SCOPE OF AYURVEDA IN MODERN ERA: NEW HORIZONS

Health is elemental for good quality of life and a good healthcare system is a cornerstone of sustainable society. World health statistics 2019 summarises that, the global health status have been improved over the decades. Even though there are phenomenal achievements in global life expectancy and infectious disease management , the new outbreaks of communicable diseases and the additional burden of Non-communicable diseases stands as a flaw in the modern medical system that emerged in 18th century. It is at this point, there exists the need of bringing alternative system of medicine to the main stream for better disease prevention and management. In such a scenario- Ayurveda (the science of life) – the science coming under the umbrella of alternative system of medicine as well as the one focussing on mind ,health and spirituality becomes imperative. The current inclination for healthy diets, immunity enhancement ,rejuvenation and lifestyle management, calls for retroactive and proactive attempts to bring Ayurveda in the mainstream of health care. . In a modern era where the whole world is inclining for Ayurveda, India -the land rich for its traditions and heritage should step forward with its own indigenous system of medicine.


ISSN: 2320-5407
Int. J. Adv. Res. 9(03), 666-675 667 In such a scenario-Ayurveda (the science of life) -the science coming under the umbrella of alternative system of medicine as well as the one focussing on mind ,health and spirituality becomes imperative.
Even though the concepts and models for health have undergone several recasting processes, the most agonising is the realisation that the Alma-Ata Declaration of 1978 -that once emerged as a major milestone of the twentieth century in the field of public health is on its 30th anniversary. It is at this point the famous statement of Padmabhushan awardee Dr.B.MHegde on health as "enthusiasm to work and enthusiasm to be compassionate" becomes relevant. Thus the older definition of health has to be amended and supplemented through various healthcare programmes to foster the concept of holistic health. Based on this perspective, Ayurveda has defined healthy life as an intelligent co-ordination of the Soul, Mind, Senses and Body with the totality of life. There is no other medical science other than Ayurveda that calls for the need of being a grantor to stay healthy. On the other aspect, the concept of ideal health can only be achieved if human beings tend to treat the rest of society including other creatures as equivalent to them. In the context of increasing crime, rapes and illegal activities, no community can be considered as healthy even if their blood pressure and cholesterol levels are in the normal limits. On the other hand, the recent outbreaks of COVID -19 has evoked awareness regarding disease prevention and health promotion . [3] The current inclination for healthy diets, immunity enhancement ,rejuvenation and lifestyle management, calls for retroactive and proactive attempts to bring Ayurveda in the mainstream of health care.

Paradigm Shifts In Concepts Of Health:
The meaning and definition of health has evolved over time. In keeping with the biomedical perspective, early definitions of health focused only on the theme of the body's ability to function. In the 5th century BC, health was defined as "harmonious functioning of the organs" by Pindar giving major emphasis on physical attributes of health . [4] The Biomedical model of medicine that emerged in mid-19 century was another model of health which defined health as freedom from disease, pain and defect. It rather focussed on physical entities, without an attempt to focus on social and psychological influences on total health. The modern understanding of health became official when the 3 Alma ata declaration of 1978 defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity . [5] It is evident from many recent studies that this definition is very limiting and does not take into account, the various dimensions of health and their interaction with each other. This declaration generated numerous criticisms and reactions worldwide and it is due to the drawback of this definition, the concept of "Health for All by 2000" became unattainable. In the year 1984, WHO shifted from the framework of health as a "state of health" to a "resource for everyday life", brought a stage of transition.Holding the concept of health is a fundamental right for humans, the first international conference on health promotion, held in Ottawa ,Canada, renowned as Ottawa charter, emphasised on prerequisites of health i.e. food,shelter,peace, good economy, sustainable resources. Highlighting the social, economic, environmental and psychological influences on health, Ottawa unlocked the door to holistic approach to health, which is the core of definition of health promotion . [6] The Jakarta declaration of 1997 which was grounded on ensuring active community participation for achieving health, provides access to health education and health information, i.e. health literacy .The millennium summit of 2000 -was another benchmark in the history of medical care and was encompassed with 8 development goals including bringing peace , partnership, eradication of poverty ,remarkably shows the stage of transition from calling health as a state to a condition influenced by psychosocial and environmental factors..S.AndrewSchrroeder in his very famous article "rethinking health: Healthy or healthier than mentioned on a comparative or a relative concept of health. His statement that health is as comparative as any physical entity or health state varies from person to person or the two different states of the same persons has aroused new thoughts . [4] "Healthy people 2020" was another nation based tactic, with objectives of identifying and reducing health disparities in a targeted period of 10 year through a preventive approach. Even though, the previous health plans and policies has brought down infant mortality rates and communicable disease incidence rates ,the rapidly growing medical expenses,poverty,additional burden of non-communicable disease has paved for National health policy 2017.It seeks to deliver an affordable but quality dominant health care service to everyone on a global basis. Disease prevention, health promotion, disease management, palliative and rehabilitative care through an integrated medical set is the uniqueness of NHP . [7]

