Present Status of Traditional Medicine in Nepal
Dr Rishi Ram Koirala, MD Ayurveda
(President- Ayurveda Doctors Association-Nepal)
Background
The term Traditional Medicine (TM) refers to way of protecting and restoring health that existed before the arrival of modern allopathic medicine. As the term implies, these approaches to health belong to the traditions of each country, and have been handed down from generation to generation. TM includes diverse health practices, approaches, nowledge and belief incorporating plant, animal and/or mineral based medicines, piritual therapies, manual techniques and exercises, applied singularly or in combination to maintain well-being as well as to treat, diagnose or prevent illness (WHO).
The WHO Traditional Medicine Strategy paper 2002-2005 explains that traditional, complementary and alternative medicine attracts the full spectrum of reactions, ranging from uncritical enthusiasm to uninformed skepticism. Yet the use of traditional medicine
remains widespread in developing countries. In many parts of the world, policy-makers,
health professionals and the public are wrestling with the question about the safety,
effectiveness, quality, availability, preservation and further development of this type of
health care. Meanwhile, in many developed countries, complementary and traditional
medicine is becoming more and more popular.
Situation of existing traditional health systems in Nepal
Ayurveda, Amchi, Homeopathy associating with Unani, Naturopathy are the important
traditional health system existing in Nepal. Among them, Ayurveda has been practicing
since the time immemorial.
Ayurveda
Ayurveda is the omnipresent science of our rich tradition, heritage, and century-old
knowledge. It is the most authentically recorded, culturally based health system in Nepal.
Furthermore, this traditional knowledge provides great wealth and heritage to our nation.
The history of Ayurveda can be traced to different periods, the earliest being the Vedic
period when the Aryans complied the four Veda (1500-800 BC) with maximum reference
in Rigveda and Atharvaveda. Ayurveda originated in heaven from Brahma. Brahma
passed this knowledge to Dakshaprajapati then to Ashvinikumars. Then it transmitted to
Lord Indra. On the earth, Maharshi Bharadwaj approached Lord Indra and got it.
Two types of Ayurveda practitioners are exist in Nepal. First, Ayurveda based traditional
healers, who are practicing this knowledge since the time immemorial and it has been
established as family profession and tradition. Second, academic Ayurveda practitioners
trained from educational institutions, training centers, colleges and universities.
Homeopathy
This system has been recognized as a national health system and a homeopathy hospital
is running by government since 2010 BS. The only one hospital in the country is located
in Kathmandu with three graduated doctors studied in India. But the junior level
technicians (total eight in number) associated with hospitals are from Allopathic
background with refresh training on Homeopathy. There is no separate regulatory body to
control and monitor this system of medicine and to register practitioners like in modern
medicine (Nepal Medical Council) and Ayurveda (Nepal Ayurvedic Medical Council).
The Unani system of medicine is also incorporated in this hospital. Nearly one hundred
and fifty Homeopathy technicians are practicing in the Kathmandu city registering in
Health Professional Council (informal data given by the staff of the hospital). It is learned
that this system of traditional medicine has been running with several confusions and
dilemma due the lack clear policy and planning the state. Recently, formal education in
Homeopathy has begun in Nepal.
Naturopathy
This is not an official system of medicine, but it has been well-practiced by the
community. Training in naturopathy is provided by the private sector. There are private
hospitals, training centers, clinics, and dispensaries in the country.
Amchi
Amchi is a Tibetan medicine or healing practice existing in the upper Himalayan region
of the country. This is not an official system of medicine. There are two types of
practitioners in this system. Some of them institutionally trained and others follow the
tradition. No official records regarding this system of medicine and manpower involved
are available government offices. Reports show (as published in print Medias) this
system has been remarkably contributing in Northern area, especially Far Western
Region, for treatment of various kinds of ailments using the locally available medicinal
plants. The practitioners have been claiming official recognition formation separate
regulatory body since long time before.
Faith & Spiritual therapies
A large number of the population is still dependent on these practitioners. Basically they
follow some ethno-traditional, tantrik, spiritual and Ayurvedic knowledge. Though they
are not included in the official system of health care system, they are well known by
different names in different communities.
