Sanctity over Science: Ayurveda in the Time of Covid-19

Introduction
The Covid-19 pandemic will be remembered in India not just for the toll it took on lives and
livelihoods, but also for the Indian state’s zealous promotion of Ayurveda and other traditional medical
traditions to contain and combat the virus. In the face of this unprecedented public health crisis, the
Indian state itself became the biggest purveyor of traditional herbal remedies whose efficacy was
dubious at best and whose safety was very much in doubt.
The fiasco of Ayurveda in the time of Covid-19 was a fiasco foretold. How the ayurvedic
establishment played fast and loose with scientific evidence -- rushing to claim it even when half-baked
and turning hostile to rigorous evidence-based studies which questioned its wisdom-- makes perfect
sense when seen against the backdrop of the contested nature of reason and truth in the contemporary
intellectual milieu in India. For nearly half a century now, prominent public intellectuals in India have
been hostile to the very idea that objective, cross-culturally valid truths about nature and society can be
discovered through a systematic application of reason which finds its most well-developed expression in
modern science. They have instead argued for re-discovering and re-valorizing alternative sciences
based upon “another reason” of Indian knowledge traditions which they believe were unjustly
marginalized by the imposition of the Enlightenment rationality through the apparatus of the British Raj
-- a rationality which was inherited by the Indian state after Independence. 1 Ayurveda, the ancient (and
antiquated) Indian tradition of medicine, is the perfect case study for these debates over the nature of
science and “alternative sciences” because medicine is where the rubber hits the road, so to speak:
matters of health and disease are where the abstract issues of justification of our beliefs, and our
interventions based upon those beliefs, get translated into public policies which impact the lives of the
people most directly.

1 The critique of modern science as a source of colonization of the Indian mind began with Ashis Nandy and his
colleagues associated with new social movements that emerged in the 1980s in the wake of the multiple crises
India was facing at that time, including the Emergency imposed by Indira Gandhi, the social dislocations and
environmental crises unleashed by the Green Revolution, the energy crisis of the 1970s and the disaster at the
Union Carbide factory at Bhopal in 1984. These movements, with Nandy as their chief theoretician, advocated for
alternative energy, agricultural and medical policies that were grounded in indigenous sciences and technologies
which could overcome what they saw as the inherent “ violence” of “Western” ways of knowing which split the
object of inquiry from the life-world of the knower. The critique of scientific objectivity and universality as
legitimation for Western hegemony has become a self-evident first principle of postmodern and postcolonial
theory. For a brief history of postcolonial theory that pays due obeisance to Nandy, see Dipesh Chakrabarty’s
Intimations of Modernity (2002). For a bracing critique of the anti-Enlightenment trajectory of colonial discourse
theory, see Washbrook (1999, and also, Nanda, 2003). The phrase “another reason” is from the title of Gyan
Prakash’s well-known book.
 The Indian state’s eager advocacy of Ayurveda during the Covid crisis is a fulfillment of the post-
truth intellectuals’ stated purpose of “decolonizing knowledge” and giving voice to indigenous
knowledge systems marginalized by colonial and postcolonial modernity. For once, a traditional science
indigenous to India, Ayurveda, became “ a reason of the state,” to use Ashis Nandy’s words. 2 Far from
being “silenced” or neglected in favor of modern medicine, the Indian state, through the Ministry of
AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy), and the global ambassadorship of Narendra
Modi himself, became the biggest booster of all home-grown medical traditions, with Ayurveda leading
all the rest.3 Even before the Covid crisis, promotion of Ayurveda and yoga was a prominent part of the
agenda of the Bhartiya Janata Party which has been in control of the state since 2014. 4 Clearly,
promotion of this purportedly ancient “Vedic” science is part of the Hindu nationalist agenda for
creating and reinforcing a sense of Hinduism as the cultural essence of India. 5
Now that the critics’ hopes for the flourishing of local knowledge-traditions have become a
reality, what resources are they left with for a critical evaluation of the remedies being offered? After
having so thoroughly dismantled the very idea of objective truth, what grounds are they left with to
challenge the inflated and unfounded claims for the effectiveness and safety of these medicines? More
broadly, what happens to the task of critique when intellectuals, whose responsibility it is to seek the
truth lying hidden behind the veil of distortion and misrepresentation, adopt a stance of suspicion
toward the very idea of objectively verifiable facts that are not contingent on the cultural assumptions
and power positions of the knowers? The ebbing of critical spirit is evident from the fact that the

2 Nandy used the “reason of state” in its dictionary meaning as “a motive for governmental action based on
alleged needs or requirements of a political state regardless of possible transgressions of the rights or the moral
codes of individual persons” (Merriam Webster). He associated modern science with some exceptionally sinister
features that make it an arm of the deep state which is exempt from democratic norms. Nandy argues that the ills
of science are not contextual but are inherent in its spirit of objectification which makes it ”a human enterprise
particularly open to co-optation by the powerful and the wealthy…[the culture of science ] invites … state power
outside the reaches of the democratic process [and leads to] the growth of institutionalized violence.” (1998:1-2).
Is the supposedly more “holistic” science of Ayurveda any less inviting of state power?
3 The professed “medical pluralism” of the AYUSH ministry is “not uniform but hierarchical,” to quote Venera
Khalikova (2018:198) who argues that while AYUSH is supposed to promote all indigenous medical traditions, “one
medical system –Ayurveda – receives most social and ideological support [as it is] constructed as the only truly
Indian and homegrown national medicine.”
4 The BJP’s 2014 Election Manifesto contained the following statement: “Yoga and Ayurveda are the gifts of
ancient Indian civilization to humanity and we will increase the public investment to promote Yoga and AYUSH. We
will start integrated courses for Indian System of Medicine (ISM) and modern science and Ayurgenomics. We will
set up institutions and launch a vigorous program to standardize and validate Ayurvedic medicine.”
http://library.bjp.org/jspui/bitstream/123456789/252/1/bjp_lection_manifesto_english_2014.pdf. Almost
immediately after the BJP won the 2014 election, AYUSH was given the status of a full ministry, separate from the
Ministry of Health, new teaching and research institutes were set up, and an annual National Ayurveda Day was
instituted to coincide with Dhanvantri puja. .
5 Ayurveda’s Buddhist lineage has been well-established by the detailed historical study by Kenneth Zysk (1991)
intellectuals who have so vociferously argued for alternative, non-Western epistemologies were
conspicuous by their silence through the Covid crisis when the public sphere in India was inundated by
state-sponsored boosterism for Ayurvedic immunity boosters and cures.
The postcolonial challenge to the idea of objective scientific facts raises a host of philosophical
as well as historical questions about the encounter between modern science and modern Hinduism.
These questions require a deeper investigation than is possible in one essay. 6 The focus of this essay will
be limited to a critical overview of AYUSH’s campaign to “integrate” ayurvedic herbal formulations with
modern medical treatments for Covid-19 despite the absence of adequate scientific evidence for the
efficacy and safety of these herbals. This essay seeks to highlight the slippery and opportunistic use and
denial of scientific evidence by the ministry of AYUSH to serve the nationalist goal of promoting a
traditional science with a purported “Vedic” lineage.
Even though Ayurveda and AYUSH are at the center of this investigation, it is important to keep
in mind that while ayurvedic medicines are popular, widely used and heavily promoted by the state,
Ayurveda is nowhere close to the prominence that modern biomedicine enjoys in India. Two caveats are
in order before we begin
One, the critical analysis of Ayurveda that follows does not automatically mean a clean-chit for
the biomedical establishment in India which did not exactly cover itself in glory through the Covid
crisis. . As a recent report in the New York Times has revealed, the government-appointed scientists
working for the Indian Council of Medical Research downplayed the possibility of a new outbreak, and
overplayed those models whose projections dovetailed with the government’s claims that the lockdown
announced by Modi in March 2020 -- a lockdown that devastated the livelihood and health of millions of
working people -- had contained the virus and the battle was already won. The result was that India was
totally unprepared for the deadly second wave when it came in early 2021. 7 India’s home-grown Covid
vaccine, Covaxin, was approved for emergency use on a “clinical trial basis” even before the phase 3
clinical trial was completed. The scientific community clearly failed to stand up to the political pressures
for speedy delivery of the vaccine that stemmed from the government’s “vaccine triumphalism.” 8 After
6 These questions, especially as they relate to the history of pseudo-scientization of Ayurveda, will be explored at
length in my forthcoming book, Captured by the Vedas: Science and Hinduism.

