Ayurvedic Interventions Research Articles

Ayurvedic management of female infertility due to tubal blockage

Secondary Infertility is a major concern worldwide, accounting for about 40% of female infertility due to lifestyle factor. Secondary Infertility is having a close proximity to a disorder Vandhyatwa explained in Ayurvedic classics, due to a variety of causes. Several Ayurvedic interventions are advised such as Panchakarma (∼purification therapy) for vitiated Doshas in female reproductive organs, Snehapana (∼oral intake of medicated oil) followed by Virechana (∼purgation) to produce quality ovum. Other internal medications like Phalaghrita, Ashokarishta, Kanchanara guggulu etc. have a probable mode of action with enhancing the perceptibility of endometrium for implantation. Correlating fallopian tubes with the Artavavaha Srotas, its block is compared with the Sanga Srotodushti (obstructive pathology occurring in channels)of this Srotas. By virtue of the purification therapy and internal medication working synergistically might remove the Srotodustht. A 30 year old female with a history of eight years post marital infertility was treated with Panchakarma along with Ayurvedic medicines after being diagnosed as infertility due to tubal blockage for a period of 16weeks. After 16weeks of treatment, she reported with amenorrhoea and found Urine Pregnancy Test positive. Subsequently, confirmed the pregnancy by USG, as single live intrauterine foetus of Sonic Gestational Age- 8weeks 5days.

A retrospective analysis of Ayurvedic clinical management of mild COVID-19 patients

BACKGROUND: The COVID-19 virus is a new contagious pathogen which has made a huge impact on health, economic and societal perspectives of our country. Early detection, rapid isolation, and adoption of effective infection prevention and control (IPC) measures are key to preventing and controlling COVID-19 infection. Patients are now receiving symptomatic treatment. This retrospective study aims to assess and comprehend the effectiveness of Ayurvedic interventions in the treatment of mild symptomatic COVID-19 patients. OBJECTIVE: The objective of this study is to analyze the outcome of Ayurvedic interventions in managing mild symptomatic COVID-19-infected cases. MATERIALS AND METHODS: COVID-19 patients (diagnosed through RT-PCR test) admitted at Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh were treated with Ayurvedic interventions. The data were collected and have been analyzed retrospectively. Data collected were systematically analyzed and presented using appropriate software (SPSS version 21). RESULTS: The treatment given in this particular study were aimed at dissipating the pathogenesis based on Ayurvedic principles of management. Relief in major clinical symptoms such as fever, cough, and throat pain has been observed in studied cases of COVID-19. The clinical recovery rate observed in this study was 94.3%, which is comparatively high with reference to the current clinical recovery rate, i.e., 69.5% in Chandigarh (India). CONCLUSION: The Ayurvedic interventions, AYUSH-64, Agasthya Hareetaki Rasayana, and Anu Taila Nasya, may play a major role in managing mild symptomatic cases of COVID-19. IEC number: 8-55/2020-CARIRD/TECH/COVID/149

A randomized open label parallel group pilot study to evaluate efficacy of Ayurveda interventions in the management of asymptomatic and mild COVID-19 patients-experiences of a Lucknow based level 2 hospital of Uttar Pradesh, India

BackgroundSARS--CoV-2 has emerged as a global threat since its onset in December 2019. India has also been severely affected by the dreadful Corona Virus and is currently battling one of the worst pandemics of history. WHO and the world medical fraternity are putting their efforts to materialize a treatment or vaccine for this novel virus. A randomized open label parallel group study was designed in a Lucknow based level 2 COVID hospital to evaluate the efficacy of Ayurvedic interventions in the management of asymptomatic and mild COVID 19 patients. ObjectiveTo evaluate the efficacy of Ayurveda in the management of mildly affected COVID-19 patients. Materials and methodsThe current trial was an open label randomized 10-day study. Total 120 asymptomatic and/or mild COVID-19 positive patients fulfilling inclusion criteria were randomly grouped into three. RT-PCR of all the patients were done on 5th, 7th and on 10th day respectively. The observations were noted and results were analyzed statistically. Kruskal–Wallis test and Wilcoxon Sign rank test were used for data analysis where applicable. ResultsImprovement in symptoms, enhancement in Agni and recovery from COVID infection was observed. The results obtained were encouraging and showed better viral clearance and control of symptom progression in the patients placed on Ayurvedic medications. ConclusionThe promising results in the study showed that an approach involving Ayurveda can be helpful for the management of the mild COVID-19 patients. Ayurveda can be used to limit community spread and check disease progression to a more appalling state. Trial registrationTrial was registered with Clinical Trials Registry- India (CTRI registration number: CTRI/2020/06/025800.

