Advance Access Publication 27 October 2005 eCAM 2005;2(4)465–473
Ayurveda and Traditional Chinese Medicine:
A Comparative Overview
, Dnyaneshwar Warude
, P. Pushpangadan
and Narendra Bhatt
Interdisciplinary School of Health Sciences, University of Pune, Pune 411 007,
National Botanical Research
Institute, Lucknow 226 001 and
Zandu Pharmaceutical Ltd, Mumbai 400 025, India
Ayurveda, the traditional Indian medicine (TIM) and traditional Chinese medicine (TCM) remain the
most ancient yet living traditions. There has been increased global interest in traditional medicine.
Efforts to monitor and regulate herbal drugs and traditional medicine are underway. China has been suc-
cessful in promoting its therapies with more research and science-based approach, while Ayurveda still
needs more extensive scientific research and evidence base. This review gives an overview of basic prin-
ciples and commonalities of TIM and TCM and discusses key determinants of success, which these great
traditions need to address to compete in global markets.
Keywords: Ayurveda – Chinese medicine – complementary and alternative medicine –
Ayurveda, the traditional Indian medicine (TIM) and tradi-
tional Chinese med icine (TCM) remain the mos t ancient yet
living traditions. These are the two ‘great traditions’ with
sound philosophical, experie ntial and experimental basis.
Increased side effects, lack of curative treatment for several
chronic diseases, high cost of new drugs, microbial resistance
and emergi ng diseases are some reasons for renewed public
interest in complementary and alternative medicines (1).
It has been postulated that by 2010 at least two-thirds of the
United States population will be using one or mor e of the
alternative therapeutic approaches. Use of indigenous drugs
of natural origin forms a major part of such therapies; more
than 1500 herbals are sold as dietary supplements or ethnic
traditional medicines (2). Pharmaceutical companies have
renewed their strategies in favor of natural product drug
development and discovery (3). For instance, in Europe,
AnalytiCon Discovery has stressed on drug discovery based
on natural product chemistry (4). In the Asia-Pacific region,
MerLion Pharmaceuticals in Singapore has comprehensive
structures and capabilities necessary for natural product-
based drug discovery (5). China has successfully promoted
its own therapies over the globe with a science-based
approach. Growing po pularity of TCM can be evidenced by
the rapid increase in number of licensed Chinese medicine pro-
viders in the United States. The Chinese government has
pledged to create several export-oriented TCM giants in the
coming years (6). Continuous efforts in promotion of the indi-
genous therapies by China have put TCM in a commendable
position. Global acceptance of Ayurveda is gearing up and
there has been a steep rise in the demand for medicinal plants
from India (7). The Pharmaceutical Research and Develop-
ment Committee report of Ministry of Chemicals, Government
of India also underscores the importance of traditional know-
ledge (8). The increasing use of traditional therapies demands
more scientifically sound evidence for the principles behind
therapies and for effectiveness of medicines. Recent advance-
ments in the analytical and biological sciences, alon g with
innovations in genomics and proteomics can play an important
role in validation of these therapies. Western scientific com-
munity views traditional med icines cautiously and stress the
concerns related to research, development and quality (9,10).
This review delineates the challenges that TCM and TIM
need to address to become more acceptable to the world
For reprints and all correspondence: Bhushan Patwardhan, PhD,
Interdisciplinary School of Health Sciences, University of Pune,
Pune 411 007, India. Tel/Fax: þ91-20-25691758;
Ó The Author (2005). Published by Oxford University Press. All rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access
version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press
are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety
but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact email@example.com
Global Markets, Regulations and Acceptance
The global pharmaceutical market was worth US $550 billion
in 2004 (11) and is expected to exceed US $900 billion by the
year 2008. The herbal industry shares about US $62 billion
with good growth potential. The World Bank reports trade in
medicinal plants, botanical drug products and raw materials
is growing at an annual growth rate between 5 and 15% (12).
Within the European community, botanical medicine repres-
ents an important share of the pharmaceutical market (13);
the nutraceutical sector is also growing rapidly. In 2001, US
$17.8 billion was spent in the United States on dietary supple-
ments, US $4.2 billion of it for botanical remedies (14). In
India the value of botanicals related trade is about US $10 bil-
lion per annum with annual export of US $1.1 billion (15)
while China’s annual herbal drug production is worth US
$48 billion with export of US $3.6 billion (16). Presently, the
United States is the largest market for Indian botanical pro-
ducts accounting for about 50% of the total exports. Japan,
Hong Kong, Korea and Singapore are the major importer of
TCM taking 66% share of China’s botanical drugs export (17).
Globally, there have been concerted efforts to monitor qual-
ity and regulate the growing business of herbal drugs and tradi-
tional medicine. Health authorities and governments of various
nations have taken an active interest in providing standardized
botanical medications. United States Congress has fuelled
rapid growth in the nutraceutical market with passage of the
Dietary Supplement Health and Education Act in 1994. US
Food and Drug Administration (FDA) has recently published
the International Conference on Harmonization guidance
Common Technical Document addressing concerns related to
quality of medicines that also includes herbals (18). The
National Center for Complementary and Alternative Medicine
has been inaugurated as the United States Federal Govern-
ment’s lead agency for scientific research in this arena of
medicine. Its mission is to explore complementary and altern-
ative healing practices in the context of rigorous science, sup-
port sophist icated research, train researchers, disseminate
information to the public on the modalities that work and
explain the scientific rationale underlying discoveries. The
center is committed to explore and fund all such therapies for
which there is sufficient preliminary data, compelling public
health need and ethical justifications (19,20). World Health
Organization (WHO) is keen regarding traditional medicine
and has been active in creating strategies, guidelines and stand-
ards of botanical medicines (21). The global scenario illus-
trates vividly both promise and challenges presented by the
traditional medicines. India needs to identify the extent to
which Ayurvedic therapeutics is safe and eff ective so that it
could get wide global acceptance.
