Not many know it but Ayurveda has a long tradition of surgery, says Hemantha Kumar, professor at the National Institute of Ayurveda, Jaipur. He cites Sushruta, the sage from 500 BC known in India as the “father of surgery”. “In his treatise Sushruta Samhita, he had even referred to over a hundred kinds of surgical instruments," he says. "Scissors, scalpel, needles used in surgeries today were first designed in India. Like it or not, Sushruta has given the techniques to the world.”
So, on 19 November, when the Central Council of Indian Medicine (CCIM) issued a notification allowing Ayurveda surgery students who had completed their post-graduation to perform certain surgical procedures, Prof. Kumar thought it was long overdue. The list includes 58 types of general, dental, ENT and ophthalmological procedures.
The notification, however, has led to a storm in the medical community. In a statement, the Indian Medical Association (IMA) said it was “corrupting modern medicine by mixing with other systems and poaching the disciplines of modern medicine through the back door”. This was “foul play of the first order”, it added, demanding the notification be withdrawn immediately.
Prof. Kumar, who heads the department of Shalya Tantra at the Jaipur institute, was perplexed. “Three out of 14 departments in Ayurveda, namely Shalya, Shalakya and Prasuti Tantra, involve surgeries. We have been doing it for years. I have been teaching them myself.”
The CCIM agrees. In a press note on 22 November, it said the details of these surgical procedures were already laid down in the syllabi of Ayurvedic postgraduate courses decided by the CCIM. “The present clarification was issued in overall public interest by CCIM by bringing the said details into the regulation. Hence this does not signify any policy shift.” It did not mention why it felt the need to issue the notification at this point.
From the medico-legal point of view, the surgeries aren’t—and weren’t—illegal. The notification has, however, made public questions of whether Ayurvedic surgeons and hospitals are equipped to train aspiring surgeons. In an indication of how knotty this debate can be, some Ayurveds have reservations about their colleagues conducting surgeries, while some practitioners of modern medicine believe there is such a shortage of health infrastructure that all streams of medicine can lend a helping hand.
There isn’t much difference, it seems, between the approaches to surgery in modern medicine and Ayurveda. “The techniques are similar, although allopathy often uses advanced technology,” says Prof. Kumar. “Our surgeries are mostly minor and moderate, and often cost less than private allopathic hospitals. In dental procedure, for example, we will do a tooth extraction, not a transplant.” Often, Ayurveda colleges employ modern medicine practitioners as anaesthetists. For post-operative care, they prescribe antibiotics and painkillers used in modern medicine. “In at least seven states in India, we are legally allowed to do that,” adds Prof. Kumar.
The question, then, is about training and regulation.
What Ayurveda lacks, says Raghu Ram, president of the Association of Surgeons in India, is the ongoing research and rigorous regulatory oversight that modern medicine hospitals have.
“Surgery is an art and science,” says Dr Ram. “It involves technical expertise; you need to attend many workshops to standardise training and impart it.” The infrastructure of training, research and exchange of knowledge in modern medicine is much better evolved, he adds. “Many surgeons write about how many operations they have done, how many and what kind of complications occur. These are then published in peer-reviewed journals across the world. Do Ayurvedic surgeons do the same to the same extent? The answer is no.”
Satya Dornala, a specialist in Panch-Karma detoxifying therapy at the Delhi-based Swami Vivekananda Ayurvedic Panchkarma Hospital, says the notification sets a worrying precedent, in that it “takes the arc of modern medicine under the banner of Ayurveda”. There have been, he notes, instances of Ayurvedic doctors prescribing modern medicines post-surgery even in states where it is not allowed.
“I spent 10 years as a student at a government-funded Ayurvedic college,” he says, adding that he would rather not name the college. “I strongly say, my college wasn’t equipped to perform these surgical procedures (listed in the notification). In fact, nearly 95% of Ayurvedic institutions in the country are not equipped with the necessary infrastructure, skilled manpower and supporting staff to impart quality training.”
Between 2016-18, the CCIM itself found at least 138 Ayurveda colleges unfit to run undergraduate or postgraduate courses. Yet, a 2018 report in Business Standard noted, the Union Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) ministry had not closed these.
In any case, India suffers significant gaps in healthcare infrastructure. According to research earlier this year by Brookings Institute, a US-based policy organization, the country has only 0.55 beds per 1,000 people. According to a government statement in Parliament in 2019, there is only one modern medicine doctor for every 1,445 Indians. The World Health Organisation’s norm is one doctor per 1,000 people.
“There’s a stark difference in the kind of facilities available in India based on where you live,” says Sambit Patnaik, a visiting surgeon at the Apollo-Spectra hospital, Mumbai. “In a city like Mumbai, you would be spoilt for choice. Seventy kilometres away, in Lonavala, you would find people running to a baba or witch-doctor instead of a hospital. We need a helping hand from all specialities to run the show in India.”
For all its shortcomings, Ayurvedic surgery has changed from the time of Sushruta, says Dr Patnaik. “Today, they have borrowed a lot of technology from modern medicine. They are using camera, cutting devices, laparoscope, and almost everything available in modern medicine. I have also seen Ayurvedic surgeons do surgeries that are more complicated than the ones listed.”
At the end of the day, he says, it depends on the quality of institutions surgeons train in, and how much effort they make to keep up with evolving surgical practices. “India has an ocean of diseases. As practitioners of modern medicine, we are treating bucketfuls of patients. So if one can cure someone seeking medical care, nothing like that.”