Ayurvedic management of vitiligo (Shvitra)

Introduction: Vitiligo is a common autoimmune disorder in which the destruction of melanocytes occurs, resulting in the formation of white spots on the skin. It has a major impact on the quality of life of patients, as they feel distressed and stigmatized by their condition. Treatment available in contemporary medicine has its own limitations and side effects. In Ayurveda, Shvitra is the term employed for the hypopigmentation disorders of the skin. Due to the holistic approach, Ayurveda has the vast potential to treat such autoimmune skin diseases. Here, a case study of chronic vitiligo treated successfully with ayurvedic interventions is reported. Main Clinical Finding: There were white patches measuring about 7x5 cm, 4x3 cm, 3x3 cm and 4x2 cm on right and left arm, neck, chest, forehead region respectively. There were multiple small patches on fingers of hand also. The spots and patches were asymmetric, well defined whitish-pink and without scaling and discharge. Diagnosis: The patches were spread on large area (bahala), colour of patches was white/whitish pink (tvaka vaivarnyata), no secretion from lesion (aparisravi) ,with no itching (kandu) and loss of hair (romavidhvamsha) on affected area, so the case was diagnosed as Shvitra kustha on the bases of observed sign and symptoms. Intervention: The management approach was personalized and holistic in nature incorporating Ahara,vihara and Aushadha. In Sanshamana chikitsa Pitta-kapha shamaka and Vyadhi pratyanika line of treatment including internal administration of Khadira sara, decotition of Amla and Udumbara Chhala and Shashilekha Vati with external application of Chakramarda beeja, Muli beeja and Vakuchi beeja lepa was incorporated. Outcome: After 3 months of interventions, skinny spots appeared between the white patches. After six months, patches of chest, neck and forehead almost disappeared and that of arms significantly decreased with no recurrence. No adverse effect was seen during treatment and in follow up period

Efficacy and safety of Ayurveda interventions for acid peptic disease

Background: Acid peptic disease (APD) has a negative impact on patients’ quality of life and general health status of the individuals. There are a number of case studies and clinical trials on efficacy of Ayurvedic interventions in the management of APD. However, a systematic review of these researches is not available which is needed to evaluate the clinical significance of those studies. Objective: The aim of this study is to conduct a systematic review of the available evidence for the efficacy and safety of Ayurvedic interventions for APD. Methods and Analysis: On the basis of the PRISMA-P statement, a systematic review protocol has been developed. Data from electronic databases such as PubMed, Cochrane Central Register of Controlled Trials, AYUSH Research Portal, DHARA, Shodhganga, Ayurvedic Research Database, Institute for Teaching and Research in Ayurveda, Gujarat Ayurveda University, Jamnagar, Clinical trial registries, and relevant journals will be used to find articles for systematic review. Only studies that have been published in English or Hindi will be considered for inclusion in the systematic review. Data from the selected studies based on study characteristics will be extracted separately by two review authors for data analysis and quality assessment of the studies. The risk of bias in the chosen studies will be evaluated using appropriate available tools. If studies that are qualified for meta-analysis are available during the review, then it will be done. If meta-analysis is not possible, then the findings will be presented in the form of a comprehensive qualitative synthesis. Conclusion: The findings of this study will aid in determining the current state of evidence on the efficacy and safety of Ayurvedic interventions for the treatment of APD. The review will also serve as a source for researchers while planning future studies in order to generate high-quality evidence on the efficacy and safety of Ayurvedic therapies in APD. Study Registration: PROSPERO 2020: CRD42020207484

The COVID-19 Pandemic and the Relevance of Ayurveda's Whole Systems Approach to Health and Disease Management.

The COVID-19 Pandemic and the Relevance of Ayurveda's Whole Systems Approach to Health and Disease Management.

