In November 2020, the Central government amended the Central Council of Indian Medicine Regulations, 2016, to introduce formal training in Shalya (general surgery) and Shalakya (diseases of ear, nose, throat, eye, head, oro-dentistry) specialisations for postgraduate students of Ayurveda [1].

Postgraduate (PG) trainees of Shalya and Shalakya will receive practical training in surgery and will be equipped to independently perform some pre-defined procedures after completion of their PG degree, as stated in the gazette notification issued on November 19 [1, 2]. The students will be trained in two streams of surgery and will be awarded the degrees of MS (Ayurveda) Shalya Tantra (General Surgery), and MS (Ayurveda) Shalakya Tantra (diseases of the eye, ear, nose, throat, head, and oro-dentistry). Training modules for surgical procedures will be added to the regular curriculum of Ayurvedic studies.

This policy decision of the Government will allow Ayurveda practitioners to legally perform procedures such as skin grafting, cataract surgery, and root canal treatment. The list of procedures that will be taught includes — all types of skin grafting, ear lobe repair, excision of simple cyst and benign tumours (lipoma, fibroma, schwannoma, etc) of non-vital organs, excision/amputation of gangrene, traumatic wound management — all types of suturing, ligation and repair of tendon and muscles, foreign body removal from the stomach, colostomy, cataract surgery, local anaesthesia in the eye, rhinoplasty, hair lip repair, loose tooth extraction, dental caries tooth/teeth, root canal treatment etc [1, 2].

It must be noted that the diagnosis and surgical management of a patient requires a multidisciplinary approach, involving various disciplines of allopathic medicine which have developed over a long period of time. Specialised branches like radiology, pathology, microbiology, and biochemistry are involved in the diagnosis of diseases. Any surgical procedure requires pre-anaesthetic check-ups involving disciplines like cardiology, and patients with complicated conditions may require clearances from nephrology, endocrinology, neurology, gastroenterology, etc. Anaesthesia was developed over many decades and is at present fully equipped to handle extremely complicated surgeries. Post-operative care requires a dedicated intensive care unit set up, especially for complex surgeries by qualified individuals from anaesthesia and critical care medicine.

Developing traditional medicine is a welcome step, but the skills and expertise of 8 to 10 domains are learned over a period of 8-10 years by students in the allopathic system. Is it possible to develop the so-called MS (Ayurveda) Shalya Tantra / Shalakya Tantra within a few years of training to develop the same degree of expertise, without prior tedious and comprehensive training on the surgical anatomy and pathophysiology of the diseases mentioned?

The Ayurvedic surgery system is not widely accepted at present, and it has not yet evolved to handle complex surgeries and their possible complications [3]. So, it is a major ethical issue to subject patients to surgery at the hands of Ayurvedic postgraduate students. It is unclear how the referral system will work in case of complications in these complex operations performed under general anaesthesia. A failure to debate these issues among stakeholders could have disastrous results in terms of patient care.

Ayurveda has a glorious history of 3500 years. Even today, proficient practitioners of Ayurveda, although reduced in numbers due to the poor quality of academic training [4], continue to command respect while delivering effective health services. There are reputed Ayurveda hospitals and clinics across the globe. The core strengths of Ayurveda lie in the management of non-communicable diseases. It also has unique expertise not available in other health sciences in designing wellness strategies based on its concept of homeostasis (swasthya) at multiple levels of the biological system [5].

We need to integrate the Indian systems of medicine, AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy), including the promotion of Yoga as a form of lifestyle change to tackle non-communicable diseases. If not handled correctly, this integrative system of medicine will end up as a disastrous cocktail, with patients paying the price [2].

Sudipta Mohakud (corresponding author — [email protected]), Associate Professor, Department of Radio Diagnosis, AIIMS Bhubaneshwar, Odisha 751019 INDIA; Pradeep Sharma ([email protected]), Consultant Biochemist, Department of Biochemistry, Central Laboratory AMRI Hospital, Bhubaneshwar, Odisha 751019 INDIA.