A faculty member at a top ayurveda college has renewed calls on regulatory authorities to revise the curriculum and develop standard treatment protocols after a study revealed arbitrary diagnostic and treatment strategies adopted by a sample of ayurveda practitioners.

The study, based on responses from 141 ayurveda practitioners from across the country, has found that treatment plans lacked uniformity and were guided by personal experience rather than ayurvedic principles of physiology and disease, including the fundamental "tridosha" theory.

The findings pointed to a lack of consensus among the ayurveda practitioners about diagnostic decisions and interpretations of disease mechanisms that at times led to conflicting treatment plans, researchers at the Banaras Hindu University (BHU) who conducted the study have said.

“Different physicians adopt different interpretations of the key principles taught in ayurveda such as tridosha. This can lead to contradictory or opposing treatment plans,” said Kishor Patwardhan, a professor with the faculty of ayurveda at BHU’s Institute of Medical Sciences who led the study.

The study’s findings were published this week in the Indian Journal of Medical Ethics.

Patwardhan had two years ago through a paper in the IJME urged the National Council of Indian Systems of Medicine, the apex regulatory body for traditional systems of medicine, to drop obsolete concepts and subject the principles of ayurveda to rigorous scientific scrutiny.

Over 500 ayurveda colleges in the country offer a five-year programme in ayurvedic medicine. Market analysts have documented a growth in ayurveda products, with one research report estimating that the market for ayurveda, yoga, siddha, unani and homoeopathy products grew from $2 billion in 2014 to $18 billion in 2020.

The tridosha theory proposes that health and disease are governed by three primary regulatory forces called the doshas — vata, pitta and kapha — whose levels and imbalance in the body determine health and disease processes.

Much of ayurveda treatment seeks to maintain or return the doshas into a state of “equilibrium” or “balance” through a combination of diet, herbal remedies and lifestyle changes.

For the study, Patwardhan and his colleagues Mayank Chauhan and Vijay Srivastava sent an online survey to experienced ayurveda practitioners, asking them to diagnose and recommend treatment plans for five “case-scenarios”: dual-cause anaemia, intervertebral disc prolapse, Covid-19, a skin disorder called pompholyx and male infertility.

Ayurveda education places high priority on a concept called “prakriti” — a specific proportion of the doshas unique to every person and expected to play a role in drawing up a personalised treatment plan.

The study found that efforts at such personalisation through a determination of prakriti was “greatly subjective” without any uniformity. The ayurveda physicians assessed the five illnesses in different, inconsistent ways.

Some appeared to simply disregard prakriti. For instance, the questionnaire intentionally excluded information on prakriti in the intervertebral disc prolapse patient. However, only seven of the 67 physicians who addressed this illness pointed out the absence of this major factor.

Some physicians identified a disease as associated with the vata dosha, while others identified the same disease as associated with the kapha dosha. Such interpretations led to contradictory or opposing lines of treatment plans, the study has found.

“If the content being taught is not being applied in a uniform, reproducible, and meaningful manner, the validity of the subject content itself becomes questionable,” Patwardhan and his collaborators have said in their study.

They have called for “an urgent review” of ayurveda education and practice to address what they have described as weaknesses in the physiological and pathological concepts taught in ayurveda and eliminate unsubstantiated ideas.

This includes a concept called “bhuta vidya” that deals with combating diseases produced by “supernatural powers”.

The introduction of contemporary anatomy, physiology, biochemistry, pathology, and cell biology along with modern diagnostic methods would add value to ayurveda education, they said in their paper.

Alongside the revamp of ayurveda education, Patwardhan and his colleagues have also sought the creation of a database that documents what treatment plans are actually beneficial to which sets of patients through a long-term observational study.

Patwardhan had in 2022 raised concerns that the current ayurveda curriculum continues to rely on ancient texts that propose, for instance, that semen is produced in the bone marrow and that the liver imparts the red colour to blood.

G.L. Krishna, another ayurveda physician and visiting scholar at the National Centre for Biological Sciences, Bangalore, who too has been campaigning for the modernisation of the ayurveda curriculum, said that while the BHU team’s calls for revisions were justified, the study design could have been stronger.

Among the 141 respondents, 79 had postgraduate qualifications and 44 had a PhD in ayurvedic medicine.