A REVIEW ON SANDHIVATA (OSTEOARTHRITIS) AND ITS MANAGEMENT THROUGH AYURVEDA

In the present era Sandhivata is the most common disease affecting a large population. Sandhivata term is derived from words as “Sandhi” and “Vata”. When Vata lodges in Sandhi (joints), it is characterized by pain, swelling, and restriction of joint movement. The clinical presentation of Sandhivata closely mimics with the disorder called Osteoarthritis which is the second most common rheumatologic problem. Sandhivata is the disease mentioned in Ayurveda and is a type of Vatavyadhi which most commonly occurs in Vridhavastha due to Dhatukshaya.
 Sandhivata is one of the challenging diseases for the clinicians due to its chronicity, incurability, complications etc. The allopathic treatment provides the symptomatic relief but the underlined pathology remains untreated due to absence of effective therapy and also giving rise to many side effects, toxic effects and adverse reactions. The treatment procedure described in Ayurveda focuses not only on drugs but also lifestyle modification thus having a holistic approach in its management. So, the present study deals with systemic review of Sandhivata and the aim of this work is to review and highlight the effectiveness of different Ayurvedic interventions in patients with osteoarthritis (OA).

Efficacy and Safety of Ayurveda Interventions for Depression

Introduction: Depression is a disorder of major public health importance. The widely prescribed antidepressants of modern science are falling short in effectively managing the depression. Recent studies reported that depressive patients prefer to use other treatment options like complementary and alternative medicine (CAM therapies). Although systematic reviews on this topic have been published for CAM therapies; however, exclusive to Ayurveda interventions has not been performed till date. Therefore, the present study is intended to do a systematic review of the published clinical data in view of safety, efficacy, or effectiveness of Ayurvedic interventions in the management of depression and meta-analysis of eligible studies will be carried out, if appropriate. Materials and methods: A systematic review of randomized controlled trials (RCTs), multiple arms clinical trials, trial quasi-experimental trials (nonrandomized controlled clinical trials and before after studies), and observational studies (case series and case reports) will be performed through databases like PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials: Issue 6 of 12, June 2018), AYUSH Research Portal (Govt. of India), DHARA, Google Scholar, and Online clinical trials registers. Studies published from the date of inception till the date the searches are run will be sought. The selection of the studies, data abstraction, and validations will be performed independently by the reviewers and any disagreements will be discussed by the team with fourth reviewer to reach consensus. Established guidelines for study selection, quality assessment, and narrative synthesis will be followed. Risk of bias assessment will be performed with the help of Cochrane risk-of-bias tool for randomized trials (RoB2) tool for RCTs and risk of bias tool to assess nonrandomized studies of interventions (ROBINS-I) tool for non- RCTs (NRCTs). Results of the study will be narratively synthesized and presented in count, percentage, and frequency and meta-analysis will be planned if they are sufficiently homogeneous. Patients will not be involved in any phase of the study; however, ethical approval has been obtained from the Institutional Ethics Committee. Dissemination: The systematic review will be published in a peer-reviewed journal and will also be disseminated electronically and in print. The review may guide healthcare practices and policy framing regarding the treatment of depression with Ayurvedic interventions. Study registration no: PROSPERO-CRD42020139382.

Three case reports of moderate COVID-19 infection managed through Ayurvedic approach

Coronavirus disease 2019 (COVID-19), a global pandemic, is resulting in significant morbidity and mortality worldwide. The overburden of the disease is due to the vicious circulating virus characteristics, lack of potent vaccine, complications and limitations of the existing medicine and aggravation of disease along with comorbid conditions in elderly people, etc. In the present scenario, effective traditional treatment modalities should be scientifically applied to reduce the impact of massive disaster. Here is the necessity to develop an appropriate treatment protocol from the field of Ayurveda. This is a documentation of three confirmed COVID-19 cases managed with Ayurvedic medication with minimum number of hospital stay compared with the national average. Ayurvedic management has a significant positive impact on the mental and physical quality of life in COVID-19 patients. Both the physical and mental scores got improved of more than 50% percentage in each case after treatment. Ayurvedic science has a unique approach to COVID -19 and can be adopted wisely to overcome the current crisis. Marked radiological changes were observed in three cases. Ayurvedic interventions can be used to counteract the pathogenesis of SARS-CoV-2.

