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The Journal of Alternative and Complementary Medicine Vol. 26, No. 12 pp. 1089-1092

The COVID-19 Pandemic and the Relevance of Ayurveda's Whole Systems Approach to Health and Disease Management

Unnikrishnan Payyappallimana, Kishor Patwardhan, Prasad Mangalath, Christian S. Kessler, Rama Jayasundar, Anupama Kizhakkeveettil, Antonio Morandi, and Rammanohar Puthiyedath

(authors affiliated with various institutions in India, Germany, US, and Italy)

Free full text:
https://www.liebertpub.com/doi/10.1089/acm.2020.0370

Excerpts:

A surprising dissonance between conventional medical research and clinical practice can be observed during this pandemic, challenging fundamental assumptions of evidence-based medicine and conventional biomedical practice.3 Might this development lead us to a pier of practice-based evidence (PBE) focusing on patient-centered care on compassionate grounds? Or does the global medical community need to strike a better balance between those two approaches to optimizing therapeutic responses to this pandemic? A recent editorial in PLOS Medicine reads, “It is surely time to turn to a more fit-for-purpose scientific paradigm. Complex adaptive systems theory proposes that precise quantification of particular cause–effect relationships is both impossible (because such relationships are not constant and cannot be meaningfully isolated) and unnecessary (because what matters is what emerges in a particular real-world situation).”


The PBE building exercise that has been evoked by the COVID-19 pandemic puts all medical systems—conventional medicine and traditional medicine systems—on more or less level ground. An unprecedented opportunity is emerging for a constructive dialogue between the systems and coevolution and systematic collaboration within a synergistic framework. The PBE and the complexity research approaches, which are primary methods of Ayurveda and other traditional medical systems, need to complement the conventional research.

Traditional medicine systems such as Ayurveda have a highly developed theoretical and methodological framework to study new diseases and develop treatment guidelines based on rationale derived from clinical medicine principles and therapeutic experience since millennia...The application of systematic protocols to formulate clinical practice guidelines from Ayurveda and their integration into COVID-19 patients' treatment could fill gaps and unmet needs in the official health response systems.


Clinical Trials Registry India lists 107 studies (as on August 20, 2020) on Ayurveda initiated by various institutions using the guidelines issued by the Ministry of AYUSH.


Ayurvedic treatment is generally multimodal in its approach, and treatments are decided based on varying clinical presentations, stages of disease progression, and customized according to the patient's characteristics. An exclusive focus on modern pharmacologic approaches based on evaluating a single molecule's activity on a specific biological mechanism of a disease overlooks such a person-centric multifactorial approach.


The flurry of knee jerk claims of efficacy and product-based marketing efforts from various Ayurveda institutions and physicians on popular media has rightly led the Ministry of AYUSH to prohibit anyone from making claims regarding the efficacy without systematic evidence.


In some Indian states and specific sublocalities, there are reports of Ayurveda protocol-based interventions being administered for prophylaxis and care of COVID-19...Nevertheless, in the absence of proper documentation and research, one is left with a paucity of rigorous data to draw substantial conclusions.


As a primary step, new diseases such as COVID-19 need to be also studied from within Ayurveda's theoretical framework. It has been demonstrated that clinical profiling of COVID-19 from an Ayurvedic perspective is possible.13 Pragmatic treatment protocols have already been suggested,15 and Ayurvedic treatment outcomes in a COVID-19 patient have been published as a case report,28 pointing out the need to consider Ayurveda's holistic approach to offer care for COVID-19 patients...The absence of official access to COVID-19 patients makes it difficult for Ayurvedic physicians to develop a comprehensive treatment strategy based on Ayurvedic principles.


Systematic data relating to the Ayurvedic clinical management of COVID are still in process and not yet available in a format to be presented in a research journal. Longer time is required to generate replicable PBE. Ayurveda researchers and clinicians must publish practice-based data and learn from clinical experiences as case reports and case series. Meanwhile, there is a need for consensus-based flexible best rationale approaches in collaborative clinical care and systematic documentation and publication. The treatment guidelines should be developed based on the disease's clinical profiling from the Ayurvedic perspective and structured on Ayurveda treatment principles (cikitsasutra of Ayurveda).


In the wake of an escalating pandemic such as COVID-19, a populous country like India, with >1.3 billion people, cannot afford to wait for lengthy clinical trials to produce evidence to sanction clinical care of patients. In the case of conventional medicine, this inevitable dilemma between medical research and clinical medicine has been resolved by the parallel development of the pragmatic standard of care guidelines for clinical practice while at the same time pursuing rigorous research protocols to generate higher levels of evidence. A similar approach should also be adopted in Ayurveda's case to enable the practitioners to meet challenges when the need arises. This calls for the empowerment of Ayurveda practitioners to offer clinical care for COVID-19 patients to support well-formulated official advisories...Simultaneously, efforts should be taken to bring the whole systems approach into research methodologies to effectively generate evidence supporting Ayurveda interventions for COVID-19.

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Comment: the last sentence seems to assume that Ayurvedic interventions will be effective.