Politics of Knowledge in the Debates on Toxicity in Ayurvedic Medicines

Recent Controversies over Bhasmas

In: Asian Medicine

In the last decade, a controversy has arisen over a specific type of herbo-mineral ayurvedic preparations called bhasmas (Skt. bhasman). The controversy mainly concerned serious complications or even the death of patients after having taken these medicines. Since these medicines were metal-based preparations, and specifically included lead or mercury, their toxicity was interpreted as causing the patients’ suffering. In response to that, in public discourse a plethora of writing on the issue of toxicity in ayurvedic medicines ensued, both accusatory and defensive in tone. This laid out the potential for their condemnation, with serious implications for their credibility, not to speak of their markets. This article attempts to analyse this writing, focusing mainly on the academic publications, from the perspective of the politics of knowledge. It will argue that hierarchies in the epistemologies of medical knowledge systems guide the scientific analysis of these herbo-mineral preparations, some of which contain mercury, illustrating how this happens through publications that are unequivocally critical of bhasmas, those that are defensive of them, and those that indicate a median position. It will also analyse the possible regulatory and manufacturing regimes that can emerge when a certain kind of balanced analysis informs policy-making. Focusing on the modes of translation between epistemologies of different knowledge systems that have characterised the process of making ‘traditional’ knowledge contemporary, it shows how this principally reflects the hierarchy between dominant and marginal knowledge on an everyday basis, affecting most production and marketing decisions, that backfire not only on specific products, but affect an evaluation of the system as a whole.

Abstract

In the last decade, a controversy has arisen over a specific type of herbo-mineral ayurvedic preparations called bhasmas (Skt. bhasman). The controversy mainly concerned serious complications or even the death of patients after having taken these medicines. Since these medicines were metal-based preparations, and specifically included lead or mercury, their toxicity was interpreted as causing the patients’ suffering. In response to that, in public discourse a plethora of writing on the issue of toxicity in ayurvedic medicines ensued, both accusatory and defensive in tone. This laid out the potential for their condemnation, with serious implications for their credibility, not to speak of their markets. This article attempts to analyse this writing, focusing mainly on the academic publications, from the perspective of the politics of knowledge. It will argue that hierarchies in the epistemologies of medical knowledge systems guide the scientific analysis of these herbo-mineral preparations, some of which contain mercury, illustrating how this happens through publications that are unequivocally critical of bhasmas, those that are defensive of them, and those that indicate a median position. It will also analyse the possible regulatory and manufacturing regimes that can emerge when a certain kind of balanced analysis informs policy-making. Focusing on the modes of translation between epistemologies of different knowledge systems that have characterised the process of making ‘traditional’ knowledge contemporary, it shows how this principally reflects the hierarchy between dominant and marginal knowledge on an everyday basis, affecting most production and marketing decisions, that backfire not only on specific products, but affect an evaluation of the system as a whole.

The Background

In recent years, there have been reports of ‘poisoning’ of patients, who had taken herbo-mineral preparations of Ayurveda (known as bhasmas in ayurvedic parlance). These reports have appeared in the popular press and academic articles in India, the United States, and Europe, generating a great deal of controversy in both popular and academic media. Three aspects of this debate can be identified. The first concerns the actual toxicity of the metal ingredients of these medicines. Based on that, the second controversy is over the interpretation of toxicity in different systems of knowledge, in this case mainly Ayurveda and biomedicine. The third aspect that emerges concerns the implications for the regulatory and manufacturing framework of ayurvedic medicines, given their increasing popularity, their growing market, and a real need for their legal and scientific processing. A critical analysis of the issues in these three aspects from the perspective of the politics of knowledge would serve to cast the debate and controversies over bhasmas in a very different light to that in which they have been seen so far. The apparent binaries in the understanding of bhasmas are shown to be moderated by scientists true to their calling who offer a median position. Also, the implications on both the regulatory as well as manufacturing frames that cast ayurvedic medicines anew—whether by modifying the manufacturing of an existing formulation, or by modifying the formulation itself—will be analysed, also from the perspective of a politics of knowledge.

This paper strives to analyse and unpack the academic debates that appeared in notable peer-reviewed journals between 1993 and 2013. In the published academic articles on the topic, it is possible to delineate three kinds of articles. Based on their way of analysing a sample of ayurvedic medicines, a majority of these1 demonstrate that the bhasmas contained metals/minerals outside of the permissible limit, were ‘toxic’ and hence harmful to patients, and should be generally warned against. Their position vis-à-vis that of medicines from a non-biomedical system is dismissive, superior, and critical. On the other hand, a host of articles (published mostly in Indian journals) argued that these medicines are non-toxic and efficacious.2 Very few could be seen to be situated somewhere in-between,3 weighing their arguments more carefully, placing each one in context and arguing its worth. I will select a few of these articles and analyse arguments presented around two kinds of issues.

The first issue concerns the generalisations about ‘ayurvedic medicines’ that are offered based on the analysis of ‘ayurvedic proprietary medicines’ that are commonly available in India, the US, and Europe. Ayurvedic medicines, according to the law in India, may be marketed in two forms, as ‘classical’ formulations and as ‘patent’ or ‘proprietary’ formulations. The former are based on processes and forms—āsava and ariṣṭa (decoctions), leha (pastes), and vaṭī (small tablets)—prescribed in traditionally used texts of ayurvedic medicine, and subsequently listed in the ayurvedic formulary created by official institutions. The latter are new formulations offered by ayurvedic pharmaceutical companies, based on some classical formulations, but tweaked to include or exclude certain ingredients and positioned for specific disease conditions. These may not only include medicines but also food supplements, tonics, vitalisers, and the like. Given that the pharmacological sciences in Ayurveda have been struggling to find a vocabulary to establish their legitimacy, and considering both the anxiety of the ayurvedic pharmaceutical industry to exploit the current buoyancy in the market reaping quick profits, and the weak regulatory mechanism in place for ‘proprietary’ preparations, any generalisation that seeks to equate the latter with ayurvedic medicine in general can be very flawed. Second, this article will seek to unravel the understanding of ‘toxicity’ itself through what I perceive to be the politics of knowledge in these debates. Each of these systems has a different understanding of what the term means; therefore, toxicity is as much a construct as any other concept.

In the mainstream, peer-reviewed, scientific journals, however, it is not presented in this manner. The assumption therein is that toxicity can be defined only in a specific, i.e., ‘scientific’ manner, and any substance that fits their definition has to be toxic. Given that this biomedical analysis in these journals strongly influences defining the terms of discourse about medicines everywhere, for epistemological, market, and policy arenas, the position presented in these writings can make or mar the future of any kind of ayurvedic, but especially herbo-mineral pharmaceuticals, thus making it a clear play of power, hegemony, and responsibility. When this play happens via biomedical assessments of ayurvedic medicines or any of the Complementary and Alternative Medicine (CAM) systems, the negative implications not only concern the particular pharmaceutical in question but possibly affect the entire medical system. The root cause lies in the realm of the epistemological divide that has characterised the continuous confrontations between biomedicine and older or so-called ‘traditional’ systems of medicine. This has largely remained unchanged over the recent decades and affects the very parameters of scientific analysis that makes an appraisal of ayurvedic medicines. That is why it is important to examine some of the fundamental arguments and definitions found in these articles. I begin with analysing various definitions of bhasmas.

The term bhasma is applied to the end product of substances of metal, mineral, or animal origin, which are calcined or incinerated by a special process.4 Literally, it means any organic or inorganic substance burnt into its ash. Like most other ayurvedic medicines, at least three considerations need to be fundamentally known about them: (1) that they are prescription medicines not to be taken over-the-counter (OTC), (2) that they should preferably be prescribed according to the individual constitution-type of the patient, and (3) that all suggested precautions should be followed while they are being used. In the event that any of these is not followed, the patient might suffer. Moreover, all medicines that have effects can have side-effects, especially if it is not known what else they are interacting with within the patient’s body. Given that in many parts of the world patients often take medicines from one system of medical knowledge without informing the practitioner from the other that they may be consulting, this can set a dangerous trend. Patients cannot be blamed for trying different things because of the two reasons that govern their choice: desperation on the one hand, and on the other the belief that has become common knowledge, that ‘traditional’ medicines do not harm or interfere with biomedical drug actions and are therefore considered safe to be taken with all else. Particularly, when something as potent as herbo-mineral compounds are being taken, the last point could well be the exception. Moreover, the logic of the prescribed purification process, followed completely through and done by the book,5 is the only insurance for the removal of the metal toxicity of the bhasma. If this logic has been adhered to, then it is believed—and this belief is based on years of use and practice—that the metal has been transformed into its medicinal value, and its non-toxicity is guaranteed by the vaidyas (practitioners of Ayurveda). If such a medicine is to be evaluated for toxicity then the parameters of safety have to be the ones deployed by Ayurveda, which does have these available in its texts. This argument is spelt out in detail as this article unfolds.