Basic Principles: TIM and TCM
Ayurveda and TCM have many commonalities. The focus of
both the systems is on the patient rather than disease. Both sys-
tems fundamentally aim to promote health and enhance the
quality of life, with therapeutic strategies for treatment of spe-
cific diseases or symptoms in holistic fashion. Almost half of
the botanical sources used as medicines have similarities;
moreover, both systems have similar philosophies geared
towards enabling classification of individuals, materials and
diseases. TCM considers the human at the center of the uni-
verse as an antenna between celestia l and earthly elements.
Water, earth, metal, wood and fire are the five elements of
the material world. The world is a single unit and its movement
gives rise to yin and yang, the two main antithetic aspects. The
actual meaning of the term yin and yang is ‘oppos ites’, such as
the positive and the negative. However, Chinese believe that
yin and yang is not absolute but relative. Consistent with the
modern view of homeostasis, yin and yang are interchanged
to meet the view that ‘yang declines and yin rises’ or ‘yang
is raised to produce a decline of yin’. The four bodily
humors (qi, blood, moisture and essence) and internal organ
systems (zang fu) play an important role in balancing the yin
and yang in human body. Proper formation, maintenanc e and
circulation of these energies are essential for health. When
the two energies fall out of harmony, disease develops. The
physician takes into account this concept while treating
patients. Drugs or herbs are used to correct this imbalance of
yin–yang in the human body (22,23).
Ayurveda considers that the universe is made up of combina-
tions of the five elements (pancha mahabhutas). These are aka-
sha (ether), vayu (air), teja (fire), aap (water) and prithvi
(earth). The five elements can be seen to exist in the material
universe at all scales of life and in both organic and inorganic
things. In biological system, such as humans, elements are
coded into three forces, which govern all life processes. These
three forces (kapha, pitta and vata) are known as the three
doshas or simply the tridosha. Each of the doshas is composed
of one or two elements. Vata is composed of space and air,
Pitta of fire, and kapha of water and earth. Vata dosha has
the mobility and quickness of space and air; pitta dosha the
metabolic qualities of fire; kapha dosha the stability and solid-
ity of water and earth. The tridosha regulates every physiolo-
gical and psychological process in the living organism. The
interplay among them determines the qualities and conditions
of the individual. A harmonious state of the three doshas cre-
ates balance and health; an imbalance, which might be an
excess (vriddhi) or deficiency (kshaya), manifests as a sign
or symptom of disease (24,25) (Figs 1 and 2).
Determinants of Success
Quality of the Botanical Drugs
Consistency in composition and biological activity are essen-
tial requirements for the safe and effective use of therapeutic
agents. Quality is the critical determinant of safety and effi-
cacy of botanical medicines; however, botanical preparations
rarely meet the standards of quality, which refers to procedures
and markers for assessing and verifying the strength of botan-
ical raw materials or extracts or formulations thereof (26).
466 Ayurveda and traditional Chinese medicine
Chromatographic techniques and chemic al marker assisted
characterization of the botanicals does not ensure consistent
biological activity or stability (27). Therefore, production of
quality botanical medicines has become a challenge to regulat-
ory authorities, scientific organizations and manufacturers.
WHO (28), USFDA (29), European Scientific Cooperative
on Phytomedicine (ESCOP) (30) have published standard
sets of guidelines to address the concerns. Some of the pro-
gressive manufacturers follow them to provide standardized
botanical medicine. In India, about 9000 licensed units manu-
facture traditional medicines with or without proper standard-
ization (31). Indian manufacturers general ly follow WHO
guidelines for quality control. Adulteration of market sam ples
remains a major problem in domestic and export markets of
Indian herbal products. Chemical analysis of some antiarthr itic
medicines from Ayurv eda has led to a finding that synthetic
anti-inflammatory drugs like phenylbutazone, indomethacin
and/or corticosteroids have been added (32). Heavy metals
Basic principles of TCM
Symbol for yin and yang
Mutual nourishment cycle
Mutual restraint cycle
Figure 1. Basic principles of TCM.
