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India’s medical tourism sector, largely confined to allopathic treatment (barring Kerala), received a major fillip with the World Health Organisation selecting India to host the first and only WHO Global Centre for Traditional Medicine (GCTM). Prime Minister Narendra Modi, Mauritius Prime Minister Pravind Kumar Jugnauth and WHO Director-General Tedros Ghebreyesus, laid the foundation stone of the Centre in Jamnagar, Gujarat, on April 19, 2022. Interestingly, Mauritius has been observing Dhanteras as Ayurveda Day since 2017.
India’s Traditional Medicine systems (Ayurveda, Siddha, Unani, and Sowa Rigpa of the Himalayan ranges) and other world traditions will now be studied and preserved at the GCTM. Jamnagar was selected as it established the world’s first Ayurvedic University five decades ago, and hosts the Institute of Teaching and Research in Ayurveda. The Traditional Medicine industry has been growing exponentially since 2015, and is currently worth $18.1 billion annually. It is expected to touch $23 billion by 2022-23. The central budget for Ayush promotion for 2022-23 has been raised to Rs 3050 crore.
Yoga at Olympics
The intangible benefits of Yoga have long been recognised across the spectrum. Yoga is now being clinically studied at NIMHANS, AIIMS, and S-VYASA, for its therapeutic value in the treatment of non-communicable diseases such as diabetes, cancer, hypertension, and psychological problems like depression that is known to cause loss of grey matter in the brain. Yoga helps in memory loss associated with mild cognitive impairment.
Breathing techniques taught in Yoga expel bodily impurities and heal the body in a non-invasive manner. Yoga is compatible with other medicinal systems. The Integrated Oncology Guidelines framed in 2014 with European and US participation found Yoga helped cancer patients to cope with fatigue, nausea, and depression. Western doctors are urging recognition of Yoga and insurance coverage for yoga therapies.
India has now taken a quantitative leap by promoting Yoga as a sport to attract children and the youth. This, combined with the pull of International Yoga Day (June 21) could make Yoga a truly global phenomenon and eventually have it accepted as an Olympic sport. This requires acceptance in at least 80 countries; so far, 35 are on board.
The National Yogasana Sports Federation, affiliated to the World Yogasana Sports Federation, believes that making Yogasanas an Olympic event would expand awareness of yoga and its myriad mental and physical health benefits. It began laying the foundations for this goal by conducting national championships in yoga in 30 states; a world championship will be held later in 2022. Interestingly, the first World Yoga Championship was held in 1989 in Montevideo, Uruguay, so this may not be a very far-fetched ambition.
NYSF president Udit Sheth points to the need to train coaches and judges, besides the athletes. Curriculum is being framed for teaching asanas, standardising the system of scoring, and refining the asanas with the aid of technology and artificial intelligence. Using the Karate Model, where white to black belt indicates the level of accomplishment, the federation in 2015-16 prepared eight levels of learning, with four levels for coaches. In 2018-19, the Indian Yoga Association met at the Coimbatore ashram of Jaggi Vasudev to hone the agenda; Swami Ramdev helped refine asanas appropriate for a competitive format. To enhance the appeal of the sport, the federation has asked the centre to include Yoga in the proposed Ayush Visa for foreigners coming to India for treatment or study.
The WHO Global Centre for Traditional Medicine will be a game changer for traditional medicine which, for millions across the world, is often the first line of treatment. It will create a database of traditional knowledge systems using technology; create international standards for testing and certification of traditional medicines to enhance confidence in these medicines; evolve as a platform for global experts of traditional medicines to share experiences; and perhaps host an annual traditional medicine festival. The GCTM will mobilize funding for research in traditional medicines and develop protocols for holistic treatment of specific diseases so that patients could benefit from both traditional and modern medicine. It has been tasked to ensure that indigenous communities benefit from their intellectual property.
The Government of India has extended a grant of US$ 250 million to the GCTM. As many as 170 out of 194 WHO Member States use traditional medicine, and their governments urged WHO’s support in creating a body of reliable evidence and data on traditional medicine practices and products.
The medicinal value of plants has been known to diverse communities across regions who shared this knowledge freely, without putting a price on it, an “open source model”, as Prime Minister Narendra Modi put it. Ayurveda and Yoga together offered India holistic health for over five thousand years. During the Covid pandemic, both proved especially helpful for India and the world, boosting immunity and countering stress.
The post-Covid world offers enormous scope for Traditional Medicine systems, and vast employment opportunities in the creation of supply chains, diagnostic tools, telemedicine. For farmers, it offers an opportunity to grow medicinal plants and trees; the FSSAI is currently finalising regulations for exports and framing guidelines for Ayush Aahar.