Concerning the use of bhasmas of the three points identified above, the first point needs to be reiterated: they are advised to be taken only on prescription and not bought over the counter by patients. This begs the question, why do so many patients now do precisely the opposite? The answer lies in a seemingly unrelated, but widely-shared perception of these so-called ‘traditional’ systems and their products. It implies that these systems have useful medicines with no side-effects, especially for those conditions for which biomedicine has no satisfactory medication. While this kind of perception seems to be positive, it actually serves to undermine these comprehensive knowledge systems, and their systematic epistemologies that govern diagnosis, prognosis, and treatment. Most people in urban areas in India, where self-medication and decisions to opt for alternative medication are most widespread, ignore or are unaware of the fact that administering these medicines is usually a product of complex assessments of three things—the disease condition, the constitution of the patient, and the continuous assessments of the medicines’ impact. They believe, rather, that all they need to know is that these medicines are gentle and good for them, and little else. For this, neither the patient, nor other doctors, nor the practitioners of ayurvedic medicines are responsible. It has been argued elsewhere that it is the marketing strategy of ayurvedic medicines as OTC products by ayurvedic drug companies in India that is responsible for this perception.6 Here, I would argue that the understanding of toxicity itself is a construct at two levels, the epistemological and the empirical. First, a brief explanation of how this is the case.

The epistemology of Ayurveda is derived from a philosophy of human beings’ relationship with nature, aimed at a longer and healthier lifespan. It is empirically based on experience and the application of this knowledge over a very long period of time and in a manner in which practice both affirms the uniformity of principles and the necessity for diversity in practice. In the context of bhasmas and toxicity, what is significant is that the medicinal properties of metals and minerals have been known for a long time, and their usage has been refined through practice. By the time of the Rasataraṅgiṇī in the thirteenth century, it is clear, from both text and practice, that bhasmas are very potent medicines if they are carefully prepared—utilising the nuanced methods of śodhana and māraṇa to make sure the toxicity of the metal/mineral is removed. Patwardhan, Warude, and Giresh point to two ways in which this can be tested: first, the original metal/mineral should not be recoverable from the final bhasma and second, it should have ultra-fine particles that float on water.7 In addition to this, there is the science of testing for the non-toxic character of the properly made bhasma, as explained below.

The second aspect of the epistemology of the bhasma concerns its usage. It should be administered judiciously in terms of indications not only of a disease condition, but also taking into account the specific constitution of the patient, as well as the anupāna (the ‘vehicle’ for carrying the bhasma into the system), and the pathya (the kind of food intake and behaviour that is permissible along with the medication). Furthermore, interventions must be possible when, even with all precautions observed, the patient exhibits reactive symptoms. If anything, as a medical intervention system, Ayurveda’s epistemology is not only about drug action in isolation, but about drug interaction with everything else that is ingested by the patient—food and drink. This is one place where the holism of Ayurveda is evident—that it takes into account the fact that the digestive system processes food, drink, and medicine together. It thus anticipates food-medicine reactions, and makes dietary provisions before medicine is administered. Also, Ayurveda is able to establish the possible balance between pathya (diet and behaviour) and auṣadhi (herbal medicine) because its epistemology clearly assesses everything in nature in terms of its characteristics. According to Ayurveda, everything in nature or produced by it embodies the five elements in specific ways, which lends it a particular character and efficacy. Once the characters of different foods and medicines have been balanced, these potent medicines will have their impact. This is why ayurvedic practitioners are able to claim that their medicines have no ‘side-effects’—because they have ruled them out through precise prescription practices to begin with. It is also why administering the medicine and then closely monitoring the effects are so vital to the judgement of what the medicine is about. It also demonstrates how the epistemological and the empirical are so closely connected with each other.

Based on this explanation it becomes easier to see why modern scientific analyses, bound as they are by their own epistemologies and empirical parameters, are unable to assess these medicines properly. It also indicates another fundamental problem that makes the understanding of Ayurveda difficult—that Ayurveda’s epistemology spells out the character of the drug, the course of drug action, and the remedies for reaction, but it does not spell out how it knows these things, nor why certain actions and reactions take place. In any case, this does not happen in a language and explanatory structure that could be understood by modern science. Methodologically, the means of arriving at knowledge in the two knowledge systems are fundamentally different, and all the research so far at either end has not been able to address this issue.

Toxicity of Bhasmas in Three Kinds of Articles

I have identified three types of articles that discuss toxicity in bhasmas: (1) the first indicates that bhasmas are toxic, (2) the second argues that bhasmas are non-toxic, and (3) the third takes a median position. To begin with, the definitions of bhasma in the first two types of articles are compared. Thereafter, examples of each of the three categories of articles will be critically analysed. Singh and Rai state that bhasmas are ‘unique metallic-herbal preparations (called Bhasma), which involves different processing steps including repeated steps of calcination of metal in the presence of natural precursor (herbal juices, decoctions, and powders, etc.)’.8 Whereas, Koch et al. begin their recent article by defining them thus:

A special subset of herbal medicines is Rasa Shastra, where metals, minerals or gems are intentionally added to herbs. Although important micronutrients such as iron and zinc are commonly used, elements widely considered toxic in the west, such as lead, mercury or arsenic, are also used.9

In fact, in that article the definition is incorrect from the very beginning—it is not the case that metals, minerals, or gems are intentionally added to herbs, but that the medicine is prepared from a calcination process of the metals or minerals, in which herbs and other natural products may be used. Besides, in Ayurveda too, these substances are recognised to be ‘toxic’, but are understood to have medicinal value once this calcination process is undertaken, hence the creation of the bhasma

Articles that Indicate Toxicity of Bhasmas10

The first article that precipitated the controversy over bhasmas was published in 2004 in the reputed Journal of the American Medical Association, and was principally authored by Robert Saper,11 followed by a number of others. The article claimed as its objective ‘To determine the prevalence and concentration of heavy metals in ayurvedic HMPs [Herbal Medicine Products] manufactured in South Asia and sold in Boston-area stores and to compare estimated daily metal ingestion with regulatory standards’.12 It concluded that, ‘Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory’.13

Two damning conclusions are drawn in this article, exemplified in the above quote: first, that what is meant to be a herbal medicinal product actually contains heavy metals and second, that this implies a generalisation that all ayurvedic medicines are suspect of containing heavy metals. On the basis of this most fundamental aspect of its analysis, this academic article starts with a popular perception that all ayurvedic medicines are ‘herbal’. It would have reflected an appropriate academic assessment had the authors investigated the distinctions that exist in Ayurveda between its different categories and forms of medicine—herbal and non-herbal. Further, the authors submit that ‘we were not able to ascertain the metals’ chemical forms, which can impact bioavailability and toxicity, specially in the case of mercury’ and also that, ‘Whether these findings can be generalized to those HMPs sold elsewhere in the United States requires further study’.14 Mentioning ‘ayurvedic herbal medicine products’ in the title of the paper also raises the question to what extent such generalisations on ‘herbal’ medicines can be made if many of the study samples are actually herbo-mineral products.

In another article in the Indian Journal of Medical Sciences, Kales and Saper15 posit ayurvedic lead poisoning as an under-recognised international problem, with reference to another article16 in the same issue that presents some evidence of lead poisoning resulting from ingestion of ayurvedic medicines from within India. They argue that because non-specific signs and symptoms of lead poisoning are usually evident and that other reasons like infrequent consideration in differential diagnosis, the lack of availability of routine measurements of lead in the blood, and consulting only ayurvedic practitioners, cases of lead poisoning are under-reported and therefore under-recognised. Hence it implies that despite the fact that 80 per cent of India’s population routinely takes ayurvedic and similar medication,17 the true hazards are unknown. This article also refers to the US Center for Disease Control and Prevention Studies of lead poisoning published between 2000 and 2003. Kales and Saper reiterate the concern of the ‘persistent international problem of heavy metal contamination, particularly lead, in traditional medicine products (TMPs)’.18 The generalisations made in this article on the basis of thin evidence and conjectures are presented without an understanding of the issues on the ground. For instance, although a high proportion of India’s population uses Ayurveda, herbo-mineral products are a very small proportion of the medicines manufactured in the first place. Thus, these are a small proportion of ayurvedic medicines that people use. Hence, to look for overwhelming evidence of lead poisoning or conjecture about its absence is meaningless. On the other hand, that there might be lead contamination of purely herbal products from contaminated raw plant material or other sources is a different matter and of concern, which ought to be addressed by strict standards of manufacturing practice and regulation. Yet, this is obviously a confounded issue.