Figure 2. Basic principles of TIM: relation of pancha mahabhutas and
eCAM 2005;2(4) 467
such as mercury, arsenic and lead contam ination has also
become a critical problem (33,34). Market botanicals are
stored under undesirable conditions over the years and may
have contamination or adulteration of other materials, which
thereby adversely affect the efficacy and sometimes even add
to toxicity. Lack of proper processing of the materials even
by pharmaceutical firms contributes to decline of the herbal
business. Availability of the desired genotype of plan t in the
required quantity, free from toxic contaminants and with
desired therapeutic activity have also become a critical issue
(35). China has successfully overcome such difficulties by
modernizing its traditional medicine profession with
government-sponsored Good Agricultural Polici es (GAPs) and
Good Manufacturing Practices (GMPs). GAPs stresses selec-
tion of the correct germplasm with high content of stable active
components. The cultivation practices offer Standard Operat-
ing Procedures for use of fertilizers, irrigation systems and dis-
ease management allied with insects and pest prevention and
cure. GAPs also establish standards for noxious and harmful
contaminants like heavy metals, pesticide residues and
microbes in plants. All manufactures of TCM are mandated
to comply with guidelines laid down by China’s State Drug
Administration (SDA) by 2004 and farms producing raw
ingredients must comply with SDA-imposed standards by
2007. As a result, 1470 companies have qualified for GMPs
while 570 failed to meet the standards (36). For marketing of
herbal medicine in China, special requirements such as quality
dossier, safety and efficacy evaluation and specific labeling
criteria are required. New herbal drugs must be approved
according to the Drug Administration Laws.
Similar integrated efforts are needed to raise the image of
Ayurvedic medicines in the global business. Gove rnment of
India has promulgated GMP regulations for traditional systems
of medicines to improve the quality and standard of
Ayurvedic, Siddha and Unani drugs in pharmacies. New rules
delineating essential infrastructure, manpower and quality
control requirements came into force from 2000 and form
part of the Drugs and Cosmetics Act, 1940 (37). Licensing of
Ayurvedic medicine is also governed under drug and cosmet-
ics act, 1940. Ayurvedic Patent and Proprietary medicines
need to contain only the ingredients mentioned in the recom-
mended books as specified in the Act. For any new herbal
medicine safety and eff icacy data are mandatory. Depending
on nature of herbs and market availability, different require-
ments exist for submis sion of clinical trial and safety data.
Standardization of herbal drugs is not just an analytical
operation for identification and assay of active principles;
rather, it comprises total information and controls to necessar-
ily guarantee consistent composition of all herbals. A good
example of this is a polyherbal formulation (Artrex
for the treatment of arthritis that contains four botanicals. The
formulation, standardized using modern scientific tools and
with known markers, has been granted a US patent (38). Valid-
ated agro-industrial technologies should be applied for cultiva-
tion and processing of medicinal plants and manufacturing of
herbal medicines. Indian herbal drug industry needs to ensure
procurement of standardized authentic raw material free from
toxic contaminants. Improving processing technologies, con-
ducting all operations under GMP compliance and mainten-
ance of in-process quality control for manufacturing quality
herbal products also need evidence for therapeutic efficacy,
safety and shelf life. Such approaches remain important in
global promotion of Ayurveda.
In China and India formal training is an integral part of the
national health program, which helps in ensuring quality stand-
ards in health care delivery. China became successful in integ-
rating TCM in the national health care system. Scie nce-based
approaches were utilized and inculcated in the education of
TCM with emphasis on research. Hospitals practicing TCM
treat more than 200 million outpatients and almost 3 million
inpatients annually. About 95% of general hospitals in China
have traditional medicine departments (39).
Government of India also has expresse d support and encour-
agement for the TIM. A separate department for Indian Sys-
tems of Medicine and Homeopathy (ISM&H) now known as
AYUSH (Ayurveda, Yoga, Unani, Siddha, Homoeopathy)
was established in March 1995 to promote indigenous sys-
tems. Priorities include education, standardization of drugs,
enhancement of availability of raw materials, research and
development, information, communication and larger involve-
ment in the national system for delivering health care. The
Central Council of Indian Medicine oversees teaching and
training institutes while Central Council for Research in
Ayurveda and Siddha deals with interdisciplinary research.
Some TIM products are being added into family welfare pro-
grams of the government under the World Bank project. These
medicines are mainly for common diseases like anemia, edema
during pregnancy, postpartum problems such as pain, uterine
and abdominal complications, difficulties with lactation, nutri-
tional deficiencies and childhood diarrhea (40). The govern-
ment has also established 10 new drug testing laboratories
for TIM and is upgrading existing laboratories to provide
documented high quality evidence to licensing authorities for
the safety and quality of herbal medicines. This replaces the
earlier ad hoc system of testing that was considered unreliable.
In 2002, the Council for Scientific and Industrial Research has
launched a rese arch program under New Millennium Indian
Technology Leadership Initiative scheme in Ayurveda identi-
fying three disease areas such as arthritis, diabetes and
hepatic disorders, which afflict large numbers of the Indian
Many additional concerns need to be addressed. The quality
of education in many colleges needs to be improved. Unde r the
pretext of integration, attempts to make hybrid curricula pro-
ducing inadequately trained graduates remain unacceptable
for either modern or traditional systems (41). A paucity of
funds is noticeable; ISM&H gets only 2% of the total health
budget of the nation. A corrective and promotive policy
needs to be initiated for TIM to fully realize its potential and
468 Ayurveda and traditional Chinese medicine
contribute more meaningfully to integrative health services.
The industry has not been able to grow and develop optimally
during the last few decades. Largely, the achieved growth is
owing to industry’s own initiatives, in-house research and
development. A national organization, Ayurvedic Drugs
Manufacturers’ Association is taking a proactive role to
improve quality and research that needs to be nurtured, stimu-
lated and sustained by providing special funding or incentives.
