The recent controversy on X between a hepatologist and an Indian chess Grand Master, on whether practitioners of traditional medicine can claim to be doctors, has sparked much commentary on the role and the status of practitioners of traditional Indian medicine systems such as Ayurveda and Unani, in India.

About AYUSH

• Ayurveda: An Indian traditional healing system, over 3000 years old, focusing on body balance through diet, lifestyle changes, and herbs.
• Yoga & Naturopathy: Yoga involves exercises and breathing techniques, while naturopathy uses natural methods for healing.
• Unani: An ancient medicine system with Greek-Arabic origins.
• Siddha: A traditional system primarily practiced in South India.
• Homoeopathy: A German alternative system following the ‘like cures like’ principle.

Issue of Conflict

• The primary contention is whether doctors practicing these AYUSH systems can prescribe modern allopathic medicines, which are typically evidence-based and prescribed by MBBS degree holders. 
• This conflict is not new; it dates back 80 years, even before India’s independence.

Historical Evolution of AYUSH Recognition

• Bhore Committee (1946): Officially known as the Health Survey and Development Committee, was in favour of  modern scientific medicine (allopathy). 
  • The committee noted that many countries were phasing out traditional medicine systems and left it to individual states to take a call on the extent to which traditional medicine played a role in their public health systems.
• Swadeshi Chikitsa Samiti (1948): Traditional doctors protested the Bhore Committee’s report. 
  • Under pressure, the government formed the Swadeshi Chikitsa Samiti. 
  • This committee linked Ayurveda to the Vedas and Hindu nationalism, asserting that its decline was due to British rule.
  • Faced with conflicting recommendations, the then government remained undecided on whether to remove or recognise AYUSH systems.
• Indian Medical Central Council Act of 1970: A significant step was taken with the Indian Medical Central Council Act of 1970, which granted recognition and regulation to Ayurveda, Siddha, and Unani doctors.
• National Commission for Indian System for Medicine Act of 2020:  Further support for AYUSH came with the replacement of the 1970 Act by the National Commission for Indian System for Medicine Act of 2020.

Conceptual Divide Between AYUSH and Modern Medicine

AYUSH and modern medicine lies in their fundamentally different theoretical frameworks:

• Ayurveda: Concepts are based on ‘doshas’ – three types of energies (Vata, Pitta, Kapha) that, when imbalanced, cause illness. 
  • It also incorporates spiritual aspects like the difference between Paramatma (supreme soul) and Jeevatma (individual soul).
• Modern Medicine: Focuses on cell physiology, human anatomy, and diseases caused by germs (bacteria, viruses). 
  • The distinct concepts make integrative medicine (combining both systems) difficult to implement, as “both cannot run together”.

Legal Stance on Prescription Rights

• Drugs and Cosmetic Rules 1945: Rule 2, Section EE, defines “Registered Medical Practitioner” as someone officially licensed by a system. 
  • This rule allows state governments to register medical practitioners who can prescribe modern medicines, not explicitly restricting it to MBBS doctors.
• Supreme Court Ruling (1998): In the landmark case of Dr. Mukhtiar Chand and Others vs. State of Punjab and Others, the Supreme Court clarified that “medicine prescription is part of the same system of medicine“. 
  • This unequivocally stated that Ayurveda doctors do not have the right to prescribe modern medicine. 
  • They can only prescribe Ayurvedic medicines, and similarly for Unani doctors.
• Continued Non-Compliance: Despite the Supreme Court’s clear judgment, many state governments have continued to allow AYUSH doctors to prescribe allopathic medicines, often due to pressure from AYUSH doctors for political reasons. 
  • The Indian Medical Association (IMA) frequently challenges these actions in High Courts.

The Question of Surgical Procedures

The debate extends to whether AYUSH doctors can perform surgeries or procedures like intubation (inserting a tube into the windpipe).

• Hospital Practices: It is an “open secret” that some hospitals employ Ayurvedic doctors (BAMS graduates) instead of MBBS doctors at lower salaries to perform medical tasks.
• Government Order (2020): The government released an order allowing Ayurvedic PG (post-graduate) doctors to perform 58 minor surgeries. These include gall bladder surgery, appendix surgery, and removal of benign tumours.
  • This notification has been challenged in court. 
  • A key concern is that if Ayurvedic doctors perform surgeries, they would inevitably use modern medical techniques like anaesthesia and antibiotics, despite not being educated in modern medicine for these practices.

Rethinking AYUSH Investments

• Politicisation of AYUSH: The AYUSH system is often entangled with political narratives, being projected as a symbol of Hindu pride and ancient Indian heritage.
  • Claims of the existence of Pushpak Viman or Kauravas as test-tube babies are invoked to glorify India’s past. 
  • This emotional and cultural connection can overshadow the need for rigorous scientific validation, which is essential for integrating any medical system into modern healthcare.
• Public Funding Without Proven Outcomes: The government has spent approximately ₹20,000 crore of tax payer money on research councils functioning under AYUSH. 
  • However, there is limited evidence to justify such investment in terms of health outcomes or efficacy.

Conclusion

While AYUSH systems have a historical legacy and continue to be practiced, their integration with or overlap into modern allopathic medicine faces significant conceptual, legal, and practical hurdles. 

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