Further, the article claims that case reports of clinical intoxication documenting toxic levels of lead in patients’ blood provide strong evidence that the metals contained in these ayurvedic products are not ‘detoxified’ through traditional means of preparing the TMPs. Another case in point is an article that appeared in the journal of Oncology and Hematology in 2011, titled ‘Ayurvedic Herbal Medicine and Lead Poisoning’.19 It offers an analysis of one patient who was admitted with symptoms of lead poisoning to the emergency department of a hospital in the US. While the article refers to the experience of the Center for Disease Control published previously, the arguments made herein are based on tracking histo-pathological and other examinations of this one patient, reportedly resulting from an ingestion of ‘an Indian ayurvedic medicine, Jambrulin’.20 First, the title reports that an ayurvedic herbal medicine caused lead poisoning. This erroneously indicates that it is herbal under false pretences, because a herbal medicine by definition should not contain metals or minerals (again, contamination would be a different matter). What the article analyses is actually a herbo-mineral preparation, which would be the correct category to use. Second, the name Jambrulin indicates a legally-recognised category of ayurvedic medicine known as ‘proprietary’ medicine, which is different from a ‘classical’ formulation. Besides, there was no report of this medicine being taken under supervision and monitoring, which is mandatory according to the principles of prescription and treatment as described above and as clearly indicated in ayurvedic texts21 and, indeed, continues to be a part of present ayurvedic practice. Yet, the generalisations offered are unmindful of the complexity and careful consideration that accompanies the administration of bhasmas in Ayurveda. The article claims that ‘toxic exposure to lead through alternative sources remains a significant and poorly recognized public health problem’.22 It further says ‘a comprehensive analysis of 193 Ayurvedic medications revealed the presence of heavy metals in ~20% of products analyzed . . . as they are marketed as supplements, they are not regulated by the U.S. FDA’.23 In this quote, yet another category of ayurvedic products is introduced—supplements, by which are meant food supplements. This is a category created by ayurvedic drug companies unable to sell ayurvedic products as medicine in the US because they are not recognised by the US FDA. Supplements require less stringent regulations, hence this guise is adopted. It is precisely because of this that none of the strictures associated with the administration and monitoring of these medicines are adopted. When there are complications, as are bound to take place, as warned in classical ayurvedic texts, the entire knowledge system has to take the blame.

In another article by Radhika Singh on ‘Toxic Metal Analysis in Ayurvedic Drug Systems’,24 a number of similar issues are raised. Singh, however, analyses three classical formulations, Talisadi Churna, Panchsaka Churna, and Triphala Churna. She concedes that:

The heavy metals (Hg, As, Pb etc.) are used in detoxified state in these medicinal products because of their reported therapeutic properties. If the detoxification process is not systematically followed during manufacturing, it is possible for the resulting products to contain high levels of heavy metals (such as Hg, As, Pb, Cd etc.) which can be highly toxic for human beings.25

Her main concern, however, seems to be that ‘Ayurvedic preparations are never tested before coming to the shop shelves; neither do they require any certification to get there’.26 She conducts tests for metal toxicity on formulations which are randomly picked from the market. Comparing her results with the maximum permissible limit of heavy metals in the guidelines issued by the WHO and the government of India, she demonstrates that each of these drugs has a very high amount of copper, and also lead. While the zinc levels are not specified by regulations, she argues that if they are above a certain limit, the taste and the look of the bhasma are unpleasant. Her analysis could possibly lead to the conclusion that there is a serious lack of standardisation of the manufacture of bhasmas and that serious attention should be paid to this. While the title of the article implies ‘ayurvedic drug systems’, she is actually analysing only the drug content of samples that were chosen both in terms of the specific products from manufacturers and the particular formulations identified. It is surprising that nowhere is this justified in terms of why the author specifically chose these and not others, etc., (a standard requirement in any rigorous research would be to explain the chosen samples), especially because it thereby generalises the ‘ayurvedic drug systems’. The implications of such generalisations, however, in terms of a scientific evaluation of Ayurveda demonstrating illegal toxicity levels of its medicines, proves damaging for the system as a whole.

These articles are all actually concerned with a limited range of products available in the market as ‘proprietary’ medicines and quite rightly strive to point out their shortcomings in an effort to enable a more scientific understanding of their potential toxicity. This could well have been true had the generalisations not been made with respect to all ayurvedic medicines. In no comparable kind of analysis would there be a confusion between, for example, a generic/‘classical’ formulation and a patented/‘proprietary’ one and that, too, with scant reference to the prescription, line of treatment, mode of administration, and expected outcomes of the very pharmaceutical that was being analysed. Further, there scarcely would have been an intermixing of analysis of the innate chemical/pharmacological properties of the product with its shortcomings stemming from poor regulatory frameworks. The two deservedly belong to different realms of analysis. While for the consumer they come as a package, scientific analysis of the pharmacological properties, or indeed an unreasonable amount of metal ingredients that could cause lead poisoning for instance, surely needs to posit itself more firmly within the epistemology of the pharmacological framework to which the medicine itself belongs. And this is where the potential for an alternative mode of toxicity analysis stems from.

Articles that Emphasise the Non-toxicity of Bhasmas

The articles indicating the non-toxicity of bhasmas are part of a large body of literature that has been generated in the last 60 to 70 years in India. These studies were done by those trained in Ayurveda and modern scientific analysis, and who use concepts of the latter to analyse medicines, diagnostic tools, and lines of treatment of Ayurveda with the expressed intention of explaining it to their cynical colleagues from the world of science. Yet, very little of this literature is cited in international publications on Ayurveda. This could very well be because it remains practically unknown to the scientific world outside of India. It could also be the case that the dominant scientific world is aware of this literature, but does not lend it credence because it may not be peer-reviewed or the analysis conducted in world-class facilities. Yet, if the international publications do not take up the results of the research on Ayurveda done in India, how could the veracity of any of the claims, whether for or against Ayurveda, be realistically tested or established? There seems to be a serious disconnection between the two worlds of publishing, which could also indicate the hierarchies of power between them. This has direct implications for the credibility that research on Ayurveda in India is likely to enjoy globally. Here, they are analysed with the hope that this at least is highlighted as an issue in the international politics of knowledge that circumscribes the position of Ayurveda in the global space.

In a study done on albino rats on the effects of Tamra Bhasma, a generic ayurvedic formulation, conducted in the laboratory of Dhootpapeshwar, one of the oldest manufacturers of quality ayurvedic products,27 it was observed that when administered orally and at designated therapeutic levels, there were no behavioural changes in the rats, no histopathological and other alterations, and no symptoms of serious toxicity.28 The researchers conclude that:

The overall chronic toxicity study data indicates that the test substance at its TD [= Tamra Bhasma] and 2TD [= Tamra Bhasma in double therapeutic doses] level is very well tolerated since no toxicity symptoms of serious cause could be observed in any of the parameters analysed. The cause for concern is the acute congestion and round cell infiltration reported in histopathological examination of tissues (liver, kidneys). The fact that these effects observed were not dose dependent in nature and occurred in [the] control group also, the result rules out serious toxicity potential especially at the dose levels employed in therapeutic indications.

The safety of the drug Tamra Bhasma reported may be attributed to [the] bhasmikaraṇa29 process which converts the metal into its specially desired chemical compound which eliminates the toxicity of the metal and has the necessary medicinal benefits.30

The argument that the safety of the drug Tamra Bhasma may be attributed to bhasmikaraṇa is reiterated in the extensive work done by Anand Chaudhary on bhasmas, some of which is referred to here. Chaudhary argues that both aspects of the debate on bhasmas, i.e., the conversion of the metal into a non-toxic substance and the claim that it has medicinal benefits, are covered in ayurvedic texts referred to earlier. First, these texts lay out the very processes of the preparation of bhasmas. The fact that the formulations of bhasmas vary for different metals and for different disease conditions, indicates that the medicinal potential of these metals has been known in fair detail. Additionally, these texts also constantly reiterate that enormous care needs to be taken in the preparation process, which indicates an awareness of how easily things can go wrong.31 Second, in various texts, of which the Rasataraṅgiṇī is one of the best-known examples, the possible negative effects of bhasmas are identified. These result from poor preparation, incorrect administration, or even a reaction of the physical system to a bhasma that may not suit. For each of these negative effects the counter-strategies, some of which were already referred to above, are also clearly enunciated. The most significant underlying norm is, however, that bhasmas are medicines that can only be administered under strict supervision of a knowledgeable physician.