Efficacy of Ayurveda Interventions in Parkinson's Disease

Introduction: Parkinson's disease (PD) is the most common form of a group of progressive neurodegenerative disorders characterized by motor, autonomic, and cognitive disturbances. The prevalence of PD is increasing with age and it affects 1% of the population above 60 years. In light of the demand for alternative measures to control PD, a systematic review is being planned to generate evidence for the efficacy, effectiveness, and safety profile of Ayurvedic interventions in the management of PD. Objectives: The primary objective of the present study is the systematic review of published clinical data in view of the safety, efficacy, and effectiveness of Ayurvedic interventions in the management of PD. Materials and methods: Electronic searches from various online databases and clinical trial registries will be done. A manual search for gray literature will also be done from various sources, e.g., printed journals, conference proceedings, colleges, university libraries, etc. Studies published in the English and Hindi language till March 2019 will be sought. Types of study include randomized controlled trials (RCTs), quasiexperimental trials, single group clinical trials, comparative clinical trials (CCTs), pragmatic trials, and review papers on Ayurvedic management of PD or Kampavata. Three investigators shall independently screen all citations and abstracts identified by a primary comprehensive search to sort out potentially eligible trials and eligible trials will be independently evaluated for inclusion in the review based on the inclusion criteria. Data extraction forms for individual study including methods, participants, intervention, comparator, and the outcome shall be prepared. Each of the included trials will be assessed for risk of bias. Primary data analysis will be done for both qualitative and quantitative data. Heterogeneity among trials will be assessed by inspecting forest plots. If heterogeneity is detected, and it is still considered clinically meaningful to combine studies, a random-effects model will be used. A sensitivity analysis, to investigate the robustness of the results to the quality components will be done, provided there are sufficient trials. A funnel plot will be utilized to indicate publication bias, heterogeneity of results, or differences in the methodological quality. Dissemination: The systematic review will be published in a peer-reviewed journal. It will also be disseminated electronically and via print. The review may guide healthcare practices and policy-framing in the treatment of PD with Ayurvedic interventions. Trial registration number: PROSPERO 2019: CRD42019131920 Dated 20/12/2019.

Indian Clinical Trials on COVID-19: A Review of Clinical Trials Registry of India (CTRI)

Background: The COVID-19 or Coronavirus has impacted the world in an unprecedented way. More than 200 countries have been affected because of this novel coronavirus. Global public health, economy and society have all faced near breakdown. There is a surge for identifying vaccine or repurposing existing drugs for this virus. Objectives: An attempt has been made to provide a comprehensive overview on clinical trials that are being conducted in India on COVID-19. Type of clinical trials, study designs, DCGI approval status of trials, allopathic and Ayurvedic interventions and other characteristics of COVID-19 clinical trials have been analyzed in this study. Methods & Data Collection: Clinical Trials Registry of India (CTRI) was used as the data source for the study. COVID-19 Clinical trials registered up to 14th July 2020 was collected using following keywords “SARS-CoV-2, Novel Coronavirus or Corona Virus, or Coronavirus and COVID or COVID-19. After excluding repeated or trials registered by non-Indian countries 312 clinical trials were considered for the final analysis. Results: Interventional studies were more compared to observations studies, most of the clinical trials were investigating AYUSH related interventions as an effective therapeutics compared evidence based allopathic interventional drugs or medicines. There were six vaccine candidates under clinical trials in India. Four trials were examining the safety and efficacy of BCG as a potential vaccine for COVID-19. Of the 312 trials 12.50% of the trials have obtained DCGI approval. Most of the studies were phase 2 & 3 trials, 82% trials were yet to start recruiting participants for their clinical trials. Conclusion: This study provides a detailed overview of ongoing Indian clinical trials on COVID-19. This study is useful for researchers, policymakers for prioritizing research on COVID-19 and for general public to understand and aware about the Indian efforts in clinical research on COVID-19.

Integrating bioinformatics and epigenetics with Ayurveda-a possible contribution towards COVID-19 fight

The entire world is struggling from the COVID-19 pandemics. Scientific community all around the world have been looking for any possible measure to fight against this dreadful disease. Ayurveda, the traditional Indian system of medicine, has immense potential to contribute towards this pandemic both in prevention and management. But Ayurveda fraternity has the challenge to explain the available possible measures in contemporary language. The science of bioinformatics & epigenetics has provided possibility for scientific & contemporary explanation of Ayurvedic interventions.