Ayurveda: pre-historic legends of Himalaya- in Nepal
The root of Ayurveda dates back to the Vedic period. Ayurveda, the life science, is also
the oldest authentically recorded science in existence today. Based on the pre-historic
documents, the first international Ayurveda congress was held on the lap of the
Himalayas. According to the Carak samhita there were 52 eminent scholars, rishi and experts that gathered there and performed meditation, afterwards discussing, developing
and documenting this science. Therefore, the Himalayan region receives recognition and
praise for its highest knowledge, aspiration, purity, and harmony of life. This region is
also the source of many highly valued medicinal plants. Ayurveda is an ancient art of
healing or medicine, which has been practiced continuously throughout Nepal, India, Sri
Lanka and a few other countries since ancient times. This knowledge of Ayurveda can be
found in a number of manuscripts, books, healing practices, in cultural functions and
ceremonies, and the teachings and practices of traditional healers. In fact, the practice of
Ayurveda is essentially a culturally based health system. Furthermore, it was a way of life
for the community, and its educational value was highly regarded.
The cultural heritage of the Himalaya
This country is one of the richest in culture, tradition, and knowledge of Ayurveda and
traditional health practices. In fact, Ayurveda has a strong cultural and scientific heritage
in this country. Nepal eluded foreign invasions in its history and has unique socio-cultural
and traditional practices. These practices still exist today, in various different ways such
as: ethnic or tribal groups, social, familial, generation to generation, ritual, or ceremonial
practices, daily routines or spiritual practices, diets or self-healing practices, traditional
healers, yogis, monks, lamas etc among the institutional trained practitioners.
The majority of people in Nepal continue to rely on this system of health care. Ayurveda
and the traditional medical wisdom and practices are prevalent in the community and are
totally dependent on locally available medicinal herbs, knowledge, technology and their
application. The country has contributed many valuable medicinal and aromatic plants,
locally termed as jadibuti, and the indigenous people have been using them in traditional
ways for their health and economy since time immemorial. This system contributes a
major role in the health care system (Rishi, IUCN).
Resources of Traditional Medicinal in Nepal
Classical manuscripts: Ayurveda is a system of health which is based on its basic
principles, the consciousness, proto-elemental, time, space, and its evolving theories
concepts. It has deep history in taxonomical, pharmacokinetic, pharmacological, and
clinical studies of drugs and the findings are used for the detail study of individual
constitution, pathological states, disease conditions, drugs, formulations, forms, and
dosages. Therefore, these manuscripts are not merely documents of individual records,
but they provide widespread theoretical foundation and explanation. There are nearly
4000 copies of hand written manuscripts that exist. These manuscripts are written on leaf,
bark and hand made papers. The languages are Sanskrit, Pali, Newari, Nepali and other
local languages, and are also recorded in Tibetan language. The contents of these
manuscripts are concerned with plants, flowers, food, animals, cosmetics, minerals,
tantric, basic principles, life conducts, diseases, yoga, rituals, environment, astrology,
crystals, Ayurveda philosophy and more. These authentic manuscripts are the real wealth
of this country.
Traditional Practitioners/Healers their knowledge, practices, concepts, innovations,technology, and recipes: These groups of traditional practitioners are deeply rooted in the
culture of Ayurveda. They have aspired to reach the cultural values, norms, and respect
of the people. They are readily available and work as a member of close relatives or
family members. They are capable of managing a diversity of health problems with
locally available resources. They are the repository of this culture and science, and are the
wealth of the nation. A large number of the population still depends upon thesepractitioners. Traditional and indigenous knowledge has been used for ceturies by
indigenous and local communities under local laws, customs and traditions.
Fundamentally, they follow Ayurvedic, ethno-botanical, ethno-traditional, tantrik,
spiritual and Amchi knowledge. This knowledge has been transmitted and evolved from
generation to generation. The estimated number of these practitioners in Nepal is
400,000. Although they are not included in the official system of health care as a health
practitioner, their role is highly important. Some of them who are currently practicing are
the 23rd generation of practitioners in their family. This generation to generation practice
is handed down through the family and also through master-disciple tradition. In a survey
done by consultants, it was found that there were four hundred fifty five traditional
practitioners identified and interviewed. They were from 142 villages of six Village
Development Councils of the Gorkha district of Nepal. Most of the practitioners were
familiar with the knowledge passed down through generations.