Preparation of formularies and pharmacopoeial standards
have been attempted but a lot remains to be done. Numbers of
Indian botanical sources and their medicinal uses as in case of
turmeric have been patented by claiming innovations that are
already in the public domain. Necessary measures to protect
such intellectual property are important as the retrieval and con-
testing of patents is a very costly and time-consuming affair
(42). For this purpose, the Government of India has established
a Traditional Knowledge Digital Library on traditional medi-
cinal plants, which will also lead to a Traditional Knowledge
Resource Classification (43). Linking this to internationally
accepted International Patent Classification system will mean
building the bridge between the knowledge contained in an
old Sanskrit text and a patent examiner. This may control the
problem of mistakingly granting patents since the examiner
will know the Indian rights to that knowledge. It could integrate
widely scattered and distributed references on TIM in retriev-
able form and will be a major impetus to modern research in
the developing world.
Natural products extracts of therapeutic relevance are of para-
mount importance as reservoirs of structural and chemical
diversity. A recent review on national pharmacopoeias from
several countri es reveals at least 120 distinct chemical sub-
stances from different plants that have utility as lifesaving
drugs (44). This has been achieved through chemical and phar-
macological screening of only 6% of the total plant species.
Untapped, hidden wealth in the flora needs to be unearthed
and explored to cure diseases like AIDS, cancer, diabetes,
etc. Recently, NIH has started extensive research for anti-
inflammatory compounds from turmeric, ginger and boswellia
with the aid of Ayurvedic knowledge. Screening of different
plants for novel anticancer compounds is also in progress
with reference experiential data from traditional systems
(45). Botanical immunodrugs from traditional medicine can
provide newer opportunities to bioprospect diverse and syner-
gistic chemical moieties, which in combination might act on
multiple targets and improve the therapeutic spectrum (46).
PUBMED, Google scholar and Science direct are the widely
recognized web databases of scientific literature. We have
given comparative citations for Indian and Chinese medicine
using different key words and also provided the patent data
of USPTO. Visibility of Ayurvedic medicine remains much
lower as compared with TCM (Table 1).
Chinese medicine became successful in crossing philosoph-
ical barriers through constant reworking of the basic system.
The first compound derived from Chinese herbal remedies to
enter the western market was ephedrine, an amphetamine-
like stimulant from ma huang (Ephedra sinica). The next
was artimisinin, a potent antimalarial from qinghao (Artemisia
annua). In 2003, Chinese researchers launched a phase II trial
to test the efficacy of a drug called kanglai te from iijen (Coix
lachryma-jobi) for treating non-small-cell lung cancer (47).
This is the first drug from TCM to enter clinical trials in the
United States. Other drug molecules from TCM are xue
baoPG2 (general tonic from Astragalus membracaceus) and
camptothecin analogs as CPT11 and topotecan (anticancer
from Camptotheca accuminata), which have a huge market.
In 2002, 1141 different traditional plant drugs were registered
for their therapeutic activities including several new single
compounds from plants as arteannuin (antimalarial), indirubin
(anticancer), etc. One of the twelve focal points in the current
Five-Year Plan of China’s Ministry of Science and Techno-
logy is to modernize research in TCM. Pharmacopoeia of the
People’s Republic of China (2000) (48) contains 992 mono-
graphs of Chinese crude drugs and traditional Chinese patent
medicines in which 76 new admissions and 248 monographs
have been revised. Controlled clinical trials have been initiated
at several hospitals and research organizations to prove the
efficacy and safety of the Chinese medicine (49,50). Recent
reports on adverse effects of drug like ma huang (51) and
gingko (52) have sounded a cautionary note that promoting tra-
ditional medicine from conception to commercialization will
not be easy.
India has world-class expertise and facilities for organic
synthesis, isolation and structure elucidation, biological
screening, toxicological testing and pharmacokinetics. This is
supplemented by the expertise for development of agro-
technology for cultivation of medicinal plants. Industry parti-
cipation to ensure successful upscaling and implementation
of technol ogy is increasing. Generation of leads with structural
diversities through creation of natural product libraries, identi-
fication of proper targets and their proper validation and
optimization is of paramount importance (53). India has
Table 1. Citations and patent data for Indian and Chinese medicine (as on
September 10, 2005)
Database Key words:
TIM 361 TCM 6847
Science Direct Ayurvedic
TIM 77 TCM 612
Google scholar Ayurvedic
TIM 32 900 TCM 68 300
US patent granted Ayurvedic
US patent filed Ayurvedic
eCAM 2005;2(4) 469
progressive research institutes like Central Drug Research
Institute (CDRI), Central Institute of Medicinal and Aromatic
Plants and National Botanical Research Institute at Lucknow,
Regional Research Laboratories (RRL), at Jammu,
Bhubaneshwar and Jorhat, National Chemical Laboratory at
Pune, which routinely undertake research on medicinal plants.
Most of them are involved in standardizing the herbal medi-
cines and isolating active compounds. Few selected crops
have been taken for improvement yet there is a need for
research on quality planting materials for farmers, conserva-
tion of endangered species and to prevent exploitation of the
natural resources. Reserpine (antihypertensive from rauwolfia)
is an extremely valuable contribution from Ayurvedic systems.
Curcumin (54) (anti-inflammatory from turmeric), withaferin
A (55) (anti-inflammatory from ashwagandha), kutkoside
(56) (hepatoprotective from kutki), andrographolide (57) (hep-
atoprotective from andrographis) and vasicine (58) (bron-
chodilator and expectorant from vasaka) are chemical entities
with attractive scaffolds for drug discovery.