Efficacy and Safety of Ayurveda Interventions as Stand-alone or Adjuvant Therapy in Management of COVID-19

Background: Coronavirus disease (COVID-19) is a highly infectious disease caused by the SARS-CoV-2 virus. World Health Organization (WHO) labeled it as a pandemic on March 11, 2020. Currently, there is no approved vaccine or treatment for the prevention and management of COVID- 19, although multiple pharmacological/nonpharmacological options are being explored. Several clinical trials are going on in conventional as well as traditional medicines to find out an effective and safe treatment regimen. Aim: To study and identify Ayurveda interventions for the management of patients with COVID-19 as a stand-alone or an adjuvant therapy in clinical practice. Materials and methods: A systematic review protocol was developed based on the PRISMA-P statement. Articles for review will be selected from AYUSH Research Portal's “National Repository on AYUSH COVID-19 Clinical and Other R&D Initiatives” and other electronic databases, i.e., PubMed, Cochrane Central Register of Controlled Trials, DHARA, IndMED, Google Scholar, etc. Readily accessible peer-reviewed full articles published in English or Hindi will be included. There will be no restrictions on the type of study or study setting or date of publication. Data from the included studies will be extracted independently by two review authors on study characteristics (i.e., authorship, publication-related information, methodology, participants, interventions, comparators, outcomes, and results) in a prestructured format for assessment of study quality and data analysis. The risk of bias in included studies will be assessed through suitable existing tools. We will conduct meta-analysis only when the included studies will be sufficiently homogeneous in terms of design, study population characteristics, interventions, and outcome measures. If it is not possible to conduct a meta-analysis, we will summarize the results of included studies as systematic qualitative synthesis. Conclusion: The results generated from this review will be helpful in identifying the status of evidence regarding the efficacy and safety of Ayurvedic interventions for the management of COVID-19. It will also provide ideas for future research to generate good-quality evidence regarding the efficacy of Ayurvedic interventions in COVID-19. Study registration: Registered with PROSPERO - [CRD42020206588].

Ayurveda as an adjuvent therapy in cancer management

A review articles published in reputed journals of cancer suggests that patients under combined therapy (coordination of medical/radiation oncologist & surgeon) of cancer treatment experience adverse events included constitutional symptoms, gastrointestinal complications & pain. The most common reason for withdrawal was disease progression, followed by adverse effects. Complications during cancer treatment include- complications due to disease/ treatment & psychosocial problems. Ayurvedic formulations including single drugs like Gvarras, Panchatulasiras & combination drugs like Rasayan Churna, Yastimadhu Ghrita etc. have proven to be effective medicines when given in between consecutive chemo/radiation therapies. Ayurvedic interventions with combined therapies reduce cost of treatment with decrease in relapse of disease & decreased AEs.

Efficacy and Safety of Ayurveda Interventions for Obesity

Background: Obesity is similar to Sthaulya or Medoroga described in Ayurvedic classical texts. Results from case studies/series and small clinical trials concluded that Ayurveda interventions have been effective in the management of obesity. This protocol aimed to do a systematic review of clinical studies related to Ayurvedic interventions in the management of obesity and further meta-analysis of eligible studies to generate the evidence regarding effectiveness and safety of Ayurvedic treatment modalities for obesity. Materials and methods: Clinical studies related to Ayurvedic interventions in the management of Sthaulya/Medoroga or overweight/obesity published in English/Hindi will be screened as per the inclusion criteria without restriction on publication date and type. Primary outcomes to be assessed will be improvement in clinical features of Sthaulya/Medoroga and change in body weight, body mass index (BMI), waist circumference, waist-hip ratio, and skin-fold thickness. Data will be extracted independently by two review authors on study characteristics (authorship, publication-related information, methodology, participants, interventions, comparators, outcomes, and results) in a prestructured format for assessment of study quality and data analysis. Two authors will independently assess the risk of bias in included studies. We will conduct metaanalyses only when the included studies will be sufficiently homogeneous in terms of design, study population characteristics, interventions, and outcome measures. If meta-analyses will not be conducive, we will summarize the results of included studies as systematic qualitative synthesis. Conclusion: The results generated from this review will be helpful in identifying the status of evidence for Ayurvedic interventions in management of obesity. It will also provide way for future research to generate stronger evidence regarding efficacy of Ayurvedic interventions in the treatment of obesity. Clinical significance: The study will be able to generate evidence for effective implementation of Ayurvedic interventions in treatment and prevention strategies for obesity. Study registration: PROSPERO 2019—CRD42019130104.