7 “As India’s Lethal Covid Wave Neared, Politics Overrode Science,” New York Times, Sept `4, 2021
`https://www.nytimes.com/2021/09/14/world/asia/india-modi-science-icmr.html?searchResultPosition=12

8 “How Covaxin became a victim of vaccine triumphalism,” Mint, May 27, 2021
https://www.livemint.com/science/news/how-covaxin-became-a-victim-of-vaccine-triumphalism-
11622022760541.html. See also, “10 Questions the DCGI Needs To Answer About the Two Vaccine Candidates
Approved”, The Wire, Jan 3, 2021 https://science.thewire.in/health/dcgi-vg-somani-serum-instityte-covishield-
nearly nine months after it was approved in India, Covaxin is still struggling to get WHO’s approval for
global use.9 The problems were not limited to the vaccine alone. There are reports that indiscriminate
use of steroids to reduce Covid symptoms in critically ill patients may have contributed to the sharp rise
in black fungus cases in India.10 This is not a record that brings much credit to conventional medicine in
India, even though credit must be given to the frontline doctors, nurses and paramedics who took great
risks to save lives.
Two, even though the ministry of AYUSH has been a favorite child of the Modi administrations I
and II, it cannot compete with conventional biomedicine when it comes to state spending,
infrastructure and resources. Ayurveda, and all the rest of traditional medical systems combined, get
only a fraction of the resources the government allocates for biomedicine. In the Union budget for 2021-
2022, AYUSH will get 40 percent more funds than in the period from 2020-2021, as compared to an
increase of only 7 percent for the Department of Health and Family that oversees biomedicine. But even
with this generous increase, AYUSH will receive only 2, 970.30 crore rupees, while the budget for the
Health and Family ministry, after a 7 percent bump, will come to around 71, 268 crore rupees. 11 The
Hindu nationalist government’s enthusiasm for the traditional medical system should not be taken as
evidence that they have eclipsed modern medicine in India.
Ayurvedic Remedies for Covid: The Timeline
Operating on the principle that all crises are opportunities, the ministry of AYUSH .has used the
Covid-19 pandemic as an ideal moment for integrating Ayurveda and to a lesser extent, Unanai,
homeopathic and siddha medicines, into standard biomedicine. In fact, Modi acknowledged that much
when he addressed the Fourth Global Ayurveda Festival in March 2021, when India was at the verge of
the deadly second phase of the pandemic. He celebrated the “current situation” as a golden opportunity

bharat-biotech-covaxin-approval-unanswered-questions/

9 “WHO Says ‘Number of Inaccuracies' Holding Back Covaxin Clearance, Wants Bharat Biotech to Answer” The
Wire, Oct. 29, 2021, https://thewire.in/world/number-of-inaccuracies-holding-back-covaxin-clearance-says-who-
wants-bharat-biotech-to-answer

10 “Mucormycosis: The 'black fungus' ,aiming Covid patients in India”. BBC News, May 9, 2021
https://www.bbc.com/news/world-asia-india-57027829

11 “Total allocation for health ministry up only 7%, no increase in budget for Ayushman Bharat”. The Print, Feb. 1,
2021. “https://theprint.in/health/total-allocation-for-health-ministry-up-only-7-no-increase-in-budget-for-
ayushman-bharat/596492/#google_vignette
for generating more traffic for “wellness tourism” to India and for integrating Ayurveda into evidence-
based medicine.12
What follows below is the timeline of AYUSH ministry’s response to the pandemic. These
interventions have been extensively reported in the media. They are compiled here, in the sequence in
which they appeared, for the purpose of creating a record.
1. In January 2020, when the first cases of COVID were beginning to be diagnosed in India, AYUSH
issued an advisory recommending ayurvedic herbal drugs (Samshamani vati and Agastya vati
and tulsi decoctions) homeopathic remedies (Arsenicum Album 30) and Unani formulations for
prevention and treatment. This advisory was re-issued in March 2020, this time with
“evidence.”13
2. State governments ruled by BJP lost no time in distributing these dubious drugs as soon as
AYUSH gave them its blessing. By April 2020, the state government of Gujarat had distributed
1,05,41,000 doses of “kadha,” a decoction of various ayurvedic herbs, 1.72 lakh doses of
Samshamani vati , 76.72 lakh doses of Arsenicum Album 30. 14
3. In June 2020, Baba Ramdev, who runs the Patanjali business empire, came up with Coronil
which he claimed was the world’s first antiviral pill that cured covid-19 within seven days. 15 His
claims for “cure” were widely criticized, and the Health ministry asked him to sell it only as an
immunity booster. But Coronil as a cure will surface again, as we shall see.
4. In October, 2020, AYUSH issued a National Clinical Management Protocol which promoted the
use of “ashwagandha, guduchi, pippali, Ayush 64 tablets in different doses, and yoga to prevent
Covid, treat mild symptoms and for post-Covid self-care.” 16 Ayush 64, which was supposed to
12 “Current situation right time for ayurveda to become popular globally: Narendra Modi. The Hindu, March 12,
2021. https://www.thehindu.com/news/national/current-situation-right-time-for-ayurveda-to-become-popular-
globally-narendra-modi/article34055946.ece.

13 “Advisory for Coronavirus,” Ministry of AYUSH, Jan 29, 2020. https://pib.gov.in/PressReleasePage.aspx?

PRID=1600895&utm_source=pocket_mylist

14 “Gujarat illustrates Modi Government’s science denialism during the coronavirus pandemic.” Caravan, June
2020. https://caravanmagazine.in/health/gujarat-modi-science-denialism-coronavirus-pandemic

15 “Baba Ramdev's Patanjali launches India's 'first Ayurvedic' medicine for coronavirus, Coronil,” Business Today,
June 23, 2020.
https://www.businesstoday.in/industry/pharma/story/baba-ramdev-patanjali-launches-india-first-ayurvedic-
medicine-for-coronavirus-coronil-262007-2020-06-23

16 “National clinical management protocol based on Ayurveda and Yoga for management of Covid-19.” Ministry
of AYUSH, October 2010. https://www.ayush.gov.in/docs/ayush-Protocol-covid-19.pdf
 (but failed to) cure malaria was “repurposed” as an antiviral drug and included in the
management of Covid. Anyone can now buy Ayush 64 from Amazon.in where many
formulations explicitly advertise it as an antiviral drug. 17
5. In February 2021, Ramdev was back again. Flanked by Harsh Vardhan and Nitin Gadkari, the
ministers for health and transportation respectively, he announced that WHO has approved
Coronil as Covid cure. WHO denied that it had given any such approval and Ramdev was forced
to retreat. This time, however, he released a clinical study conducted by his lieutenant, Acharya
Balkrishna, in collaboration with a private medical school in Rajasthan (Devpura 2021). This
study claimed complete elimination of the virus from asymptomatic, Covid-positive patients in
seven days. The design and the conclusions of the study were found wanting by biomedical
experts.18 But before this study could be properly vetted by the scientific community, the Health
ministry approved Coronil to be included as part of the standard treatment; that is, allopathic
doctors could prescribe Coronil along with their own medications. Losing no time, the Haryana
government began distributing Coronil kits. (Ramdev is, after all, the native son of Haryana). 19
6. In May 2021, AYUSH announced “a massive nationwide campaign” to distribute “AYUSH 64 and
siddha drug, Kabasura Kudineer” and that “the main collaborator in the campaign is Sewa
Bharati.” 20 Within days, reports poured in of RSS men and women handing out this stuff in BJP
ruled states.
7. At the height of the deadly second wave in April and May of 2021, Baba Ramdev prescribed
yogic breathing while mocking those who were desperately searching for life-saving oxygen. 21

17 Sri Sri Ravi Shankar's brand, Sri Sri Tattva, even carries the image of a fist attacking a globule with spikes meant
to represent coronavirus on the container of Ayush-64 pills.

