
• UNANI — of Greco-Arabic origin, based on the theory of the four humours
• SIDDHA — practised chiefly in Tamil Nadu, using herbo-mineral and metallic preparations
• Homoeopathy — based on "like cures like" and the use of extreme dilutions
• SOWA-RIGPA — the Tibetan system practised in the Himalayan region
• The arguments for mainstreaming AYUSH in the public system:
• A very large existing workforce of registered practitioners, comparable in number to allopathic doctors
• Wide public acceptance and cultural rootedness, so that people consult them willingly
• Availability in rural and remote areas where allopathic doctors will not serve
• Low cost and use of locally available materials
• A perceived role in chronic conditions and in wellness and prevention
• YOGA has evidence of benefit in hypertension, stress, back pain, and metabolic and mental health, and is the component with the strongest scientific support
• The forms mainstreaming has taken — CO-location of AYUSH practitioners and dispensaries in PHCs, CHCs and district hospitals; a ministry of AYUSH; AYUSH gram and AYUSH health and wellness centres; inclusion of AYUSH drugs in supply; the National AYUSH Mission; and, most significantly, the use of AYUSH graduates with a bridge course as community health officers at Health and Wellness Centres
• The criticisms and concerns, which must be given for a balanced answer:
• The evidence base is limited for many preparations, with few adequately designed randomised trials
• Homoeopathy in particular lacks a plausible mechanism, since remedies are diluted beyond the point at which any molecule of the original substance remains, and systematic reviews have not found effects distinguishable from placebo
• Heavy metal content in some traditional herbo-mineral preparations, with documented lead, mercury and arsenic poisoning, which is a genuine safety issue rather than a theoretical one
• Standardisation and quality control of preparations
• Adulteration of some proprietary products with steroids or anti-inflammatory drugs, which produces apparent benefit and real harm
• Cross-practice, where AYUSH practitioners prescribe allopathic medicines without training in them — which is widespread, legally contested and a real risk with antibiotics, steroids and cardiac drugs
• Delay in effective treatment where a serious condition is managed by an ineffective remedy, which is the most serious harm, and matters most in tuberculosis, cancer and diabetes
• Objections from the medical profession to bridge courses as diluting standards
• The balanced position that an answer should reach:
• The workforce is a real and available resource in a country with too few doctors, and refusing to use it has its own cost in unserved populations
• Their use should be governed by clear protocols defining exactly what they may do, with adequate training, supervision and a functioning referral route
• Research should be encouraged, and claims should be tested by the same standards applied to any other treatment
• Quality control, pharmacovigilance and regulation of heavy metals and adulteration must be enforced
• Patients should be able to choose, and should be referred promptly for conditions requiring specific treatment
• The essential safeguard is that delay in diagnosis and referral is the harm to guard against, more than any property of the remedies themselves