A close view of the keezharnelli plant. Photo: Deepugn/Wikimedia Commons, public domain.
Kochi: A person who worked in the multimedia industry, and was keen on protecting herself from illnesses that might affect her voice, had been consuming water boiled with tulsi (Ocimum tenuiflorum) leaves every day for many months. She ended up with haemarthrosis – blood accumulated in the joints.
Dr Remya Krishnan, an associate professor and head of the department of Ayurvedic clinical pharmacology at the Rajiv Gandhi Ayurveda Medical College, Mahe, who had treated the patient, told this correspondent that although tulsi is acclaimed for its medicinal properties, consuming it every day could be bad for those susceptible to bleeding.
Dr Abi Abraham, a nephrologist in Kochi, said he has had to rescue the kidneys of three patients from becoming irreversibly damaged by a high intake of Averrhoa bilimbi, a sour fruit popular in the local cuisine. In response to claims that the fruit lowers blood cholesterol levels, his patients had consumed enormous amounts of a concoction made with it.
Krishnan added that every herb, fruit, stem or root could prove similarly harmful if it is consumed without regard for its potential side effects.
Many of those who sell as well as buy into these solutions do so in the name of Ayurveda, which is often not warranted. Naturally occurring substances in concentrated form can vary in their properties, according to Rajeev Kumar R., an Ayurvedic physician who has been running a private clinic in Ernakulam for 15 years.
For example, in Ayurvedic terms, tulsi has teeksha (pungent) and ushna (hot) properties, Kumar said. So while it is normally not harmful, consuming too much of it could aggravate preexisting bleeding disorders.
Dr Cyriac Abby Philips, a gastroenterologist in Ernakulam, recalled a case of liver injury with a known Ayurvedic preparation called Dasamularishtam. The patient had consumed two or three ounces a day for a year – likely an overdose, according to other physicians.
There are many medical reports like these – and they all hinge on a general consensus that everything Ayurvedic is safe. However, Dr Pavana J., a specialist medical officer at the District Ayurveda Hospital in Kollam, said “all medication should be strictly taken under a physician’s guidance,” and that while herbal formulations are generally considered to be safe, “we should be aware” of their chemical contents.
Krishnan said most doctors also don’t accept there could be a flaw in the way they practice Ayurveda, in turn feeding their hapless patients’ ignorance.
Both Krishnan and Pavana concurred that new regulations aimed at pharmacists as well as a prescription audit could help undo this malaise.
“Irrational prescriptions are precisely the reason we see a lot of people turn to modern medicine after Ayurveda treatment fails, and [which] also lead to toxicity problems,” Krishnan said. “A majority of practitioners are into trial-and-error methods – which means prescribing five or six or even up to ten medications” at a time.
Oncologist Dr V.P. Gangadharan said many cases of breast cancer have been detected early – only for doctors to lose the advantage after patients seek ‘alternative medicines’ first, often sold in the name of Ayurveda. Many of them would return a year or so later with several other problems, including – but not limited to – bone disease, problems of the spinal cord and kidneys, along with the cancer spreading to other parts of the body.
Another example of insensible use as medicines concerns a herb known in Kerala as keezharnelli (Phyllanthus niruri). It enjoys a reputation in the state as a singular herb to treat jaundice. But to prescribe its medicinal form, Krishnan said, a physician has to know the disease’s pathogenesis: whether the disease is viral or the patient has some obstructions in the liver. Indiscriminate prescription wouldn’t be Ayurveda, Krishnan said.
“It is neither kitchen therapy nor traditional healing. Science is not luck, neither is Ayurveda, where only some people get cured,” Krishnan said. “Ayurveda is very specific. It is based on siddhantas and the practice is ruled by logic.”
Gruels and healers
Instead, in her telling, Ayurveda is often held back by its reputation as a traditional form of medicine. “The word ‘tradition’ plays with people’s [minds] because whatever is said to be ‘traditional’ is said to be good, too.”
The WHO defines ‘tradition’ as a set of ideas, beliefs, culture or experiences passed through generations.
Krishnan supplied one prominent example of how claims of tradition interfere destructively with Ayurvedic precepts: Karkataka kanji, loosely translated as “monsoon gruel”.
The concoction’s origins probably lie in folklore medicine, and it has become a fad in Kerala of late. The gruel contains multiple herbs bundled together, to last for up to a month, and is purported to be a rejuvenant. But Krishnan said there is no mention of any such kanji in Ayurvedic texts.
