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1.  Health sector reforms for 21st century healthcare 
The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40–70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of “integrative healthcare” because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.
doi:10.4103/0975-9476.154214
PMCID: PMC4395927  PMID: 25878456
Healthcare; integrative medicine; public health
2.  Contribution of world health organization in the global acceptance of Ayurveda 
Amongst the mandates of United Nations, health of mankind is the thrust area of UN through World Health Organization (WHO). Planning and execution of policies for mainstreaming of traditional medicines (TRM) of respective countries along with conventional system of medicine (allopathy), first in the country of origin followed by the international arena, is the priority agenda of operations of WHO. Within Indian context, WHO accorded prime focus to Ayurveda in its activities related to TRM.Sponsorship and encouragement of studies substantiating parameters of standardization, safety and efficacy of herbal medicines of Ayurveda are under chief consideration of WHO. In this review, several guidelines of WHO are summarized. Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), Central Council of Research in Ayurveda and Siddha and numerous other collaborative centers of WHO in India are assigned with several Appraisal Project Work (APW) and Direct Financial Cooperation (DFC) projects that will strengthen Ayurveda as evidence-based medicine for its global acceptance. Implementation of pharmacovigilance program in Ayurveda, publication of documents for rational use and initiatives to prepare consumer guidelines for appropriate use of Ayurvedic medicines are some other contributions of WHO toward advancement of Ayurveda at national as well as global level. Here, we suggest further exploration, interaction and interpretation of traditional knowledge in the light of contemporary core sciences and biomedical sciences that can pave the way for accreditation of Ayurveda worldwide as an established system of medicine.
doi:10.4103/0975-9476.90769
PMCID: PMC3255448  PMID: 22253507
Ayurveda; efficacy; standardization; safety; traditional medicine
3.  Current Status of Herbal Drugs in India: An Overview 
Herbal drugs constitute a major share of all the officially recognised systems of health in India viz. Ayurveda, Yoga, Unani, Siddha, Homeopathy and Naturopathy, except Allopathy. More than 70% of India’s 1.1 billion population still use these non-allopathic systems of medicine. Currently, there is no separate category of herbal drugs or dietary supplements, as per the Indian Drugs Act. However, there is a vast experiential-evidence base for many of the natural drugs. This offers immense opportunities for Observational Therapeutics and Reverse Pharmacology. Evidence-based herbals are widely used in the diverse systems and manufactured, as per the pharmacopoeial guidelines, by a well-organised industry. Significant basic and clinical research has been carried out on the medicinal plants and their formulations, with the state-of-the-art methods in a number of Institutes/Universities. There are some good examples. Indian medicinal plants also provide a rich source for antioxidants that are known to prevent/delay different diseased states. The antioxidant protection is observed at different levels. The medicinal plants also contain other beneficial compounds like ingredients for functional foods. Hence, the global knowledge about Ayurveda and Indian herbals will hopefully be enhanced by information on the evidence-base of these plants. This will yield rich dividends in the coming years.
doi:10.3164/jcbn.2007001
PMCID: PMC2274994  PMID: 18392106
Ayurveda; Indian medicinal plants; reverse pharmacology; observational therapeutics; antioxidant
4.  Is ‘mainstreaming AYUSH’ the right policy for Meghalaya, northeast India? 
Background
National policy on medical pluralism in India encourages the mainstreaming of AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) systems and the revitalization of local health traditions (LHT). In Meghalaya state in the northeast, the main LHT is its indigenous tribal traditional medicine. This paper presents the perceptions of tribal medicine and of AYUSH systems among various policy actors and locates the tribal medicine of Meghalaya within the policy on medical pluralism currently being implemented in the state, a region that is ethnically and culturally different and predominantly inhabited by indigenous peoples.
Methods
A stakeholder mapping exercise identified appropriate policy actors and 46 in-depth interviews were conducted with policy makers, doctors, academics, members of healer associations and elders of the community. A further 44 interviews were conducted with 24 Khasi and 20 Garo traditional healers. Interview data were supplemented with document analysis and observations. Qualitative data were analyzed using thematic content analysis that incorporated elements of grounded theory.
Results
In Meghalaya there is high awareness and utilization of tribal medicine, but no visible efforts by the public sector to support or engage with healers. The AYUSH systems in contrast had little local acceptance but promotion of these systems has led to a substantial increase in AYUSH doctors, particularly homeopaths, in rural areas. Policy actors outside the health department saw an important role for tribal medicine due to its popularity, local belief in its efficacy and its cultural resonance. The need to engage with healers to enhance referral, training, documentation and research of tribal medicine was made.
Conclusions
The wide acceptance of tribal medicine suggests that tribal medicine needs to be supported. The results of the study question the process of the implementation of the ‘mainstreaming AYUSH’ policy for Meghalaya and highlight the importance of contextualizing health policy within the local culture. A potential role for Health Policy and Systems Research (HPSR) at sub-national levels is also highlighted.
doi:10.1186/s12906-015-0818-x
PMCID: PMC4539927  PMID: 26283420
Health policy; Health systems; Indigenous medicine; Medical pluralism; Traditional medicine
5.  Traditional Indian medicine and homeopathy for HIV/AIDS: a review of the literature 
Background
Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine and homeopathy (TIMH), which is used by up to two-thirds of its population to help meet primary health care needs, particularly in rural areas. India has an estimated 2.5 million HIV infected persons. However, little is known about TIMH use, safety or efficacy in HIV/AIDS management in India, which has one of the largest indigenous medical systems in the world. The purpose of this review was to assess the quality of peer-reviewed, published literature on TIMH for HIV/AIDS care and treatment.
