AYUSH AND OTHER SYSTEMS OF MEDICINE

DR. SUHASINI K Dept. of Community Medicine J.N. Medical College, Belgaum.

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• Introduction • Background • Organization• Objectives, Stratergies and Activities• Need for integration• Infrastructure available under AYUSH• Guidelines laid down by NRHM • Brief overview of all the system• Other systems• SWOT analysis

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Introduction

• Modern day stressful life-style have lead to a rise in life-style diseases all over the world.

• It has been realized that no single system of medicine can address the health care needs of modern society.

• Around 65-70% of the population in rural India use traditional system of medicine

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Introduction

• India has rich tradition of medicinal wisdom coupled with its strong capability in modern medicine

• A country where medical pluralism is officially recognized and encouraged

• Currently, it recognizes six different healthcare systems

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• AYUSH: Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy

• There is no official provision for cross-talk between the professionals belonging to these different streams during medical education, research and practice.

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AYUSH is synonymous with:• ISM&H• Allied sciences• Traditional health care• Indigenous system of medicine • Alternative medicine• CAM (Complementary and Alternative

Medicine)6

Background

• Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was created in March,1995- MOHFW

• Re-named as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in November, 2003

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Background efforts to Integrate AYUSH • Swadeshi movement lead to demand for ISM-

1938• Chopra committee & Dave committee- 1960• WHO & UNICEF - 1970• National Health Policy of - 1983• Separate department for AYUSH-March 1995 • National Policy on ISM&H -2002 • National Rural Health Mission-2005

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• The department is a part of the Ministry of Health and Family welfare, Govt of India

• Administratively headed by the Secretary, Dept of AYUSH- Sh. Nilanjan Sanyal (at present)

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• The Ayurveda system is popular mostly in the States of Kerala, Himachal Pradesh, Gujarat, Karnataka

• The Siddha system is widely acceptable in Tamil Nadu and Kerala.

• The Unani system is particularly popular in Andhra Pradesh, Karnataka, Tamil Nadu, Bihar.

• The Homeopathy is practiced all over the country but primarily popular in Uttar Pradesh, Kerala, West Bengal.

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• Why AYUSH system is lagging back? AYUSH systems negated the necessary

learning from modern medicine- not updated

The growth of modern systems negated the footage and the legacy of existing systems

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Organization

The Department has • 2 Subordinate offices• 1 Public sector undertaking• 2 Statutory organisations• 4 Research councils• 8 Educational institutions • 1 National Medicinal plant board (with 35

State/ UT level boards)

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Subordinate Offices :

• These include the Pharmacopoeial Laboratory for Indian Medicine (PLIM), Ghaziabad

• The Homoeopathic Pharmacopoeial Laboratory (HPL), Ghaziabad

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Public Sector Undertaking:• The Indian Medicine Pharmaceutical

Corporation (IMPCL), Almora, Uttaranchal

• Prime objective of manufacturing authentic Ayurvedic and Unani medicines

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Statutory Regulatory Councils: • The Central Council of Indian Medicine (CCIM)• The Central Council for Homoeopathy (CCH)

Main responsibilities:-• To regulate education • Practice of respective systems of medicine • Advice the Government regarding education.

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Research Councils: (located in New Delhi)• Central Council for Research in Ayurveda and

Siddha (CCRAS)• Central Council for Research in Unani Medicines

(CCRUM)• Central Council for Research in Homoeopathy

(CCRH) • Central Council for Research in Yoga and

Naturopathy (CCRYN).

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National Apex Institutes:• National Institute of Ayurveda, Jaipur• National Institute of Siddha, Chennai• National Institute of Unani Medicines, Bangalore • Morarji Desai National Institute of Yoga, New

Delhi• National Institute of Naturopathy, Pune• National Institute of Homoeopathy, Kolkata• Rashtriya Ayurveda Vidyapeeth, New Delhi.

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Broad Goal of the Programme:

• Mainstreaming of AYUSH in the health care service delivery system, with a view to strengthen the existing public health system.

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The objective of integration of AYUSH

• To bring about an architectural correction and re-inforce the existing public health care delivery system

• To facilitate the use of natural, safe and friendly remedies which are time tested, accessible, acceptable and affordable.

