DR.REMYA KRISHNAN MD(AY) PHDASSOCIATE PROFESSOR & HODDEPARTMENT OF DRAVYAGUNA, RGAMC , MAHE.

Evidence Based Ayurveda in reality

Would be DoctorsDoctors who are just starting out their career.Doctors who are in the thick of Medical practise.Doctors who are at the sharp end of difficult decisionin the clinic.

FACTS, SOLUTIONS AND DIRECTIONSFOR:

• To enable the physician to enjoy his patients .• To enable the physician to practise “Science

based Medicine” instead of “Medicine based Science”.

• To inspire a Medical student/House surgeon/ Doctor of any age “to constantly inspire himself” to do the best in the Science for the patient .

AIM OF THE BOOK

WHAT THE BOOK SPEAKS

• Ayurvedic evidence?! How can we best find it, interpret it, and contribute to it?

• The crucial role of Basic science of Ayurveda in its evidence structure.

• How can we sort of ways for which we can think of and apply evidence in our practise and research?

• “How” to choose an Evidence Based medicine (More important than what to choose )

• Exercise judgement on the best estimates of diagnosis, prognosis , cure and prevention.

• Accurately project the scientificity of this Medical system .

• World wide recognition of what is called EVIDENCE BASED AYURVEDA.

OBJECTIVE OF THE BOOK

WHAT IS THIS “EVIDENCE” ???

• Evidence simply means proof .• Evidence is required for the “SCIENCE

FORWARDED MEDICINE” and not for the “Medicine forwarded Science”

• Evidence (Proven Science) behind ,the medicine originally determines the strength of proof of a medicine .

• Medicine forwarded science starts from an “unknown compound for an unknown disease“ and hence is not necessarily proven.

PROVEN MEDICINE

Proven Medicine DOES NOT MEAN Proven Medical Science.

Proven Medical Science can only narrate ETERNALLY PROVEN MEDICINES .

Proven Medicine with no proven science behind makes it “UNCERTAIN medicine”.Proven Medicine with no proven science behind is INVALID PROOF.

MEDICAL EVIDENCE TODAY

The current medical research is focussed on “medicine” and not on “Science”

The core of current research evidence is Randomised Control Study and Probability based Statistics .

Probability Based Evidence - Physician’s detachment from the dynamic principles of Basic science which best explains the nature of patient and disease.

Medical(Mechanical)evidence

Understanding - The physician is made deprived of “Science based reasoning .Wisdom – The physician is not allowed to apply wisdom .

What is lacking ??

• Medicine not led by Proven Science can turn harmful in any moment. • The medicine is applied based on “Statistics” and not “ Science”.• Today’s medicine can turn out to be tomorrow’s venom• MODERNITY DOES NOT NECESSARILY MEAN VALIDITY OF MEDICINE

DISSATISFIED DOCTOR

Is today’s EBM “evident”??

Today’s EBM is not the real EBM .

In true EBM, Evidence (Proven Science) must lead the Applied Medicine . In current EBM , ‘Medicine based proof ’ is leading the Applied Medicine .

Today’s EBM is originally just MBE ( Medicine Based Evidence)

A comparison of evidence Modern Medicine (MBE) Ayurveda (EBM)Evidence resources are published DRUG reports and journal articles (Pubmed/ Medline)

Evidence resources are published and peer reviewed LIFE SCIENCE theorems & principles to guide Applied Medicine

Applied Research Evidence Basic research EvidenceMedicine Based Evidences(MBE)

Evidence Based Medicine (EBM)

Temporarily valid Permananantly valid

Ayurveda –Evidence Based??

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Ayurveda- EBM or MBE ?

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“ svR4a svRmaloCy y4a sMwvm4Rivt\|A4a@yvSyet\ tTve c kayeR c tdnNtrm\||“EVIDENCE (TATWA) APPLIED MEDICINE(KARYA)

Evidence Based Ayurveda

Evidence Based Ayurveda is Ayurvedic Medical decision making and action based on systematic scientific critical appraisal of Basic Science( Ayurvedic) Evidences in patient health care .

Present scenario

• Poorly recognised by the majority of physicians of Ayurveda in India .

• No specific knowledge regarding EBA to medical students and physicians .

• Absence of EBA Physicians provides little stimulus for the development of specific protocols of EBA .

Bruhathrayees

• Imperative resource for medical decision making .• Evidences formed after scientific evaluation and best peer

reviewed for over centuries. • Evidences based on “ Basic science of human life ”.• Evidences deemed safest and effective by unbiased scientists .• Evidences which aptly guide Applied Medicine .

VALIDITY

The most scientific theories do not change in their fundamental understanding.

No amendment possible means “truly scientific” .

Could be best simplified and applied on target.

Five fold evidences in Ayurveda Scientific Principles • Roga tatwas- Disease oriented principles • Rogi tatwas- Patient oriented principles • Bheshaja tatwas- Treatment Principles• Kaala tatwas – State and stage (disease and

patient) oriented principles• Phala tatwas- Effect determinant principles

Current Ayurvedic research

• Disconnected from basic science.• Deviated from Five- fold evidences.• Absence of scientific reasoning (Tarka).• Probability based statistics.• Unscientific Double blind studies and Placebo

control

What to re-search?