Results
Of 206 original articles reviewed, 21 laboratory studies, 17 clinical studies, and 6 previous reviews of the literature were identified that covered at least one system of TIMH, which includes Ayurveda, Unani medicine, Siddha medicine, homeopathy, yoga and naturopathy. Most studies examined either Ayurvedic or homeopathic treatments. Only 4 of these studies were randomized controlled trials, and only 10 were published in MEDLINE-indexed journals. Overall, the studies reported positive effects and even "cure" and reversal of HIV infection, but frequent methodological flaws call into question their internal and external validity. Common reasons for poor quality included small sample sizes, high drop-out rates, design flaws such as selection of inappropriate or weak outcome measures, flaws in statistical analysis, and reporting flaws such as lack of details on products and their standardization, poor or no description of randomization, and incomplete reporting of study results.
Conclusion
This review exposes a broad gap between the widespread use of TIMH therapies for HIV/AIDS, and the dearth of high-quality data supporting their effectiveness and safety. In light of the suboptimal effectiveness of vaccines, barrier methods and behavior change strategies for prevention of HIV infection and the cost and side effects of antiretroviral therapy (ART) for its treatment, it is both important and urgent to develop and implement a rigorous research agenda to investigate the potential risks and benefits of TIMH and to identify its role in the management of HIV/AIDS and associated illnesses in India.
doi:10.1186/1742-6405-5-25
PMCID: PMC2637286  PMID: 19102742
6.  Pharmacovigilance: Boon for the safety and efficacy of Ayuvedic formulations 
Pharmacovigilance is a corrective process originating in pharmaco-epidemiology. The 1997 Erice Declaration, presented at the World Health Organisation, became the basis on which the concept was implemented internationally for conventional systems of medicine. The increasing international acceptance of Ayurveda, led regulators to implement a similar program for Ayurveda, particularly as some medical professionals, scientists and members of the public reported adverse reactions after taking Ayurvedic formulations. The World Health Organisation therefore persuaded the Department of AYUSH, Ministry of Health and Family Welfare, Government of India, to implement a pharmacovigilance program for Ayurveda, as a means to ensuring the safety and efficacy of Ayurvedic medicines. After a year of due diligence, the pharmacovigilance program was launched nationally on 29 September 2008. Since that time, Ayurveda, Siddha and Unani medicines have been monitored according to the provisions of a protocol prepared by the National Pharmacovigilance Resource Centre, IPGTRA, Jamnagar, and approved by Department of AYUSH. The program was reviewed, first, on 21st January 2009 by the National Pharmaco-vigilance Consultative Committee for ASU drugs (NPCC-ASU), and again, on 15 Feburary, 2010, when an evaluation meeting effectively rubber stamped the program. Among the outcomes of these meetings were several suggestions of measures to improve the program’s efficiency. Recent developments include the constitution of pharmacovigilance centers at all Ayurveda Teaching institutes and research centers.
doi:10.4103/0975-9476.74427
PMCID: PMC3117316  PMID: 21731371
Adverse drug reaction; Awareness; Ayurvedic medicine; Pharmacovigilance; Safety
7.  Challenges of mainstreaming: Ayurvedic practice in Delhi Government health institutions 
This paper is an attempt to understand the project of mainstreaming in India's health care system that has started with an aim to bring marginalized and alternative systems of medicine in mainstream. The project has gained much attention with the establishment of Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) in the year 2003, which is now a ministry. It has ushered some positive results in terms of growth of AYUSH hospitals and dispensaries. However, it has also raised challenges around the theory and practice of mainstreaming. With an emphasis on Ayurvedic practice in Delhi Government Health Institutions, this article has tried to analyze some of those challenges and intricacies. Drawing on Weber's theory of bureaucratization and Giddens's theory of structuration, the paper asks what happens to an alternative medical system when it becomes part of the bureaucratic set-up. Along with the questions of structures, it also tries to combine the question of the agency of both patients and doctors considered to be the cornerstone of the Ayurvedic medical system. Although our study recognizes some of the successes of the mainstreaming project, it also underlines the challenges and problems it faces by analyzing three points of view (institutions, doctors, and patients).
doi:10.1016/j.jaim.2015.10.001
PMCID: PMC4910286  PMID: 27297512
Ayurveda; Bureaucratization; Mainstreaming; Medical pluralism; Public health
8.  Situational analysis and future directions of AYUSH: An assessment through 5-year plans of India 
AYUSH is an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. These are the six indigenous systems of medicine practiced in India. A department called Department of Indian System of medicine was created in March 1995 and renamed to AYUSH in November 2003 with a focus to provide increased attention for the development of these systems. Very recently, in 2014, a separate ministry was created under the union Government of India, which is headed by a minister of state. Planning regarding these systems of medicine was a part of 5-year planning process since 1951. Since then many developments have happened in this sector albeit the system was struggling with a great degree of uncertainty at the time of 1st5-year plan. A progressive path of development could be observed since the first to the 12th5-year plan. It was up to the 7thplan the growth was little sluggish and from 8thplan onward the growth took its pace and several innovative development processes could be observed thereafter. The system is gradually progressing ahead with a vision to be a globally accepted system, as envisaged in 11th5-year plan. Currently, AYUSH system is a part of mainstream health system implemented under National Rural Health Mission (NRHM). NRHM came into play in 2005 but implemented at ground level in 2006 and introduced the scheme of “Mainstreaming of AYUSH and revitalization of local health traditions” to strengthen public health services. This scheme is currently in operation in its second phase, since 1stApril 2012, with the 12th5-year plan. The scheme was primarily brought in to operation with three important objectives; choice of treatment system to the patients, strengthen facility functionally and strengthen the implementation of national health programmes, however, in some places it seems to be a forced medical pluralism owing to a top-down approach by the union government without considerable involvement of the concerned community. In this study, the 5-year planning documents have been reviewed, from the 1stplan to 12thplan, to enable reflection and throw some light into the future directions of AYUSH system.
doi:10.5455/jice.20151101093011
PMCID: PMC4665030  PMID: 26649240
Ancient medical manuscripts; Indian systems of medicine; Indian systems of medicine informatics; mainstreaming of Ayurveda; Yoga and Naturopathy; Unani; Sidha and Homeopathy; medical tourism
9.  Capacity building of AYUSH practitioners to study the feasibility of their involvement in non-communicable disease prevention and control 
Ancient Science of Life  2012;32(2):116-119.
Background:
Sharing of public health knowledge and skills by professionals in allopathic system of medicine with Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) professionals in India has always been considered as part of integrating the health system in India. But till date, a curriculum has not been framed for follow-up.
Materials and Methods:
A training course was developed for AYUSH professionals in India on the public health principles for the prevention and control of non-communicable diseases (NCDs). Three course chairs interacted with international and national public health and AYUSH experts, and the curriculum for a 3-month course was developed.
Results:
The curriculum comprised interactive lectures, problem-based exercise, field visits, and research protocol development. A total of four participants, nominated by the World Health Organization, India, were trained during the course, with significant (P = 0.00) improvement in knowledge from 53.2 to 80.0 points.
Conclusion:
A novel and feasible public health course for complementary and alternative medicine professionals on the public health principles for NCDs’ prevention and control is needed to bridge the demand gap for public health professionals in India.
doi:10.4103/0257-7941.118552
PMCID: PMC3807955  PMID: 24167339
AYUSH course; non-communicable disease; public health
10.  A Review of Swertia chirayita (Gentianaceae) as a Traditional Medicinal Plant 
Swertia chirayita (Gentianaceae), a popular medicinal herb indigenous to the temperate Himalayas is used in traditional medicine to treat numerous ailments such as liver disorders, malaria, and diabetes and are reported to have a wide spectrum of pharmacological properties. Its medicinal usage is well-documented in Indian pharmaceutical codex, the British, and the American pharmacopeias and in different traditional medicine such as the Ayurveda, Unani, Siddha, and other conventional medical systems. This ethnomedicinal herb is known mostly for its bitter taste caused by the presence of different bioactive compounds that are directly associated with human health welfare. The increasing high usage of Swertia chirayita, mostly the underground tissues, as well as the illegal overharvesting combined with habitat destruction resulted in a drastic reduction of its populations and has brought this plant to the verge of extinction. The increasing national and international demand for Swertia chirayita has led to unscrupulous collection from the wild and adulteration of supplies. The aim of this review is to provide a synthesis of the current state of scientific knowledge on the medicinal uses, phytochemistry, pharmacological activities, safety evaluation as well as the potential role of plant biotechnology in the conservation of Swertia chirayita and to highlight its future prospects. Pharmacological data reported in literature suggest that Swertia chirayita shows a beneficial effect in the treatment of several ailments. However, there is lack of adequate information on the safety evaluation of the plant. The pharmacological usefulness of Swertia chirayita requires the need for conservation-friendly approaches in its utilization. Providing high-quality genetically uniform clones for sustainable use and thereby saving the genetic diversity of this species in nature is important. In this regard, plant biotechnological applications such as micropropagation, synthetic seed production, and hairy root technology can play a significant role in a holistic conservation strategy. In addition to micropropagation, storage of these valuable genetic resources is equally important for germplasm preservation. However, more advanced research is warranted to determine the activities of bioactive compounds in vitro and in vivo, establish their underlying mechanisms of action and commence the process of clinical research.