In a study published in the Indian Journal of Experimental Biology,32 Sarkar, with Chaudhary and others, reports on the testing of toxicity on laboratory animals after the administration of two herbo-mineral preparations, Lauha Bhasma and Mandura Bhasma, which are used to treat different types of anaemia and are also used as immunomodulators. Having taken preparations from recognised sources, such that the veracity of the bhasmas was assured, the study followed a strict protocol of animal-testing according to WHO guidelines to check on the effects these medicines have on rats. An analysis of the haematology, the clinical chemistry, the organ weights, the histopathology, the gross pathology, and the body weight were conducted. The study concluded that:

Body weight indicates [the] health status of any living being. So here [an] increase in the body weight of the albino rats indicate[s] [the] normal progressive health status of the animals, and it is also indicative of the fact that no degenerative changes are occurring during drug administration. So, increase in body weight in both [the] toxicity and recovery study could suggest that there is no harmful effect of the test drugs on body function[s] as a whole.33

Thus, the two articles presented here concluded that the bhasmas tested were non-toxic—although always with the rider that this would be the case only if they were properly prepared and administered.

Articles that Indicate a Median Position with Respect to Bhasmas

Singh and Rai carefully analyse hitherto unexplored dimensions of the chemical compositions of carbonaceous materials in bhasmas in order to better understand the processes of standardisation that would be applicable to them. This indicates that these authors have respect for these medicines and are proceeding to analyse them utilising a method that would be widely acceptable. They state that:

Our earlier report on Naga Bhasma also shows the presence of nano-size crystalline PbS [lead sulphate] along with different nutrient elements in the finally prepared medicine. However, in contrast to the other works on Bhasma medicine, the work [for the] first time suggests the presence of organic matters in Bhasma medicine, but remains short for their identification. [The] present work is an extension of the previous work on Naga Bhasma, which removes the above lacunae and addresses the role of natural precursors in detail and also gives [the] science and mechanism behind such complex preparations, . . . which could help in [the] standardization of Bhasma medicines.34

This article is a clear attempt to understand the process of making a bhasma. It presents new research on a scientific analysis of the precursors used with the express purpose of helping to standardise the production of the medicines.

Kapoor’s article35 is another case in point. An elaborate analysis of bhasmas from the historical, textual point of view, but with an emphasis on the pharmacological, it struggles between two positions. While there is an appreciation of the process of making the bhasma, Kapoor worries about the qualitative knowledge of the vaidya who administers it, as opposed to the quantitative orientation of the modern biochemist/scientist who evaluates it. He points out that, ‘The Ayurvedic practitioners assert that one must treat discretely the heavy or toxic metals in elemental form—read toxic, from those in compound form—the bhasma, regarded human-safe’.36 But he raises an important question, ‘What is the chemical nature of the end product of the bhasma process?’37 He points out that in the numerous studies on the chemical composition of bhasmas produced by the highest bodies of research on Ayurveda in India, the CCRAS (Central Council for Research in Ayurveda and Siddha) and the CCRUM (Central Council for Research in Unani Medicine), the chemical elements are specified, but the substances produced at different stages of the calcination process, i.e., the drug intermediates, are not identified. Knowing the intermediates would help the physician to understand what possible effects an incompletely calcined or prepared bhasma might have on the patient. In discussing this, there is an attempt to understand and analyse it all in great detail, while continuously pointing out the shortcomings that can occur at various stages of manufacture, including incomplete calcinations and contamination at source.

The author rightly concludes that since information of the chemical nature and consequently of the drug action of the intermediates is not available, the vaidya is probably practising with incomplete information, which would affect clinical outcomes, even when the drug is administered with utmost sincerity. Kapoor also refers to the standard practice of administering the drug through a vehicle, such as butter, honey, or milk—known as the principle of anupāna.38 He argues that the effect of anupāna on drug action is known—as any text identified in the pharmacopoeia would indicate—but that this knowledge is always qualitative. Today, if we adopt the quantitative frame as the reference point, two arguments are possible: firstly, that corresponding possibilities of quantifying these qualitative criteria could be explored; and secondly, that it could be challenged, and an alternate system of evaluation could be put in place. If the latter is clearly spelt out and translated into a language that the world of modern science and policy-makers understands, then chances are high that it could become accepted and considered to be ‘objective’ in some sense, even if not phrased in exactly the same language that objectivity has been hitherto expressed. Kapoor’s extensive work is an example of how one can seek to bridge the two epistemologies while keeping their limitations in mind. This is a very important source for understanding how a scientist can address this issue while being aware of the politics of knowledge involved.

An outstanding article that takes a median position in this debate was written by Thatte and others.39 It was published well before the toxicity issues came up internationally. In 1993, Thatte and others, a group of innovative pharmacologists in Bombay, discussed the understanding of toxicity in Ayurveda. Their article titled ‘The Flip Side of Ayurveda’ offers a remarkable analysis of a number of dimensions of this issue. Their discussion begins with the case of a hyperglycaemic patient, who died because of an adverse drug reaction created by ingesting an ayurvedic drug for psoriasis. Thatte et al. point out that this drug was taken through self-medication, without supervision. They also state that as doctors who do not use or prescribe ayurvedic medicines, they need to know and understand the different dimensions of ayurvedic medicines because of the 80 per cent of their patients taking them and the aggressive marketing of these products, leading to the understanding that these can be taken over the counter, specifically for non-specific medical conditions. Thatte et al. identify the processes that are required to make these medicines, with the understanding that they may not be followed precisely in modern manufacturing facilities.

Most importantly, Thatte et al. identify a separate science in Ayurveda, which deals with toxicological aspects and is known as viṣagaravairodhika(praśamana)tantra (toxicology), citing the detailed knowledge of toxicity that was known in this medical knowledge system. They analysed the toxic effects of a herbo-mineral preparation, Mahayograj Guggul, which was taken by a 70 year-old patient for a condition of rheumatoid arthritis. It gave him relief from his arthritis, but he developed symptoms of lead poisoning, including severe anaemia with classic basophilic stippling of the red blood cells. Taking into account both the lack of monitored administration of the drug and the lack of regulation of the production processes of these medicines, they concluded that:

Firstly, Ayurveda definitely recommends Mahayogiraj Guggul for rheumatoid arthritis but has cautioned about duration of therapy, which was overlooked. Secondly, as there are no quality control procedures in existence, there is no way to know whether the lead in this formulation had been processed in the complex way it should have been.40

The most important conclusion of this article, to my mind, is that they recognise that ayurvedic drugs can have adverse effects or side-effects, especially when administered with other drugs. They state:

The most glaring are possible drug interactions with the usually co-administered allopathic drugs. Several plants have been shown to alter bio-availability of allopathic drugs. Similarly when used in combination with allopathic drugs they may alter their pharmacodynamics.41

In this context, they cite another, earlier work of their own that explores and establishes some of these issues.42 In addition, they cite 16 different works, most of which are published in Indian journals, which substantiate their arguments. Notably, this work is cited in some articles published internationally.43 Yet, none of this knowledge is referred to, and it seems to have made no difference to the analytical frame of either of these later pieces of work.

It must be pointed out that the work in the larger field of pharmacology by Sharadini Dahanukar and Urmila Thatte, two of the four authors of the 1993 article, established a completely different arena of research in that these authors actively engaged with the epistemology of ayurvedic medicines and pharmacology. They were trained in mainstream pharmacology, but systematically studied Ayurveda under distinguished teachers and proceeded to conduct analyses of ayurvedic medicines by evolving paths of scientific exchange. This exchange did not privilege the epistemology or any one scientific language over the other, but sought to figure out the parameters of translation that would do justice to the philosophy and perspectives of both while enabling communication between them. I am convinced that this is the kind of work that needs to be done and taken forward much more energetically, if there is something to be genuinely learnt from different systems of medical knowledge and their use for patient welfare.

This part of the analysis links to the second main argument that I wish to make in the following section of this article, concerning the understanding of toxicity itself. Toxicity is as much a construct as an objective criterion; therefore, the reference points specific to the product ought to be considered whenever any analysis is being undertaken.

Construction of Toxicity in Different Systems of Medicine

I would argue that the real issue in the debates on toxicity is that of the politics of knowledge. By this I mean that there exists a hierarchy between different types of medical knowledge, created and maintained assiduously, and caused by the hegemonic position of the biomedical sciences over those of ‘non-modern’ knowledge systems. The epistemological basis of the biomedical sciences is the established superior frame of reference. Therefore, it has also been used to evaluate the medicines and lines of treatment belonging to the ‘non-modern’ knowledge systems. In most of the articles analysed above, it is clear that the frame used to analyse and evaluate toxicity in ayurvedic medicines is completely alien to Ayurveda in terms of structure and content. Yet, the confidence with which such analysis is offered by scientists and, even more so, published by reputed international journals shows that there is scant recognition of epistemological frames outside those of modern bio-chemistry, which inform biomedicine. This confidence needs to be challenged in order to demonstrate the discordance between the two frames of analysis, which exists due to the hegemonic position of biomedicine and a fundamental difference in the epistemologies of the two medical knowledge systems.

