Naresh Trehan's Medanta brings modern medicine and Ayurveda under one roof

The institution has used traditional medicines such as papaya leaves to treat dengue and guava leaf for diarrhea

A burgeoning population and the advent of a range of new pathogenic and lifestyle diseases has made healthcare in India extremely complex. The medical fraternity has risen to the occasion at every step to meet the challenges in maintaining and improving public health, delivering several new molecules and therapeutic procedures to improve the overall well being of the populace. In a new series, Business Standard brings you five institutions that stand out in the field of medical research in India. 

It was in 2006 that Naresh Trehan laid the foundation for Medanta The Medicity in Gurgaon on 43 acres of land. Armed with an ambitious plan to create a facility that could be counted among the best hospitals in the world, Dr Trehan was a man with a mission. Given that he had already put Escorts, the hospital he set up in 1983, on the map of Asia for clinical excellence, it was not hard to believe he'd do the same and more with Medanta. His plan was to have every system of medicine under one roof, working together. That's called integrative medicine and the first few studies have been conducted and are already part of clinical practice at Medanta.

Medanta, the hospital which is seeking the centre-of-excellence tag for its initiatives in integrative medicine, is working on India's ancient medicinal repository to calibrate its science and give it a modern outlook so that it can be brought into mainstream practice. The institution is now in the process of presenting proof of concept, after which it will take the necessary steps for getting approvals in the realm of modern medicine. The manufacturing units for the medicine have already been approved and certified by the health ministry, even as Medanta is working on standardising medicines.

Dr Pooja Sharma, head of research at Medanta shares the many publications that have been made and presented. The first is the study on the management of dengue, which is a malaise that affects the population in Delhi every year. In modern medicine, there is really no real remedy,  just treatment of symptoms by trying to get the fever down with paracetamol. However, Ayurveda has a solution. Eighty-one patients were given Ayurvedic medicine along with paracetamol and fluids. Of these, 19 patients developed thrombocytopenia, or low platelet count, which is the most common side effect of dengue. They were treated with Papaya leaf juice and they all regained normal temperature within three days. They crossed the threshold of danger, which in modern medicine could take up to seven days. With Ayurveda, the healing process was hastened. 

Having proved its efficacy, the drug is being developed by the ministry of Ayush. 

The second study done is a randomised controlled trial, in which one group of patients gets medicine and another does not. Guava leaf decoction is given for diarrhea and has provided relief to 90 per cent of the patients. A paper on this is being worked on. 

The third study is on patients who underwent major surgeries that involved opening the chest for lung or heart surgery. Anesthesia slows down body functions and one of the problems that cause great discomfort to patients is impaired bowel movement. An Ayurvedic drug given to patient helped 82 per cent of the recipients. 

“Dr Trehan has made it part of standard protocol of post-surgical care,” says Dr Sharma. 

Similarly, a publication on improving quality of life with Yoga for patients of Breast cancer has been presented.

The hospital follows parallel practice, says Dr Pooja Sharma who worked with Dr Geeta Krishnan, a senior and very respected Ayurvedic doctor currently on deputation to the World Health Organization (WHO). Doctors of modern medicine and those of Ayurveda are present in the same hospitals and the former may refer patients to the latter.  

The option of going for parallel practice lies ultimately with the patient and is complementary to modern medicine. For example, a practitioner of modern medicine often sends a patient to an Ayurvedic doctor if he has no cure. A case in point is Neuralgia. During surgery, the nerve endings are cut, and the patient feels pain even after the wound has healed. This is called  Neuralgia. For the surgeon, pain in the scar is insignificant compared to the major complication which has been sorted out. In Ayurveda, a patient of Neuralgia can be relieved of pain completely. Similarly, doctors of modern medicine find it hard to find the pain patients of chronic pelvic pain syndrome experience. But Ayurveda can offer a remedy. 

While some doctors like Ali Zamir Khan, a thoracic surgeon at Medanta, use integrated medicine routinely, not all are believers. “At the end of the day, patients come to the hospital for relief, and that is what is offered with this approach of integrating different systems of medicine,” says Dr Pooja Sharma. 

Validation of proof of concept: Safety is the first priority as many traditional medications use heavy metals in the form of Bhasmas. These have to be made correctly or they may prove toxic. 

Medications manufactured at CGMP facilities and certified and approved by the Drug Controller General (DCGI) are used. 

“Remember, many cancer drugs are plant-based and can still be toxic,” says Dr Sharma. The other reason to proceed with caution is drug interactions. Since no studies have ever been done on combining modern medicine with traditional, the process of adopting an integrated approach is slow and cautious. 

Yoga, too, has been used successfully in thoracic surgery where a patient may have as much as 80 per cent of his lung removed in extreme cases. Yoga helps patients recover breathing capacity because the lung is like a balloon and has the propensity to expand substantially. While the doctor can surgically remove the lung to get rid of cancer, the patient's recovery depends on the extent to which his lung can expand. Yoga exercises are part of standard post-operative protocol.

Another important publication is on the use of Panchkarma, an effective treatment in cardiology to manage abnormal lipid balance in the heart. Six months of statins help in reducing lipid profile and 15 days of Panchkarma treatment works just as effectively. In a study being done in Russia, yoga is added to the modern medicine regime to promote muscle strength 

“We used one group that had been given statins and another that had undergone Panchkarma and when we compared the two, we saw 15 per cent improvement with statin and 35 per cent improvement with Panchkarma,” says Dr Sharma. Had the improvement been minor it wouldn't have been seen as significant. However, in this case, the percentage of patients responding to Panchkarma cannot be ignored.  

Ayurveda has its own set of problems, though. Drugs in this domain are rarely quantified, unlike in modern medicine -- where the name of the molecule, the combinations, and manufacturing processes are standardised. However, the Ministry of Ayush is now intervening to give this traditional science a big push and is trying to understand Ayurvedic pharmacology. Also, the principle physician in charge of the patient is usually a votary of modern medicine and must be sure Ayurvedic drugs don't harm the patient -- ergo parallel and complementary medication. 

The bottom line is that the patient's well-being is supreme and while Ayurveda may well be endowed to achieve this end, an integrated approach is likely to work better than standalone therapy in ensuring overall wellness. 
 

Watch this space for the next article in this series, on LV Prasad Eye Hospital's initiatives in stem cells and cornea regeneration