Controlled clinical trials are important to develop evidence
for safety and efficacy. Results from clinical trials are encour-
aging (59), but lot more clinical research is required to estab-
lish validity of the system. Ayurvedic preparations have been
successfully evaluated for treatment of bronchial asth ma
(60,61), rheumatoid arthritis (62), ischaemic heart disease
(63,64). Piperine from pipali has come out as a bioenhancer
in recent clinical evaluation (65,66). Botanicals like Withania
somnifera (67); Asparagus racemosus (68) have exhibited sig-
nificant vaccine adjuvant activity in experimental systems,
which have valuable applications in immunobiological indus-
try. An IND application of Lupin Ltd. is in process and a US
patent has been granted for development of herbal-based anti-
psoriatic composition containing Argemone mexicana (69).
Standardized fraction of gugulipid from Commiphora wightii
developed by CDRI has been marketed (Guglip
, Cipla Ltd)
for treating hyperlipidemia and atheriosclerosis (70). RRL
Jammu has commercialized Boswellia serrata gum resin as
NSAID (Non-Steroidal Anti-Inflammatory Drug) (Sallaki
Gufic). It is also hypolipidemic.
A multicentric study by the Indian Council of Medical
Research (ICMR) showed promising results that a preparation
from Pterocarpus marsupium was effective in reducing levels
of blood glucose and glycosylated haemoglobin in patients
with non-insulin-d ependent diabetes mellitus (71). Analysis
of most frequently used plant based therapies in Ayurvedic
system revealed that 43% of them have been tested on humans
while 62% have been the subject of one or more animal stud-
ies. Among these drugs having sufficient clinical data are gug-
gul, brahmi, ashwagandha, amlaki, guduchi, kutki, shatavari
and shunthi (72) Pharmacopoeia of India (1996) (73) covers
few botanical monographs like clove, gugg ul, opium, mentha,
senna, and ashwagandha. The Ayurvedic Pharmacopoeia of
India gives monographs for 258 different Ayurvedic drugs.
The standards mentioned are quite inadequate to build quality
of the botanical materials (74). Indian Drug Manufacturers
Association has published Indian Herbal Pharmacopoeia
(2002) (75) with 52 monographs on widely used medicinal
plants growing in India where scientific data have been
Harmonization and validation of the complex proce ss of
Ayurvedic therapeutics remain important. Novel efforts like
Ayugenomics (76) aim to understand Ayurvedic concept of
Prakruti from pharmcogenomics perspective to provide a
base for human classification, diagnostics and customized
medicine (77). Projects like AyuSoft (78) aim to develop
intelligent and interactive software based on Ayurvedic clas-
sics as a decision support system. New analytical approaches
like Herboprint (79) use three-dimensional HPLC and
attempt to develop tools for activity-based standardization of
Apart from the drug manufacturer, many other supporting
industries play important roles in commerce of traditional
medicine. The whole pipeline covers collectors and breeders,
dealers of the plant materials, processing and manufacturing
industry, practitioners of traditional medicine and finally the
consumers. Presently, Indian systems of medicine use more
than 1100 medicinal plants of which most are collected from
the wild. More than 60 species are in great demand (80). The
tribal belt of India is rich in these plants and the tribes mainly
depend on this trade for livelihood. There are ample of oppor-
tunities for adulteration and contamination in the process.
Thus, the adequate availability of quality raw materials free
from adulterants at reasonable prices have become a big prob-
lem for industry and the demand is increasing every year.
However, very few efforts have been made either by govern-
ment or by industry to seriously study the supply and demand.
Similar to China, India needs to follow GAPs to ensure the use
of correct raw materials and cover the entire life cycle includ-
ing the harvesting, processing, transportation and storage.
Chinese government has developed more than 100 research
units and encouraged private enterprises to build over 600
standard planting bases for herbs in great demand. Selection
of the correct germplasm using modern DNA fingerprinting
and chemoprofiling techniques is also a priority (81). India is
emerging as a leader in generic drugs and is exporting them
to developed countries. This is a result of adopting standard
guidelines and GMPs. However, TIM has yet to capitalize on
the quality herbal medicine where GAPs are.
New experiments are beginning to emerge on benefit sharing
models for indigenous innovation. For example, Trichopus
zeylanicus, found in the tropical forests of southwestern India
was collected by the ‘Kani’ tribal peopl e (a traditionally
nomadic community from the forests of the Agasthyamalai
hills in the Thiruvananthapuram district of Kerala, India).
Scientists at the Tropical Botanic Garden and Research
Institute (TBGRI) in Kerala discovered uses of this plant that
are claimed to boost the immune system. Chemical and phar-
macological investigations carried out initially at RRL, Jammu
and later at TBGRI showed that the leaves of the plant
470 Ayurveda and traditional Chinese medicine
contained various glycolipids and some other non-steroidal
compounds with profound adaptogenic and immune-
enhancing properties (82,83). The fruits showed mainly
antifatigue properties. TBGRI was successful in developing a
scientifically validated and standardized herbal drug, based
on the tribal lea d (84). The drug was named ‘Jeevani’ and
Arya Vaidya Pharmacy released it for commercial produc-
tion in 1995 (85). TBGRI agreed to equally share the royalty
with the tribal community. This experiment was acknow-
ledged by UNDP by conferring a special award to the con-
cerned scientists (86).