doi:10.3389/fphar.2015.00308
PMCID: PMC4709473  PMID: 26793105
biological activity; conservation; medicinal plant; Swertia chirayita; traditional medicine
11.  Knowledge and Attitudes about HIV/AIDS among Homoeopathic Practitioners and Educators in India 
This study is designed to assess AIDS knowledge among Homeopathy educators and physicians in India, which has not been evaluated previously. India now has the largest number of HIV infected persons worldwide, with an estimated cumulative 5.1 million infections. Homeopathy is the dominant system among the nationally-recognized alternative or complementary systems of medicine, which collectively provide health care to around 600 million people in India. Homeopathy, with its holistic and patient-centered approach, has a wide reach to people at risk of contracting human immunodeficiency virus (HIV). Participants were 68 homeopathy physicians (34 educators and 34 practitioners) who completed a CDC questionnaire measuring HIV/AIDS Knowledge regarding AIDS. This study reports the current level of knowledge of, and attitudes about, HIV/AIDS among homeopathy educators and practitioners. These findings will assist in the development of an education module to equip homeopathic health care personnel to impart accurate AIDS information and prevention counseling to their patients in an efficient manner.
doi:10.1093/ecam/nem018
PMCID: PMC2396477  PMID: 18604257
Education; HIV/AIDS; homeopathy; India
12.  An Evaluation on Medical Education, Research and Development of AYUSH Systems of Medicine through Five Year Plans of India 
Introduction
Indian system of medicine has its origin in India. The system is currently renamed as AYUSH, an acronym for Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homeopathy. These are the six Indian systems of medicine prevalent and practiced in India and in few neighboring Asian countries.
Objective
The primary objective of this review was to gain insight in to the prior and existing initiatives which would enable reflection and assist in the identification of future change.
Materials and Methods
A review was carried out based on the five year plan documents, obtained from the planning commission web portal of Govt. of India, on medical education, research and development of AYUSH systems of medicine.
Results
Post independence, the process of five year planning took its birth with the initiation of long term planning in India. The planning process embraced all the social and technology sectors in it. Since the beginning of five year planning, health and family welfare planning became imperative as a social sector planning. Planning regarding Indian Systems of Medicine became a part of health and family welfare planning since then. During the entire planning process a progressive path of development could be observed as per this evaluation. A relatively sluggish process of development was observed up to seventh plan however post eighth plan the growth took its pace. Eighth plan onwards several innovative development processes could be noticed. Despite the relative developments and growth of Indian systems of medicine these systems have to face lot of criticism and appraisal owing to their various characteristic features. In the beginning the system thrived with great degree of uncertainty, as described in 1st five year plan, however progressed ahead with a vision to be a globally accepted system, as envisaged in 11th five year plan.
Conclusion
A very strong optimistic approach in spreading India’s own medical heritage is the need of the hour. The efforts are neither completely insufficient nor sufficient enough; hence a continuous endeavor for the revival and dissemination of India’s own medical inheritance for the welfare of the society at large is highly desirable.
doi:10.7860/JCDR/2016/18194.7793
PMCID: PMC4948421  PMID: 27437245
Accreditation of AYUSH institutions; Clinical training; ISM medical education; National level entrance examination
13.  Premna integrifolia L.: A review of its biodiversity, traditional uses and phytochemistry 
Ancient Science of Life  2015;35(1):4-11.
Premna integrifolia Linn. (Verbenaceae) is an important woody, medicinal plant and has been prominent place in Ayurveda, Siddha and Unani system of medicines. Objective of the present review is to avail the comprehensive information on ecological biodiversity, traditional uses and phytochemistry of P. integrifolia. Information of the plant was searched using various electronic databases in reference to the terms Premna integrifolia, ecological biodiversity, traditional uses and phytoconstituents of P. integrifolia along with Ayurvedic books, Indian classical texts, pharmacopoeias, journals, etc. There is an inherent difference within the three Ayurvedic Formulary of India (AFIs) published with regard to the botanical sources of Agnimanthā. Complete data of the plant has been collected manually since from the years 1947–2015 and was arranged accordingly. Available data have reports that roots of P. integrifolia are widely used for the preparation of Ayurvedic formulations like Daśamūlakvātha, Ariṣṭa, Cūrṇa and Chayawanprashavleh for the treatment of a variety of afflictions. It has also reported to have p-methoxy cinnamic acid, linalool, linoleic acid, β-sitosterol and flavone luteolin, iridoid glycoside, premnine, ganiarine and ganikarine, premnazole, aphelandrine, pentacyclic terpene betulin, caryophellen, premnenol, premna spirodiene, clerodendrin-A, etc., phytoconstituents in its various parts. There is need to validate its traditional uses, isolation and confirmation of reported phytoconstituents, biological and clinical efficacy by modern analytical and biological techniques which could be recommendation for further scientific research.
doi:10.4103/0257-7941.165624
PMCID: PMC4623632  PMID: 26600661
Ecological biodiversity; phytochemistry; Premna integrifolia; traditional uses
14.  Non-codified traditional medicine practices from Belgaum Region in Southern India: present scenario 
Background
Traditional medicine in India can be classified into codified (Ayurveda, Unani, Siddha, Homeopathy) and non-codified (folk medicine) systems. Both the systems contributing equally to the primary healthcare in India. The present study is aimed to understand the current scenario of medicinal practices of non-codified system of traditional medicine in Belgaum region, India.
