Junior Resident-3, Department of Kriya Sharir, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, INDIA.
Assistant Professor, Department of Panchakarma, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, INDIA.
Indian J Med Ethics. 2024 Jul-Sep;IX(3):180-192. doi: 10.20529/IJME.2024.039.
The curricula of Ayurveda programmes emphasise various theoretical constructs such as Tridosha (three factors determining the state of health), Agnibala (digestive strength), Samprapti (patho-physiology), among others. It is often argued that practitioners follow an individualised approach based on these principles while treating patients. Yet, dependable data on their real-world influence is lacking. The aim of this study was to record the extent to which these constructs drive decision-making among Ayurveda practitioners and to examine whether these constructs determine individualisation of the interventions.
We employed an emailed survey to record physicians' perceptions. Convenience sampling was chosen as the sampling method. Registered Ayurveda practitioners located across India with a minimum of five years of clinical experience were invited to participate. Five case-based scenarios depicting different clinical conditions were presented to the physicians. Questions that accompanied each case scenario asked the physicians to record clinical diagnoses, treatment plans, and the Ayurveda principles that determined their treatment.
A total of 141 physicians responded, from whom we received 152 responses as seven physicians responded to more than one scenario. The results suggest a significant lack of consensus among physicians regarding clinical diagnoses, interventions, and their understanding of pathophysiology in the given clinical scenarios. Many conflicting opinions were also noted.
Theoretical constructs do not appear to determine either prescriptions or individualisation uniformly. Two ethical questions arise: "Is this situation due to an inherently weak theoretical framework of Ayurveda?" and "How can one justify spending hundreds of hours teaching these theories?"
阿育吠陀课程强调各种理论结构，如三德（决定健康状态的三个因素）、阿格尼巴拉（消化能力）、桑帕拉提（病理生理学）等。人们常说，从业者在治疗患者时，会根据这些原则采取个性化的方法。然而，关于这些原则在现实世界中实际影响的可靠数据却缺乏。本研究旨在记录这些结构在多大程度上影响阿育吠陀从业者的决策，并研究这些结构是否决定了干预措施的个性化。
我们采用电子邮件调查来记录医生的看法。选择便利抽样作为抽样方法。邀请了在印度各地有至少五年临床经验的注册阿育吠陀从业者参加。向医生展示了五个描述不同临床情况的基于案例的场景。每个案例场景都伴随着问题，要求医生记录临床诊断、治疗计划以及决定其治疗的阿育吠陀原则。
共有 141 名医生做出了回应，我们收到了 152 份回复，因为有 7 名医生对不止一个案例做出了回复。结果表明，医生在临床诊断、干预措施以及对所给临床场景的病理生理学的理解方面，存在显著缺乏共识。还注意到许多相互矛盾的意见。
理论结构似乎并没有统一地决定处方或个性化。出现了两个伦理问题：“这种情况是由于阿育吠陀理论框架本身薄弱吗？”和“如何证明花费数百小时教授这些理论是合理的？”