Herbal resources:
Herbal resources are other forms of Ayurvedic wealth. The geographical structure and
advanced bio-diversity has made it possible for the Himalayan country to lodge numbers
of valuable medicinal plants. The Medicinal and Aromatic database of Nepal covers 1624
species of plants found in wild state or cultivated or naturalized or imported belonging to
938 genera and 218 families. These are known to be used as medicine in Nepal.
As described in Ayurveda, the Himalayan Jadibuti are used for healthy body and happy
mind. These are used in different means such as toiletries and cosmetics; incense and
aromas; health promoting agents, supplements and medicines; natural manures,
pesticides; environmental cleaning and protection; food, food additives and drinks etc.
Protection and preservation, development and commercialization of indigenous
knowledge and herbal resources have become an issue. Herbal resources have been over
exploited as usual and indigenous knowledge either humiliated or under threat of piracy.
It has been estimated that four out of five medicinal plants utilized by human beings are
collected currently from the wild. Since herbal resources are one of the most reliable
sources of income for a majority of the people living in rural areas, competition for
harvest begins before the right season. Locals do not have scientific knowledge or
technology and tools to harvest. Probability of regeneration, therefore, becomes lesser by
the year and finally reaches extinction. There are two urgent steps required to check this:
First, the local people who rely on such natural resources for their lives must be trained;
second, encourage them to cultivate these herbs commercially. Research has found that
due to change in socio-psychological factors and educational patterns, the present
generations of traditional healers do not follow the old methods. This is a threat to
indigenous knowledge (Bhupendra, THT, 2004 June 22)
Institution/organization of Ayurveda/TM in Nepal
The institution of Ayurveda is the first health service provider as well as academic health
technician-producing institute, whose inception was before the arrival of modern
medicine. However, the century old heritage is running at tortoise pace due to extremelack of responsible and accountable organizations/institutions for preservation,
promotion, and development of this sector. They are unable to capitalize on this resource,
even in the least amount.
Ministry of Health: In the Ministry of Health, the HMG/N has already set up a focal unit – Ayurveda & Alternative Medicine Section which is responsible to develop necessary
planning, policies, rules and regulations regarding all kinds of traditional medicine
existing in country and play vital role in corporation, coordination, direction and
monitoring other organization related to TM under the ministry. The following
organizations/ institutions are working currently under the ministry.
Department of Ayurveda: This Department is under the Ministry of Health who looks
after government networks of Ayurveda and policy and planning. The constraints of
manpower, visionary leadership, budgetary allocation, prioritization of activities, and
lack of activity monitoring matrixes have been realized recently for the development of
this sector.
Ayurveda Hospitals: Two Ayurveda hospitals – one in Kathmandu with hundred beds
(Nardevi Ayurveda Ausadhalaya under Ayurveda Ayusadhalaya Development
Committee), and a regional hospital with 30 beds (more 10 beds with cabins in internal
resources) are running in Dang.
District Ayurveda Health Centers: 61
Zonal Ayurveda Dispensaries: 14
Local Ayurveda Dispensaries: 216
Council of Ayurvedic Medicine: Apex body to control, monitor and regulate Ayurveda
professional and traditional healers and academic institutions. Following three categories
of professional has been registered in the council. Ayurveda Physicians: Graduates are registered as a full fledged member of the
council.
Ayurveda Para-medicals are registered under a sub-committee of the council.
Traditional Ayurveda practitioners are enrolled and licensed for their practice.
For this that is having three generations of practicing of Ayurveda and at least
minimum of 50 years age groups (deadline is for one year) are eligible for
enrolling. Due to this limitation, many other traditional healers are not able to get
enrollment for licensing practice. The discussion is going on amending this clause
and incorporate training component to upgrade their knowledge and bring them
into the main stream.