Ayurvedic Interventions for Psoriasis

Background: Psoriasis produces significant adverse effects on the psychological and social aspects of the patient, mainly because of its visibility. World Health Organization's (WHO) recent Global Report on Psoriasis states that there are many unmet research gaps in psoriasis with respect to treatment and ways to improve healthcare services. Clinical Research on psoriasis should focus on options that can be applicable globally, on a large-scale. Plenty of studies individually proving efficacy of various Ayurvedic treatment modalities in subjective and objective improvement of psoriasis are published. Systematic reviews of complementary and alternative medicine (CAM) on psoriasis are available, but these studies do not include Ayurvedic interventions. Aim: Thorough review of published data of Ayurvedic interventions in the management of psoriasis to provide more precise estimates of safety and effectiveness of Ayurvedic interventions for psoriasis. Objective: Outlining the protocol to conduct a Systematic Review of published studies examining the effects of Ayurvedic interventions on psoriasis. Materials and methods: The preferred reporting items for systematic review and meta-analysis (PRISMA) protocols guidelines, The Cochrane Handbook for Systematic Reviews of Interventions, the consolidated standards of reporting trials guidelines, guidance on the conduct of narrative synthesis in systematic reviews provided the design to conduct and report the protocol, structure research question and search term selection and the data extraction form; though some adaptations may be made with regard to search terms, data synthesis, and evaluating the risk of bias. Trial registration number: PROSPERO 2018 CRD42018097298. Dissemination: The SR will be published in a peer-reviewed journal. The review will be updated to inform and guide healthcare practice and policy.

Efficacy and Safety of Ayurveda Interventions for Hypothyroidism in 18–60 Years’ Age-group

Introduction: Ayurvedic interventions have been in practice for treatment of thyroid-related disorders alone or in combination with complementary medicine. No systematic review has been conducted for assessing the efficacy and safety of Ayurvedic intervention in hypothyroidism. Present study aimed to provide quality evidence to assess for the efficacy and safety of Ayurveda interventions for hypothyroidism in the 18–60 years' age-group. Materials and methods: For collection of data, all research article based on randomized controlled trials, multiple-arm clinical trials, nonrandomized clinical trial, quasi-randomized controlled trials having intervention period of at least 12 weeks' duration will be considered and searched from inception to September 2019 in several databases. Primary outcome will include response to treatment (improvement in subjective criteria of assessment, i.e., hypothyroidism-related symptoms), effect on values of laboratory measures related to thyroid gland functioning like tri-iodothyronine (T3), tetra-iodothyronine (T4), and thyroid-stimulating hormone (TSH) and serious adverse events. Secondary outcome will include measurement of health-related quality of life. Data extraction will be done independently by three reviewers in a predefined format. A narrative synthesis will be conducted for all included study. If extracted data will be eligible for meta-analysis, a meta-analysis will be conducted. Ethics and dissemination: This review does not require formal ethical assessment and approval, as no confidential participant data will be included. Findings will be disseminated widely through publication, conference, and symposia. Study registration no: PROSPERO 2019 CRD42019144799

Ayurvedic Management of Fistula in Ano

Introduction: Fistula in ano is considered to be complicated and vicious due to its nature of recurrences and exacerbations. Ayurveda includes this disease under the list of Asta Mahagada (eight serious diseases that are difficult to treat by nature itself) due to this attribute. Ayurvedic literature offers various effective and safe management strategies for fistula in ano. Several works have been conducted to prove the efficacy and effectiveness of various treatment modalities mentioned in Ayurvedic texts. Kshara sutra, Kshara karma, Agnikarma, and Ksharavarti are a few to name in this list. A lacuna exists in not analyzing or compiling these works. Hence, the purpose of this systematic review is to generate evidence for efficacy, effectiveness, and safety profile of Ayurvedic interventions in the management of fistula in ano. Materials and methods: Electronic search from various online databases and clinical trial registers will be done. Manual search for gray literatures will be done from various colleges and universities. There will be no language restrictions. Three authors independently will screen all citations and abstracts to identify potentially eligible trials. Based on the inclusion criteria, full articles will be evaluated and disagreements will be discussed among the three authors. Data extraction from the included studies will be done by the three reviewers independently with extraction forms containing methods, participants, interventions, comparators/controls, and outcomes. Each of the included trials will be assessed for risk of bias. Primary data analysis will be done for both qualitative and quantitative data. Heterogeneity among trials will be assessed by inspecting forest plots. If heterogeneity is detected, and it is still considered clinically meaningful to combine studies, a random- effects model will be used. Meta-analysis will be done for pooled estimates and others would be presented as narrative synthesis and shall be represented in tabular and graphical forms. Dissemination: The systematic review will be published in a peer-reviewed journal. It will also be disseminated electronically and in print. The review may guide healthcare practices and policy framing regarding the treatment of fistula in ano with Ayurvedic interventions. Study registration: PROSPERO registration no. CRD42019131911.