“If you ask a physician who has supervised the gruel’s preparation [about the recipe’s benefits], there will be no clear answer,” she said – alluding to one of her principal concerns with Ayurveda as it is practised today: as “experience- or eminence-based practice”. The problem is if experience is not based on science, it can’t be reproduced, she added.
In addition, she also voiced concerns about Ayurveda having become a largely medicine-oriented practice. Pavana echoed this issue, saying many practitioners have forgotten that Ayurveda is not simply a medical system, but prescribes a framework for habits and practices to live well – at the centre of which is a balanced diet.
Ayurvedic practice received a boost after the professional Bachelor of Ayurvedic Medicine and Surgery (BAMS) degree began qualifying people to join the pool of the traditional vaidyas. However, it didn’t alleviate the pressure that traditional vaidyas were under to deliver ‘miracle cures’ – an ability that people often associate with traditional healers.
Experts this correspondent spoke to said while these healers may have successfully treated a few people, they don’t understand the system and can’t explain how or why it works. And Kerala is chock-full of such healers, many of whom even claim to be able to treat migraines, snake bites and even fractures.
In October 2020, the Kerala high court formally disallowed unqualified healers from practising traditional medicine.
A senior professor in a government Ayurveda college said on condition of anonymity that “people are gullible”, although he said he has documented many cases of fraud first-hand – including both small-time healers and some he said were bigger names in the local Ayurveda circuit.
The professor also highlighted another feature of the professionalism missing from Ayurvedic practice: no teamwork among doctors of Kerala’s three major government medical colleges.
“Everyone follows a different protocol for treatments, and there are no takeaways from conferences,” the professor said. “Every department projects its own practice and is happy to live in its own silo. There is no coming together with comparative notes to discuss disease pathology, treatments provided, follow-up actions, evolving protocols and so on.”
Today, Kerala hosts one of India’s more active Ayurveda practice hotspots, with 18 Ayurveda medical colleges: 14 are private and one is a deemed university. There are also numerous private clinics. D. Induchoodan, state executive committee member of the Ayurveda Hospital Management Association, estimated that the number of beds at Ayurvedic treatment facilities could have grown by 10% in the last decade.
And they are all filling a void that a dwindling population of traditional vaidyas is leaving behind. In fact, Kerala’s department of indigenous system of medicine indicates fewer than 50 such vaidyas are registered across the state today.
But ‘real Ayurveda’ is hard to find here, Pavana said. According to her, practitioners address diseases by themselves instead of addressing the patient in whom the disease resides. She likened the ideal process to making a garland, with the practitioner first identifying multiple flowers and then finding a way to flow a single thread through all of them.
Classical Ayurveda does not administer medicines the way modern medicine does. For example, Pavana said, there are no ‘standard’ medicines for lower backache, diabetes, high cholesterol, etc. However, Ayurveda’s rise in demand is reflected through the availability of such medicines where a practitioner today seems to be able to offer specific medicines for specific ailments.
“A system-specific treatment can’t be meted out in Ayurveda,” Pavana said. while compartmentalisation may work for modern medicine, she added, it doesn’t for Ayurveda. “We need to unify all system-specific inputs in the patient under consideration.”
One implication of this view is that it’s not feasible to invoke the principles of modern medicine while practising Ayurveda. As Pavana put it, “The short-term gain with such medicines is perhaps a long-term loss for Ayurveda.”
But her criticism isn’t readily taken: many members of the Ayurveda community are grateful for the long list of specific medicines that exist for certain symptoms.
The predominant modern medical system has an influence on Ayurvedic practice, K. Murali, chief editor of the publication division, Kottakkal Arya Vaidya Sala, said. “It is also the easier way out perhaps. There is no Ayurvedic thinking involved in prescribing” these medicines.
In the final analysis, many experts – especially those trained to practice Ayurveda – said the Ayurvedic community has only itself to blame for finding itself at the receiving end of other healthcare workers’ allegations that Ayurveda is pseudoscience.
Shyama Rajagopal is an independent journalist in Kochi. She was previously a health correspondent with The Hindu, for 20 years.
This report was supported by a grant from the Thakur Family Foundation. The foundation didn’t exercise any editorial control over the contents of the report.