Methods
The study has been conducted as a basic survey of identified non-codified traditional practitioners by convenience sampling with semi structured, open ended interviews and discussions. The learning process, disease diagnosis, treatment, remuneration, sharing of knowledge and socio-demographic data was collected, analysed and discussed.
Results
One hundred and forty traditional practitioners were identified and interviewed for the present study. These practitioners are locally known as “Vaidya”. The study revealed that the non-codified healthcare tradition is practiced mainly by elderly persons in the age group of 61 years and above (40%). 73% of the practitioners learnt the tradition from their forefathers, and 19% of practitioners developed their own practices through experimentation, reading and learning. 20% of the practitioners follow distinctive “Nadi Pariksha” (pulse examination) for disease diagnosis, while others follow bodily symptoms and complaints. 29% of the traditional practitioners do not charge anything, while 59% practitioners receive money as remuneration.
Plant and animal materials are used as sources of medicines, with a variety of preparation methods. The preference ranking test revealed higher education and migration from villages are the main reasons for decreasing interest amongst the younger generation, while deforestation emerged as the main cause of medicinal plants depletion.
Conclusion
Patrilineal transfer of the knowledge to younger generation was observed in Belgaum region. The observed resemblance in disease diagnosis, plant collection and processing between non-codified traditional system of medicine and Ayurveda require further methodical studies to establish the relationship between the two on a more objective basis. However, the practice appears to be at crossroads with threat of extinction, because of non-inheritance of the knowledge and non-availability of medicinal plants. Hence conservation strategies for both knowledge and resources at societal, scientific and legislative levels are urgently required to preserve the traditional wisdom.
doi:10.1186/1746-4269-10-49
PMCID: PMC4084578  PMID: 24934868
Belgaum; Convenience sampling; Disease diagnosis; Ethnomedicine; Non-codified medicine; Preference ranking; Sharing of knowledge; Traditional medicine; Traditional practitioner; Western Ghats
15.  Clinical trials in allied medical fields: A cross-sectional analysis of World Health Organization International Clinical Trial Registry Platform 
Background
Clinical trials are mandatory for evidence-based practice. Hardly, any data are available regarding the number of clinical trials and their methodological quality that are conducted in allied fields of medicine.
Objective
The present study was envisaged to assess methodological quality of trials in allied medical fields.
Materials and Methods
Registered clinical trials in World Health Organization International Clinical Trials Registry Platform (http://apps.who.int/trialsearch/AdvSearch.aspx) in the following fields were extracted: Acupuncture; Ayurveda; biofeedback; complementary and alternate medicine; herbal; homeopathy; massage; naturopathy; Reiki; Siddha; Unani; and yoga. The eligible studies were assessed for the following key details: Type of sponsors; health condition in which the trial has been conducted; recruitment status; study design; if randomization was present, method of randomization and allocation concealment; single or multi-centric; retrospective or prospective registration; and publication status in case of completed studies.
Results
A total of 276 clinical trials were registered majority of which have been proposed to be conducted in the field of oncology and psychiatry. Most of the clinical trials were done in single centers (87.75%), and almost all the clinical trials were investigator-initiated with pharmaceutical company sponsored studies contributing to a maximum extent of 24.5%. A large majority of the study designs were interventional where almost 85% of the studies were randomized controlled trials. However, an appropriate method of randomization was mentioned only in 27.4%, and the rate of allocation concealment was found to be just 5.5%. Only 1–2% of the completed studies were published, and the average rate of retrospective registration was found to be 23.6% in various fields.
Conclusion
The number of clinical trials done in allied fields of medicine other than the allopathic system has lowered down, and furthermore focus is required regarding the methodological quality of these trials and more support from various organizations.
doi:10.1016/j.jaim.2015.09.003
PMCID: PMC4910572  PMID: 27297510
Complementary and alternate medicine; Evidence-based medicine; Research
16.  Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries 
Health Policy and Planning  2014;30(8):1067-1077.
This review examined the determinants, patterns and imports of official recognition, and incorporation of different traditional, complementary and alternative systems of medicine (TCAM) in the public health establishment of low- and middle-income countries, with a particular focus on India. Public health systems in most countries have tended to establish health facilities centred on allopathy, and then to recognize or derecognize different TCAM based on evidence or judgement, to arrive at health-care configurations that include several systems of medicine with disparate levels of authority, jurisdiction and government support. The rationale for the inclusion of TCAM providers in the public health workforce ranges from the need for personnel to address the disease burden borne by the public health system, to the desirability of providing patients with a choice of therapeutic modalities, and the nurturing of local culture. Integration, mostly described as a juxtaposition of different systems of medical practice, is often implemented as a system of establishing personnel with certification in different medical systems, in predominantly allopathic health-care facilities, to practise allopathic medicine. A hierarchy of systems of medicine, often unacknowledged, is exercised in most societies, with allopathy at the top, certain TCAM systems next and local healing traditions last. The tools employed by TCAM practitioners in diagnosis, research, pharmacy, marketing and education and training, which are seen to increasingly emulate those of allopathy, are sometimes inappropriate for use in therapeutic systems with widely divergent epistemologies, which call for distinct research paradigms. The coexistence of numerous systems of medicine, while offering the population greater choice, and presumably enhancing geographical access to health care as well, is often fraught with tensions related to the coexistence of philosophically disparate, even opposed, disciplines, with distinct and unaligned notions of evidence and efficacy, and ethical and operational challenges of the administration of a plural workforce.