18 “The bad science and poor ethics of Patanjali’s Coronil research,” Caravan, March 25, 2021.
https://caravanmagazine.in/health/the-bad-science-and-poor-ethics-of-patanjali-coronil-research?
utm_source=pocket_mylist

19 “Haryana govt to distribute 1 lakh Coronil kits among Covid-19 patients,” India Today, May 25, 2021
https://www.indiatoday.in/india/story/haryana-govt-coronil-kits-covid-19-patients-patanjali-1806536-2021-
05-25

20 “Ayush Ministry launches nationwide distribution campaign of AYUSH 64 & Kabasura Kudineer,”Ministry of
AYUSH, May 7, 2021. https://pib.gov.in/Pressreleaseshare.aspx?PRID=1716729

21 To quote Ramdev: "God has given us free oxygen, why don't we breathe that? How can there be a shortage
when God has filled the atmosphere with oxygen? Fools are looking for oxygen cylinders. Just breathe the free
oxygen. Why are you complaining about the shortage of oxygen and beds and crematoriums?" “Ramdev: Doctors
furious over yoga guru's insulting Covid remark,” BBC News, May 25, 2021.
https://www.bbc.com/news/world-asia-india-57237059
 8. Not to be left behind, the southern states were actively promoting near miraculous Siddha
cures. Officials from Tamil Nadu were claiming “100% success rate,” for Siddha remedies even
while admitting that “there is no empirical verification but there is enough history. People have
faith.”22
9. The go-mutra brigade provided a constant beat to this mad chorus of quacks: covering yourself
in cow dung and drinking cow pee was their preferred “medicine.” 23
10. The contours of the let-them-eat-cake variety of “medical pluralism” became clear when Sripad
Naik, the AYUSH minister, and Amit Shah, Modi’s lieutenant, checked into ultramodern medical
facilities when they contracted Covid. If they had so much confidence in the remedies they were
pushing, why did they not wash down some shamshami vati with go mutra? Why did they go for
plasma therapy when Ramdev’s Coronil and Ayush-64 could have cleared the virus?

To AYUSH ministry’s credit, the treatment protocol it released in October 2020, recommended
ayurvedic drugs only for asymptomatic and mild Covid positive patients, while advising hospitalization
for severe cases. It did force one of its own, Baba Ramdev, to retract his wild claims about Coronil as an
antiviral pill that can “cure” Covid, but then turned around and approved it as a “immunity booster” that
could -- and indeed, should -- be taken in conjunction with standard biomedical care. The medically
dubious idea of boosting your immunity to fight Covid became the all-purpose justification for giving a
free pass to any and all herbal cures that Ayurveda has in its time-worn pharmacopeia. All this
boosterism for immunity-boosters led to overconsumption of herbal remedies, many of which had
serious side-effects which are examined in the next section. 24

First, do no harm...

22 “Coronavirus: Siddha treatment has 100% success rate, claims Tamil Nadu minister, “The Scroll, June 24, 2020
https://scroll.in/latest/965564/coronavirus-siddha-treatment-has-100-success-rate-claims-tamil-nadu-
minister

23 “Coronavirus: Group hosts ‘cow urine party’, says COVID-19 due to meat-eaters,” The Hindu, March 14, 2020.
https://www.thehindu.com/news/national/coronavirus-group-hosts-cow-urine-party-says-covid-19-due-to-
meat-eaters/article31070516.ece

24 “Too much turmeric, methi, vitamin D — Doctors fight new emergencies driven by Covid fear” the Print, Sept.
4, 2020.
https://theprint.in/health/too-much-turmeric-methi-vitamin-d-doctors-fight-new-emergencies-driven-by-covid-
fear/495557/
 All of this is nothing but faith-based medicine -- the faith that ayurvedic medicine is “natural”
and therefore just gentle, harmless flower-power (“100 percent zero side-effects” as many vaidyas love
to proclaim) and that “thousands of years” of use is all the proof you need to attest to their safety. The
faith, also, that the tridosha theory of disease codified in the classical Ayurvedic texts is “scientific” by its
own lights, even though it is untestable and even if its axioms defy all that we have learnt about how
human bodies work. The policymakers of AYUSH are both prisoners and perpetrators of this faith.
It is undeniable that Indian people -- rich and poor, urban and rural, lettered and unlettered
alike -- have a high level of trust in Ayurveda. Even before the pandemic, nearly 77 percent of Indian
households were consumers of Ayurveda.25 The popularity of ayurvedic products skyrocketed during the
pandemic,26 leading Harsh Vardhan, the union minister for health, to boast that, “post-COVID, the
economy of Ayurveda, which is Rs 30,000 crore with a growth of 15 to 20 per cent, has gone up to 50 to
27
90 per cent.” Given that adequate biomedical care facilities are either non-existent, too expensive
where they do exist, and too money-grubbing and therefore untrustworthy even for those who can
afford them, it is understandable why people would turn to traditional medicines that they grew up
with. There is a certain degree of comfort in turning to your grandmothers’ home-remedies in the time
of need.
It is a betrayal of people’s trust that AYUSH completely forgot the first principle of medicine -- to
do no harm -- while pushing its faith-based agenda in the time of Covid. It justified its remedies not
based upon robust science but rather by “knowledge from Ayurveda classics and experience from
clinical practice” and computer-based models of “biological plausibility” (AYUSH, 2020: 2). When faced
with one of the biggest health crisis in memory, the health advisories that the public got were written by

25 According to a report by Confederation of Indian Industry (CII) and PricewaterhouseCoopers (PwC),

77 per cent of Indian households used Ayurvedic products in 2017, up from 69 per cent in 2015.
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/77-percent-indian-households-
use-ayurvedic-products-pwc-report/articleshow/66773295.cms?
utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

26 The sale of Coronil kits went through the roof after it was first launched, grossing some 250 crore in rupees in
just four month for Ramdev’s Patnajali empire. “Patanjali Sells More Than 2.5 million Coronil Kits in 4 Months,
Profits Cross Rs 250 Crore,” India.com, Nov 2, 2020. https://www.india.com/news/india/patanjali-sells-more-than-
2-5-million-coronil-kits-in-4-months-profits-cross-rs-250-crore-4194862/. Dabur, a major manufacturer of
ayurvedic products, saw its sales go up by 50 percent in the quarter that ended in June 2021. See “Ayurveda, the
unlikely urban beneficiary of Covid,” Mint, August 31, 2021, https://www.livemint.com/science/health/in-covid-
battle-urban-middle-class-reposes-trust-in-ayurveda-11630306106186.html.

27 “Ayurveda economy has seen up to 90 per cent growth post-COVID: Harsh Vardhan,” Economic Times, Feb 19,
2021.
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/ayurveda-economy-has-seen-up-
to-90-per-cent-growth-post-covid-harsh-vardhan/articleshow/81109404.cms?from=mdr
true believers who worship Ayurveda as a shastra revealed by gods which cannot but be true and
beneficent.
This mindset of unquestioning faith is enshrined in India’s Drugs and Cosmetic Act of 1940 which
exempts herbal recipes mentioned in 54 “authoritative books'' of Ayurveda, 25 authoritative books of
Siddha and 12 Unani-Tibb classics from any further tests, either for safety or for effectiveness. The
Drugs Act, which should be renamed snake-oil protection act, is the operating principle of AYUSH
ministry’s guidelines for safety evaluation of ayurvedic drugs. 28 In effect, this law allows anyone to hand-
make or manufacture and sell the herbal and herbal-mineral recipes mentioned in the classics written
centuries ago by simply writing in “as per text” for ingredients, effectiveness and safety data that is
required for clearance for biomedical drugs. What makes ayurvedic industry even more opaque is that
the medicinal properties of the 499 herbs recognized by the Ayurvedic Pharmacopoeia of India are
described with respect to properties -- Rasa, Guna, Virya, Vipaka and Karma -- which cannot be
translated into empirically identifiable and testable qualities and are intelligible only to ayurvedic
practitioners. It should not come as a surprise, then, that AYUSH took the soundness of its chosen
herbals for granted and turned a blind eye to the many red-flags regarding their safety that were being
raised by concerned scientists in India and around the world.
The fact of the matter is that the two herbs -- guduchi (Tinospora cordifolia)