Concept Of Health And Disease Causation: -From Demonic Theory To Illness -Wellness Continuum:
Maintenance of good health and the knowing the cause of disease were always a prime concern since the origin of mankind. Demonic theory and punitive theory, rooted on ancient beliefs of superstitions was followed by finding disequilibrium of four bodily factors as disease(Humoral theory).With the advent of germ theory by Louis Pasteur and Robert Koch, the approach for finding the causation ended in materialistic approach, where a majority of diseases could not get explained by it. In the following centuries, encompassed with multifactorial theory, web of causation theory, wheel theory and Beings theory, a complex interplay and influence of various factors including biological, behavioural, environmental, immunological, social, spiritual factors were identified and there was a paradigm shift in the approach towards management at primary, secondary and tertiary levels . [8] Even though, the whole conceptual frameworks on health, health policies, developments goals has brought an exceptional change in increasing life expectancy ,reduction in infant mortality rates and the then prevailed infectious diseases of the world, emerging diseases like ebola,HIV,Nipah,Covid-19 and non-communicable diseases are posing a threat. The growing incidence of adverse drug reactions, Microbial resistance, iatrogenic diseases are remaining as a warning sign. When modern drugs can instantly relieve acute conditions, chronic and degenerative stages are remained unnoticed. When huge amounts of money are spent on drug manufacturing, none of any neglected diseases are getting adequate and efficient medicines. High drug prices and unwanted vaccination charges are killing the common man. In addition to that, the adverse reaction from one drug is forcing the population for further spending their money. The conventional medicine system is anchored on care of diseased than health care.

Concepts Of Health In Ayurvedic System Of Medicine: -A Glimpse:
Ayurveda -the ancient system of medicine, rooted on Indian cultural and historical background is an individually tailored medical system. The uniqueness of the science as a holistic medicine is grounded upon fundamental principles like dosha(bioenergic force),agni(Metabolic fire), dhatu(tissue elements), mala(excretory wastes), atma (soul), indriya(sense organs),bala (strength)and mana(mind).Ancient Ayurveda Acharya, Sushruta has defined a man healthy, only when his doshas (Bioenergic forces) in the state of equilibrium, the digestive fire in a balanced state, tissues, and wastes working in the state of normalcy. This ancient medical system of India, delineate health on the perspective of wellbeing of mind, soul, sensory and motor organs. Acharya charaka defines a healthy person as the one acquainted with proper physique, strong sensory and motor organs, good metabolism and tolerance to hunger, thirst and varied climatic changes .
[10] Kashyapa -renowned paediatrician in the field of Ayurveda marks proper desire for food, good metabolism, proper evacuation of excretory wastes, pleasantness in sensory organs and proper sleep under the criteria for defining healthy . [11] Another physician of Ayurveda-vagbhata has described that if a person regularly practicing a wholesome lifestyle, eating wholesome food, not involved in sensual pleasures, who is generous, truthful, forgiving in nature, who is service-minded and helpful to one"s own kin -will remain unaffected by diseases .
[12] It is highly evident that Ayurveda is a pure medical science that views health as not merely the good built nor the mere absence of disease, but the one that is strongly influenced by somatic, sensorial and psychological factors. In the current era of moral deterioration, a health system upholding behavioural and moral values is astounding. The multidimensional approach of Ayurveda portrays an integral relation between body and mind. Deranged intellect, memory and patience are counted as the root causes of sickness. The Recent trends in the field of pshyco-neuro-immunolgy and the emerging papers on impact of stress on metabolism and health glorifies the contributions of Ayurveda.
According to CDC, in order to attain a healthy equity, genetics, behaviour, environmental, and physical influences, medical and social factors are identified as determinants of health .Among these factors, nutrition, lifestyle modifications, behavioural factors could be viewed as modifiable .The American college of life style medicine has stated that almost 80% of chronic diseases are preventable and controllable through lifestyle modifications as medicine. In this century of rising consensus on dietetics, nutrition and lifestyle modifications, it would be appropriate to incorporate traditional knowledge to solve the problem. [13] In alternative to modern concept as maintaining the patient as a passive participant and conquering the disease through vaccines and antibiotics, Ayurveda coming under the branch of traditional medicine, ensures a patient centred and finds the sufferer as an active contributor in treatment.