doi:10.1093/heapol/czu096
PMCID: PMC4559111  PMID: 25171821
Alternative; complementary; integration; local healing traditions; medical pluralism; traditional
17.  Mainstreaming of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy with the health care delivery system in India 
India has a population of 1.21 billion people and there is a high degree of socio-cultural, linguistic, and demographic heterogeneity. There is a limited number of health care professionals, especially doctors, per head of population. The National Rural Health Mission has decided to mainstream the Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) system of indigenous medicine to help meet the challenge of this shortage of health care professionals and to strengthen the delivery system of the health care service. Multiple interventions have been implemented to ensure a systematic merger; however, the anticipated results have not been achieved as a result of multiple challenges and barriers. To ensure the accessibility and availability of health care services to all, policy-makers need to implement strategies to facilitate the mainstreaming of the AYUSH system and to support this system with stringent monitoring mechanisms.
doi:10.1016/j.jtcme.2014.11.002
PMCID: PMC4488105  PMID: 26151021
Ayurvedic medicine; homeopathy; indigenous medicine; India; public health
18.  Literature searches on Ayurveda: An update 
Ayu  2015;36(3):238-253.
Introduction:
The journals that publish on Ayurveda are increasingly indexed by popular medical databases in recent years. However, many Eastern journals are not indexed biomedical journal databases such as PubMed. Literature searches for Ayurveda continue to be challenging due to the nonavailability of active, unbiased dedicated databases for Ayurvedic literature. In 2010, authors identified 46 databases that can be used for systematic search of Ayurvedic papers and theses. This update reviewed our previous recommendation and identified current and relevant databases.
Aims:
To update on Ayurveda literature search and strategy to retrieve maximum publications.
Methods:
Author used psoriasis as an example to search previously listed databases and identify new. The population, intervention, control, and outcome table included keywords related to psoriasis and Ayurvedic terminologies for skin diseases. Current citation update status, search results, and search options of previous databases were assessed. Eight search strategies were developed. Hundred and five journals, both biomedical and Ayurveda, which publish on Ayurveda, were identified. Variability in databases was explored to identify bias in journal citation.
Results:
Five among 46 databases are now relevant – AYUSH research portal, Annotated Bibliography of Indian Medicine, Digital Helpline for Ayurveda Research Articles (DHARA), PubMed, and Directory of Open Access Journals. Search options in these databases are not uniform, and only PubMed allows complex search strategy. “The Researches in Ayurveda” and “Ayurvedic Research Database” (ARD) are important grey resources for hand searching. About 44/105 (41.5%) journals publishing Ayurvedic studies are not indexed in any database. Only 11/105 (10.4%) exclusive Ayurveda journals are indexed in PubMed.
Conclusion:
AYUSH research portal and DHARA are two major portals after 2010. It is mandatory to search PubMed and four other databases because all five carry citations from different groups of journals. The hand searching is important to identify Ayurveda publications that are not indexed elsewhere. Availability information of citations in Ayurveda libraries from National Union Catalogue of Scientific Serials in India if regularly updated will improve the efficacy of hand searching. A grey database (ARD) contains unpublished PG/Ph.D. theses. The AYUSH portal, DHARA (funded by Ministry of AYUSH), and ARD should be merged to form single larger database to limit Ayurveda literature searches.
doi:10.4103/0974-8520.182754
PMCID: PMC4895749  PMID: 27313409
Complementary and alternative medicine; integrative medicine; library science; psoriasis; search engine; systematic review
19.  Hepatoprotective potential of ethanolic extract of Pandanus odoratissimus root against paracetamol-induced hepatotoxicity in rats 
Background:
Pandanus odoratissimus (Pandanaceae) is popular in the indigenous system of medicines like Ayurveda, Siddha, Unani and Homoeopathy. In the traditional system of medicine various plant parts such as leaves, root, flowers, and oils are used as anthelmintic, tonic, stomachic, digestive and in the treatment of jaundice and various liver disorders.
Objective:
The aim was to investigate the hepatoprotective activity of ethanolic extract of the root of P. odoratissimus against paracetamol (PCM) induced hepatotoxicity in rats.
Materials and Methods:
Hepatotoxicity was induced in male Wistar rat by PCM (2 g/kg b.w. p.o. for 7 days). The ethanolic extract of P. odoratissimus root was administered at the dose level of 200 mg/kg and 400 mg/kg b.w. orally for 7 days and silymarin (100 mg/kg b.w. p.o.) as standard drug was administered once daily for a week. The hepatoprotective effect of ethanolic extract was evaluated by assessment of biochemical parameters such as serum glutamic oxaloacetic transaminase, serum glutamic-pyruvic transaminase, serum alkaline phosphatase, total and direct bilirubin and triglycerides. Histopathological study of rat liver was also done.