• Wider utilization of AYUSH both domestically and globally

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Main strategies of thisprogramme

• Integrate and mainstream ISM&H in health care delivery system including National Programme

• Encourage and facilitate in setting up of specialty centres and ISM clinics

• Facilitate and Strengthen Quality Control Laboratory

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• Strengthening the Drug Standardization and Research activities on AYUSH

• Develop Advocacy for AYUSH

• Establish Sectoral linkages for AYUSH activities

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Main Activities

(a) Improving the availability of AYUSH treatment faculties and integrating it with the existing Health Care Service Delivery System

• Integration of AYUSH services in various CHC / Block PHC with appointment of contractual AYUSH Doctors.

• Appointment of paramedics where AYUSH Doctors shall be posted.

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• Appointment of a Data assistant to support the ISM&H Directorate

• Strengthening of AYUSH Dispensaries with provision of storage equipments

• Making provision for AYUSH Drugs at all levels• Establishment of specialized therapy centres in

District Headquarters Hospitals and Medical Colleges.

• AYUSH doctors to be involved in all National Health Care programmes, in priority areas

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• Training of AYUSH doctors in Primary Health Care• All AYUSH institutions will be strengthened with

necessary infrastructure like building, equipment, manpower etc

• One Yoga Therapy Centre will be opened in district Headquarters Hospitals

• Block level School Health Programmes to be conducted twice in a year in two groups consisting of 100 students in each group

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• It is proposed to create necessary Managerial post in the State and District level

• Necessary vehicles with supporting manpower has also been proposed to strengthen the supervisory Joint monitoring visits to health centres

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(b) Integration of AYUSH with ASHA• Training module for ASHA and ANMs have to be

updated

• Training & capacity building to be undertaken

• Drug kit that will be provided to ASHA will contain one AYUSH preparation

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(c) Drug Management• Priority will be given to manufacture of drugs in

Govt. Sector Pharmacies, as per their capacity.

• Provision of Rs. 25,000/- to supply drugs per AYUSH dispensary

• Provisions of medicines for District AYUSH wings and Specialty Therapy Centres

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(d) Special Initiatives for Development of AYUSH Drugs.

(i) Strengthening the Quality Control Laboratory

(ii) Strengthening the Drug Standardisation and Research Activities on AYUSH

(iii) Development of Herbariums and crude drug museums

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Infrastructure(India) As on 2010

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Cont.

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Infrastructure

Total no. of hospital - 3277Total no. of beds - 62649Total no. of colleges - 501Total no. of registered practitioners – 785185Total no. of dispensaries - 24289

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Infrastructure (Karnataka)

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Why mainstreaming/integration of AYUSH systems in National Health Care Delivery System under “NRHM”?

• practices are well accepted by the community (rural areas)• the medicines are easily available and prepared

from locally available resources• economical • comparatively safe

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• deficiency and unwilngness of allopathic doctors to work in rural areas

• cure for some diseases present in these system of medicine

• resurgence of interest in holistic systems of health care

• no single system of health care has the capacity to solve all of society’s health needs

• taking full advantage of local enterprise for solving local health problems

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AYUSH Interventions under NRHM

• Co-location of AYUSH dispensaries in 3528 PHCs in different States.

• Appointment of 452 AYUSH doctors and paramedics (pharmacists) on contractual basis in the primary health care system.

• Inclusion of AYUSH modules in training of ASHA.

• Inclusion of Punarnavdi Mandoor in the ASHA Kit for management of anemia during pregnancy.

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• Inclusion of seven Ayurvedic and five Unani medicines in the RCH programme.

• Establishment of specialty clinics, specialized therapy centers and AYUSH wings in district hospitals

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Guidelines under NRHM regarding AYUSH

• Under the same roof of the Health Infrastructure, i.e., PHC, CHC, however, separate space should be allocated exclusively for them in the same building

• Appropriate Regulatory Authorities lays down the terms & conditions

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• Provision of one Doctor of any of the AYUSH systems as per the local acceptability assisted by a Pharmacist in PHC

• Supply of appropriate medicines pertaining to AYUSH systems

• The specific choice of AYUSH system decided by the State depending on the local preference

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• The already existing AYUSH infrastructure should be mobilized

• Cross referral between allopathic and AYUSH streams should be encouraged based on the need for the same

• AYUSH Doctors shall be involved in IEC, health promotion and also supervisory activities

• It is decided that AYUSH medications shall be included in the drug kit of ASHA

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Areas of priority :1. Education –standards upgradation2. Drug standardization – Ghaziabad lab3. Setting up of vanaspathi van (Herbarium)4. Expansion of ISM&H treatment facility5. Research & development 6. Intellectual property Rights 7. Grant-in- aid assistance

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The Ayurvedic drugs are • Saubhagya Sunthi• Ksheerbala Taila• Bal Rasayan• Ark Pudhina • Ark Ajawain • Punarnavadi Mandoora • Ayushgutti

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Unani drugs are• Hubbe Khubsul Hadeed • Amjoone suhag shonth• Rangane Labook saba• Ark pudina • Ark Ajawain

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Budget

• The Plan allocation for 2006-07 is Rs. 381.60 crore.