The challenge can be mounted on the basis of an alternate frame for the evaluation of toxicity in herbo-mineral preparations of Ayurveda. This proposed frame would rest on a dialogue that seeks to translate some basic parameters of the ayurvedic system and modern pharmacology, conscious of the already established hierarchy of knowledge and that this should not influence that dialogue. In this proposed frame, all stages of the preparation, as well as the administration and the impact on the patient, should be included for evaluation. While it is true that biomedicine, too, would follow these stages broadly, the parameters that comprise these stages—the very definition of the disease condition, in terms of the imbalance of humours, the line of treatment, and the expected outcomes—are fundamentally different in Ayurveda and have an internal consistency. Hence, this difference needs to be recognised and respected when protocols for studies are being made and implemented. This would become possible both when biomedical researchers understand ayurvedic epistemology and also when they are culturally sensitive to the complexity of Ayurveda. The preliminary orientation toward a dialogue like this can possibly be provided by key historical and ethnographic studies that detail the use of originally poisonous but carefully processed and administered substances used as medicines in different societies and at different points in time.44

As has been demonstrated in an earlier section, the process of making a bhasma is an intricate one that embodies a combination of complex chemical and biological changes in the interactions between the herbal and mineral substances being used for the medicine. Explanations for each level of transformation and the manner in which they would affect disease outcomes may not be easily accessible. Indeed, they may not even be available. But the processes are known to be purificatory in their orientation, rendering the mineral or metal less and less toxic as the bhasma evolves toward its final preparation. At the final stage, even if an analysis shows traces of the mineral or metal in its original form, it would be unwise to routinely analyse it in terms of a ‘maximum permissible limit’ as done in modern pharmacology. The reason for this is that at this stage, the usage of the bhasma in carefully calibrated doses, prescribed according to the constitution of the individual patient, as well as for the condition for which the bhasma is deemed appropriate, has been extensively documented and commented upon in the practice of Ayurveda. Also at this stage, in a perfectly made bhasma, the metal is expected to be in a bio-assimilable form, which undoubtedly can be translated to modern pharmacological parlance and rigorous testing, if only the example set by Dahanukar and Thatte is followed! The experience of using these medicines in clinical practice over a very long period of time (now even recognised in EU laws as ‘long use’)45 with a known history of efficacy and non-toxic impact among practising vaidyas when administered in these conditions, has to be part and parcel of any appraisal of these medicines. Yet, most of the analysed articles, particularly of the first category mentioned above, do not recognise these parameters.

A New Regulatory and Manufacturing Framework for New Medicines

Another very important point made by many of these articles, in each of the categories discussed above, concerns the regulatory standards for these medicines. No doubt, any medicine that is placed on the market for human consumption must abide by stringent rules of manufacturing and quality control. In this respect, it can be safely stated that the procedures for ayurvedic medicines, developed as they have been over the last 50 years or so, leave room for more regulation. These regulations can be imposed externally, by the government, or from within the manufacturing sector itself. I suggest three areas where regulations could be improved: (1) in the aggressive marketing and advertising strategies adopted by companies, (2) in the quality control of raw materials and methods of manufacture, and (3) in the application of these quality controls by manufacturers. While the first calls for a discussion separately, the second and third will be discussed together.

Marketing and Advertising

First, it must be noted that a number of the scholars referred to earlier in this article, as well as elsewhere,46 have pointed to the great risk posed by the aggressive marketing and advertising strategies adopted by ayurvedic companies in the last 100 years. What is particularly relevant here are two aspects: in the name of making ayurvedic medicines more accessible to ordinary patients, ayurvedic medicines are being separated from their world-view, philosophy, and the rigour of practice, by transforming them from regulated drugs to OTC products. This has been a conscious strategy of these companies to counter the decrease in classical prescriptions that we find in India, especially since the 1960s,47 the decrease in the credibility of the vaidyas as physicians, as well as in standardisation of education—changes that are not in the hands of the companies but affect the sale of their products. Transforming ayurvedic medicines into OTC and then FMCG (Fast Moving Consumer Goods) products, and also focusing on adapting certain products to fit this new category, allowed the reach of the consumer to be retained, even enhanced. While this was all right for products such as Chyawanprash, this was problematic in the case of bhasmas, which should be prescribed and taken under the supervision of a vaidya. Therefore, they should not have been qualified as OTC or FMCG products in the first place.

The question then needs to be asked: Why do patients, in a country where there are so many vaidyas and hakims (practitioners of Unani medicine), take to self-medication with potent medicines like bhasmas? I would hypothesise that the answer to this lies principally in another strategy of the companies, although it may have been also fuelled by opinions of vaidyas. This is the strategy of marketing ayurvedic medicines as ‘safe and without side-effects’. Taking advantage of the widespread dissatisfaction with biomedical pharmaceutical products from which patients suffer side-effects, the most significant strategy that worked was to declare ayurvedic products ‘natural’ and ‘safe’. This commodification of ayurvedic medicines, which has already been argued to have disengaged the patient and the medicine from the epistemology and proper practice of Ayurveda, now can actually harm the patient. In the celebration of the processes of industrialisation and the market forces that dominate the discourse of development, this problem provides a damning indictment. A regulatory framework for advertisements, both for large companies as well as for clinics in smaller towns, urgently needs to be put in place.48

New Regulations and their Application by Manufacturers

On the second and third points, two broad observations can be made to begin with. The development of standards in the history of biomedical pharmaceuticals has taken at least two centuries to be established. This was understandable, given the newness of the science, the materials being used, and the context in which manufacture and commerce were undertaken. It is obvious that these things take time. Also, Kapoor points out how the use of metals in medicine has been widespread all over the world, including the Western world, until quite recently, albeit with self-conscious regulations; for instance, the certifying of arsenic trioxide by the Food and Drug Administration for the treatment of patients with promyelocytic leukaemia that is resistant to the chemotherapy drug ATRA (All Trans-Retinoic Acid).49 While it may be argued that for Ayurveda a similar timeframe need not be endured since there is precedence available that only needs to be applied, appropriate regulations are necessary.

Fresh and different kinds of regulations and standards need to be deployed here, for two reasons. First, the process of making the medicines indicates a difference in the understanding of minerals/metals, their combination with herbal substances, and their consequent chemical transformation. Further, the expectation of their medicinal properties is that of an epistemological difference of understanding the meaning of illness in a body and how a medicinal preparation intervenes to mitigate it. This implies that differences exist both at the level of preparation as well as the use of the medicine in an expected line of treatment. Therefore, diversity and differences characterise the very character of Ayurveda. In the light of this, how do we interpret the meaning of ‘standardisation’? As Kapoor points out, an analysis of bhasmas that can be made from the same metal shows that a great variation is possible amongst them. A comparison of the different bhasmas shows that the variation results from the different texts that are the source of the method of preparation, and the differences are rather substantial. He argues that:

polymorphic substances are chemically the same but, importantly, can have different physical and chemical properties due to different intrinsic energies of the crystals; the polymorphs produce different pharmacological actions with one form faring better in terms of solubility or bioavailability, etc.; bhasmas of metal mixtures and alloys will contain variably mixed compounds depending upon the relative proportions of the elements and the accompaniments.50

Thus, Kapoor feels that compounds that are formed by metals taking on different valence states should be treated like independent bhasmas, which is not the case in traditional practice. Consequently, the indications of reactions or indeed positive effects would need extensive clinical studies. This would offer a better explanation for the actions of the bhasmas, no doubt, but the question of standardisation would remain.

Within the ayurvedic community, the issue of pharmacological rigour with respect to manufacturing standards of the medicines being made in modern factories, or pharmacovigilance, defined by the WHO as ‘the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem’,51 is now a clear concern. As a result of this concern, a National Pharmacovigilance Committee for Ayurveda, Siddha, and Unani (NPC-ASU) was set up in India in 2008 along the lines set by the WHO, to begin with reportage of Adverse Drug Reactions (ADR), which could then be followed up with the Department of AYUSH (the acronym for Ayurveda, Yoga, Unani medicine, Siddha medicine, Sowa Rigpa, and Homeopathy).