Results:
Experimental findings revealed that the extract at dose level of 200 mg/kg and 400 mg/kg of b.w. showed dose dependant hepatoprotective effect against PCM induced hepatotoxicity by significantly restoring the levels of serum enzymes to normal that was comparable to that of silymarin, but the extract at dose level of 400 mg/kg was found to be more potent when compared to that of 200 mg/kg. Besides, the results obtained from histopathological study also support the study.
Conclusion:
From the results, it can be concluded that ethanolic extract of the root of P. odoratissimus afforded significant protection against PCM induced hepatotoxicity in rats.
doi:10.4103/0975-7406.148776
PMCID: PMC4333627  PMID: 25709336
Hepatoprotective activity; histopathology; Pandanus odoratissimus; paracetamol; silymarin
20.  Buyers Beware: Lead Poisoning due to Ayurvedic Medicine 
Journal of General Internal Medicine  2012;27(10):1384-1386.
ABSTRACT
A 29-year-old man, who recently emigrated from India, presented with a 2-week history of abdominal pain, as well as nausea, constipation, and fatigue. He underwent removal of a parathyroid adenoma 6 weeks prior to admission and received a locally made Indian traditional medicine (Ayurveda) for pain control; however, this information was not initially available. He was instructed to take approximately 15 g/day. Initial evaluation revealed a normocytic anemia, but other workup including imaging and endoscopy was unrevealing. Given his recent use of Ayurvedic medicines, we tested for lead poisoning and found a blood lead level of 72 mcg/dl. We sent his medicine for analysis and found it had a high lead concentration of 36,000 mcg/g, which is over 25,000 times the maximum daily dose. He improved with cessation of the medicine and treatment with succimer. Lead poisoning can present with a variety of nonspecific signs and symptoms, including abdominal pain and anemia. Ayurvedic medicines, as well as traditional medicines from other cultures, may be a source of lead or other heavy metals. It is essential for physicians to be aware of adverse effects of Ayurvedic medicines as they are easily available and increasing in popularity.
doi:10.1007/s11606-012-2048-y
PMCID: PMC3445671  PMID: 22476953
dietary supplements; lead; India; medicine; Ayurvedic; Phytotherapy; plant extracts/chemistry
21.  Evaluation of implementation status of national policy on Indian systems of medicine and homeopathy 2002: Stakeholders’ perspective 
Ancient Science of Life  2013;33(2):103-108.
Background:
National Policy on Indian systems of medicine and homoeopathy (ISM and H policy) was formulated in 2002 to encourage the development of Ayurveda, Sidhha, Unani, Yoga, Naturopathy and Homoeopathy in India. This study proposes to assess the views of public health experts on current implementation of ISM and H Policy.
Methods:
An online questionnaire was designed to ascertain the views of public health experts on ISM and H Policy and mailed to 100 public health experts. The tool was tested for content validity and a pilot study was done. Results were analyzed with the help of SPSS version 16.
Results and Conclusion:
Response rate was 61%. Majority of experts considered implementation status of ISM and H Policy as poor. Lack of quality education was mentioned as major factor responsible for current scenario of ISM and H Policy by most of experts. Lack of funds and government support were emerged as major bottlenecks in implementation of ISM and H Policy.
doi:10.4103/0257-7941.139048
PMCID: PMC4171850  PMID: 25284943
AYUSH; evaluation; implementation; ISM and H policy
22.  Khamiras, a natural cardiac tonic: An overview 
The Unani system of Medicine (Unanipathy), which originated in Greece, is based on the principles proposed by Galen, a Greek practitioner. Since then, many Arab and Persian scholars have contributed to the system. Among them Ibn-e-Sina, an Arab philosopher and Physicist who wrote ‘Kitab-al-shifa’ are worth mentioning. This system has an extensive and inspiring record in India. It was introduced in India around the tenth century A.D with the spread of Islamic civilization. At present, Unanipathy has become an important part of the Indian system of Medicine. Unani medicines have been used since ancient times, as medicines for the treatment of various ailments. In spite of the great advances observed in modern medicine in recent decades, Unani drugs still make an important contribution to healthcare. The Unani system of medicine is matchless in treating chronic diseases like arthritis, asthma, mental, cardiac, and digestive disorders, urinary infections, and sexual diseases. The medicines administered go well with the temperament of the patient, thus speeding up the process of recovery and also reducing the risk of drug reaction. The Unani system of medicine recognizes the influence of the surroundings and ecological conditions on the state of health of human beings. The system aims at restoring the equilibrium of various elements and faculties of the human body. It has laid down six essential prerequisites for the prevention of diseases and places great emphasis, on the one hand, on the maintenance of proper ecological balance, and on the other, on keeping water, food, and air free from pollution. These essentials, known as ‘Asbab-e-Sitta Zarooriya’, are air, food, and drink, bodily movement and repose, psychic movement and repose, sleep and wakefulness, and excretion and retention. The Unani system is a secular system in temperament and is popular among the masses. In Unani medicine, although the general preference is for single drugs, compound formulations are also used in the treatment of various complex and chronic disorders. In the light of the present knowledge, this review is a small effort to discuss the efficacious nature of ‘Khamira’, a semi-solid preparation, which is traditionally used for cardiac ailments, such as, palpitations, weakness of the heart, and so on. On the basis of their constituents these are named as, Khamira Aabresham, Khamira Gaozaban, Khamira Marwareed, and so on. Khameeras are also used as general tonics for other vital organs like the liver and brain. In view of the increasing number of cardiac diseases, a thorough evaluation of this ancient work on Khamira is of special significance.