• It is proposed to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore in the 10th Plan to Rs.2486.45 crore in the 11th Plan

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Ayurveda • Origin : Vedas—the Atharvaveda 1000 BC Charaka & Sushrutha • Principles : Panchamahabhutas

3 dhoshas- vata (ether + air) pitta (fire) kapha (water +earth)

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• Most ancient system(5000 years ago) which is still in practice

• Practiced in India, Nepal, Sri Lanka, Pakistan, Tibet, China, USA and European countries

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TREATMENT :• Shodhana therapy (Purification Treatment) • Shamana therapy (Palliative Treatment) • Pathya Vyavastha (Prescription of diet and activity) • Nidan Parivarjan (Avoidance of disease causing and aggravating factors) • Satvavajaya (Psychotherapy) • Rasayana therapy(use of immunomodulators and rejuvenation medicines)

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PANCHAKARMA:

• One can consider this as a body de-tox program

Five actions1.Vamana (emesis)2.Virechana (purgation)3.Basti (enema)4.Nasya (nasal administration)5.Raktamokshana (blood letting)

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Yoga

• ORIGIN : Its founders were great Saints and Sages

• Maharishi Patanjali called "The Father of Yoga" - Ashtanga Yoga Book

• The practice of Yoga prevents psychosomatic disorders

• Improves an individuals resistance and ability to endure stressful situations

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- Japa Yoga, the path of divine - Karma Yoga, the path of work - Bhakti Yoga, the path of worship -Jnana Yoga, the path of philosophy - Raja Yoga, the path of psychic control

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PrathyaharaPranayama

Naturopathy

• Naturopathy is an art and science of healthy living and a drugless system of healing based on well founded philosophy

• Father of naturopathy is Dr. Benedict Lust

• The revival of Naturopathy started in India by translation of Germany’s Louis Kuhne’s book “New Science of Healing”

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• Shri D. Venkat Chelapati Sharma translated this book in Telgu language in 1894.

• Shri Shroti Kishan Swaroop of Bijnor translated this book into Hindi and Urdu languages in 1904.

• Gandhiji was influenced by the book Return to Nature written by Adolf Just and become a firm believer of Naturopathy

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Principles

• All disease, their cause and their treatment are one.

• Acute diseases are our friends, not the enemies. Chronic diseases are the outcome of wrong treatment and suppression of the acute diseases.

• The basic cause of disease is not bacteria • In Naturopathy patient is treated and not the

disease. 54

Treatment

• Hydro Therapy • Air Therapy • Fire Therapy• Space Therapy • Mud Therapy• Sun therapy • Food Therapy

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Unani

• ORIGIN : originated in Greece The foundation of Unani system was laid by

Hippocrates. In India, was introduced by Arabs

• Arthritis, Leucoderma, Jaundice, Liver disorders, Nervous system disorders, Bronchial Asthma –better than other system

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• Unani Medicines got enriched by imbibing what was best in the contemporary systems of traditional medicines in Egypt, Syria, Iraq, Persia, India, China and other Middle East countries.

• The system suffered a severe setback during the British rule in India.

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• Dieto therapy (Ilaj-bil-Ghiza),• Climatic therapy (Ilaj-bil-Hawa), • Regimental therapy (Ilaj-bit-Tadbir), • Pharmacotherapy (Ilaj-bid-Dawa) makes it a different and remarkable and

popular system.

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SIDDHA – ‘achievements’

Origin : one of the oldest systems of medicine in India

• attributed to the great Siddha Ayastiyar • Siddha literature is in Tamil and • It is practiced largely in Tamil speaking part of

India and abroad

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• The Siddha System is largely therapeutic in nature.

• use of metals and minerals is very much advocated.