Numerous drugs have entered the international market through
exploration of ethnopharmacology and traditional medicine.
Progress in genomics and proteomics has opened new gate-
ways in therapeutics and drug discovery and development.
Better understanding of the human genome has helped in
understanding scientific basis of individual variation. Drug
targets have evolved during the last decade, but the industry
remains target-rich and lead-poor trapped in the old mindset
and strategies. TIM and TCM, carry many generations’ obser-
vations that have well-organized and documented data (87).
Although scientific studies have been done on a large number
of Indian botanicals, a considerably smaller number of market-
able drugs or phytochemical entities have entered the
evidence-based therapeutics. China has successfully promoted
its own therapies and drugs like ginseng, ma huang and gingko
with scientific evidences acceptable for the global community.
Approach of integrative medicine by selective incorporation of
elements of TCM alongside the mode rn methods of diagnosis
has achieved a great success in China (88).
India needs a clear policy for such integration without com-
promise on the strategies that are science-based. Efforts are
needed to establish and validate pharmacoepidemiological
evidence regarding safety and practice of Ayurvedic medicines
(89). Pharmacoeconomic studies on TIM and TCM are rare,
but can help in understanding cost-effectiveness and cost-
benefit of traditional medicine. In all such attempts, TCM
examples would help India at various levels including policies,
quality standards, integration practices, research models and
the complementary integration where public health is kept at
the central position. Both TIM and TCM are great traditions
with strong philosophical basis and could play an important
role in new therapies, drug disc overy and development
We thank Council for Scientific and Industrial Research,
New Millennium Indian Technology Leadership Initiative
Herbal Drug Development Group for discussions. Financial
assistance from the University Grants Commission to one of
the authors (D.W.) is also gratefully acknowledged.
1. Humber JM. The role of complementary and alternative medicine: accom-
modating pluralism. J Am Med Assoc 2002;288:1655–6.
2. Legal status of traditional medicine, complementary/alternative
medicine: a worldwide reviewWorld Health Organization, Geneva,
3. Seidl PR. Pharmaceuticals from natural products: current trends. An Acad
Bras Cienc 2002;74:145–50.
4. Available at http://www.ac-discovery.com.
5. Available at http://www.merlionpharma.com/index.html.
6. Jiang Y, Wang Y, Yan X. Chinese pharmaceutical companies: an emer-
ging industry. Drug Discov Today 2000;6:610–2.
7. Dubey NK, Rajeshkumar, Tripathi P. Global promotion of herbal medi-
cine: India’s opportunity. Curr Sci 2004;86:37–41.
8. Mashelkar RA. Transforming India into the knowledge power. PDRC
report, Government of India, 1999.
9. Patwardhan B, Chopra A, Vaidya ADB. Herbal remedies and the bias
against Ayurveda. Curr Sci 2003;84:1165–6.
10. Fabricant DS, Farnsworth NR. The value of plants used in
traditional medicine for drug discovery. Environ Health Perspect
11. Maggon K. Best selling human medicine 2002–2004. Drug Discov Today
12. World Health Organization. Report of the inter-regional workshop on
intellectual property rights in the context of traditional medicine,
Bangkok, Thailand, Dec 6–8, 2000. http://www.who.int/medicines/
13. Bodekar G, Kronenberg F. A public health agenda for complementary,
alternative and traditional (indigenous) medicine. Am J Public Health
14. De Smet PA. Herbal remedies. New Engl J Med 2002;347:2046–56.
15. Singh J, Singh AK, Khanuja SPS. Medicinal plants: India’s opportunities.
Pharma Bioworld 2003;1:59–66.
16. Handa SS. Indian efforts for quality control and standardization of herbal
drugs/products. Proceedings of the 1st joint workshop on quality control
and standardization of traditional medicine—Indo-China experience,
Jan 8–10, 2004.
17. A dream of globalizing the TCM market. Report of the Ministry of
Commerce of the People’s Republic of China, 2003.
18. Guidance for industry, M4: The CTD-quality questions answers/local
issues, United States Food, Drug Administration 2004. Available at
19. Cooper EL. CAM, eCAM, bioprospecting: the 21st century pyramid. Evid
Based Complement Alternat Med 2005;2:125–7.
20. Gavaghan H. Koop may set up new center for alternative medicine. Nature
21. Traditional Medicine Strategy 2002–2005. World Health Organization,
22. Gibert TF. Reflections on traditional Chinese medicine and its
pharmacopoeia. Ann Pharm Fr 1998;56:282–5.
23. Cheng JT. Review: drug therapy in Chinese traditional medicine. J Clin
24. Hankey A. CAM modalities can stimulate advances in theoretical biology.
Evid Based Complement Alternat Med 2005;2:5–12.
25. Lad V. The human constitution. In: Ayurveda: The Science of
Self-Healing. Wilmot: Lotus Press, 1985, 26–36.
26. Cardellina JH. Challenges and opportunities confronting the botanical
dietary supplement industry. J Nat Prod 2002;65:1073–84.
27. Marccus DM, Grollman AP. Botanical medicines—the need for new
regulations. New Engl J Med 2002;347:2073–6.