and ashwagandha (Withania somnifera) – that were the main ingredients of practically every drug
approved by AYUSH are known to be injurious to the liver. The evidence of real risk was available in the
medical literature before the Covid crisis, and even more evidence of their toxicity emerged as more and
more people began to consume more and more of these drugs during the pandemic. Any responsible
agency that puts public health above its faith-based agenda would have paid attention to the toxicity
data, and at least cautioned the public and regulated the use of these herbs more strictly. That is indeed
the ethical imperative that follows from the injunction to “first, do no harm.”
But as we shall see in what follows, the alarm bells went unheeded. Any evidence that
challenged the faith of the true believers was treated as an affront to the Great Tradition. Those raising
the red flags were threatened with legal action for tarnishing the image of traditional medicine.
Defending the sanctity of tradition won over defending public health.
The very idea that guduchi and ashwagandha could be toxic was anathema to AYUSH because
these two herbs were the stars of its protocol for Covid care. Ramdev’s Coronil and Samshami vati both

28 “General Guidelines for Safety/Toxicity Evaluation of Ayurvedic Formulations”. Ministry of AYUSH,

2018. ,https://www.ayush.gov.in/docs/guideline_safety_toxicity.pdf
contain guduchi as the active ingredient. In addition, the Protocol for Covid management that AYUSH
released in 2020 recommends guduchi, alone or with pippali, in concentrations ranging from 375-500
mg twice daily for asymptomatic and mild covid cases. Ashwagandha was recommended, twice daily, 1-
3 grams for prophylaxis and post-Covid care. Ashwagandha was also a major component of Ramdev’s
Coronil. The third rail of covid protocol was AYUSH 64, a polyherbal pill which has had an unremarkable
career as a failed antimalarial pill. It was released in the 1980s with much fanfare as an ayurvedic
alternative to chloroquine but it badly under-performed in clinical trials (Valecha et al, 2000). This
wonder-drug-that-wasn’t was “repurposed” (AYUSH’s own term) for Covid care based upon computer
simulations and the sum-total of one clinical trial that discovered, miraculously, antiviral properties in
this supposed anti-malarial formulation. The clinical study was so full of problems that even supporters
of Ayurveda found faults with it (Pandey et al, 2020). All these remedies -- guduchi-containing
preparations, ashwagandha and Ayush-64 -- were greenlighted by AYUSH to be used in conjunction with
standard biomedical treatments as “immunity boosters” which itself is a dubious concept. 29
The unquestioning confidence AYUSH placed in guduchi and ashwagandha comes from the
exalted place these herbs occupy in classical ayurvedic texts. These are rasayana herbs -- the most
excellent of all medicinal herbs which are supposed to possess near-miraculous powers that range from
preventing and even reversing aging to improving everything from the workings of the mind to the
complexion of the skin. 30 Indeed, the power of rasayana extends beyond ordinary bodily functions to
conferring superpowers. Both Charaka and Susruta samhitas ascribe to rasayana therapy the same
eightfold occult powers that a yogi could obtain by following the ascetic practices laid out in Patanjali’s
Yoga Sutras (Maas, 2017, Wujastyk, 2017). 31 These claims of natural and supernatural healing

29 For a review of scientific opinion on immunity boosting, see “Covid-19: Can 'boosting' your immune system
protect you?,” BBC-Future, April 9, 2020. https://www.bbc.com/future/article/20200408-covid-19-can-
boosting-your-immune-system-protect-you
30According to the Central Council for Research in Ayurvedic Science, the research flagship of AYUSH, “ a
Rasayana essentially means nutrition at all levels from macro to micro-cellular level. Rasayana therapy replenishes
the vital fluids of the body; boost the ojas (vital force of life) and the immune system….Rasayana therapy prevents
effect of aging and provides longevity, improves mental and intellectual competence, preservation of youthfulness,
increased luster, body complexion and glow of the skin, healthy condition of voice, excellent potentiality of the
body and the sense-organs….The commonly used Rasayana drugs are Amalaki (Phyllanthus emblica),
Ashwagandha (withania somnifera), Brahmi (Bacopa monnieri), Shankhapushpi (Convolvulus pluricaulis), Guduchi
(Tinospora cordifolia) and Yastimadhu (Glycyrrhiza glabra) etc., which promotes physical and mental
strength.”(emphasis added). http://www.ccras.nic.in/content/rasayana-ayurvedic-rejuvenation-therapy

31 Suśrutasaṃhitā, Cikitsāsthāna 29.13 states: “Using these two [kinds of soma], man achieves eightfold
lordship.” Carakasaṃhitā, Śārīrasthāna 1.140 a– 141b] explains these eightfold powers as: “Entering
the mind of other persons, knowledge of objects, acting according to one’s will, vision, hearing, mindfulness,
beauty and invisibility according to one’s wish, this is the eightfold power, the capacity of
properties have never been put to systematic test because the “authoritative books” of Ayurveda enjoy
the protection of the Drugs Act.
Guduchi occupies a central place in this select category of rasayana herbs. According to the
research arm of AYUSH, the Central Council for Research in Ayurvedic Science (CCRAS), “Guduchi is
mentioned in various Ayurvedic classical texts like Charaka Samhitha, Sushrutha Samhitha, Astanga
Hridaya, Bhava Prakasha Nighantu. Its synonyms are Amrita, Amara, Amrithavalli, Vatsadani etc.
Guduchi is having Balya (strengthening), Rasayana (rejuvenating), Tridosha shamaka (pacifying all
doshas) and Rakta shoddhaka (blood purifying) properties.” 32 A truly all-purpose herb, in other words,
that strengthens, rejuvenates, pacifies all humors and purifies the blood. No wonder another name for it
is “amrita,” the nectar that the Gods churned from the ocean, the nectar that revived Rama’s monkey
warriors in the battle against Ravana etc. 33 Guduchi, along with ashwagandha and amla, are considered
essential components of “Lehana karma,” or immunity boosting, which CCRAS presents as an ayurvedic
equivalent to vaccines.34 In prescribing these herbs for Covid care, AYUSH was faithfully following the
recommendations of classical Ayurveda.

Yogis.” (Maas, 2017:73). In other words, rasayana herbs were treated as medicinal means for achieving the
superhuman powers that yoga was supposed to confer. The quest for these special powers became even more
pronounced in alchemical rasayana where herbs began to be compounded with metallic elements, notably
mercury (Wujastyk, 2017).