doi:10.4103/0975-7406.67009
PMCID: PMC3147110  PMID: 21814439
Cardiotonic; khameera; Unani system of medicine
23.  Homoeopathic and herbal prescribing in general practice in Scotland 
What is already known about this subject
Homoeopathy and herbalism are increasingly popular among the public and prescribed by general practitioners in the NHS.
Doctors and regulatory authorities have expressed concerns about their efficacy and safety.
Studies from the 1990s suggest that between 5.9 and 7.5% of English NHS general practitioners have prescribed homoeopathy, while less than 1% have prescribed herbal remedies. Current levels of prescribing are unknown but are thought to have increased.
What this study adds
Sixty percent of Scottish general practices now prescribe homoeopathic or herbal remedies.
The prevalence of homoeopathic prescribing in those under 16 years has doubled since 2000 and is maximal in children < 1 year old, of whom 1% are prescribed a homoeopathic remedy.
Recognized drug–herb interactions were identified in 4% of patients prescribed oral herbal remedies.
Aims
To investigate the current levels of homoeopathic and herbal prescribing in Scottish general practice.
Methods
Prescribing of homoeopathic and herbal remedies in primary care was assessed in 1891 669 patients for the year 2003–2004, using computerized prescribing data retrieved from 323 general practices in Scotland.
Results
Forty-nine percent of practices prescribed homoeopathic and 32% herbal remedies. A total of 193 homoeopathic and 17 herbal remedies were prescribed, with 5% of practices accounting for 46% of patients and 50% of remedies. Four thousand one hundred and sixty patients (2.2/1000 registered patients) were prescribed at least one homoeopathic remedy during the study period, with the highest prevalence to children under 12 months of age (9.5/1000 children of that age). Children under the age of 16 made up 16% of the population prescribed homoeopathic remedies (2.2/1000 registered patients of that age). Three hundred and sixty-one patients (0.2/1000 registered patients) were prescribed at least one herbal remedy during the study period, 44 of whom were children < 16 years old. Patients prescribed a homoeopathic or herbal remedy were also prescribed a median of four and five conventional medicines, respectively. Of patients prescribed an oral herbal remedy, 4% were also concomitantly prescribed a conventional medicine with which a drug–herb interaction has been documented.
Conclusions
Our study reports that a substantial number of Scottish general practitioners prescribe homoeopathic and herbal remedies, with an approximate doubling in the number of children prescribed homoeopathic remedies. The level of homoeopathic and herbal prescribing raises questions about homoeopathic/herbal provision in the National Health Service and should prompt critical review.
doi:10.1111/j.1365-2125.2006.02702.x
PMCID: PMC1885188  PMID: 16796701
herbal medicine; homoeopathy; primary care
24.  Symbiohealth – Need of the hour 
Ayu  2011;32(1):6-11.
A symbiotic relationship between Allopathy (Modern medicine) and Ayurveda is fundamental in creating a health care system that is : (a) more effective than either system used alone, (b) less expensive, (c) less toxic and (d) more likely to create a healthier society. The fundamental basis of Allopathy is “offense thinking,” corresponding to Newton′s physics, which makes it an excellent disease management system; on the other hand, Ayurveda is based upon “defense thinking” and corresponds to Quantum physics, and is an excellent system for prevention of disease and for protection and rejuvenation of health. A judicious use of the two systems in group practice will provide better care to the masses.
doi:10.4103/0974-8520.85715
PMCID: PMC3215420  PMID: 22131751
Ayurveda; defense; human ecosystem; offense; symbiohelath
25.  Critical analysis of India's National Mission on Medicinal Plants (NMMP) in providing access to quality botanical drugs to improve public health 
Drugs play an important role in improving health of the population. Medicinal plants help in addressing the health issues of a large section of the population – especially the low and middle-income people. However, there are some concerns about the supply, efficacy and safety in using them. This study reviews India's major initiative toward medicinal plants namely, the National Mission on Medicinal Plants to meet medicinal plants challenges. The study analyzed the mission's probable shortcomings due to its design and operational details. This study used “content analysis” approach for analysis of mission's publicly available documents, viz. “Operational guidelines” and its two amendments. The study identified prevalent 28 shortcomings in the original document related to clarity of the document; accountability, transparency and stakeholders’ representation. These challenges were partially addressed in two amendments, which indicate persistence of shortcomings in design and operational details. The mission can help in improving and strengthening the Ayurveda, Yoga, Unani, Siddha and Homeopathy program by addressing those shortcomings.
doi:10.4103/0975-9476.146549
PMCID: PMC4630695  PMID: 26604556
Content analysis; herbal medicine; medicinal plant policy; National mission on medicinal plants; the Indian herbal policy

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