Appraisal of Evidence Application of Evidence.Optimization of Evidence in new health care

requirements . Science based Quality control of Ayurvedic

drugs & formulations.

Current problem in Ayurveda

Ignorance of Evidence Based Medicine

Blind hunt of Medicine Based Evidence The Drug action is unpredictable

without Evidence Based Medicine .

Medicine Based Evidence

Conflicting opinionsMisinterpretation of research outcome by Modern scientific parameters.Research outcome mostly benefit Modern Medicine.Research outcome immaterial to Ayurveda

WHAT DO WE LACK??

WE HAVE STABLE EVIDENCE OF BASIC RESEARCH

WE LACK : APPRAISAL OF EVIDENCE APLICATION OF EVIDENCE

INFACT IT IS’’ WE ‘’WHO ARE LACKING , NOT OUR SCIENCE

EVIDENCE APPRAISAL

Evidence appraisal refers to the process of

systematised examination and analysis of Five fold evidence to evolve scientific standards from them relevant to the medical context to streamline the therapeutics for attaining effectiveness of therapies

A Novel scientific technique for appraisal of evidences are mentioned for the first time in Ayurveda in this book known as EVIDENCE TRIAD APPROACH (ETA)

WHY EVIDENCE APPRAISAL?!

• Trains you for “on the target prescribing”.• Transforms you into a true “Bhishak”.• Enables you to choose the simplest & best

Evidence Based intervention for your patient.• Minimises the number of drugs in your

prescription just to one or two.

When EBA is practised

No separate logic of treatment for each specialist.Each specialist would be the best Doctor integrator of various systemic pathologies.Diagnosis of one integral disease behind multiple symptoms is possible. Implementation of the best appropriate evidence .

Why do we mimic Modern Medicine?

Obsessed by Western charm Ignorance .Misunderstanding.Diffidence .Excessive commercial interest.

Only Solution

• TRAINING& WORKSHOPS ON PRACTISE OF EVIDENCE BASED AYURVEDA.

• ALL IDEAS ARE USELESS UNLESS WE APPLY THEM .

• THIS BOOK INCORORATES SOME BEST PRACTICAL SOLUTIONS .

• THIS BOOK INCORPORATES SIMPLE AND DIRECT STEPS FOR GUIDANCE IN PRACTISE OF EBA.

Finding Evidence-Based Answers to Clinical Questions I need Example Evidence resources to

consider

An overview of a particular disease, condition or background information

How to evolve the pathogenesis of Dengue fever in Ayurvedic terms?I have a Dengue suspicious patient , hence need an immediate overview of the condition

Five fold Evidence

Drug action Which Treatment Principle is appropriate for my patient with HTN? Vataanulomana /Pittanulomana ?

Five fold evidence

Finding Evidence-Based Answers to Clinical Questions

Best recommendations for disease

management

What is the best Treatment Principle for my patient with DUB ? How to decipher the patient particular samprapti in Ayurveda?

Five fold evidence

To solve confusions : Why does Amrutharishta fail to check fever in my patient?What should I understand when my patient’s joint pain shoot up after Sneha sweda??

Five fold evidence

Information to share with patients

What specific Pathya should I suggest to my patient ?What Apathya should I ask him to avoid ?

Five fold evidence

ART OF PRESCRIBING

Abandon This medicine – That disease Approach.

Adopt Treatment Principle (Evidence) based Clinical Practise & Research .

Medicine Based Prescribing

Unscientific Unpredictable

Dangerous Destructive

Why not Evidence Based Ayurveda?????

Commercial gain

EBA “HEALTH FOR ALL”

World wide acceptance

Today, world is not accepting Ayurveda, only because it is practiced ‘Medicine Based’ and not ‘Evidence Based’

EVIDENCE BASED AYURVEDA

Why not practise EBA??

Modern Medicine –PROBABILITY BASED

Modern Medicine is only MEDICINE BASED EVIDENCE .

SALIENT FEATURES OF BOOK“EBA&RP”

• ENABLES YOU TO KNOW AND PRACTISE EVIDENCE BASED AYURVEDA .

• INCORPORATES NEW TECHNIQUES ON HOW TO MAKE THE BEST USE OF OUR EVIDENCES .

• EMPHASIS ON HOW TO DEAL WITH THE COMMON CONFUSIONS IN MEDICAL DECISION MAKING.

• GREATER COVERAGE OF APPLIED ASPECTS IN MEDICINE • MAKE US COMPETENT AND CONFIDENT IN OUR

CAREER

Conclusion

Let us stop living in science as if we are asleep !!

Let us ponder into our Basic Science and streamline evidence by their organized application!

Let us recognize and practise Evidence Based Medicine ! Let us adopt the best scientific ways to serve the mankind!

ONLY WE CAN PRACTISE EVIDENCE BASED MEDICINE IN REALITY

LET US SHOW THE WORLD THE WORLD THE STRENGTH OFEVIDENCE BASED AYURVEDA

ATTENTION PLEASE!

xuw. wUyat\....Have a GREAT Year Ahead!