32 “ A common drug that does wonder: Giloe (Guduchi)” Central Council for Research in Ayurvedic Science,
“http://www.ccras.nic.in/sites/default/files/viewpdf/Blogs/30012020_DrKPrameelaDevi.pdf

33 This is how AYUSH ministry’s own National Medicinal Plants Board describes Guduchi: “ The Sanskrit and Hindi
name Amrita [a synonym for guduchi] is derived from ancient Hindu scriptures where Amrit was used to bring the
dead back to life and keep away from growing ill or old. Bhav-Prakash Nighanta provides mythological description
about the origin of Guduchi/Amrita from the drops of Divine nectar (Amrit) which was sprinkled on the dead
bodies of monkeys to make then alive who were died [sic] during the battle between Rama and Ravan. Few drops
of the nectar from the bodies of the monkeys fell on the ground and from them, Guduchi sprouted.” Tinospora
Cordifolia (Giloy): Amrita for Life, https://www.nmpb.nic.in/sites/default/files/Giloy_Book.pdf. The occult
properties of guduchi are not explicitly included in its medical virtues, but kept alive by recounting in a publication,
sponsored by the state, meant to make a scientific case for this herb. This state-endorsed mythology is repeated in
an endless number of promotional materials on the websites of spiritual gurus like Deepak Chopra, and businesses
selling traditional medicines.
34 The Central Council of Research In Ayurveda defines Lehan Karma as follows: “In Ayurveda, the essence of all
Dhatus is called “Ojas” and it is responsible for the defense of the human body against diseases
(Vyadhikshamatva). In modern medical science, vaccination is done to produce immunity against a disease.
Acharya Sushruta, Vagbhata and Kashyapa describe Lehana for this purpose which ultimately enhances immunity.
Lehana Karma and Rasayana are done to enhance growth and development by providing sufficient nutrition and
promoting health with improving intellect and speech. Rasayana are rejuvenating agents which produce resistance
against disease. Different types of herbs and formulations are described in Ayurveda to improve immunity.”
(emphasis added). http://www.ccras.nic.in/content/lehan-karma-ayurveda
 There is a fly in AYUSH’s ointment, however, and its name is globalization. The global market for
herbal medicines and wellness-tourism is massive and growing and India badly wants a piece of it. The
global medicinal herbal market was valued at 98.60 billion US dollars in 2020 and is expected to grow to
391.22 billion dollars by 2028. 35 India is lagging behind China with $358.6 million, estimated at 0.5
percent of the global herbal market in 2015-2016 when China’s exports was valued at $3.8 billion, nearly
ten times that of India (Kudlu and Nichter, 2019). It is one of the top priorities of the Modi government
to increase India’s share of this market, and for that purpose Modi has been acting as a global
ambassador for Ayurveda and yoga and can take legitimate credit for the WHO’s Global Institute for
Traditional Medicine to be set up in India. 36
But globalization is a double-edged sword for worldwide popularity brings worldwide scrutiny.
As complementary and alternative medicines have become more popular in North America and Europe,
their claims for efficacy and safety are being put to rigorous scientific tests by the international scientific
community that has no investment in the worshipful mindset of the Indian ayurvedic lobby. After all, it
was only after ayurvedic remedies went offshore to distant lands that the heavy load of toxic heavy
metals they carry became an issue of worldwide concern. It was the careful clinical investigation of
American, British and other Western medical scientists that revealed the toxic effects of the dangerous
levels of mercury, lead, arsenic and other heavy metals that are found in popular ayurvedic formulations
(Ernst, 2002, Saper 2004).
In recent years, a new area of concern regarding side-effects of drugs, including medicinal
herbs, has emerged around the world -- drug induced liver injury, or DILI. A number of
pharmacovigilance groups that collect data on adverse reactions of drugs have been initiated around the
world, taking the lead from the National Institute of Health in the United States which initiated the Drug-
induced Liver Injury Network (DILIN) in 2004 (NIH: 2004). Similar research initiatives have begun in the
Asia-Pacific regions as well, with India an active participant. 37 Herbal food supplements and/or
medicines were not the original concern of these networks as most of the reported cases of liver
damage in the West were found to be caused by prescription painkillers and antibiotics. But as the use

35 “Herbal medicine market size and forecast.” Verified Market Research, July 2021.
https://www.verifiedmarketresearch.com/product/herbal-medicine-market/

36 “WHO to set up centre for traditional medicine in India, PM says matter of pride,” The Hindu, Nov. 11, 2020.
https://www.thehindu.com/news/national/who-to-set-up-centre-for-traditional-medicine-in-india/
article33091388.ece
37 The Institute of Liver and Biliary Sciences in New Delhi is the nodal point for AARC, the research consortium
that gathers DILI data from over 50 research centers across India, China and the wider Asia-Pacific region.
http://www.aclf.in/
of alternative or complementary medicine has grown around the world, their contribution to the cases
of liver injury too has gone up globally, bringing them under increased scrutiny. The collective effort of
these researchers has already brought to light what was lost in mythology and popular lore. It is
becoming clear that our “divine” herbs may not be so wondrous after all.
That traditional herbal medicine is a major contributor to liver disease is now fairly well
established in settings as varied as the United States, China, Korea and Asian-Pacific countries. In the
United States the use of complementary and alternative medicine (CAM) has sky-rocketed in recent
years with nearly half of the US population reporting using at least one dietary supplement. The
incidence of liver disease attributed to these agents has also risen equally sharply in the US, from 7
percent in 2004 to 20 percent in 2017 (Hillman et al, 2016). In the Asia-Pacific region as a whole where
herbal medicines, including traditional Chinese and Indian medicines are widely used, 71.7 percent of
acute liver failure among those with compromised livers were attributed to traditional medicines --
Chinese and Indian -- while 27 percent attributed to anti-tuberculosis medicines (Devarbhavi et al. 2021,
Devarbhavi, 2018). In China, where traditional Chinese medicine is well integrated with biomedicine, a
sizable proportion -- ranging from 30 to 60 percent -- of liver disease is attributed to traditional
medicines. A similar pattern is found to prevail in countries like Singapore and Japan where traditional
Chinese and other traditional remedies are popular (Philips et al, 2019). In most of the cases, it is not
possible to pin-point the herb responsible for the liver injury because most traditional medicines come
as poly-herbal preparations.
Given that India does not have a well-developed system -- and more importantly, the culture --
of watching out for and reporting adverse drug reactions, the data on drug-induced injuries is relatively
scarce. But the picture of the damage drugs -- both conventional and ayurvedic -- cause to the liver is
coming into sharper focus thanks to the medical doctors associated with the Indian Network of Drug-
Induced Liver Injury (IN-DILI). Analysis of data collected over five years (2013-2018) from 30 centers all
around India at the nodal center in St. John’s hospital in Bangalore was published in 2020. A total of
1288 cases were studied and an attempt made to understand the agents associated with their condition.
A combination of anti-TB drugs was found to be the main culprit (46.4 percent), followed by ayurvedic
formulations (13.9 percent) that had been prescribed for general ailments. What is worse is that the DILI
associated with traditional medicines was more severe as compared to the damage caused by anti-TB
drugs. (Devarbhavi et. al, 2021).
Because the traditional ayurvedic medicines are mostly polyherbal decoctions, pills or churnas,
and notorious for not identifying or misidentifying the ingredients which are often adulterated, it is not
easy to pinpoint which herb, precisely, is the culprit. Typical cases present themselves along the
following lines reported in actual case studies. A person goes to a traditional ayurvedic healer for
treatment of diabetes and is given a multi-herbal formulation, develops jaundice after 10 days of use
and goes back to the healer to take care of his jaundice. The healer reduces the dose of the original drug
and prescribes dietary restrictions. A week later, the patient ends up in the emergency room and biopsy
shows severe liver damage. The patient recovers completely after the ayurvedic drugs are withdrawn
(Pillips et al, 2019). Or a more tragic case of a 54 year man with no history of alcohol consumption goes
to an ayurvedic doctor to boost his appetite and energy. The doctor prescribes a multi-ingredient,
unlabeled bhasma. Within a week this man lands in the emergency room with severe symptoms of
jaundice and a liver so damaged to require a transplant. Tragically, before a suitable liver could be
found, the patient dies (Philips et al, 2018b). Quite often, those taking herbal medicines simply self-
medicate, sometimes following home-made recipes and often buying proprietary formulations which
are heavily advertised and freely available without prescription. Even after the offending drugs are
sometimes recovered from the patients, lack of accurate information regarding their composition and
the multiplicity of herbs and/or metals makes it almost impossible to zero in on the exact cause of the
injury.
Despite these problems of identification, case studies have started to emerge that implicate
AYUSH ministry’s most prized herbs -- guduchi and ashwagandha -- in liver injury. The first important
study to emerge in India was by a team of liver specialists from Kochi, Kerala led by Dr. Cyriac Abby
Philips. Out of 1440 liver disease patients who presented themselves in the hospital emergency
department, 94 reported taking ayurvedic medicines before they experienced problems with the liver.
Out of the 94, 33 had no history of excessive alcohol consumption and/or viral hepatitis. What they had
in common was that they were taking a variety of ayurvedic drugs for various unrelated ailments for
some time (10 to 84 days) before the onset of their symptoms. The research team managed to retrieve
and analyze some 47 formulations, some manufactured by well-known brands and others prescribed by
traditional healers. All patients on these drugs suffered from chronic inflammation of the liver, with
nearly one-third of them showing autoimmune antibodies. Five patients died, while others recovered
after the ayurvedic drugs were discontinued. Majority of the formulations were found to be laden with
heavy metals like lead, arsenic and mercury (Phillips et al, 2018a). While the exact herbal composition of
these polyherbal formations was not possible to determine, eight of them were found to contain
guduchi (Philips 2021).
 Even more sharply focused data emerged from the United States where in the span of three
months three female patients turned up with serious symptoms of jaundice in a California community
hospital. Two of these patients, both of South Asian origin, had been taking pure guduchi or guduchi
containing formulations. The first woman was taking an ayurvedic supplement called Giloy Kwath for her
problems with hypothyroidism and borderline diabetes, and the second woman, also suffering from
hypothyroidism, had turned to two formulations called Manjishthadi Kwatham and Aragwadhadi
Kwatham. The third woman of Hispanic origin was on Kanchnar Guggulu (a non-guduchi containing
polyherbal) for menstrual problems. Here we have a situation where the herbal composition was
clearer: the first patient was on pure guduchi, while the second patient was taking two formulations,
both of which contained guduchi. In both of these cases, there were clear symptoms of liver damage
that went away once the drugs were withdrawn (Karousatos et al, 2021).
An even sharper picture emerged from a team of doctors from Mumbai in the middle of the
pandemic (from September to December 2020) when the guduchi craze was at its peak. These doctors
reported case studies of six patients who were doing exactly what AYUSH had been recommending:
making decoctions of guduchi at home (four patients) or consuming guduchi-containing syrups and pills
(2 patients) to boost their immunity. All showed features of chronic liver disease, four with autoimmune
features. In all six cases, the symptoms receded after the guduchi consumption was discontinued.
(Nagral et al, 2021). So much for AYUSH’s “lehana karma.”
Meanwhile, clinical evidence is emerging that ashwagandha, AYUSH’s other big immunity
booster, may not be all that it is cracked out to be. Ashwagandha was only second to guduchi when it
came to AYUSH’s Covid-care. It is also the number one drug when it comes to India’s attempt to gain
international acclaim for its traditional pharmacopeia. The Indian government has put in considerable
energy in having the Western drug regulators grant it approval as a medicinal product, so far with no
success.38 It is one ayurvedic herb that has carved out name-recognition and a sizable market-niche in
the West -- it was the 7th best-selling herb in the unregulated food-supplement market in the United
States,39 where it is marketed for relief from anxiety and insomnia.
38 According to the American Botanical Council, “..in 2008, the Government of India, Department of Ayurveda,
Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) — as part of a global strategy for brand-building of
Ayurvedic medicine — prioritized the promotion of ashwagandha preparations, in particular, for attaining
marketing authorizations as medicinal products in several foreign markets including selected EU member states, as
well as in Australia, Canada, and Commonwealth of Independent States (CIS) countries.”
https://www.herbalgram.org/resources/herbalgram/issues/99/table-of-contents/hg99-herbprofile-
ashwagandha/

