This document outlines suggestions for standardizing clinical decision-making in Ayurveda based on its foundational texts. It advocates developing Standardized Diagnostic Guidelines and Standard Treatment Guidelines using a methodology called Evidence Triad Approach. This methodology systematically evaluates a patient's condition to determine the specific Ayurvedic diagnosis and treatment. It aims to replace a "cookbook medicine" approach and instead focus on accurately applying principles from Ayurvedic texts to each unique patient. The document also emphasizes practicing Ayurveda as a science-based, evidence-based medicine to validate its scientific nature.

1. A FEW HUMBLE SUGGESTIONS ON
AYURVEDA -STG
Dr. Remya Krishnan MD PhD(Ay)

2.  Standardise the clinical decision-making of all physicians of Ayurveda based
on the inbuilt rational golden standard of Shaasthraarthas.
 Improve the quality and rationality of clinical decision making in every
individual subject.
 Establish the transparency and reproducibility of inbuilt rational standards
of diagnosis and therapeutics in Ayurveda and thus accurately expose the
scientificity of this medical science as it is.
 To build confidence in profession.

3.  To comprehend the variable patients with the same disease in the scientific
perspective of Ayurveda and decide HOW TO DO based on shaasthraarthas.
 To examine and verify the truths in the impact of logical application of
Shaasthraarthas in accordance with the unique environment of the patient.
 To comprehend the Shaasthraartha led logics regarding“what, where, when,
why and how” in the patient uniformly by all the physicians.
 To recognize the effective components of the practice of Precision Medicine
in every individual patient
 To know and practice “How to do” and not “ What to choose” in variable
clinical conditions of the same disease.

4.  The methodology to formulate Standardised Diagnostic Guidelines (SDG) and STG must
explain necessary steps in order to explore Vikara prakruthi, adhishtana and samutthana
vishesha.
 The methodology must address which specific “ Vyadhi Tatwa (VT)” is applied to reach the
specific Ayurvedic diagnosis.
 The methodology must address which Bheshaja Tatwa (BT) is applied to arrive at specific
therapeutic decision.
 The Bheshaja dravya/ yoga chosen must explain the compatibility of different components
of Ayurvedic Pharmacokinetics ( Charaka Sutra sthana) with the particular clinical situation
in particular patient
 The Pathya ( Ahara&Vihara) must also explain the same
 STG must avoid Kriyaa sankara (polytherapy)

5.  A similar CLASS of diseases instead of disease after disease , like for
example, the variable classes of infective, inflammatory, metabolic, immune
mediated etc.
 Understanding the common class of diseases based on their Vikara prakruthi
is extremely crucial step for standardised diagnosis and treatment.
(Even viral and bacterial infections vary in their nature of body response
and manifestation and hence obviously in their diagnostic and treatment
logics also.)
 Why and how- the particular decision on diagnosis and treatment is
scientifically correct with regard to patient situation.
 The clinical problem first and foremost and not any randomly chosen
therapeutic solution

6.  Ayurveda is Science led Medicine and not Medicine led Science.
 Hence SDG and STG should be science based and not treatment based.
 Ayurveda is a deterministic science based on deductive reasoning and not a
probabilistic science based on inductive one.
 Hence the current research methodology based on RCT as golden standard
from probability led Biostatistics is inappropriate for the deterministic
science of Ayurveda.
 We cannot prove medicine and after medicine in disease after disease ever
by RCT and we are not intended to make benefit risks in patient by trial and
error.
 The objective of Ayurveda is INTENDED EFFECT of reversal of pathogenesis
and Health and not a couple of unpredictable benefit risks .

7.  Systematic comprehension and documentation of Vikaraprakruthi, Adhishtana and Samutthana
vishesha of the clinical condition are crucial to arrive at Ayurvedic clinical diagnostic decision (
Vyadhi Tatwa).
 The very same applies to Ayurvedic clinical therapeutic decision ( Bheshaja Tatwa) also
 The Science of rational decision making explained in Ayurveda is not led by empirical treatment
oriented experiences and data , rather it is led by principles of practice of Science Based
Medicine.
 Hence Evidence Based Practice of Ayurveda is not medication/ treatment-oriented benefit risk led
evidences, rather it should be originally led by the crucial questions – What, why, how, when ,
where, why here, etc, the answers of which are provided by the inbuilt evidence base of science
of Ayurveda – the Samhitas and nighantus
 The standardised practice of Ayurveda is hence that of Science Based Evidence -Based Medicine

9.  Myself and my husband Dr. Rajkumar have been doing both basic and applied research in the principles of
practice of Science-Based Medicine of Ayurveda in Vyadhi Tatwas and Bheshaja Tatwas and their true
implication and application in clinical practice
 After reaching certain valid conclusions after constant and repeated evaluation in clinical setting, I have
had my first publication on the concept of Science Based Evidence Based Ayurveda (SBEBA)titled Evidence
Based Ayurveda & Rational Prescribing ,a book which introduces a novel Science led methodology for
standardised clinical decision making in any condition technically termed as “ Evidence Triad Approach”
(ETA).
 Evidence Triad Approach (ETA) is the standardisation methodology of SBEBA which aids and Ayurveda
physician to arrive at pinpointed diagnosis and treatment based unique patient environment.
 It is meant to replace the contemporary cookbook medicine approach of choosing treatment/ medicine in
Ayurveda.
 It facilitates accurate interpretation of pertinent shasthraarthas and their effective translation to the
unique environment of the particular patient

10.  There should be prescription audit in Ayurveda based on the rational standards of diagnostics
and therapeutics of Science Based Medicine
 Rational Prescribing (Prescribing based on VT and BT) is important to maximise clinical
effectiveness and cut off the wastage of precious medicinal resources.
 Rational prescribing in Ayurveda is a highly complex intellectual task for physicians for which
they requires a specialised methodology to practice and training to perform.
 SBEBA has done the essential groundworks for the practice of Science Based Medicine in the
past two decades, the outcome of which are being currently repeated and reproduced by many
Ayurveda practitioners from all over India and thus results repeatedly validated.
 Ayurveda has to emerge, evolve and establish as SCIENCE BASED EVIDENCE BASED MEDICINE for
exposing its innate scientificity and potential before the world
Thank you