In this context, Ramakrishna reports that at a Continuing Medical Education Programme on ‘Research Methodology for Ayurveda Academicians’ held at the prestigious BYL Nair Charitable Hospital, many of the participants were not very enthusiastic about the concept of reporting ADR and the idea of the NPC-ASU. He writes that it was ‘disappointing to know that 3 years after the launch of the NPC-ASU programme and many orientation/awareness programmes, the Ayurvedic fraternity is still finding it difficult to accept the flip side of Ayurveda’,52 in an obvious reference to the work of Dahanukar and Thatte, all those years ago. But, those that visualise a vibrant future for Ayurveda on the basis of its ability to negotiate with the contemporary global requirements, argue and work enthusiastically toward realising it.53 In this context, however, it is worthwhile to refer to the position taken by Mao and Desai, who agree with Saper et al.54 on the public health hazard of ayurvedic medicines that demonstrated high levels of heavy metal content. They, however, caution against policy conclusions that recommend stringent across-the-board testing by third parties. What they argue is worth quoting at length:

. . . we suggest rigorously designed pharmacoepidemiology research using case control or cohort designs to evaluate the true risk of the use of Ayurvedic medicines and heavy metal poison in humans.

Such a study would require a validated instrument to record dietary intake of Ayurvedic medicines and measurement of serum levels of heavy metal content in large populations of humans. . . .

Unless there is evidence that heavy metal content in authentic Ayurvedic medicines is harmful, the suggested strict government oversight may be costly without yielding public health benefit.55

Yet, I would argue that from the policy-makers’ point of view, especially in India, regulation of ayurvedic drugs needs to be stepped up. The Drugs and Cosmetics Act 1940, now amended several times, contains some very good provisions; for example, Good Manufacturing Practices, Good Agricultural Practices, etc. These have the potential to regulate every stage of the production of ayurvedic medicines—from the quality of the raw material to the final product. These provisions must be enforced. This requires a vigilance on the part of the ayurvedic community, whether manufacturers, practitioners, or researchers. But this would be possible only if those in the community believe in two things at the same time: that they have a very valuable form of therapeutics and not only a commodity, and that this represents a knowledge system that not only compares with, but perhaps truly complements the dazzling achievements of modern pharmaceutics. Only then will there be a base for the future of metal-containing ayurvedic medicines.

Conclusions

In conclusion, I would like to reiterate that it is very important to differentiate between the veracity of ayurvedic products in the market and the prescribed process of their careful making and prescription practices. Many of the articles cited invariably talk of the difficulty of the processes of making bhasmas and doubt as to whether these are being followed, due to haste and homogeneity that mark the modern production of all commodities, to which ayurvedic products now invariably belong. Additionally, they refer to the regimen of food and diet that must accompany every ayurvedic prescription, because of the logic of bio-availability and the balance of humours that are enabled by this combination. Both the prescription of the diet to accompany medication, and it being followed, depend on a large number of non-medical factors, like the fast-changing food patterns of people, especially in urban areas. It is perhaps also important to recognise that even if the cultural precepts that guide the use of Ayurveda and similar systems by people on the ground remain in their consciousness and actual practice, their continuation would depend on the possibility of sustainable production of medicines and of agriculture in general. In a culture in which food is medicine, it is important that foods are available and eaten according to their season. While this is very much a larger issue, it is important to flag it even in a discussion of toxicity, because it ties in with the larger chain of prescription, production, and consumption of medicines.

Finally, Ayurveda and other such medical knowledge systems cannot only be understood as ‘traditional’, as they have been for a long time in the literature. They are living systems of practice and research that need to be understood within the transformed parameters of production and practice. It is also important to remember that while much of scientific analysis seems to be spurred by the public purpose of ‘the interests of the consumer’ and regulations catering to ‘the safety of medicines being sold to them’, in countries like India and in many parts of the world, they were meant, in the light of poverty and underdevelopment, to fulfil a public purpose. This concerned not only the treatment of disease, but also to help maintain the general health of the population, a possibility not yet abandoned by many people experienced in public health care in these countries. Therefore, it is important to recognise that skewed scientific analysis only serves to damage these possibilities, and those undertaking analysis in the name of science ought to be aware of a larger responsibility they have.

Acknowledgement

I would like to thank Barbara Gerke for her vital support in editing this paper.

1 See, for example, Gunturu et al. 2011; Kales, Christophi, and Saper 2007; Koch et al. 2011; Saper et al. 2004, 2008.

2 To quote a few, Chaudhary, Singh, and Kumar 2010; Krishnamachary et al. 2012; Sarkar et al. 2009.

3 Kapoor 2010; Singh and Rai 2012; Thatte et al. 1993.

4 Chaudhary 2012.

5 It is true that varied texts exist and are used by practitioners while making formulas. However, in the Ayurvedic Pharmacopoeia of India (Government of India 1962), 54 texts were identified as legitimate sources for making formulas, and every manufacturer is required to quote chapter and verse and the name of the text referred to on the product’s label. Therefore, it is easy to check the ‘book’ from which the procedure is followed.

6 This is discussed in great detail in Banerjee 2009.

7 Patwardhan, Warude, and Giresh 2005, pp. 1535–6.

8 Singh and Rai 2012, p. 178.

9 Koch et al. 2011, p. 4545.

10 All the references cited for this article are from internationally acclaimed peer-reviewed journals that clearly share both the parameters and (possibly) prejudices of the authors.

11 Saper et al. 2004.

12 Ibid., p. 2868.

13 Ibid.

14 Ibid., p. 2872.

15 Kales and Saper 2009.

16 Singh et al. 2009.

17 See, for example, Kales and Saper 2009, p. 379, and also Priya and Shweta 2011, p. xxiii.

18 Kales and Saper 2009, p. 379.

19 Gunturu et al. 2011.

20 Ibid., p. 1.

21 The most commonly referred to text is the Rasataraṅgiṇī. See Sharma and Shastri (eds) 2004.

22 Gunturu et al. 2011, p. 3.

23 Ibid., p. 5.

24 Singh 2008.

25 Ibid., p. 664.

26 Ibid.

27 The work of the research division of this manufacturer is chosen because Dhootpapeshwar is one of the oldest in India. It takes pride in following the difficult processes of making ayurvedic medicines even at the level of mass manufacture. The latter is a critical category because it has been observed that compromises are being made due to the time and expense involved. Further, this work is not meant to show that its own products are safe, but to demonstrate that a classical formulation, when prepared according to the procedures stated in the texts, can be expected to be safe. Hence, this work is as much a reflection of the ayurvedic system as of the company’s own products.

28 Vahalia et al. 2011, p. 77.

29 Bhasmikaraṇa means burning, calcining, and reducing to ashes.

30 Vahalia et al. 2011, p. 77.

31 This is reiterated in a carefully scientifically analysed piece by Krishnamachary et al. 2012.

32 Sarkar et al. 2009.

33 Ibid., p. 990.

34 Singh and Rai 2012, p. 178.

35 Kapoor 2010.

36 Ibid., p. 563.

37 Ibid., p. 564.

38 Ibid., p. 563.

39 Thatte et al. 1993.

40 Ibid., p. 181.

41 Ibid., p. 182.

42 Dahanukar, Kapadia, and Karandikar 1982.

43 For example, Dargan et al. 2008.

44 See, for example, Shepard 2004 for anthropological examples of taste in relation to poisonous substances in Peru, or Obringer 1997 on the medicinal use of poisons in ancient and medieval China.

45 See the Traditional Herbal Medicinal Product Directive 2004/24/EC of the European Union. URL: , last accessed 3 December 2013. See also Schwabl, this issue.

46 For instance, Bode 2008.

47 This is an area that has been studied in detailed and diverse ways by anthropologists, and it is impossible to take account of them here. The specific point being referred to here is that the prescription of classical formulations by vaidyas in the context of rigorous ayurvedic treatment regimens decreased in the 1970s and 1980s in India, and that prompted the emphasis on ‘proprietary’ medicines.

48 A simple account of this and steps being taken to counter it may be found at: URL: , last accessed 29 November 2013.

49 Kapoor 2010, p. 571.

50 Ibid., p. 566.

51 WHO, URL: , last accessed 29 November 2013.

52 Ramakrishna 2012, p. 57.

53 For example, Chaudhary, Singh, and Kumar 2010.

54 Saper et al. 2008.

55 Mao and Desai 2009, p. 271.

Bibliography

  • BanerjeeM. Power Knowledge Medicine 2009 Hyderabad Orient Blackswan

  • BodeM. Taking Traditional Knowledge to the Market: The Modern Image of the Ayurvedic and Unani Industry 1980–2000 2008 Hyderabad Orient Blackswan

    • Search Google Scholar
    • Export Citation
  • ChaudharyA. ‘Challenges in Pharmaceutics and Therapeutics of Rasaoushadhies (Bio-mineral Preparations) of Ayurveda—A Strategy Ahead’ 2012 last accessed 17 December 2013 Lecture presented at the World Ayurveda Congress December 2012 Bhopal, India URL: <http://www.authorstream.com/Presentation/anand7000-1623268-challenges-manufacturing-rasaoushadhies-ofayurveda/>

    • Search Google Scholar
    • Export Citation
  • ChaudharyA.SinghN.KumarN. ‘Pharmacovigilance: Boon for Safety and Efficacy of Ayurvedic Formulations’ Journal of Ayurveda & Integrative Medicine 2010 1 4 251 6

    • Search Google Scholar
    • Export Citation
  • Dahanukar S. A.KapadiaA. B.KarandikarS. M. ‘Influence of Trikatu on Rifampicin Bioavailability’ Indian Drugs 1982 19 271 3

  • DarganP. I.GawarammanaI. B.ArcherJ. R. H.HouseI. M. ‘Heavy Metal Poisoning from Ayurvedic Traditional Medicines: An Emerging Problem?’ International Journal of Environment and Health 2008 2 3/4 463 74

    • Search Google Scholar
    • Export Citation
  • Government of India Ayurvedic Pharmacopoeia of India 1962 Ministry of Health New Delhi

  • GunturuK. S.NagarajanP.McPhedranP.GoodmanT. R. ‘Ayurvedic Herbal Medicine and Lead Poisoning’ Journal of Hematology & Oncology 2011 4 51 doi: 10.1186/1756-8722-4-51

    • Search Google Scholar
    • Export Citation
  • KalesS. N.SaperR. B. ‘Ayurvedic Lead Poisoning: An Under-Recognized, International Problem’ Indian Journal of Medical Sciences 2009 last accessed 29 November 2013 63 9 379 81 URL: <http://www.indianjmedsci.org/text.asp? 2009/63/9/379/56108>

    • Search Google Scholar
    • Export Citation
  • KalesS. N.ChristophiC. A.SaperR. B. ‘Hematopoietic Toxicity from Lead-containing Ayurvedic Medications’ Medical Science Monitor 2007 13 7 CR295 CR298

    • Search Google Scholar
    • Export Citation
  • KapoorR. C. ‘Some Observations on the Metal-based Preparations of Indian Systems of Medicine’ Indian Journal of Traditional Knowledge 2010 9 3 562 75

    • Search Google Scholar
    • Export Citation
  • KochI.MoriartyM.HouseK.SuiJ. ‘Bioaccessibility of Lead and Arsenic in Traditional Indian Medicines’ Science of the Total Environment 2011 409 21 4545 52

    • Search Google Scholar
    • Export Citation
  • KrishnamacharyB.RajendranN.PemiahB.KrishnaswamyS. ‘Scientific Validation of the Different Purifications Steps Involved in the Preparation of an Indian Ayurvedic Medicine, Lauha Bhasma’ Journal of Ethnopharmacology 2012 142 1 98 104

    • Search Google Scholar
    • Export Citation
  • MaoJ. J.DesaiK. ‘Metal Content in Ayurvedic Medicines’ Journal of the American Medical Association 2009 301 3 271 2

  • ObringerF. L’Aconit et L’Orpiment. Drogues et Poisons en Chine Ancienne et Médiévale 1997 Paris Fayard

  • PatwardhanB.WarudeD.GireshT. ‘Heavy Metals and Ayurveda’ Current Science 2005 88 10 1535 6

  • PriyaR.ShwetaA. S. Status and Role of AYUSH and Local Health Traditions under the National Rural Health Mission: Report of a Study of the National Health Systems Resource Centre Ministry of Health and Family Welfare New Delhi 2011 New Delhi Ministry of Health and Family Welfare

    • Search Google Scholar
    • Export Citation
  • RamakrishnaS. K. ‘Letter to the Editor: Reorientation Program on Research Methodology for Ayurveda Academicians: A Clinical Pharmacologist’s Perspective’ Journal of Ayurveda & Integrative Medicine 2012 3 2 57 8

    • Search Google Scholar
    • Export Citation
  • SaperR.PhillipsR.SehgalA.KhouriN. ‘Lead, Mercury and Arsenic in US and Indian-manufactured Ayurvedic Medicines Sold Via the Internet’ Journal of the American Medical Association 2008 300 8 915 23

    • Search Google Scholar
    • Export Citation
  • SaperR.KalesS.PaquinJ.BurnsM. ‘Heavy Metal Content of Ayurvedic Herbal Medicine Products’ Journal of the American Medical Association 2004 292 23 2868 73

    • Search Google Scholar
    • Export Citation
  • SarkarP. K.PrajapatiP. K.ShuklaV. J.RavishankarB. ‘Toxicity and Recovery Studies of Two Ayurvedic Preparations of Iron’ Indian Journal of Experimental Biology 2009 47 987 92

    • Search Google Scholar
    • Export Citation
  • SharmaS.ShastriK. Rastarangini 2004 11th ed Delhi Motilal Banarsidass reprint

  • ShepardG. H.Jr. ‘A Sensory Ecology of Medicinal Plant Therapy in Two Amazonian Societies’ American Anthropologist New Series 2004 106 2 252 66

    • Search Google Scholar
    • Export Citation
  • SinghR. ‘Toxic Metal Analysis in Ayurvedic Drug Systems’ Conference Report: 23rd National Systems Conference NSC 2008 December 17–19 2008 664 6

    • Search Google Scholar
    • Export Citation
  • SinghS. K.RaiS. B. ‘Detection of Carbonaceous Material in Naga Bhasma’ Indian Journal of Pharmaceutical Sciences 2012 74 2 178 83

  • SinghS.MukherjeeK. K.GillK. D.FloraS. J. ‘Lead-induced Peripheral Neuropathy following Ayurvedic Medication’ Indian Journal of Medical Sciences 2009 63 408 10

    • Search Google Scholar
    • Export Citation
  • ThatteU. M.RegeN. N.PhatakS. D.DahanukarS. A. ‘The Flip Side of Ayurveda’ Journal of Postgraduate Medicine 1993 39 179 82 182a

  • VahaliaM. K.ThakurK. S.NadkarniS.SangleV. D. ‘Chronic Toxicity Study for Tamra Bhasma (A Generic Ayurvedic Mineral Formulation) in Laboratory Animals’ Recent Research in Science and Technology 2011 last accessed 29 April 2013 3 11 76 9 URL: <http://recent-science.com/index.php/rrst/article/viewfile/9199/4660>

    • Search Google Scholar
    • Export Citation
  • 4

    Chaudhary 2012.

  • 7

    Patwardhan Warude and Giresh 2005pp. 1535–6.

  • 8

    Singh and Rai 2012p. 178.

  • 9

    Koch et al. 2011p. 4545.

  • 11

    Saper et al. 2004.

  • 12

    Ibid. p. 2868.

  • 14

    Ibid. p. 2872.

  • 15

    Kales and Saper 2009.

  • 16

    Singh et al. 2009.

  • 17

    See for example Kales and Saper 2009p. 379 and also Priya and Shweta 2011 p. xxiii.

  • 18

    Kales and Saper 2009p. 379.

  • 19

    Gunturu et al. 2011.

  • 20

    Ibid. p. 1.

  • 22

    Gunturu et al. 2011p. 3.

  • 23

    Ibid. p. 5.

  • 24

    Singh 2008.

  • 25

    Ibid. p. 664.

  • 28

    Vahalia et al. 2011p. 77.

  • 30

    Vahalia et al. 2011p. 77.

  • 32

    Sarkar et al. 2009.

  • 33

    Ibid. p. 990.

  • 34

    Singh and Rai 2012p. 178.

  • 35

    Kapoor 2010.

  • 36

    Ibid. p. 563.

  • 37

    Ibid. p. 564.

  • 38

    Ibid. p. 563.

  • 39

    Thatte et al. 1993.

  • 40

    Ibid. p. 181.

  • 41

    Ibid. p. 182.

  • 42

    Dahanukar Kapadia and Karandikar 1982.

  • 43

    For example Dargan et al. 2008.

  • 46

    For instance Bode 2008.

  • 49

    Kapoor 2010p. 571.

  • 50

    Ibid. p. 566.

  • 52

    Ramakrishna 2012p. 57.

  • 53

    For example Chaudhary Singh and Kumar 2010.

  • 54

    Saper et al. 2008.

  • 55

    Mao and Desai 2009p. 271.