39 “An Herb to Watch: Ashwagandha science growing consumer recognition and sales”
https://www.nutraingredients-usa.com/Article/2016/03/30/An-herb-to-watch-Ashwagandha-science-growing-
 Clinical evidence that dietary supplements of ashwagandha could be interfering with liver
functions has begun to trickle in from non-Indian markets. Earlier report from Japan of a young man
who developed jaundice after he topped his conventional anti-anxiety medicines with ashwagandha, has
now found additional evidence for liver injury from five more cases reported from Iceland and the
United States (Bjornsson et al, 2020). The connection with ashwagandha was easy to make as three
patients from Iceland had consumed ashwagandha from the same trade-marked product “Now
Ashwagandha,” produced by Now, a US-based food-supplement multinational business (one of the US
cases came from a patient who had used another major brand, “Nature’s Way”). Prompted by these
studies, the Indian DILI-network has begun to pay attention to this herb in India as well. 40
Shoot the Messenger
Three things are clear from all that has been said so far: one, AYUSH zealously promoted herbal
remedies containing two herbs, guduchi and ashwagandha, as immunity boosters; two, both of these
herbs had been found to be present in cases of herbal medicine-induced liver injuries; and three, the
clinical studies reporting these liver injuries were based on solid data, had been reviewed for
publication in some of the best international journals in the field and, more importantly, they were
available even before the pandemic began.
In other words, alarm bells were already ringing, and yet AYUSH saw no reason to moderate its
wholehearted enthusiasm for the suspect herbs. It is true that, mercifully, there was no major
thalidomide-like catastrophe as a result of these herbs, 41 but no one is keeping track of the adverse
effects the unsuspecting consumers of the “natural and safe” immunity boosters may have suffered in
the short or the longer term. How many vaidyas follow up after they hand their patients the churans and
the decoctions? How many are competent enough to connect the subsequent side-effects, even if they
are reported back to them, to their own remedies? How many bother to ask the patients to get
diagnostic blood tests before or after they prescribe their medicines? The easiest way to maintain the
“natural and safe” mystique of traditional medicine is not to go looking for possible adverse effects, or
bother to report them even when they are too obvious to ignore. There is always the option to shoot
consumer-recognition-and-sales

40 Personal communication with Dr. Cyriac Abby Philips.

41 Thalidomide was developed in the 1950s as a sedative and was widely prescribed worldwide for all kinds of
ailments. It was considered so safe that it was freely prescribed to children and pregnant women. It took many
years -- and many deformed babies -- to establish the effect this drug has on the development of the
foetus. Its use has been banned ever since, although it has been found effective against leprosy and HIV-AIDS.
https://www.sciencemuseum.org.uk/objects-and-stories/medicine/thalidomide
the messenger who does go looking for side-effects in a systematic manner – as the liver-experts are
beginning to do – for “tarnishing” the tradition. And that, as we shall see, is the option that AYUSH
chose.
One could argue in AYUSH’s defense that the possibility of the good that these herbs may do --
boost immunity and protect against the deadly Covid virus outweighs any possible harm they may
cause. All medicines have some side-effects but that is no reason not to use them in the correct dosage
and with due precautions. Afterall, the same studies that found herbal medicines damaging the liver also
found anti-TB medicines to be an even bigger culprit. By this logic, AYUSH is justified in advocating its
time-tested remedies. The problem is that the good that these herbs may or may not do has never been
established in any systematic manner: even enthusiastic boosters of Ayurveda like Bhushan Patwardhan
admit that they can “count the number of randomized control trials of Ayurveda on the fingers of one
hand.”42 The benefits of these herbs are simply stipulated, taken on faith, based upon anecdotal
evidence and the authority of the Good Books of Chakra, Susurata and other long-dead vaidyas.
One could argue that AYUSH was acting in good faith based upon, as AYUSH itself insists,
“thousands of years” of use. But to quote Edzard Ernst, a long-time researcher and critic of alternative
medicine,
“ ...it can never be sufficient for healthcare practitioners to merely act in good faith. All
healthcare professionals have a positive moral duty to ensure that the treatment of their
patients is based upon sound evidence and theory. Thus, regardless of how sincerely an untrue
medical belief is held, the practitioner who acts on false beliefs—however honestly and with
good intent—is judged [to have acted unethically].” (Edzard and Smith, 2018: 154, emphasis
added).