28. Quality Control Guidelines for Medicinal Plant MaterialsWorld Health
Organization, Geneva, 1998; Available at http://www.who.int/medicines/
29. Draft guidelines: Guidance for Industry—Botanical drug products—
United States Food, Drug Administration—CDER. 2000. Available at
30. EMEA Guidance on Herbal Products The European Agency for the
Evaluation of Medicinal Products, London, 2001. Available at www.
31. Warude D, Patwardhan B. Botanicals: quality and regulatory issues. J Sci
Ind Res 2005;64:83–92.
32. Farnsworth NR. Relative safety of herbal medicines. Herbalgram
eCAM 2005;2(4) 471
33. Saper RB, Kales SN, Paquin J, Burns MJ, Eisenberg DM, Davis RB,
Phillips RS. Heavy metal content of ayurvedic herbal medicine products.
J Am Med Assoc 2004;292:2868–73.
34. Ernst E. Toxic heavy metals and undeclared drugs in Asian herbal
medicines. Trends Pharmacol Sci 2002;23:136–9.
35. Mukherjee PK. Herbal drugs-toxicity and regulations. In: Quality Control
Herbal Drugs. New Delhi: Business Horizons, 2002, 39–87.
36. China’s new quality control, functional foods and nutraceuticals, 2003.
37. Sharma DC. India raises standards for traditional drugs. Lancet 2000;
38. Patwardhan B. A method of treating musculoskeletal disease and a novel
composition there of. US Patent 5494668, 1996.
39. The State Administration of traditional Chinese medicine of the People’s
Republic of China. Anthology of Policies, Laws and Regulations of the
People’s Republic of China on Traditional Chinese Medicine. Shangdong:
Shangdong University, 1997.
40. Kumar S. India’s government promotes traditional healing practices.
41. Department of Indian Systems of Medicines and Homoeopathy. Govern-
ment of India. Annual Report 1999–2000.
42. Barbara AJ, Ginger W. Turmeric patent overturned in legal victory.
43. Ganguli P. Patents and patent information in 1979 and 2004: a perspective
from India. World Patent Inf 2004;26:61–2.
44. Goswami A, Barooch PK, Sandhu JS. Prospect of herbal drugs in the age
of globalization—Indian scinario. J Sci Ind Res 2002;61:423–43.
45. Diwanay S, Gautam M, Patwardhan B. Cytoprotection and immuno-
modulation in cancer therapy. Curr Med Chem Anti-Canc Agents 2004;4:
46. Patwardhan B, Gautam M. Botanical immunodrugs: scope and opportun-
ities. Drug Discov Today 2005;7:495–502.
47. Normile D. The new face of traditional Chinese medicine. Science
48. The Pharmacopoeia of Peoples Republic of China, Pharmacopoeia
Commission of the Ministry of Public Health, China, 2002.
49. Tang JL, Zhan SY, Ernst E. Review of randomized controlled trials of
traditional Chinese medicine. Br Med J 1999;319:160–1.
50. Cao Y, Shi Y, Zheng Y, Shi M, Lo SK. Blood-nourishing and hard-
softening capsule costs less in the management of osteoarthritic knee
pain: a randomized controlled trial. Evid Based Complement Alternat
51. Nelson R. FDA issues alert on ephedra supplements in the USA. Lancet
52. Fong KCS, Kinnear PE. Gingko biloba and retrobulbar hemorrhage fol-
lowing peribulbar local anesthetic injection for cataract surgery. Postgrad
Med J 2003;79:531–2.
53. Patwardhan B, Vaidya ADB, Chorghade M. Ayurveda and natural product
drug discovery. Curr Sci 2004;86:789–99.
54. Ammon HP, Safayhi H, Mack T, Sabieraj J. Mechanism of anti-
inflammatory actions of curcumin and boswellic acids. J Ethnopharmacol
55. Jayaprakasam B, Muraleedharan GN. Cyclooxygenase-2 enzyme inhibit-
ory withanolides from Withania somnifera leaves. Tetrahydron 2003;59:
56. Dwivedi Y, Rastogi R, Garg NK, Dhawan BN. Picroliv and its
components kutkoside and picroside I protect liver against
galactosamine-induced damage in rats. Pharmacol Toxicol 1992;71:
57. Visen PK, Shukla B, Patnaik GK, Dhawan BN. Andrographolide protects
rat hepatocytes against paracetamol-induced damage. J Ethnopharmacol
58. Johri RK, Zutshi U. Mechanism of action of 6,7,8,9,10,12-hexahydro-
azepino-[2,1-b]quinazolin-12-one-(RLX)—a novel bronchodilator. Indian
J Physiol Pharmacol 2000;44:75–81.
59. Bhatt AD. Clinical trials of Ayurvedic medicine: myths, realities and
challenges. J Assoc Physicians India 2001;49:558–62.
60. Sekhar AV, Gandhi DN, Rao NM, Rawal UD. An experimental and clin-
ical evaluation of anti-asthmatic potentialities of Devadaru compound
(DC). Indian J Physiol Pharmacol 2003;47:101–7.
61. Gupta I, Gupta V, Parihar A, Gupta S, Ludtke R, Safayhi H. Effects of
Boswellia serrata gum resin in patients with bronchial asthma: results of
a double-blind, placebo-controlled, 6-week clinical study. Eur J Med
62. Chopra A, Lavin P, Patwardhan B, Chitre D. Randomized double blind
trial of an ayurvedic plant derived formulation for treatment of rheumatoid
arthritis. J Rheumatol 2000;27:1365–72.
