Amrit Kaal for Ayurveda (The Golden Era): Growth Scenario, Drivers, Determinants, and Temporal Analysis

Ayurveda System Ayurveda is one of the oldest documented, coded traditional medicine. The last decade marks the most rapid institutional, scientific, and global expansion of Ayurveda in the postindependence era. The policy reforms, research advancements, COVID-19-related developments, digital health integration, educational reforms, and global recognition have reshaped Ayurveda. With strong government support, international collaboration, and evidence-based clinical studies, Ayurveda is transitioning from a traditional knowledge system to a globally recognized, research-driven medical science. Global acceptance was restricted due to various issues such as lack of standardization, limited funding, and absence of robust scientific data. However, since the last decade, there has been a paradigm shift, and it is through addressing various issues and bottlenecks leading to comprehensive growth never seen before, and momentum remains to be gaining. Policy Reforms and Government Initiatives Postindependence, the Government of India initiated the Indian Systems of Medicine (ISM) unit under the Ministry of Health. With growing demand, the Department of ISM and Homoeopathy was created in 1995. In 2003, it was renamed as the Department of AYUSH with an increased budget. In 2014, this department was upgraded to the independent, full-fledged Ministry of AYUSH, and this forms a landmark in Indian medical policy. The establishment of apex bodies and initiatives like CCIM (1971) and National Council for Indian System of Medicine (NCISM) (2020) for education, the Central Council for Research in Ayurveda (CCRAS) for research, and the Rashtriya Ayurveda Vidyapeetha for training physicians in traditional as well as emerging ayurvedic clinical practices laid the platform for its development. The establishment of national educational institutes like the Institute of Teaching and Research in Ayurveda, Jamnagar (Institute of National Importance), the National Institute of Ayurveda, Jaipur, and the All India Institute of Ayurveda, New Delhi, and Goa were supportive in Ayurveda’s academic growth. The establishment of state government institutes related to education, health care, and pharmacy led to Ayurveda development across the whole of India. Governmental initiatives were the pillars in the Ayurveda development. The Pharmacopoeia Commission for Indian Medicine and Homoeopathy (PCIM and H) is looking into pharmacopeial standards and quality control of drugs; National Medicinal Plants Board, Pharmacovigilance Programme for AYUSH, NABH (for AYUSH Hospitals) under the Quality Council of India, International Cooperation Cell, Ministry of AYUSH promote AYUSH globally and aids memorandum of understandings (MoUs) and international centers. AYUSH Information Cells abroad in various Indian embassies or high commissions, Central Ayurveda Research Institute units across India, Drug Testing Laboratories, Pharmacognosy, and Ethnopharmacology divisions are a few of the noteworthy initiatives. Education and Human Resource Development Ayurveda had 135 colleges in 2000 with an intake capacity of around 4900 seats, rose to 240 colleges in 2010, and had 419 colleges in 2020 with around 29000 BAMS seats, 450 colleges in 2022, and 560 Ayurveda colleges in 2025, and BAMS seats are around 31000. Growth and growth sustenance are due to public interest and demand. Education programs, including BAMS, MD in 18 specialties, PhD, fellowship programs, postdoctoral fellowships, DM programs, B Pharma, allied courses, D Pharma, nursing courses, value-added courses, and certificate courses, are increasing. Ayurveda education and service centers are increasing in India as well as globally. With quantitative increase, the quality status of human resources is the genuinely raised concern by various stakeholders. Although the quality of human resources is the concern, the measures being taken to address it are welcome. Efforts by the Central Council for Indian Medicine (CCIM) and the NCISM have led to an increase in quality physicians and human resources over time. Over decades, Ayurveda has demonstrated growth, credibility, effective treatment, and research and is definitely due to a gradual increase in its quality human resources. Further, it is adequately addressed by newer reforms in education by the NCISM. Ayurveda Education Reforms of Quality Human Resource Development NCISM1 is enhancing the quality of traditional medicine education, modernization of curriculum, competency, and outcome-based education. Added novel and updated teaching methods and assessment methods. Ayurveda education is now aligned with the National Education Policy 2020. The curriculum developed is robust, meets contemporary international standards, promotes best practices in teaching, learning, assessment, research, and innovation, it ensures ethical practices and accountability. Major curriculum reforms are competency-based dynamic curriculum for BAMS programs and outcome-based dynamic curriculum for postgraduate programs. The curriculum is reformed into modules, units, and credits. It clearly defines the program outcomes, course outcomes, competencies, and learning objectives. Curriculum weightage is based on the market trends, applicability, and future trends. It has integrated Ayurveda with the contemporary knowledge systems and best practices. It uses diverse teaching and assessment methods for thorough learning and a comprehensive assessment. The curriculum has a clear question paper