Components Of Health In Ayurveda:
Ayurveda -the science of life proposes the incoherent harmony between human and their environment. This medical system suggests lifestyle modifications and dietary guidelines to bring consonance between physical, mental and spiritual needs of mankind. The central of Ayurveda health principles attempts on dynamic efforts to monitor, preserve and promote individual and global health status.Ayurveda includes individual, social and global health care under the whole definition of health. Ayurveda approach is designed at two levels i.e. disease prevention and disease management. Preservation, health promotion and primary prevention of physical and mental ailments are told under the preventive aspect, whereas eradication of diseases, halting the disease progression, prevention of relapses comes under the second category. In the scope of personal heath, Ayurveda advocates guidelines on the levels of biological, psychological and spiritual perspectives. The idea of personalisation commences with the concepts of prakrithi(body type) and doshawhich are fundamental in understanding human body type for procuring adequate treatment. Regular intake of healthy diet, adopting healthy regimens, hanging on to attempts for bringing prosperoussociety and proper control overs sensorium are explained as the secret behind staying healthy. . The present unprecedented situation with corona has evoked further thoughts on essential mental health for an individual. This pandemic has created disrupted individual mental health status. It has seen stated that there are relatively higher incidence of anxiety disorders(50.9%),depression(48.3%),post-traumatic stress disorder (53.8 %) and stress (81.9%) in countries like china, Spain, Italy, turkey ,Denmark etc . [14] The turmoil evoking manifestation of ruined global mental health persuades to re explore Ayurvedic principles for a healthy mind. Ayurvedic interventions like satwavajayackitsa,yoga,shodhanaand external therapies are to be brought forward as an armour. behavioural influence on disease causation in his work on" Airs, Waters, and Places," is a gentle yet profound reminder of similar catastrophes. Man has brought drastic devastation to all the three components of environment and not surprisingly ill health is precipitated by adverse environmental factors such as water pollution, soil pollution and air pollution. Ayurveda in the chapter of janapadhowamsa has pointed that the onslaught of adharma and prajnaparadha are the root causes of every pandemic.This novel corona virus pandemichas uprooted all our contemporary perceptions and priorities on health, wealth and power. On the occasion of World Earth Day, April 2, 2020statement by UN Secretary-General AntónioGuterres was as follows"We must act decisively to protect our planet from both the coronavirus and the existential threat of climate disruption. It is at this point,the pressing need to conserve our nature and ethical and moral guidelines to be followed in society as per Ayurveda further makes this traditional science impetus one.It forces the need of following an ethical code of conduct, to attain a mental status to feel that good happenings in a society can also aids pleasure to one"s own mind and sensorium. A comprehensive knowledge about physical, mental and spiritual wellbeing, optimal union of intellect, patience and memory, withdrawal from violence, jealousy,competition,ego as well imbibing Ayurvedic dietary guidelines such as clinging to satwikaahara for the mental and spiritual upliftment is essential.