63. Gupta R, Singhal S, Goyle A, Sharma VN. Antioxidant and
hypocholesterolaemic effects of Terminalia arjuna tree-bark powder: a
randomized placebo-controlled trial. J Assoc Physicians India 2000;49:
64. Kumar PU, Adhikari P, Pereira P, Bhat P. Safety and efficacy of Hartone
in stable angina pectoris—an open comparative trial. J Assoc Physicians
65. Majeed M, Badmaev V, Rajendran R. Use of piperine as a
bioavailability enhancer. US Patent 5972382, Sabinsa Corporation USA,
66. Atal CK, Dubey RK, Singh J. Biochemical basis of enhanced drug
availability by piperine: evidence that piperine is a potent inhibitor of
drug metabolism. J Pharmacol Exp Ther 1985;232:258–62.
67. Gautam M, Diwanay SS, Gairola S, Shinde YS, Jadhav SS,
Patwardhan BK. Immune response modulation to DPT vaccine by aqueous
extract of Withania somnifera in experimental system. Int Immuno-
68. Gautam M, Diwanay S, Gairola S, Shinde Y, Patki P, Patwardhan B.
Immunoadjuvant potential of Asparagus racemosus aqueous
extract in experimental system. J Ethnopharmacol 2004;91:
69. Arora S, Gupta L, Srivastava V, Sanganabhatla N, Sara DB. Herbal com-
position for treating various disorders including psoriasis, a process for
preparation thereof and method for treatment of such disorders. US Patent
70. Singh K, Chandar R, Kapoor NK. Guggulsterone, a potent hypo-
lipidaemic, prevents oxidation of low-density lipoprotein. Phytother Res
71. Indian Council of Medical Research. Flexible dose open trail of Vijayasar
in cases of newly diagnosed non-insulin dependent diabetes mellitus.
Indian J Med Res 1998;108:24–9.
72. Khan S, Balick MJ. Therapeutic plants of ayurveda: a review of selected
clinical and other studies for 166 species. J Altern Complement Med
73. The Pharmacopoeia of India. Controller of Publication, Government of
74. Raina MK. Quality control of herbal and herbo-mineral formulations.
Indian J Nat Prod 2003;19:11–5.
75. The Indian Herbal Pharmacopoeia. Mumbai, Indian Drug Manufacturer’s
76. Patwardhan B. Ayugenomics
: integration for customized medicine.
Indian J Nat Prod 2003;19:16–23.
77. Patwardhan B, Joshi K, Chopra A. Classification of human population
based on HLA gene polymorphism and the concept of Prakriti in
Ayurveda. J Altern Complement Med 2005;11:349–53.
78. AyuSoft—a decision support system for Ayurveda. C-DAC, (Center
for Development of Advance Computing) Pune. Project sponsored by
Ministry of Communication and Information Technology, Government
of India, 2004. www.edac.in.
79. VijayaKumar D, Raghavan KV. Novel chromatographic fingerprinting
method for standardization of single medicines and formulations. Indian
Institute of Chemical Technology, Hyderabad, WO 0246739-EP2
0000991 991-263397CSIR G01N30-88, 2002.
80. Farooqi AA, Sreeramu BS. History, importance, present status and future
prospects of medicinal crops. In: Cultivation of Medicinal and Aromatic
Crops. Hyderabad: Universities press, 2001, 1–19.
81. Wo Jizhou Thinking about the situation of research on GAP in
China. Proceedings of the 1st joint workshop on quality control and
standardization of traditional medicine—Indo-China experience, Jan 8–
82. Subramoniam A, Evans DA, Rajasekharan S, Pushpangadan P. Effect of
Trichopus zeylanicus Gaertn. (active fraction) on phagocytosis by
peritoneal macrophages and humoral immune response in mice. Indian
J Pharmacol 2000;32:221–5.
83. Susan C, Sethuraman MG, George V, Pushpangadan P. Phytochemical
constituents of Trichopus zeylanicus ssp. Travancoricus. J Med Aromatic
Plant Sci 2002;24:703–6.
84. Pushpangadan P. Traditional knowledge & folklore—A benefit-
sharing model experimented in India. International conference of
commission on intellectual property rights organized by Royal Society,
London, Feb 21–22, 2002.
472 Ayurveda and traditional Chinese medicine
85. Pushpangadan P. Biodiversity and emerging benefit-sharing
arrangements—challenges and opportunities for India. Proc Indian Natl
Sci Acad 2002;B68:297–311.
86. Available at http://www.undp.org/biodiversity/biodiversitycd/practice
87. Patwardhan B. Ayurveda: the ‘designer’ medicine: a review of ethno phar-
macology and bioprospecting research. Indian Drugs 2000;37:213–27.
88. Faass N. Integrating Complementary Medicine into Health Systems.
Gaithersburg: Aspen Publications, 2001.
89. Vaidya RA, Vaidya ADB, Patwardhan B, Tillu G, Rao Y. Ayurvedic
pharmacoepidemiology: a proposed new discipline. J Assoc Physicians
Received June 13, 2005; accepted October 7, 2005
eCAM 2005;2(4) 473