As the regulatory body overseeing all traditional medical systems of the country, AYUSH had a
moral duty to ensure that its policies are based upon “sound evidence and theory.” Sincere, deeply held
belief in the timeless truths of ancient books does not absolve the policy-makers and the ayurvedic
establishment of their dereliction of duty.
How did AYUSH react when it was presented with toxicity data based upon sound evidence and
theory? It went all out to shoot the messenger. The ministry issued a threat of a defamation lawsuit

42 Dr. Bhushan Patwardhan, Professor and Director of the Interdisciplinary School of Health Sciences,
Pune University, is one of the most prominent advocates of “Ayurveda Renaissance” (Patwardhan et al
2011). The cited quotation is from “Questions over science swirl, but AYUSH stands firm,” The Hindu, April 26,
2015 at https://www.thehindu.com/sunday-anchor/medicine-wars-homeopathy-allopathy-ayurveda-unani-in-
india/article10792873.ece?utm_source=pocket_mylist
against Dr. Philips, the lead researcher of the liver-toxicity studies and a leading critic of untested claims
of alternative medicines. The ministry deemed Dr. Philip’s well-justified concerns as “defaming the
Ayurvedic System of Medicine” and found them “tantamount to deliberately tarnishing the image of
AYUSH systems and infringe the faith of people in this traditional system of medicine.” 43 The letter was
sent to national and state-level medical boards demanding action to silence the doctor. (Incidentally,
this was not the first time AYUSH had Dr. Philips in its firing line: he had been asked to appear thrice
before the ministry after he published his findings on liver toxicity in 2018.) AYUSH clearly acted as a
defender of the faith, rather than as a defender of public health and safety.
Even before the pandemic, AYUSH had tried to prevent non-Ayurvedic doctors and researchers
from investigating traditional systems that come under the umbrella of AYUSH. In April 2019, just before
the pandemic hit, AYUSH issued a gag order on non-ayurvedic researchers and editors of scientific
journals to the effect that every piece of research they undertake and publish has to be “vetted” by
experts in Ayurveda -- the same “experts'' who, incidentally, have established a global reputation for
low-quality non peer-reviewed “research” based on ghost patients and pay-for-Ph.D. degrees! 44
Why such a censorious advisory from a government body that never tires of proclaiming the
“scientific” status of all traditional knowledge systems? Two rationales were offered, both of them
laughable.
According to AYUSH, mainstream biologists and biomedical researchers are not intellectually
equipped to understand Ayurveda because their paradigm of how the human body functions and what
causes and cures diseases does not apply to Ayurveda. AYUSH proclaims that “the principles, concepts
and approaches of AYUSH systems are not at all comparable to the conventional medical systems” and
therefore only the five AYUSH-certified research councils can carry out such research. This makes a
mockery of the modern ayurvedic establishment’s own loud and proud proclamations of Ayurveda being
as sound a science as modern medicine. It makes a mockery of AYUSH’s own eagerness to claim every
scrap of “scientific” validation where and when it can find it. If Ayurveda is so entirely incommensurate
with modern science, what is one to make of Baba Ramdev’s parading of “scientific evidence” to prove

43 The letter is reproduced in “AYUSH ministry threatens Kerala doctor with defamation, for ‘denigrating’
Ayurveda,” The Print, Sept. 21, 2021 at https://theprint.in/health/ayush-ministry-threatens-kerala-doctor-with-
defamation-for-denigrating-ayurveda/736863 /

44 “Measures taken by the Government to curtail mis-information via non-AYUSH Researchers” Ministry of
AYUSH July 16, 2019. https://pib.gov.in/PressReleasePage.aspx?PRID=1578976. For the state of “expertise” in
Ayurveda, see Jean Langford (2004)
the efficacy of Coronil? What is one to make of “Ayurgenomics” which the BJP swore to advance in its
2014 election manifesto? 45
The real objective was simple and quite transparent: to protect Ayurveda from any falsifying
evidence. AYUSH was quite explicit about it. It wanted to keep non-Ayush researchers on a tight leash to
prevent them from asking inconvenient questions that would, to quote from the AYUSH notice to non-
AYUSH researchers, “damage the credibility and sanctity of the whole system.” Maintaining the
“sanctity” of its faith-based medicine is the primary objective. It is clear that any evidence that validates
Ayurveda, however shoddy the methodology, is “scientific,” while all else is deemed willful and
malicious “misinformation” meant to damage our hallowed tradition.
The corporate and professional ayurvedic interest groups, too, have played an aggressive role in
censoring biomedical research in Ayurveda. AYUSH’s threat to Dr. Philips, for example, was instigated
by the Ayurveda Medical Association of India, whose general secretary, Sadath Dinakar, filed a
complaint with the prime minister’s office. 46 Ayurvedic doctors see good science as a threat to their
interests and have become adept at filing lawsuits for “hurt sentiments” against critics, including the
Indian Medical Association.47 Business interests, notably a major multinational company, Herbalife, hired
a Delhi law firm to pressure a major scientific journal to remove a peer-reviewed paper by Dr. Philips
detailing the case study of a woman who died as a result of consuming the slimming Herbalife product. 48
Instead of supporting and protecting honest science, AYUSH has taken the lead in protecting
sectional interests of its own constituency. It is the public that ends up paying a price for such chicancry.
Old is not gold
Long use – the proverbial “thousands of years” -- is invoked like a mantra whenever the subject
of safety of herbal medicines comes up. It was not surprising that when the Mumbai hospital study on
liver damage in patients consuming guduchi for protecting themselves from Covid-19 was released in

45 See note 5.

46 “Union AYUSH Ministry threatens defamation against Kerala doctor,” The Hindu, Sept 27, 2021.
https://www.thehindu.com/news/national/kerala/union-ayush-ministry-threatens-defamation-against-kerala-
doctor/article36696410.ece?utm_source=pocket_mylist”

47 “Ayurveda suit filed to threaten IMA, says chief,” Times of India, Aug 6, 2021
https://timesofindia.indiatimes.com/city/delhi/ayurveda-suit-filed-to-threaten-ima-says-chief/articleshow/
85083552.cms

48 “Paper about Herbalife®-related patient death removed after company threatens to sue the
journal,”Science Integrity Digest, Dec. 2020 https://scienceintegritydigest.com/2020/12/20/paper-
about-herbalife-related-patient-death-removed-after-company-threatens-to-sue-the-journal/
January 2021 (see the section “First do no harm..” above), the ministry of AYUSH tried to shoot it down
by insisting that “guduchi or giloy has been used in Ayurveda since long.” AYUSH also claimed that there
were “hundreds of studies” that had shown guduchi protects the liver, rather than damage it. 49 What it
failed to admit is that these “hundreds of studies” are all either in tissue cultures or in laboratory
animals, none in actual clinical settings. 50
That thousands of years of use is itself evidence of safety and effectiveness of ayurvedic
medicines is foundational to modern ayurveda. This is indeed the unstated assumption behind India’s
Drugs and Cosmetics Act that grants complete exemption to herbs, and recipes containing these herbs,
from any further tests if the manufacturers follow the instructions of the classical texts literally. On the
face of it, the idea does make rational sense: if these herbs were damaging to the human body, their
adverse effects would have come to light in the thousands of years that they have been in use. Just by
hit and trial, if nothing else, we would have learnt to stay away from them, or at least use them
judiciously.51 It is rational, then, to surmise that because herbs like guduchi and ashwagandha have not
only been used but prized for their health-giving properties, it must mean that they work, and work
safely enough.
It is time to rethink this foundational belief. The rest of the world is waking up to the fact that
herbal medicines pose a global health hazard and “long history of usage is insufficient to assure the
safety of herbal remedies,” as Arthur Grollman and Donald Marcus wrote in an important paper in 2016.
Nothing brought home this lesson more than the story of aristolochia, popularly known as birthwort, a
medicinal herb used all over the world, from Europe, the Americas, to China and India for literally
thousands of years. The use of this herb was first recorded in ancient Greece by Theophartus (371-287
BCE), a student of Aristotle, for use in treating snakebites, insomnia, constipation and uterine problems
49 “Relating Giloy to Liver Damage is completely Misleading, Says Ministry of Ayush” Ministry of AYUSH, July 7,
2021 at https://pib.gov.in/PressReleasePage.aspx?PRID=1733260

50 “The hepatoprotective effects of giloy / ashwagandha are not validated and are only foundational
evidence studied in cell/tissue and small animal models. No human clinical studies on liver related
events (beneficial) have been shown properly as per quality methodology and trials. The current data on
"hepato-protection" is quite delusional, as even some of the main basic foundational studies on
Ashwagandha are either faked or with serious flaws - an example
https://pubpeer.com/publications/25049463 ,”
personal communication from Dr. Cyriac Abby Philips.