Ayurveda On Prevention Of Disease Occurrence And Recurrence:
There had been marked changes in India after the year of 1970.We are exposed to a global community where we are forced to use genetically modified grains, tinned foods, alcoholic beverages and Teflon coated utensils. The majority of global populations runs behind competitions and target achievements in business ending up in severe stress. People are forced to take sleeping pills and tranquilizers following stress disorders. While evaluating the current health status and practices of modern era, it is highly evident that the ill practices and unawareness of mankind is welcoming the most of disease burdens. In today"s modern world, we are emitting a lot of carcinogenic and disease causing factors to our environment. The trend of burning every mere things is becoming a part of our culture. Around the world a double decker bus load of plastic is burnt every second. It is said that 70 million metric tons of plastics are burnt or dumped annually. Not only plastics, but tons and loads of leather materials and papers are burnt .There was an incidence of Delhi judges accusing the authorities for "passing the buck "on air pollution and failing to take action to tackle Delhi"s toxic smog by last year. It is quite surprising that we are not aware of the presence of a lethal substance -bisphenol in the urine of more than 93 percent of US adults. The chemical is still used in the manufacture of polycarbonate plastics causing hypertension, insulin resistance, thyroid dysfunctions and oxidative stress . [15] . Our temporary pleasures and unawareness are bringing a lot of morbidities. As this is a period, where the effort to avoid getting sick is better than treating the illness, prevention of environmental pollutions should also be given a prior position.
Ayurveda owes a unique position in healthcare systems worldwide. Beginning from the need of a stay back from worldly attachments, it brings about the caution of standing away from the temporary pleasures. Ayurvedic science has always paid priority to the ideology behind achararasayana, where one is asked to take a balanced diet, satwikaahaara, good sleep, to restrain from worldly attachment and misbehaviours sprouting at the level of bodyas violence, at vaakas verbal assaults and to possess submissive and compassionate mind-set at the level of mind. Ayurveda is not merely a medical system, but it also employs and suggests a way of life, eco-friendly and cost effective therapy for physical , mental and spiritual wellbeing.
Patent body channels, unimpaired metabolism, unvitiated state of doshas ,uninterrupted movements and circulation of metabolites, properly functioning tissue elements, pleasant sensorium stands a major criteria to attain complete health. The three fold ,8 fold and 10 fold health examinations are the key to successful diagnosis and treatment in Ayurveda. The fundamental principles of disease pathogenesis in Ayurveda is due to imbalances in various bodily functions like metabolism, absorption, secretion, circulation and excretion. Ayurveda identifies genetic abnormalities, disordered lifestyles, impaired metabolism, misused sensorium, altered immune system and trauma as the reason of disease causation and recurrences. We live in a world where there are higher chances of disease recurrences in a pathology where there are sufficient factors to precipitate the same. Frequent detoxification, revival of agni and dosha ,prakritistahapana ,rasayana and vajeekarana procedures are to be put forward in favour of getting the lost health. The exclusive descriptions on daily regimens, seasonal regimen, timely detoxification, neonate care, menstrual hygiene and the need of being in sajjana for the procurement of healthy life is peculiar to Ayurveda .There is a unique contribution of Ayurveda entirely dedicated for immune enhancement, extending healthy life span and nourishment which is termed as Rasayana in ancient literature. Rasayana therapy gives a ray of hope for positive health as well as in prevention of disease recurrences by boosting immunity and body strength . [16] 672

Practical Guidelines For Implementing Concepts Of Health In Society:
Although there had been remarkable achievements of health indicators, increase rates of Lifestyle disorders, iatrogenic diseases, decline of mental health, adverse drug reactions, environmental deterioration have lead the people think of an alternative integrated health system .National and state health campaigns using Ayurvedic wisdom on the arenas of dietetics and nutrition, swasthavrthafor a healthy life, lifestyle modifications sexual conducts, moral-psychological and ethical guidelines should be implemented. State and local AYUSH health information boards are to be established for creating awareness. There should be adequate man power training in this field where BAMS graduates, Asha workers, Ayurveda practitioners, college students gets sufficient training to become an active participant. There is a necessity to include regular cultural events, awareness classes, youth clubs, women"s clubs, palliative centres under the provision of health policy to ensure effective participation of community. School health education programmes can be considered as the effective strategy that a country should use to control health related problems. Awareness classes, parent counselling, practical demonstrations, social clubs should be incorporated in curriculum.. The doctrine of Ayurveda on dietetics, daily and seasonal regimens, exercise ,yoga, good sexual and behavioural conduct are to be considered to guide future national health policies. Yoga rooms, meditation centres, recreation areas are to be built separately at schools and offices for a mentally healthy future generation. Women"s clubs are to be encouraged to present on issues and guidelines related to menarche, menopause, sexual infections, prenatal and post natal care.