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  • BanerjeeM. Power Knowledge Medicine 2009 Hyderabad Orient Blackswan

  • BodeM. Taking Traditional Knowledge to the Market: The Modern Image of the Ayurvedic and Unani Industry 1980–2000 2008 Hyderabad Orient Blackswan

    • Search Google Scholar
    • Export Citation
  • ChaudharyA. ‘Challenges in Pharmaceutics and Therapeutics of Rasaoushadhies (Bio-mineral Preparations) of Ayurveda—A Strategy Ahead’ 2012 last accessed 17 December 2013 Lecture presented at the World Ayurveda Congress December 2012 Bhopal, India URL: <http://www.authorstream.com/Presentation/anand7000-1623268-challenges-manufacturing-rasaoushadhies-ofayurveda/>

    • Search Google Scholar
    • Export Citation
  • ChaudharyA.SinghN.KumarN. ‘Pharmacovigilance: Boon for Safety and Efficacy of Ayurvedic Formulations’ Journal of Ayurveda & Integrative Medicine 2010 1 4 251 6

    • Search Google Scholar
    • Export Citation
  • Dahanukar S. A.KapadiaA. B.KarandikarS. M. ‘Influence of Trikatu on Rifampicin Bioavailability’ Indian Drugs 1982 19 271 3

  • DarganP. I.GawarammanaI. B.ArcherJ. R. H.HouseI. M. ‘Heavy Metal Poisoning from Ayurvedic Traditional Medicines: An Emerging Problem?’ International Journal of Environment and Health 2008 2 3/4 463 74

    • Search Google Scholar
    • Export Citation
  • Government of India Ayurvedic Pharmacopoeia of India 1962 Ministry of Health New Delhi

  • GunturuK. S.NagarajanP.McPhedranP.GoodmanT. R. ‘Ayurvedic Herbal Medicine and Lead Poisoning’ Journal of Hematology & Oncology 2011 4 51 doi: 10.1186/1756-8722-4-51

    • Search Google Scholar
    • Export Citation
  • KalesS. N.SaperR. B. ‘Ayurvedic Lead Poisoning: An Under-Recognized, International Problem’ Indian Journal of Medical Sciences 2009 last accessed 29 November 2013 63 9 379 81 URL: <http://www.indianjmedsci.org/text.asp? 2009/63/9/379/56108>

    • Search Google Scholar
    • Export Citation
  • KalesS. N.ChristophiC. A.SaperR. B. ‘Hematopoietic Toxicity from Lead-containing Ayurvedic Medications’ Medical Science Monitor 2007 13 7 CR295 CR298

    • Search Google Scholar
    • Export Citation
  • KapoorR. C. ‘Some Observations on the Metal-based Preparations of Indian Systems of Medicine’ Indian Journal of Traditional Knowledge 2010 9 3 562 75

    • Search Google Scholar
    • Export Citation
  • KochI.MoriartyM.HouseK.SuiJ. ‘Bioaccessibility of Lead and Arsenic in Traditional Indian Medicines’ Science of the Total Environment 2011 409 21 4545 52

    • Search Google Scholar
    • Export Citation
  • KrishnamacharyB.RajendranN.PemiahB.KrishnaswamyS. ‘Scientific Validation of the Different Purifications Steps Involved in the Preparation of an Indian Ayurvedic Medicine, Lauha Bhasma’ Journal of Ethnopharmacology 2012 142 1 98 104

    • Search Google Scholar
    • Export Citation
  • MaoJ. J.DesaiK. ‘Metal Content in Ayurvedic Medicines’ Journal of the American Medical Association 2009 301 3 271 2

  • ObringerF. L’Aconit et L’Orpiment. Drogues et Poisons en Chine Ancienne et Médiévale 1997 Paris Fayard

  • PatwardhanB.WarudeD.GireshT. ‘Heavy Metals and Ayurveda’ Current Science 2005 88 10 1535 6

  • PriyaR.ShwetaA. S. Status and Role of AYUSH and Local Health Traditions under the National Rural Health Mission: Report of a Study of the National Health Systems Resource Centre Ministry of Health and Family Welfare New Delhi 2011 New Delhi Ministry of Health and Family Welfare

    • Search Google Scholar
    • Export Citation
  • RamakrishnaS. K. ‘Letter to the Editor: Reorientation Program on Research Methodology for Ayurveda Academicians: A Clinical Pharmacologist’s Perspective’ Journal of Ayurveda & Integrative Medicine 2012 3 2 57 8

    • Search Google Scholar
    • Export Citation
  • SaperR.PhillipsR.SehgalA.KhouriN. ‘Lead, Mercury and Arsenic in US and Indian-manufactured Ayurvedic Medicines Sold Via the Internet’ Journal of the American Medical Association 2008 300 8 915 23

    • Search Google Scholar
    • Export Citation
  • SaperR.KalesS.PaquinJ.BurnsM. ‘Heavy Metal Content of Ayurvedic Herbal Medicine Products’ Journal of the American Medical Association 2004 292 23 2868 73

    • Search Google Scholar
    • Export Citation
  • SarkarP. K.PrajapatiP. K.ShuklaV. J.RavishankarB. ‘Toxicity and Recovery Studies of Two Ayurvedic Preparations of Iron’ Indian Journal of Experimental Biology 2009 47 987 92

    • Search Google Scholar
    • Export Citation
  • SharmaS.ShastriK. Rastarangini 2004 11th ed Delhi Motilal Banarsidass reprint

  • ShepardG. H.Jr. ‘A Sensory Ecology of Medicinal Plant Therapy in Two Amazonian Societies’ American Anthropologist New Series 2004 106 2 252 66

    • Search Google Scholar
    • Export Citation
  • SinghR. ‘Toxic Metal Analysis in Ayurvedic Drug Systems’ Conference Report: 23rd National Systems Conference NSC 2008 December 17–19 2008 664 6

    • Search Google Scholar
    • Export Citation
  • SinghS. K.RaiS. B. ‘Detection of Carbonaceous Material in Naga Bhasma’ Indian Journal of Pharmaceutical Sciences 2012 74 2 178 83

  • SinghS.MukherjeeK. K.GillK. D.FloraS. J. ‘Lead-induced Peripheral Neuropathy following Ayurvedic Medication’ Indian Journal of Medical Sciences 2009 63 408 10

    • Search Google Scholar
    • Export Citation
  • ThatteU. M.RegeN. N.PhatakS. D.DahanukarS. A. ‘The Flip Side of Ayurveda’ Journal of Postgraduate Medicine 1993 39 179 82 182a

  • VahaliaM. K.ThakurK. S.NadkarniS.SangleV. D. ‘Chronic Toxicity Study for Tamra Bhasma (A Generic Ayurvedic Mineral Formulation) in Laboratory Animals’ Recent Research in Science and Technology 2011 last accessed 29 April 2013 3 11 76 9 URL: <http://recent-science.com/index.php/rrst/article/viewfile/9199/4660>

    • Search Google Scholar
    • Export Citation
  • 4

    Chaudhary 2012.

  • 7

    Patwardhan Warude and Giresh 2005pp. 1535–6.

  • 8

    Singh and Rai 2012p. 178.

  • 9

    Koch et al. 2011p. 4545.

  • 11

    Saper et al. 2004.

  • 12

    Ibid. p. 2868.

  • 14

    Ibid. p. 2872.

  • 15

    Kales and Saper 2009.

  • 16

    Singh et al. 2009.

  • 17

    See for example Kales and Saper 2009p. 379 and also Priya and Shweta 2011 p. xxiii.

  • 18

    Kales and Saper 2009p. 379.

  • 19

    Gunturu et al. 2011.

  • 20

    Ibid. p. 1.

  • 22

    Gunturu et al. 2011p. 3.

  • 23

    Ibid. p. 5.

  • 24

    Singh 2008.

  • 25

    Ibid. p. 664.

  • 28

    Vahalia et al. 2011p. 77.

  • 30

    Vahalia et al. 2011p. 77.

  • 32

    Sarkar et al. 2009.

  • 33

    Ibid. p. 990.

  • 34

    Singh and Rai 2012p. 178.

  • 35

    Kapoor 2010.

  • 36

    Ibid. p. 563.

  • 37

    Ibid. p. 564.

  • 38

    Ibid. p. 563.

  • 39

    Thatte et al. 1993.

  • 40

    Ibid. p. 181.

  • 41

    Ibid. p. 182.

  • 42

    Dahanukar Kapadia and Karandikar 1982.

  • 43

    For example Dargan et al. 2008.

  • 46

    For instance Bode 2008.

  • 49

    Kapoor 2010p. 571.

  • 50

    Ibid. p. 566.

  • 52

    Ramakrishna 2012p. 57.

  • 53

    For example Chaudhary Singh and Kumar 2010.

  • 54

    Saper et al. 2008.

  • 55

    Mao and Desai 2009p. 271.

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