A Systematic Review Protocol Evaluating the Efficacy and Safety of Ayurvedic Interventions for Glaucoma

Introduction: The features of glaucoma have similarities with those of Adhimantha as mentioned in Ayurveda, where it exhibits features based on the Doshas involved. The aim of this study is to conduct systematic review of published studies in view of safety and efficacy of Ayurvedic interventions in the management of glaucoma and to run meta-analysis of the published clinical data if sufficient homogeneous studies are available. Materials and methods: This systematic review process would include review of randomized controlled trials (RCTs), quasi-experimental designs, multiple arms clinical trials and observational studies (case series and case control) on the management of glaucoma or Adhimantha through Ayurvedic interventions. Interventions and procedures administered from a minimum of 7 days to maximum of 6 months will be included. Electronic databases search through Ayurvedic research databases and medical journal databases such as MEDLINE, Web of Science, Cochrane register, Scopus, EMBASE, directories of open access journals and hand searching will be done using predefined search terms to identify relevant studies which would include studies done between January 1990 and January 2020. The study selection, data extraction, analysis, and synthesis of results will be done by three researchers. Study selection will follow the symptomatology of Adhimantha/glaucoma as explained in different classical texts of Ayurveda, and the quality of studies will be assessed by the Cochrane risk of bias assessment for RCT and non-RCTs. The heterogeneity of reviewed studies will be evaluated by examining forest plots, and meta-analysis will be planned by using quantitative synthesis if they are sufficiently homogeneous. Ethics approval: Formal ethical approval is not necessary as the primary data of patients will not be collected. The final results of the review will be disseminated through a peer-reviewed publication. PROSPERO registration number: PROSPERO 2019: CRD42019133911.

Protocol for Systematic Review of Efficacy and Safety of Ayurveda Interventions in Bronchial Asthma

Introduction: A systematic review is planned to investigate the safety, efficacy, and effectiveness of Ayurvedic interventions in the management of Tamaka Shwasa/bronchial asthma through systematic analysis of published clinical researches. Materials and methods: A systematic review of the published clinical work for Ayurvedic interventions for Tamaka Shwasa/bronchial asthma will be conducted. Electronic searches, such as, EMBASE, MEDLINE, COCHRANE and AYUSH Research Portal, DHARA, Shodhganga Databases on dissertation works, conference proceedings, print journals, and reference list of articles, will be considered in the search strategy. All studies as per inclusion criteria including study design and participants will be analyzed by two investigators individually; in case of ambiguity, it will be discussed by a senior expert (investigator). The population (P in PICO) will include diagnosed cases of bronchial asthma/Tamaka Shwasa, where intervention (I) will be Ayurveda stand alone or as add-on with conventional therapy and (C) comparator will be Ayurveda and non- Ayurveda interventions or placebo. The primary outcome (O) will be improvement evident by a decrease in dyspnea, rhonchi, number of attacks, and classical symptoms of Tamaka Shwasa. Risk of bias assessment using Robin's tool will be used for non-randomized clinical trials, whereas CONSORT statement will be used for quality assessment of randomized clinical trials. Dissemination: This review is ongoing, and upon completion, the review will be published in a peer-reviewed journal. The review will be updated to inform and guide healthcare practice and policy. The results will be presented in terms of high risk, moderate or low/unclear risk in risk of bias assessment. Trial registration number: PROSPERO 2019 CRD42019123886.