Academic Institutions: The first formal technical education started in the country was in
Ayurveda. In 1928 AD Nepal Rajakiya Ayurveda Vidyalaya was started in Naradevi,
Kathmandu for the production of Ayurveda manpower i.e. Vaidyas of all levels up to Acharya, equivalent to a Bachelor of the present day standards in contrast to the technical
education in the modern system. In spite of the fact that Ayurveda is traditional and that
formal education began much earlier than arrival of the modern medical system, since the
advent of “democracy” in 1950, the emphasis and all out efforts has been on themodernization and expansion of modern health services. Ayurveda Campus TU is the
continuing institute of Ayurveda Vidhyalaya. Other training Institutes under Mahendra S.
University and CTEVT in the periphery are running. At present, one graduate level
Ayurveda College, seven three-years- course educational institutions, and three fifteen-month
tranining institutions are running legally throughout the country.
Ayurveda Pharmaceutical Sector: There is one government owned producing unit, Singha Durbar Baidhyakhana Vikas Samiti (started from Malla dynasty 357 years ago
with a high reputation in its history) running below capacity and constraints of quality
measures. There are 32 other private Ayurveda pharmaceutical companies, with limited
capacity and some of them are not functioning all of the time.
National Ayurveda Research & Training Centre: Governments of Nepal & China have
signed recently for the establishment of this institute and this is a recent development in
Ayurveda sector in Nepal.
Other: There are a significant number of institutions - Public, Development Partners’,
I/NGO and Private Organizations and Institutions involved in Medicinal plants including
NTFPT - involved in this sector. There is minimal coordination within the Ayurvedic
sector, which is very important and vital for the overall development of the country and
Intellectual property rights issues.
Status of traditional medicine: A glance
System |
Ayurveda |
Homeopathy |
| Manpower |
Graduated/post
graduated
|
239 |
3 (associated with government hospital,
no authentic record available of private
practitioners)
|
Certificate level
(equivalent) |
754 |
- |
Training (15 months) |
308 |
- |
| Traditional Healers |
Nearly two dozens traditional healers have been registered to
legalize their practices.
|
| Educational Institutions |
| Graduate Level |
1 (state-owned) |
1 (recently established by
private sector) |
| Certificate level |
7 ( 6 by private
sector) |
- |
| Training |
3 (private sector) |
- |
| Health Services (all state-run) |
| Central Level |
1 |
1 |
| Regional |
1 |
- |
| Zonal |
14 |
- |
| District Level |
61 |
- |
| Dispensaries |
216 |
- |
| Manufacturing companies |
| State-run |
1 (Singh Durbar Vaidya Khana) |
| Private |
Around 30 (No reliable data is available) |
Ayurveda Health Policy (AHP) 2052: Backbone of the development of Ayurveda
For the accomplishment of the objectives identified by the National Health Policy, 2048
(1992), the specialty of Ayurvedic treatment which has been preserving health and curing
diseases from ancient times is timely. Its principal objectives is to improve health
condition of mass people and make them self-reliant on health service by officially and
mostly utilizing local medicinal herbs and medical entities which are easily available and
can be used.
Some key features of AHP:
Provision of Inter institutional and People’s participation:4.1 Health workers, wizards,
women volunteers, birth attendants, workers of social organization, who are providing
medical service by way of herbs in a traditional manner in rural areas will be provided
with trainings of growth, promotion, collection, protection and use of herbs, and people’s
participation will be mobilized in the Ayurvedic treatment service.
Encourage Herbs farming, production and enterprise of medicines: Qualitative
business of herbs will be encouraged by developing model herbs farms in Himalaya,
Mountainous and Terai regions and providing the people with knowledge on the use of
the herbs in domestic treatment and their preparation, protection and promotion.
Co-ordination will be made with governmental and non-governmental associations
related with the herbals, so as to maintain standard in domestic trade and export to
foreign countries by identifying genuine herbals.
Governmental and non-governmental Ayurvedic medicine manufacturing companies
established or to be established in the country will be encouraged to manufacture
qualitative medicines on the basis of ‘Good Manufacturing Practice’ and imports will be
reduced and export promoted.
Ensure Ayurvedic education and manpower development: Taking into consideration of
paramount role of qualified, efficient and duty-bond manpower in the technical field like
treatment, a National Ayurvedic Institute, equipped with necessary equipments as well as
a research centre, will be established under Tribhuvan University, for enhancing and
carrying on further development in effective production of Ayurvedic manpower carrying
out functions being dedicated to the field of Ayurveda and in standard of quality of its
various dimensions (education, health, and preparation of medicines).