• 25 varieties of water-soluble inorganic compounds called ‘UPPU

• 64 varieties of mineral drugs • The Siddha system is capable of treating all

types of disease other than emergency cases 61

HOMOEOPATHY

• Origin :first defined by Dr. Samuel Hahnemann 18th century“ The Organon of Medicine”• Law of Similars (like cures like) • Law of the Infinitesimal Dose (The more diluted a remedy is, the more potent it is.) • illness is specific to the individual

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Principles of Homeopathy

Similarity ruleRule of inversion Paracelsus ruleBurgi’s principle

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Areas of strength • Skin disorders• Allergic disorders• autoimmune diseases • viral infections • de-addiction • metabolic disorders

SOWA - RIGPA

• “Sowa-Rigpa” commonly known as Amchi system of medicine

• Popularly practiced in Tibet, Magnolia, Bhutan, some parts of China, Nepal, Himalayan regions of India and few parts of former Soviet Union etc

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• The majority of theory and practice of Sowa-Rigpa is similar to “Ayurveda”

• Gyud-Zi (four tantra) the fundamental text book of this medicine was first translated from India and enriched in Tibet

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Other systems

• Acupuncture is a method of healing developed in China at least 2,000 years ago.

• Stimulation of anatomical points on the body by a variety of techniques.

• Technique, studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

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• Aromatherapy involves the use of essential oils (extracts or essences)

from flowers, herbs, and trees to promote health and well-being

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• Chiropractic :is a CAM alternative medical system

• Relationship between bodily structure (primarily that of the spine) and function

• Relationship affects the preservation and restoration of health.

• Chiropractitioners use manipulative therapy as an integral treatment tool.

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• Qi gong (“chee-GUNG”) is a component of traditional Chinese medicine that combines movement, meditation, and regulation of breathing to enhance the flow of qi

• “qi” is vital energy in the body, improve blood circulation, and enhance immune function.

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• Reiki (“RAY-kee”) is a Japanese word representing Universal Life Energy.

• Spiritual energy is channeled through a Reiki practitioner, the patient’s spirit is healed, which in turn heals the physical body.

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• Therapeutic Touch

• Electromagnetic fields

• Dietary supplements

• Music therapy

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Holistic Medicine

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Myths & Interesting facts

1)Myth : AYUSH systems are not rational Fact : They are based on time-tested codified

principles and concepts

2) Myth : There is no standardization in AYUSH system of medicine

Fact : Regulated by Drug and Cosmetic Act 1940

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3) AYUSH systems use heavy metals Fact : They use heavy metals but after

detoxification and purification process

4) AYUSH system have only placebo effect and can be used only as alternative system of medicine

Fact : They have holistic approach. Scientific studies have established therapeutic effect

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• Myth : Homoeopathy is slow acting Fact : False impression, usually they are

approached for chronic diseases

• Myth : Homeopathy first aggravates the disease then cures it

Fact : not always

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SWOT Analysis

• Strengths:SafetyEfficacyTraditionalCost factorGlobal demand

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• Weakness:Statistical dataResearchBudget allocationQuality of drugsDispensingDiagnostic toolsEmergency management

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• Opportunities :Specific areas-Lifestyle diseasesPsychosomatic diseaseAnorectal disordersRhuematoid arthritisMother and child healthAllergic diseases

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• Threats :Most of AYSUH doctors practice allopathy

Quacks – inadequatly qualified persons

Lack of knowledge/ Updates

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Recommendations

• AYUSH graduates - receive instructions from qualified experts in the topics related to conventional medicine

• Involvement of biomedicine experts in AYUSH research

• MBBS graduates - introduced to the medical heritage of their own country

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Conclusion

• The “MARRIAGE” of this Art of medicine and Science of medicine – requirement of HUMANITY

• Future of integrated medicine- Bright and promising.

• Future ‘Megatrend’ In Health Care System.

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References • Text Book of Public Health and Community Medicine- AFMC Pune• Ayurveda for beginners by Mahadevan• Introduction to Classical homeopathy-IHA• Ancient wisdom, science and health- Dr BM Hegde• Patwardhan K, Gehlot S, Singh G, Rathore HC. The ayurveda

education in India: How well are the graduates exposed to basic clinical skills? Evidence Based Complement Alternate Medicine2011;2011:197391.

• AYUSH official website http://india.gov.in & http://mohfw.nic.in• nccam.nih.gov/training (National Centre for Complementary and

Alternative Medicine)

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