The Centre plans to launch an Ayush Visa for medical tourists seeking Ayurveda treatments in the country, especially in the Himalayan Hill States where infrastructure is being developed to facilitate wellness centres. An Ayush Mark will help in branding products to certify quality. The union ministries of Ayush and Commerce and Industry are also setting up an Ayush Export Promotion Council.
An Ayush-pedia online portal on the lines of Wikipedia has been proposed, and the Charak Ashram of Kotdwar will be recreated with help from the Archaeological Survey of India.
An episode in the epic, Ramayana, shows Hanuman going to the Himalayas to get a life-giving herb for Laxman. The National Institute of Sowa-Rigpa, set up in Leh in November, 2019, provides free medicine and therapy through OPD and regular camps. A Sowa-Rigpa Traditional Knowledge Digital Library has been set up with CSIR-TTKDL Unit Delhi. Traditional healers are being trained to strengthen public health in remote areas, and the cultivation of endangered and commercially viable medicinal plants of the Trans Himalayas encouraged.
Sowa-Rigpa, Science of Healing in Bhoti (Tibetan) is one of the oldest, living, and well documented medical traditions in the world. Widely practiced in Ladakh, Himachal Pradesh, Arunachal Pradesh, Sikkim, Darjeeling, and Tibetan settlements in India, as well as Central Asia, it was formally included under the Ayush system of medicines in 2010. The visual examination of urine is a distinctive diagnostic tool in this system, besides examination of the tongue and pulse.
As a vast number of pharmaceutical products are based on natural substances, mainly plants, there is urgent need to conserve biodiversity and sustainability. The popular aspirin derives from the bark of the willow tree, the contraceptive pill from the roots of wild yam plants, and child cancer treatments have been based on the rosy periwinkle. Nobel-prize winning research on artemisinin for malaria control can be sourced to ancient Chinese medicine texts.
Modern scientific methods are now being utilised to study traditional medicine. Artificial Intelligence is used to screen natural products for pharmacokinetic properties, and magnetic resonance imaging (MRI) is used to study brain activity and the relaxation response following meditation and yoga.
Medicinal plants thus offer a huge opportunity for farmers. However, but most pharmaceutical companies at the Global Ayush Investment and Innovation Summit (GAIIS) voiced concerns over sourcing of materials. They mooted protocols for growing medicinal plants, with national level certification, training of staff, labs, etc. The National Medicinal Plant Board could set up a Digital Platform and notify the khasra number of each field from where plant material is taken. All plants must be organic, no urea or fertilisers used.
Industry leaders mooted sales through the Forest Department, as is the practice in the north east. Alternately, villages can be organised at district level. Medicinal plant farmers could form a consortium to provide data on industry needs from each plant species, with testing facilities for each plant. The Indian Council for Agricultural Research must standardize the methodology for evaluating bioactive markers in plants, so that there is no lab-to-lab variation.
Emphasising the importance of data, Acharya Balkrishna, MD, Patanjali Ayurved Ltd., pointed out that the bioactive compound in haldi (turmeric) and ashwagandha is different in different states, and needs a biomarker. He lamented that the Arjun tree takes 30-40 years to grow, but dies when the bark is taken. The forest department suggested that bark could be provided from trees felled for other reasons. Balkrishna said afforestation must be increased in mountainous regions, and mooted proper training of farmers in the cultivation of medicinal plants, with increased geo-fencing and geo-tagging.
The addl. Director-General, Forests, said tissue cultivation could harness plant material from endangered forest species. But certification of seed source is imperative under WTO provisions, and only Uttar Pradesh has undertaken certification so far. The seed, bark, flowers, roots, all need certification of source, and guarantee of purity (no pesticide). However, he stressed that the Forest Departments need to know how much product is needed by industry and when. The sector being unorganised, poses impediments for industry. Around 20 lakh hectares are cultivated by farmers so far; there are seed banks for 42 species and germ plasm for 20 species, but much remains to be done. E-Charak is documenting all species in the Medicinal Plant Conservation Area.
Global AYUSH Investment & Innovation Summit
The charkha-shaped Mahatma Mandir, Ahmedabad, hosted the three-day investment summit that ended on a promising note with the Ayush sector receiving letters of intent of over Rs 9,000 crore in major categories such as FMCG, Medical Value Travel (MVT) and services, pharmaceuticals, technology & diagnostics, and farmers & agriculture. These are expected to generate around six lakh jobs. The Union Defence Ministry signed MOUs for ayush benefits in hospitals in 37 cantonment areas.
The Union Science and Technology Ministry has proposed joint research and a joint PhD program with the Council of Scientific and Industrial Research. There are plans to develop a network of AYUSH parks to encourage the promotion, research and manufacturing of AYUSH products across the country.