Applied Researches On Health Preservation:
Ayurveda is an indigenous system of medicine with unparalleled historical knowledge. Ayurvedic literature with history of more than 5000 years was written in structured formats and were evolved out of scientific discussion among Acharyas. The ancient textbook with holistic approach has undergone several redactions and validations, casting an impression of good researches and evidence based protocols once evolved. After the time period of visionary Acharyas, this system of medicine has not embraced scientific discussions and evidence based actions as before. There exists a discontinuity in the evidence based actions for the past 1400 years. Unprecedented updates on these sciences causes a huge set back in its implementation. The only forms of researches are connected with MD and PhD works, where the sample size is less. The parameters and markers for assessing and analysis of data is limited for Ayurveda and there exists a pathetic situation that researches regarding the Ayurveda subjects are carried not under the domain of Ayurveda ,but under the allied sciences. After a gap analysis, it is imperative to move towards the mainstream. A solution is urgently required through governmental efforts, research and quality measures. Generation of evidence on the fundamental principles and at the same time, incorporation of modern technologies without compromising the science is the main challenge The science rooted in its own soil should be even upgraded at the level of PG and UG. Moreover, there is an urgent need for evidence based research for global recognition and acceptance of Ayurveda. Research protocols should be designed on the basic concepts of Ayurveda like agni, prakrithi, srothas, rasayana, dhathu,ojas and ayurvedic concept of metabolism and bioavailability. There is a need of involving all basic sciences such as biotechnology, system biology, chemistryfor bringing better outcome in potentials of Ayurveda.

Model Health Care System And Its Propagation:
The current medical system which is doctor-disease centred is not giving enough room for hearing the concerns of patient..Its already late to wipe the existing wrongful trend as care for the diseases. Instead, primary prevention has to be given much importance. It may be at this point, Dr.Margaretchan, director general of WHO, made a crucial statement in the year 2008, on the then medical care. She exposed a fact that multi-billion dollar industry have lead the poor man move towards much more comprehensive, holistic and personalised health care that observes and diagnose the patients, not merely his lab reports. The past years of medical services were in the clutches of private sectors that mad the common man inaccessible to get his fundamental right .Now the present era of COVID -19 has brought an upside down inversion of the existed scenario. Bypassing private sectors, doctors were enabled to move to ground levels for affected people .Strengthening public sector, converting public institutes into COVID first line treatment centre and making active community participation was the need of the hour. Following the attacks of COVID-19, the inclination for immunity enhancement, primary prevention, rejuvenation and lifestyle modifications is increased. So a health plan which is patient centred, personalised, technology driven, and integrated health care is to be suggested. An integrated health care system plan has to be submitted to uproot the deficits in the present system. There should be such a setup in hospital where the patient can choose the needed health care system of his choice functioning under the umbrella of a single hospital. There should be integration in such a way that people are benefitted in all cases from the best option for specific disease. The concept of ICU in Ayurveda centres where Panchakarma for acute cases is to be considered. Establishment of preconception care units supported by IVF units 673 and Ayurveda gynaecology as well acute and chronic diseases management through different streams under the same umbrella is aspiring. There should be Ayurveda obesity cells and additional rejuvenation cells in hospitals carrying chemotherapy and organ transplantation..There should be sufficient incorporation of technologies for telemedicine, developing self-assessment apps and evidence based protocols. Ayurvedic nurses, therapists, dietician, pharmacists, are to armed with sufficient training. Thus a strategy has to be moulded with effective educational reforms, centres of excellence, rejuvenation units and Ayur restaurants for patients. In such an era of emerging questions about the need of integrative medicine ,more initiations should be taken at national and international level for integrating this alternative systems at the levels of primary health centres and hospitals .There should be great initiations to create the awareness on this life science and its effective implementation through medical institutions, medical officers, medical colleges and even through the internship trainees .Recruiting an Ayurveda doctor altogether for three or four dispensaries, for the mere spreading of awareness and providing good health care services including free medical camps, maternal care services, antenatal and new born care as well as inclusion of Ayurvedic medicaments in vaccinations should be welcomed. promotions and health plans regarding Ayurveda should begin and communicated via kudumbasree projects, local panchayath bodies, and PTA"s. Along with that, we must also look forward into health systems of other countries like Japan, Norway, and Sweden for their highest positioning in the health care field worldwide. On exploring their health plans, it is revealed that theses health care system has given prior importance to their own indigenous systems of medicines .Japan, apart from other western countries have tightly holded their own kampomedicine and acupuncture for the wellbeing of their community. The initiations taken by MAYO clinic and National centre for complementary and alternative medicine should be set as great examples for the promotions of integrative medicine.
India is a country very renowned for its rich heritage in the field of traditional medicine. It is a country with all kinds of resources that can aid for a full blown health status. In a modern era where the whole world is inclining for Ayurveda, India -the land rich for its traditions and heritage should step forward with its own indigenous system of medicine. We should develop standards and deeper practices for the propagation of this science of life rooted in holism. Its potential influence and relevance should be highlighted in this era of epidemics and non-communicable diseases. Thus our country India should set an example for ideal health care system before the world.