Similarly, Programme of producing bachelor-level manpower in Ayurveda will be
conducted so that physical infrastructure will be developed in harmony with the objective
to provide master level and P.H.D. level Ayurvedic education in the future.
Management of Ayurvedic Manpower: Various organizational structures under the
Ayurveda Group will be made responsive and service-oriented for consolidation of
management aspect of Ayurvedic manpower. Ayurvedic doctors and Ayurvedic health
workers will be provided with the same allowances and special facilities as doctors or
health workers of other systems are receiving or will receive.
Ayurvedic Research: there will be established an Ayurvedic Research Institute furnished
with the required equipment, for research of international standard in matters related with
the use of Ayurvedic medicines and entities and the Ayurvedic treatment.
Provision of Resource Mobilization: Assistance of native and foreign donor agencies
will be made available so as to provide financial support to various programms of
Ayurveda, to mobilize the acquired financial source by promoting export of herbs and
prepared medicines and to assist in the implementation of the said programme.
Nepal Ayurvedic Medicine Council: Establishment of Nepal Ayurveda Medical Council
in national level for fixing necessary standards of Ayurvedic education and service,
registration of doctors, well arrangement of fixation, monitoring and evaluation of their
jurisdiction.
Achievements of the formulated policy: Concisely, For the sake of development of
Ayurveda manpower as well as education, several objectives are resplendently designed
in AHP (Ayurveda Health Policy)-1995 realizing global demand and future of Ayurveda.
Educational institutions to produce graduate, post-graduate and PhD level; National
Ayurveda Study Center for quality service, management of manpower, research on
Ayurveda and resource management; etc are the major objective. However even after a
decade of policy promulgation, there is no significant progress observed except the
establishment of Nepal Ayurvedic Medical Council (Bhupendra TKP, 18 th Nov, 2006).
Legal status and Regularity situation
The use of medicinal herbs in Nepal’s traditional medical system dates back to at least
500 AD. In Nepal, traditional medicine, although low profile, has been an integral part of
the national health system. Parallel to the allopathic system, traditional medicine is
encouraged in all spheres because of its efficacy, availability, safety, and affordability
when compared to allopathic drugs.
The policy of the Government, based on five-year plans, involves a system of integrated
health services in which both allopathic and Ayurvedic medicine is practiced. Ayurvedic
clinics are considered to be part of the basic health services, and there is a section
responsible for Ayurvedic medicine in the Office of the Director General of Health
Services. The programmes for health services included in the Fifth Five-Year Plan makeprovision for four Ayurvedic hospitals, one in each of the four development regions. The Ayurvedic Governmental Pharmaceutical Unit works to provide inexpensive medicaments.
The Ayurvedic Medical Council was created through legislation passed in 1988. Section
2.1 of this Act gives the Council’s mandate as, among other things, steering the Ayurvedic
medical system efficiently and registering suitably qualified physicians to practice
Ayurvedic medicine. In Section 4, the legislation sets out highly detailed provisions for
registration that classify applicant practitioners into four groups according to their
qualifications and experience in Ayurvedic science. By Section 5.2.2, membership in a
particular group fixes the range of Ayurvedic medicines that a practitioner is permitted to
prescribe. Registered practitioners enjoy a monopoly over the practice of Ayurvedic
medicine: direct or indirect practice of Ayurvedic medicine by other medical practitioners
is forbidden by Section 5.1.1. Section 5 of the Act enables registered Ayurvedic
practitioners to issue birth and death certificates as well as certificates concerning the
Ayurvedic medical system and patients’ physical and mental fitness (WHO).
For the better future of traditional medicine
Immediate step need to capture, protect, and commercial exploit the natural resources,
medicinal plants, Traditional Medicine and their related intellectual property rights for
the overall sustainable growth and development. For this following actions are important
and Nepal is far behind in this process.
1. Documentation
2. Information Dissemination:
3. Training:
4. Research and Development:
5. Intellectual Property Right and benefit sharing:
6. Exchange programs for students and professionals:
7. Exchange of science and technology:
