This is the area that needs to be discovered and developed, in order to successfully integrate Ayurveda with the allopathic medicine. Problem is that Ayurveda is confined only to some part of our country and it is moreover a neglected area when it come to high end research. Success will only depend if Indian government more than finding this sector thinks of collaboration this sector with eminent pharmaceutical companies so they together come up with a definite answer to problem.

I dont think any research has exactly taken up this question. Usually the efficacy of an ayurvedic drug would be compared to an Allopathic standard drug but a combination of both was never preferred. I personally feel that such an interaction would be hazardous to the drug metabolism system in humans leading to formation of more potentially toxic compounds. The Ayurvedic system uses a synergistic approach where a combination of  drugs had a better efficacy than a single drug.

Integration of Ayurveda with Allopathy is a good step for comprehensive health benefits. Drug Drug interaction is not with many drugs, with selective drugs some precautions are required but such drugs are very few. In developed countries Integrative medicine is becoming a regular health service feature in many health care academic institutions and hospitals. Many Allopathic doctors of in particular internal medicine branch are already with additional qualification of CAM / Traditional Medicine and many are acquiring. There is a separate regular course in integrative medicine branch. 

Each medical stream has some strength and some weakness, if both are integrated then the health care will be comprehensive. In medical education such integration should be exclusively at post graduate level but graduate level education should be separate in its pure form to mention identity. Such strategy will boost the research in many aspects.

Another strategy may be all under one umbrella, establishing different medical treatment clinics in one campus. Inter disciplinary referral practices are to be encouraged considering strength and weakness of each one.

Many consumers believe that herbal medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines are associated with adverse effects, which include interactions with prescribed drugs. Surveys found that patients receiving conventional pharmacotherapy also take herbal products. Classics of Ayurveda, preferred avoiding incompatible drugs, diet and deeds while consuming medicines.  Ayurvedic inscriptions clearly show that all herbs are not safe and herb-drug interactions are always possible, of which some are sufficiently serious to endanger the health of the patients. It is therefore important to know possible health hazards of concomitant use of herbs along with other drugs.

Integration of different medicine is not new. It was in 372 AD when in Gund-e-Shahpur School (situated somewhere in present day Iran), all the traditional healers were invited including Vaids from Kerala, practitioners from Chinese traditional medicine, Egyptians, Romans, Arabs, Persian, Greece so on and so forth. Their books were translated into Persian and the combination evolved as "Ilm-e-Tibb". That was the beginning of the integration of the Medicine 

Integration in health care should be comprehensive, not restricted to drugs only; it should include dietetic practices, invasive and non-invasive therapeutic procedures, exercises, yoga practices etc. Further it may include diagnostic procedures also. Integrative medicine should be a separate branch particularly at post-graduate level, such is not existing in India. In European countries and USA Integrative medicine in health academics and practices is in practices. The other separate medical branches should continue in their pure form, this necessary to preserve the heritage knowledge and wisdom.

Good move. Some allopathy doctor prescribed medicine with a combination of natural or ayurvedic medicine and allopathy medicine and it gives good result. For example, a dermatologist of our area prescribed ointment viz., salicylic acid (allopathy) and psoriyane (natural ointment) for psoriasis. Integration of Ayurveda with Allopathy is a good step and need for this hour. 

@Saravanan Dear, first of all they should know the herb-drug interaction.....

Otherwise instead of doing good this may lead to disaster....

Good Morning ..

Studies have shown that St. John’s Wort significantly affects cyclosporin blood levels leading to uncontrolled reductions and unpredictable risk for visceral organs suggesting caution to be taken with co-administration of St. John’s Wort in patients with transplants. Caution is also suggested when Echinacea is co-administered with drugs dependent on CYP3A or CYP1A2 for their elimination. A few studies indicated that garlic extracts are unlikely to alter disposition of co-administered medications dependent on CYP2D6 or CYP3A4 pathway of metabolism. Standardized extracts of Gikgo biloba at recommended doses are unlikely to significantly alter the disposition of co-administered medications. Insignificant effects on digoxin pharmacokinetics were observed on co-administration of kava kava. Decreased Metformin levels with Nisha Amalaki (Powdered combination of Turmeric and Emblica) was reported in healthy volunteers (n=6) suggesting that the formulation may interfere with the absorption of metformin, further suggesting larger studies to find-out appropriate mechanism.

In Indian scenario; diabetics concomitantly use a wide range of herbs (in the form of home remedies) like Guduchi (Tinospora cordifolia), Haridra (Curcuma longa), Kumari (Aloe vera), Amalaki (Emblica officinalis), Mamajjaka (Enicostemma littorale), Methika (Trigonella foenumgracum) etc. along with conventional drugs. This kind of concomitant use is prevailing in other diseases too considering that all natural is safe often without the knowledge of their physicians. Contrary to this belief; all naturals (herbs) are not always safe. As herbs are also made up of certain functional groups; when used with other drugs (like conventional ones) interact within the biological system leading to interactions, at times which may prove to be fatal. Unfortunately, information on such interactions with herbs frequently used in Indian scenario is meager. There is need to work in this direction..  

Good Morning Saravanan Ji..

Interesting observations you tracked down. It was good to hear. Your analysis also a way of documenting safety of outcome of concomitant usage of drugs. Can you please little more highlight about the nature of drugs consumed, frequency, duration etc. Anticipating to hear from you..   

@ Younis Munshi Ji..

What kind of observations and documentations you have till now? Can you please share your experiences and highlight such interactions observed.  

Good morning Doctor. Thank you for your appreciation. I will add the details. 

@Galib Rukunidin brother:

I am attaching a file for your further studies.  Please go through it and this may also lead you to some useful research

Thank you Munshi Ji for sharing useful information. 

Most of the times, the studied interactions are in between extracts and conventional medicines. But, traditional systems of medicines use drug as a whole. Do similar kind of drug interactions can be expected, when a drug is used concomitantly as a whole ? Do you have any personal clinical experiences on this?      

As i think the effect of the drugs are depended with attachment of receptor and when we use combination the target are limited as we have limited numbers of receptor. After the saturation rest drug may lead for toxicity or adverse reaction.

Some 20 years back Ayurveda and Allopathic -Chemical combination medicine were available in the market but later these were vanished or banned don't know . Such medicines were more beneficial in many diseases. The big pharma companies should comer forward, I am ready to help.

Gandhidas Sonajirao Lavekar Sir,

I have high regards of your knowledge and work in the field of Ayurveda. But sir the question remains as we never know what kind of a reaction is taking place within the body once we take herbal medicine. There are lot of enzymes and anti-enzymes within the body which act upon to anything we take as food or medicine. When we don't know the reaction of the body to herbs, how come we may come to know reaction of the phytoceuticals with chemical constituents of allopathic drug. Sometimes it may prove good but some time it may also prove fatal. As we see in the comment section Dr. Galib Ruknuddin has highlighted certain drugs which interact with herbs and may create bad situation.

This needs more and more deep research so that the life of a patient is not jeopardized.....

Younis Munshi Ji

We are trying to come-up some information on possibility of HDI on concomitant use. We are working and trying to see the possible HDI. In one of the study, Nishamalaki (a combination of Turmeric and Amla, frequently used to manage diabetes) and conventional anti-diabetic / anti-hypertensive / hypo lipidaemic drugs etc by using Cytochrome P450 enzymes showed no interaction inferring that the combination is safe to use concomitantly. While, the second study showed some interaction of Sarpagandha with conventional anti-hypertensive drugs. These studies are yet to be published. We are working on that.

Gandhidas Sonajirao Lavekar

Namaste Sir.

Always inspiring with your views and remarks. Such combinations are available in the market. To cite one example is RISORINE of Cadila. But, my concern is how to consider PIPERINE here? Whether, it belongs to AYURVEDA (AYUSH stream) or is a Phytopharmaceutical? I see it as a Phytopharmaceutical. In such case, whether this Phytopharmaceutical behave like PIPPALI or different? We need to consider these aspects too ..

Regards

Galib Ruknuddin

Doctor sahib as per the basics of Ayurveda or Unani we have to consider whole herb. As far as my thinking is concerned every plant phytoceutical if taken alone can cause toxicity and nature has provided all sorts of antidotes to the toxins within that herb. Now if extract the phytoceutical only and use it, it may produce reverse effects instead. We have the example of reserpine extracted from Rawalfia which produced toxicity while as using Rawalfia as whole herb is relatively safe, even Acetyl salicylate which is present in natural form in Salix spp. doesn't produce gastric irritation while as same chemical present in Aspirin produces severe gastritis......

Extraction which has been prescribed in the classics like aquas extracts which in Unani System we call as Sharbat or Araq are admissible but other than that may prove fatal.

@Younis Ji

No doubt .. you are absolutely right. Ayurveda also emphasize on the same thing. I expressed the same concern in my previous post. I agree with your experiences on Sarpagandha. We further have Vasa, Kutaja and many more to cite in this direction.

To add upon, we considered working on whole drug as such instead of its extracts in HDI works.

Regards n Good Night

Stay Safe

Good evening Sir .. I want to share some points although I am very much junior to all of you and a student in this field ..forgive me if I mention any wrong point ... In spite of incredible advances in modern science, technology, and allopathic medicine a large we are unable to provide quality healthcare to all. Traditional medicine particularly herbal medicine considered as a major healthcare provider around the globe particularly in rural and remote areas. A large section of people depends on such medicine for their primary healthcare mainly in underdeveloped or developing countries. Indian traditional medicinal systems like Ayurveda, Siddha and Unani have a very rich history of their effectiveness; modern research also acknowledged the importance of such medicine. Indian traditional medicine or medicinal plants are also considered a vital source of new drugs. Mainstreaming of such medicine is important for the people. Sir although i do agree we don't know the plausible mechanism of many herbal drugs that is why we need more ethnopharmacological study... Several steps have been taken in India to promote such medicine and to integrate them into clinical practice. Hopefully, Evidence-based incorporation of Indian traditional medicine in clinical practice will help to provide quality healthcare to all.

Sir just some addendum related to drug interaction is any modification of response of one drug by simultaneous administration of another drug. The interactions may be either synergistic or antagonistic. Use of Ayurvedic drugs and allopathic medications concomitantly has led to potential chances for interactions between the drugs of two systems. This paper deals with the drug interactions of some commonly used Ayurvedic and Allopathic drugs. Guggulu is known to interact with hypolipidaemic, anticoagulants, antihypertensives and thyroid medications. Garlic interacts with anticoagulants, NSAIDs by antiplatelet activity. Aswagandha may potentiate the effects of barbiturates. Concomitant use of castor oil reduces the efficacy of antiarrhythmic drugs, diuretics, fat-soluble vitamins and antihistamines. Yashtimadhu increases potassium loss and so prolonged use with thiazide and loop diuretics may be harmful. Other examples include the interactions of herbs like Tulsi with paracetamol, Methika, Meshasringi etc. with antidiabetic drugs, Jatamamsi with benzodiazepines, berberine in Daruharidra with hypolipidaemic drugs and Vasa with theophylline. Proper knowledge of drug interaction can be useful. For example Risorine, an anti-tuberculosis drug has been developed on the basis of synergistic interactions of piperine from Pippali with rifampicin. Important mechanisms involved in ayurvedic- allopathic drug interactions are alteration of absorption and induction or inhibition of cytochrome systems. to conclude its always better and could be best to used allopathy and ayurvedic rather phytopharmaceuticals for mankind Younis Munshi

Thank you Dr. Debanjan Chatterjee for elaborated post. You have raised genuine concerns. This needs more research so that the adverse events of combination of Chemical Drugs and Herbs are highlighted and masses are educated to refrain from such practices. People are taking Herbal preparations as harmless and never ever tell the practicing AYUSH physician regarding intake of other substances along with herbal preparations....

Exactly, Sir, Younis Munshi Agree with u people used to take ethnomedicine as functional food but simulteneously what they are taking they never confess that to the physician , so its high time to research related to herb drug interaction pharmacokinetic

To my knowledge, (please correct if i am wrong) HDI studies done so far are based on phytopharmaceuticals, drug–metabolite interactions. As, in traditional system of medicine like Ayurveda or Unani, we adopt holistic approach. So, HDI studies, in present layout will not be able to answer such interactions.

Madam Namrata Joshi Ji, I differ from your narrative. The scientific developments in all the fields we see today might have been impossible 50 years back. I am firm believer of the fact that everything is possible if we can do it with passion. Though we adopt holistic approach for diagnosis and treatment of the disease but at the same time when the medicine is taken orally, there is chain of reaction within the body and once these herbs are combined with chemical drugs, it must produce some other reactions and new enzymes/antienzymes get produced which might cause such actions which sometimes be beneficial or sometimes be dangerous for the health. This reaction and formation of substances need to be evaluated and researched.......

Namaskar

I missed reading views expressed by many experts .. interesting ..

The activity of extracts always differ from the drug when used as a whole. This is well accepted n understood by all of us. Experiments with extracts will provide certain leads on possibilities of HDI, that may differ while using the herb as a whole. We did two such works and will publish them soon.

Regards

@younis Ji

Concomitant use of traditional formulations / herbs with conventional drugs is the major responsible factor for HDI. Yes, rightly pointed out about the uninformed use too .. One Shoe Doesn't fit all ...

We have two surveys on patterns of concomitant use by diabetics and hypertensives .. the observations are alarming ..

Galib Ruknuddin Sahib,

Thank you very much for your response. This area needs comprehensive study so that the safety of the patient is not compromised with.

With regards.

@ Younis Ji

To my knowledge since independence, we are Integrating Ayurveda with Allopathic System. we are not able to feel the same sense of pride. Fundamental science of both the system is different. Ayurveda fundamentals describe Nidana parivarjana ( Sanni Krista & Viprakrista), a conglomeration of body tissues with doshas, Vikara sammuthana of Dosa, Dhatu; Vikara Prakriti of Dosa & Dhatu, Vikara adhisthana, Prakriti vighata, Prakriti sthapana, etc. Kayagni, Jatharagni, dhatwagni, Mahabhutagni all have a role in the pharmacological action of any drug. Establish the protocol of Ayurveda fundamentals with the modern counterpart for evidence. But interpreting modern protocols with Ayurveda fundamentals will make more gap in our science. Now we are doing our treatment or research on looking at the Lakhyanika chikistha, Hetu viparita chikistha, Vyadhi viparita chikistha. Dhatu Samya chikistha is the ultimate aim of Ayurveda. For Dhatu Samya; 24 tatwas ( Asta Prakriti & Sodasa Vikara ) must be in samya condition. So How much success we will get after integration?

Younis Munshi

Good Evening ..

Please find attached a latest document of SEARO, where possibility of HDI is considered .. Can download the document from the website ..

Regards

Galib Ruknuddin Dr Sahib they have categorically said that there is no evidence of of Herb-Drug interaction, I do not know on what basis.

But if we see there are various papers and books written on the subject and different evidences presented in those books and papers.....

Now I must say that WHO is not to be believed for various things......

Younis Munshi Sir there are evidences of drug interactions of allopathy medicines with not only herbs but also food e.g. tyramine containing food and antidepressants. but this aspect should be investigated with due balance. Just like we cant investigate all foods before eating while taking medicines simultaneously, we cant be suspicious of all herbs. In Unani Medicine, herbs that are in the list of 1st and 2nd darja (category) may be considered generally safe without interaction and those in 3rd and 4th darja may be taken with caution.

Mohammad Yasir. As far as drug-drug interaction is concerned, any Unani drug irrespective of its stage of temperament may have an interaction with any type of drug either belong to allopathy or any other system. When more than one drug is given together/ simultaneously they interact with each other which may either produce synergistic or agonistic or additive or agonistic or any other effect. In Unani medicine, ancient scholars have described needs for compounding of drugs wherein they have mentioned 'surat-i-nufooz va ibta-nufooz ke waste', 'izafa-i-quwwat va tazeef-i-amal ke waste' and 'islah-i-advia ke waste' that may be correlated with beneficial type of interactions however for further and detail knowledge about this topic, studies may be carried out.

As we all know that pharmacology is the study of interaction between human body and any drug which is administered. So interaction can be between even two allopathy drugs, Allopathy- Ayurveda Drug, Food - Drug. Drug and any entity of body in physiological or pathological condition may interact for example in case of any particular enzyme deficiency, a drug of any medicine system may act in a different way. The point of discussion here focus on efficacy and safety of drugs , So more pharmacological studies with better research designs can be done to address the issue. The Classical vedic literature says 'Tattu samanvata' i.e. if something great is to be achieved then integration is the best way. All the medicine systems may it be Ayurveda, Allopathy, Unani have the aim of a healthy community, so a rational integration can be beneficial for the health of community at large.