P Ram Manohar

Well controlled, double-blind, placebo-controlled trials of classical Ayurvedic treatment are possible in rheumatoid arthritis

The objective of this short communication is to demonstrate the feasibility and effectiveness of multiple placebos to individualise treatment when using classical Ayurveda for rheumatoid arthritis in well controlled, double-blind, placebo-controlled trials. A total of 46 patients ≥18 years of age, with active rheumatoid arthritis as diagnosed using American College of Rheumatology criteria, were randomised to 1 of 3 outpatient treatment groups: methotrexate+placebo Ayurveda; Ayurveda+placebo methotrexate; and methotrexate+Ayurveda. The Ayurvedic doctor was free to choose from 148 formulations, which were in the form of 6 traditional dosage forms: decoctions, herbal powders, pills, herbal wines, herbal jams and herb-infused oils. Six placebos were also formulated, with each placebo representing a dosage form. All appropriate institutional review board approvals were obtained. Formulations were …

Chyawanprash: A review of therapeutic benefits as in authoritative texts and documented clinical literature.

ETHNOPHARMACOLOGICAL RELEVANCE Chyawanprash (CP), a traditional immune booster recipe, has a long history of ethnic origin, development, household preparation and usage. There are even mythological stories about the origin of this recipe including its nomenclature. In the last six decades, CP, because of entrepreneurial actions of some research Vaidyas (traditional doctors) has grown to industrial production and marketing in packed forms to a large number of consumers/patients like any food or health care product. Currently, CP has acquired a large accepted user base in India and in a few countries out-side India. AIM OF THE STUDY Authoritative texts, recognized by the Drugs and Cosmetics Act of India, describe CP as an immunity enhancer and strength giver meant for improving lung functions in diseases with compromised immunity. This review focuses on published clinical efficacy and safety studies of CP for correlation with health benefits as documented in the authoritative texts, and also briefs on its recipes and processes. MATERIALS AND METHODS Authoritative texts were searched for recipes, processes, and other technical details of CP. Labels of marketing CP products (Indian) were studied for the health claims. Electronic search for studies of CP on efficacy and safety data were performed in PubMed/MEDLINE and DHARA (Digital Helpline for Ayurveda Research Articles), and Ayurvedic books were also searched for clinical studies. RESULTS The documented clinical studies from electronic databases and Ayurvedic books evidenced that individuals who consume CP regularly for a definite period of time showed improvement in overall health status and immunity. However, most of the clinical studies in this review are of smaller sample size and short duration. Further, limitation to access and review significant data on traditional products like CP in electronic databases was noted. CONCLUSIONS Randomized controlled trials of high quality with larger sample size and longer follow-up are needed to have significant evidence on the clinical use of CP as immunity booster. Additional studies involving measurement of current biomarkers of immunity pre- and post-consumption of the product as well as benefits accruing with the use of CP as an adjuvant are suggested.

DHARA: Digital Helpline for Ayurveda Research Articles

With an evolutionary history that spans several thousands of years, Ayurveda is one of the oldest and meticulously codifi ed systems of health care in the world. However, in modern times, the Ayurvedic community has lagged behind in the task of projecting Ayurveda as an evidence-based system with adequate research support to vouchsafe its therapeutic claims of safety and effi cacy. For this reason, Ayurveda has not been able to position itself in an advantageous manner in spite of the growing interest and prevalence of Complementary and Alternative Medicine world over.

The integration quagmire: Why we need to watch our steps

W step into the year 2015 with important developments at the editorial office of the journal. We are happy to announce the setting up of the International Editorial Office of Ancient Science of Life (ASL) in Europe. This is a significant milestone in the journey of ASL in networking with and engaging scientists, academicians and practitioners to further the dialog and scientific debate on integrating and positioning Ayurveda in the global health care scenario. The International Editorial Board of ASL is constituted by a group of high profile academicians from diverse backgrounds. Heading the editorial office is Antonio Morandi, MD, a successful Neurologist from Italy who now practices only Ayurveda. He brings with him a rich experience of insights in interfacing Ayurveda and conventional medicine. The board composes of eminent personalities such as Daniel Furst, MD, who is an accomplished rheumatologist from the University of California, Los Angeles, United States and was the lead investigator in the first ever National Institutes of Health (NIH) funded clinical trial to evaluate the efficacy of Ayurvedic treatment of rheumatoid arthritis. Nereo Bresolin is a renowned Neurologist at the University of Milano, Italy and is currently involved in a study to evaluate the efficacy of Ayurveda in Duchenne Muscular Dystrophy. Valdis Pirags MD, is Diabetologist at the University of Latvia and is presently engaged in a study evaluating the efficacy of Ayurvedic treatment in Diabetes mellitus. Antonella Delle Fave, MD is Clinical Psychologist at the University of Milano, Italy and also trained in Ayurveda. She has looked at the concept of the constitution in Ayurveda and its clinical assessment. Vijayendra Murthy, MD in Ayurveda is based in London and is engaged in CAM research and teaching of Ayurveda in New Zealand and Australia. Anand Dhruva, MD is an Oncologist at University of California, San Francisco, trained in Ayurveda and engaged in research on breast cancer and Ayurveda. Paolo Roberti di Sarsina, MD, is Chairman and founder of the Charity Association for Person Centered Medicine. Carlos Chesta, MD is engaged in teaching and research on Ayurveda at Rosario Argentina and Jorge Luis Berra, MD is also engaged in Ayurveda teaching and research at Buenos Aires, Argentina.

Clinical Evidence in the Tradition of Ayurveda

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.