Reimagining Boundaries: In Defence of AYUSH Practitioners

India’s health-care shortage will not be fixed by keeping its traditional healers on the margins.

A recent critique of AYUSH practitioners in an article in The Hindu (July 29) titled ‘The medical boundaries for AYUSH practitioners’ by Dinesh S Thakur and Prashant Reddy T presents a detailed but one-sided argument against expanding the scope of practice for AYUSH professionals. While it raises concerns about patient safety and regulatory clarity, it ignores India’s healthcare realities, the history of medical education and the progress of integrative models. It is quite unfair to call the syllabus for Ayurveda students “an absolute mish-mash of concepts” and to say “there is no middle ground between both systems of medicine” when recent research shows that many AYUSH concepts have influenced modern medicine, including advanced areas such as nanomedicine and personalized medicine.

The key question is whether AYUSH practitioners should be allowed to prescribe certain modern medicines or perform specific procedures. Limiting this discussion to legal or doctrinal terms ignores the ground realities. In many districts, a single government allopathic doctor may be responsible for thousands of people. AYUSH doctors are often the first, and sometimes the only, available source of care. Preventing them from dispensing a limited list of essential drugs, ordering diagnostic tests, or making timely referrals can lead to delayed or missed treatment for people in areas with very limited medical facilities. Likewise, questioning whether “practitioners of Ayurveda can refer to themselves as doctors” is at odds with Indian law. The government should take constructive steps to provide appropriate training to AYUSH practitioners for the benefit of citizens and adopt a clear policy position. Yet, in recent Parliament discussions, the Ministry of AYUSH stated there are no plans to officially authorize AYUSH doctors with additional training to prescribe a limited range of essential allopathic medicines. This is despite the well-known fact that rural areas face a serious shortage of allopathic doctors. In many such regions, posts for allopathic doctors remain vacant for years because they are often unwilling to serve there, leaving communities with little or no access to timely medical care.

The Bhore Committee’s doubts about traditional systems are often seen as a standard for legitimacy. But its thinking reflected colonial priorities and the unquestioning adoption of Western models. These models took root partly because, for centuries, caste hierarchies in India allowed almost only Brahmin men to access Ayurveda education, preventing women and people from other communities from entering the field. When Western medicine arrived with standardized syllabi, examinations, hospitals, and wider opportunities for women and non-elite groups, it displaced an unequal system. Acknowledging this history does not diminish Ayurveda; it explains why reforms were needed and why today’s AYUSH education is more inclusive and structured.

Legal recognition has also evolved. The Indian Medicine Central Council Act, 1970, formally recognized Indian systems of medicine and created a national regulator. This has since become the National Commission for Indian System of Medicine (NCISM), with clearer licensing standards, model syllabi, and practitioner registers. It is a structured, quality-focused system, not a permissive one.

Criticism of State notifications under Rule 2(ee) of the Drugs and Cosmetics Rules, 1945, which allow certain AYUSH practitioners to prescribe a limited set of modern medicines, misses the real purpose behind these orders. They are a practical response to the lack of MBBS doctors in many areas. The focus should not be on questioning whether such powers should be given at all, but on ensuring they are exercised responsibly. This means having clear lists of permitted drugs, making training compulsory, keeping proper records of prescriptions, and imposing strict penalties for any misuse. Such measures can protect patient safety while also improving access to care.

It is also wrong to say AYUSH education is detached from modern science. Current BAMS, BHMS, and other AYUSH courses include anatomy, physiology, pathology, pharmacology, microbiology, diagnostics, and public health. While quality may vary between universities, the trend is toward stronger scientific foundations and more clinical exposure. This should continue through regular curriculum updates, standard setting, and independent reviews.

The debate on surgery needs more careful consideration. Ayurveda’s Sushruta Samhita shows a long tradition of surgical knowledge. Any permission for AYUSH surgeons to perform certain procedures should depend on skill, patient types, facilities, and supervision. While some Ayurved students have limited surgical training, the solution is not exclusion but better training by using experienced surgeons as mentors, shared skills labs, standardized assessments, and accredited departments with adequate case load and good outcomes before allowing independent practice. NCISM can lead this with transparent accreditation and periodic re-credentialing.

At the heart of the legal debate is also the issue of protecting their own professional position. Many in the allopathic community welcome integration when AYUSH practitioners work under their supervision, but resist it when it involves equal recognition and shared responsibilities. Patient safety must remain the top priority, but it can be better protected through clearly defined scopes of practice, uniform minimum standards, and joint training programmes, rather than by imposing blanket bans.

Modern healthcare already uses knowledge from different systems. The important question is what works, for whom, in which situations, and at what risk. The World Health Organization supports the role of traditional medicine in universal health coverage, provided countries regulate it well, fund research, and integrate it responsibly. India has moved in this direction by hosting the Global Centre for Traditional Medicine. The next steps are strong clinical research, monitoring drug safety, reporting adverse events across systems, and measuring outcomes in a transparent way.

It is time to move beyond the false choice between science and tradition. India’s healthcare future depends on combining the strengths of both, with decisions guided by solid evidence, ethical practice, and accountability. With proper training and oversight, AYUSH practitioners can deliver timely, culturally appropriate and safe care, particularly in areas where medical services are scarce. Excluding them simply because they follow a different system serves neither the cause of science nor the needs of society.

(Dr. Asmita Wele is Director, Research, College of Ayurved and Research Centre, D.Y. Patil Vidyapeeth, Pimpri-Pune; Dr. Kishore Paknikar is former Director, Agharkar Research Institute and Visiting Professor, IIT Bombay. Views personal.)