51 Classical ayurvedic texts, notably Charka Samhita actually pay a lot more attention to the possibility of adverse
effects than do the modern ayurvedic industry that mass produces herbal formulations. Charaka Samhita
recognized that, "that even a strong poison can become an excellent medicine if administered properly. On the
other hand, even the most useful drug can act like a poison if handled carelessly,” and paid attention to the
individual’s suitability for specific medical treatments. See Thatte and Bhalerao, 2008 for details.
in women. Traditional Chinese medicine lists several species of this herb. Aristolochia Indica, or Indian
birthwort, known as Ishwari in Hindi, finds many uses in ayurvedic medicine from curing snakebites,
inducing vomiting to termination of pregnancies. If there is one herb with documented history of
“thousands of years of use” all over the world, aristolochia/birthwort is that herb.
It took years of detective work by medical researchers to uncover the toxicity and
carcinogenicity of this herb. The aristolochia story began in the early 1990s in Belgium where nearly a
hundred women developed a rapidly progressing kidney disease that required dialysis and kidney
transplants, with a significant fraction of this cohort developing kidney cancers. All of these women so
affected had one thing in common: they had been on a weight-loss regimen that included Aristocholia
fangchi, a commonly used herb in traditional Chinese medicine where it is known as Guang Fang-ji.
Belgian pathologists noticed a similarity between the diseased tissue samples from these women with a
kidney disease prevalent in the Balkan region of Europe including Bulgaria, Romania, Serbia, Croatia and
Bosnia-Herzegovina. Earlier in 1969, a Serbian microbiologist had figured out that the Balkan kidney
disease was caused by a process of harvesting and milling wheat for bread that ended up mixing up
wheat with the seeds of a species of aristolochia plant that grows wild in that region. This led Arthur
Grollman, from Stony Brook University in New York, to hypothesize that “dietary ingestion of
aristolochic acid, in conjunction with individual genetic sensitivity, accounts for all epidemiological,
clinical and pathophysiological features [of the kidney diseases in question]. This hypothesis has an
important corollary, namely, Balkan endemic nephropathy, Chinese herb nephropathy and aristolochic
acid nephropathy are the same disease” (Grollman 2012). Grollman and his team studied the distinctive
molecular signatures of the mutations caused by aristolochic acid and successfully showed that the
pathology of kidney disease in Taiwan, where traditional Chinese medicine is widely used, and where
kidney cancers are widespread, is “almost identical” to that observed in the Balkan region. As a result of
these studies, it is now fully established that aristolochic acid, found in all species of birthwort, is a
human carcinogen. This recognition has led to a ban on the use of this herb in Europe, the UK, the USA,
Canada, Australia and East Asian countries, although not so in India where the ayurvedic industry is
petitioning AYUSH to give Ishwari, Indian birthwort, a clean chit. 52

52 Following a familiar pattern, Ayurvedic Drug Manufacturers' Association interpreted the solid evidence of
toxicity of Indian birthwort as an affront to our ancient medicine and appealed to AYUSH to “issue a press notice
immediately refuting the same.” see “Industry wants Ayush dept to clarify issue of use of aristolochic acids in
ayurvedic drugs” Pharamabiz.com, April 3, 2013 http://www.pharmabiz.com/NewsDetails.aspx?
aid=74585&sid=1&utm_source=pocket_mylist
As far as it can be ascertained, AYUSH has not, at least not yet, issued any advisories on the fate of Ishwari.
 The aristolochia story raises a host of questions which are relevant to the faith-based approach
of the ayurvedic establishment. First and most obviously, it blows holes through the whole mythology
that what is old is gold, that thousands of years of use can substitute for sound evidence for safety. For
thousands of years, what we now know as a carcinogen was being prescribed and consumed for its
medicinal virtues. And aristolochic acid- containing herbs are not alone: the Chinese ephedra (Ma
huang), comfrey tea and sassafras, herbs that have been in use forever are now known to have serious,
life-threatening effects, as do herbs like guduchi and ashwagandha which impair the liver.
This raises the question: how come so many people, all around the world, missed these adverse
effects for so long? Shouldn’t we have been able to spot these problems in the thousands of years that
we have consumed these herbs? One reason these effects evade attention is that there is generally a
long latency period between when a herbal medicine is taken and when the effects show up, making it
difficult to establish a cause and effect relationship. The second reason why these problems have gone
undetected is that no one has gone looking for them in any sustained systematic manner, at least not in
India. The almost-religious faith in the wisdom of the ancients in India has, and continues to, prevent
any systematic follow up of what happens to the patients after they are sent home with the herbal
preparations. For all the so-called pharmacovigilance cells set up by AYUSH, hardly any ayurvedic doctor
bothers to report an adverse effect even after it is brought to their notice. A recent informal survey
carried out by Urmila Thatte,, a Mumbai-based clinical pharmacologist, examined the attitudes of
ayurvedic doctors toward adverse reactions of ayurvedic medicines and reporting these to authorities.
The survey found that “of the 80 vaidyas interviewed, 14 refused to accept that ayurvedic drugs could
produce adverse reactions and the rest felt that adverse reactions would occur only if ayurvedic drugs
were improperly manufactured and irrationally prescribed. Of these 66 doctors, 48 physicians said that
they had seen "unexpected" reactions after administration of ayurvedic drugs in their practice.
Interestingly, only 14 of these 48 said that they had reported these reactions (mostly in medical
association meetings or to medical representatives),” (Thatte and Bhalerao, 2008). Combine this attitude
of the vaidyas with the ministry of AYUSH’s readiness to silence anyone who asks inconvenient
questions, it is clear that India has miles to go before it wakes up to the hazards that traditional
medicines pose to public health.
A wake-up call
The Covid-19 crisis brought Ayurveda to the center of public health policy debates like never
before. It has simultaneously exposed its many fallacies and weaknesses like never before.
 From top to bottom -- from the prime minister, the AYUSH ministry, the state-level public health
departments to the babas and gurus and big ayurvedic-drug companies -- upholding the “sanctity” of
India’s ancient medical science took precedence over honest science. The efficacy of the many remedies
was simply stipulated based upon faith, while scientific evidence showing harm was ignored and worst,
threatened with legal action. It was truly a faith-based medicine in action, with unquestioning support
from the state.
The ayurvedic establishment might think it has won the battle for the public image of Ayurveda,
but it will surely lose the war for putting Ayurveda on a firm scientific footing if it continues down this
path. Indian traditional medicines are no longer an internal matter of India alone: they now have a
presence in the rapidly growing complementary and alternative medicine segment in the rest of the
world. India, in other words, can no longer hide behind its faith-based approach in the face of a global
community of scientists who have no reason to hold Ayurveda in awe, or accept its basic assumptions at
face value.
If AYUSH is genuinely interested in salvaging whatever is useful in indigenous medical traditions,
it will have to wield the Occam’s Razor and shave off all superfluous theoretical entities -- the bhutas,
the doshas, the gunas , the prakritis -- which add nothing to the explanation of disease and health and
are entirely beyond the scope of empirical testing. Whatever testable that is left over after the deep
shave -- the herbal and herbal-metallic remedies, the dietary recommendations, the bodily
manipulations -- will have to be subjected to stringent clinical tests before Ayurveda can be safely and
productively integrated with modern medicine. If the ayurvedic establishment refuses to subject the
tradition to a ruthless self-critique, then the scientific community in the rest of world will apply Hitchens
53
Razor to it because “what can be asserted without evidence can also be dismissed without evidence.”
The burden of proof of the validity of Ayurveda rests upon its zealous guardians; and so far they
have failed to meet that burden. That is the real lesson of Ayurveda in the time of Covid-19.

53 Christopher Hitchens used this phrase in his well-known book, God is Not Great to argue against miracles as the
proof of God’s existence.