Science-Based Evidence-Based Ayurveda (SBEBA) is a conscientious, explicit, and judicious employment of Ayurvedic Science Based Evidence in clinical decision-making in every subject based on unique circumstances. The term ‘Science Based Evidence Based Ayurveda” was coined in 2012 by the physician faculties and scientists of Ayurveda Drs Rajkumar KC and Remya Krishnan, Kerala, India. SBEBA encompasses standardized tools and methods for conducting research, clinical practice, and the teaching of medicine, and there are also currently seven scientific publications of SBEBA explaining the innate logic, principles, and methods for rational implementation of SBEBA in clinical decisions and practice by the physicians of Ayurveda. The practice of Science Based evidence-based Ayurveda means integrating the physician's intelligence and clinical reasoning with the innate rational principles and standards (Shaasthraarthas) from Shaastra/the Science of Ayurveda. SBEBA is being embraced by many aspirant physicians all over India by themselves self-recognizing the impact of their transformation from the previous Belief/ Blind experience-oriented trial and error practice to the rational science-based Based Medicine practice. SBEBA not only cut down the length of the prescription but also considerably improved the accuracy and quality of the same without the burden of complicated therapies and procedures which are done so commonly today without considering Ayurvedic Science Based Evidence led standards of clinical decision-making. The cause-effect relationship between disease and treatment is thoroughly explorable by SBEBA tools and methods to establish conclusive evidence for professional diagnosis and treatment in Ayurveda for the first time in the history of Ayurveda.
Evidence-Based Medicine of Ayurveda is to be primarily logically approved by the Science of Ayurveda to approve for employment in a subject. Unlike the pain killers in pain and antying drugs in Western Medicine which block mask and suppress different chemicals, pathways, and neurons, Ayurvedic medicines are intended to work on appropriate disease targets in the single or multitangled pathology manifested as one or more diseases if they are chosen and applied wisely led by the innate logical algorithms of Ayurvedic scientific decision making. The working of treatment is meant to do reversal of cause mechanisms and not merely suppress or deactivate something for some time. So while deciding to treat a patient, the physician needs to have highly precise knowledge of the scientific clinical decision-making process led by the rational standards of science but this has never been educated and trained in Ayurveda colleges ever and for this reason, hundreds of Ayurveda physicians today will diagnose the same patient and his status in five hundred different ways blindly assuming something as something without any sort of clarity and objectivity. At the same time, SBEBA-trained physicians have a systematically organized method of arriving at rational diagnosis and treatment led by the inbuilt standards of science of Ayurveda.
The Evidence Triad Approach (ETA) which is the hallmark of SBEBA is fairly complex to perform and hence requires advanced knowledge and training in skills to perform the technique. Currently, the fundamental principles of Ayurveda are not rationally educated and trained for BAMS students and for this reason they lack the clarity and comprehension of the underlying scientific principles of Ayurveda, even though they are mugging up the same for examinations. When there is SBEBA-oriented education, research and training in Ayurveda medical colleges, the quality standards of clinical performance of physicians today would have been of the next level and Ayurveda would have become the Mainstream Medicine of India. Till now there has never been any quality evaluation or clinical audit for Ayurvedic prescribing and physicians continue to prescribe as per their beliefs, self, and shared experiences with innumerable medicines and treatments. This has often resulted in emerging some casual benefits along with high risks to patients but ultimately Ayurveda is not a medical science intended to emerge benefits and risks, rather it is intended effects and health in the intended period. Also, the existing mode of prescribing hardly questions what is fundamentally wrong with the patient and why and how. Thus a unifying movement of SBEBA makes it possible to shift the clinical practice of Ayurveda in such a way that the inbuilt rational standards of Ayurvedic Science have become the central axis for the process of clinical decision-making for emerging scientifically optimised patient-cantered care without devaluing the external evidence of healing in every individual patient. The evidence of healing solely matters in Evidence Based Medicine of Ayurveda and when a medicine/treatment is scientifically chosen and applied, the evidence of healing in the intended period by a predictable cause effect relationship only establishes the effectiveness of treatment in the medical science of Ayurveda. A couple of interchangeable benefits and risks by random blind administration of a treatment in a random population is entirely unscientific research enterprise in Ayurveda and the ancient scientists of this system have repeatedly warned in several instances to abandon such evidences of spontaneous benefits of outcome of irrational therapeutic decision and application in patients. It is technically termed as Yadrichha siddhi which is advocated to be discarded and not counted as a scientific achievement in Ayurveda.
It is a very indisputable matter that a solid foundation led by the rational components of “solid background science” is inevitable to practice a medical system as “Science-Based Medicine”. In Science Based Medicine, Medicine should begin from Science and advance through the innate logic of concerned science for attaining its most optimized application in the unique circumstances of every individual patient and this cannot be achieved by the different formulae of Biostatistics. Ayurveda is a deterministic science and not a probabilistic one and therefore it is silly and stupid to do Randomised Control Trials and blinded assays with compound/ treatment after treatment in Ayurveda. Ayurveda does not require new medicines; what is seriously lacking is physician intelligence in Science Based Medicine for emerging the most scientifically optimized clinical decisions that is why polytherapy, mixopathy and allopathy practices are done by Ayurveda physicians today.
Following the original thinking of SBEBA, the junior doctor would be precisely
as well equipped to make the right diagnosis and be as successful as the senior
one expertise in SBEBA because SBEBA Tools and methods enable all of them to uniformly and pertinently conduct uniform clinical decision-making processes in Ayurvedic diagnosis and treatment. Currently irrespective of senior or junior, unless a physician attains specific and specialized knowledge and proficiency in SBEBA, everyone equally sails in the ocean of uncertainity in clinical decision making and thus prescribes endless medications and procedures for endless periods. Clinical expertise and experience are required in the knowledge and skills in the practice of Science-Based Medicine (Shaasthraarthas) of Ayurveda and not in Biostatistics and Research Methodology the latter which is applicable only for the hunt of data for approval of drug for marketing which is in no way the objective of research of Ayurveda. Ultimately the research is meant to discover and optimise the diagnostic and treatment protocol and save the patient by facilitating fast recovery and health.
The patient is not to be treated based on empirical evidence of observational data sheets of benefits and risks that emerged from conducting a trial and error with an unknown compound in Ayurveda. Ayurvedic science advocates the practice of Jnana Poorva Karma (Knowledge Based Practice); deep seated knowledge in Science-Based Medicine for which systematic tools and methodologies are required to be known and practiced. The fundamental principles of Ayurvedic diagnosis and treatment are to be well comprehended “rightly” by the entire physician/faculty community and misled knowledge in the scientific substratum of Ayurveda would emerge fatal consequences through irrational prescribing habits of unlearnt physicians. Hence SBEBA is very much crucial today for the intended scientific updating of Ayurvedic clinical practice, research and professional education.
Dr. Remya Krishnan MD, PhD
The Pioneer of SBEBA
Ayurveda Faculty, Physician & Scientist