blueprint. NCSIM has laid stress on quality assurance measures. The National Exit Test ensures uniform competency in healthcare service at national levels. National Teachers’ Eligibility Test improves teaching quality by setting faculty standards nationally. The ranking of the Ayurveda educational institutes through quality control of India collaboration helps stakeholders to know the quality of the institute. A mechanism to rate the newer textbooks written for its quality standards helps the students. Registration of certificate, diploma, fellowship, etc. , courses in the Ayurveda Training Accreditation Board, Rashtriya Ayurveda Vidyapeeth, and Ministry of AYUSH brings validity to the course. These curricular reforms in teaching, learning, assessment, research, and quality assurance measures bring objectivity, skills, and competencies of human resources to the global standards. Research Output There is a considerable increase in research output. Decade-wise comparison of the last three decades2 showed a substantial increase in total publications and total publications from Q1 to Q2 journals. Publications from 1993 to 2012 have seen exponential growth. The COVID-19 pandemic resulted in a surge in ayurveda research as well as high-quality research, especially from 2020 to 2022. Research collaborations analysis of three decades of ayurveda research showed that institutional was 41. 8%, national was 35. 3%, international was 14%, and single authorship with no collaboration was 8. 8%. Open access publications jumped from 2% in 1993 to 50% in 2022. Scientometric studies show an exponential increase in SCOPUS and PubMed-indexed Ayurveda publications since 2010. 3 Clinical trials and systematic reviews are now increasing, reflecting acceptance within mainstream medical research. 4 Research publications on Ayurveda are not only from India but also from the US, UK, Japan, Germany, China, Australia, Norway, etc. , suggestive of global involvement in Ayurveda research and international research collaborations. Bibliographic coupling of countries showed India linking to almost all the countries. A study of 3 decades of research in Ayurveda2 showed that top funding agencies were the University Grants Commission, Council of Scientific and Industrial Research (CSIR), India, Department of Science and Technology, Ministry of Science and Technology, India, Indian Council of Medical Research (ICMR), Department of Biotechnology, Ministry of Science and Technology, India, and international bodies like the National Institutes of Health USA, National Center for Complementary and Integrative Health USA, and National Cancer Institute USA. The COVID-19 pandemic phase saw an increase in funded clinical trials on Ayurveda formulations for COVID-19, diabetes, arthritis, and neurological disorders. Study2 showed that from 2020 to 2022, Ayurveda publications related to COVID-19 numbered 544. There was significant collaboration among authors and institutes. The foundation of Ayurveda research was through CCRAS, an apex body that has research centers across India. It contributed immensely to Ayurveda research and has conducted drug trials, clinical studies, pharmacology research, pharmaceutical research, literary and fundamental research, developed raw drug monographs, standardized extracts, and contributed to Ayurvedic Pharmacopoeia of India and the Ayurvedic Formulary of India. It conducted extensive clinical studies on COVID-19. The developed Ayush Sanjivani mobile application was used to collect real-time data on the use of Ayurveda in COVID-19. Digitalization projects like Ayurveda Manuscript Advanced Repository, toward a digital library of rare classical manuscripts, and AYUSHRATNA, a database of classical textual references for drug formulation, were of great help to knowledge seekers in this digital era. Medico-ethnobotanical surveys of over 6000 medicinal plants give huge information. It brought integrative and translational research through collaboration between various governmental agencies like CSIR, ICMR, DBT, IIT, and international universities. CCRAS has initiated research promotion in various strata, such as undergraduate students, postgraduate students, faculty, practitioners, and industry, through various programs like CCRAS-SPARK, CCRAS-STAR, and CCRAS-SMART. Ayurveda Healthcare Services The government has taken steps and initiated various programs to strengthen AYUSH hospitals, dispensaries, and educational institutions. National AYUSH Mission, upgradation of AYUSH educational institutions, Ayurswasthya Yojana (Central Sector Scheme), Scheme for Public Health Initiatives under AYUSH, AYUSH Health and Wellness Centers, and National Health Mission (NHM), insurance coverage for traditional medicine. Ayurveda hospitals are more than 3000, and Ayurveda dispensaries are more than 15000 across India. With more than 4 lakh registered Ayurveda practitioners, it is contributing immensely to health care services across the nation. Ayurveda is mainstreamed through the NHM, launched by the Government of India, and has strengthened Indian public healthcare. This process has helped health care services in delivering affordable, quality, and holistic healthcare to fellow citizens. It has specially strengthened primary healthcare (PHC), preventive health, and lifestyle-based disease management. More than 8000 Ayurveda units are co-located in PHCs, community health centers (CHCs), and district hospitals with postings of Ayurveda physicians and pharmacists and supplies of Ayurveda medicines. Ayurveda is included in various national programs like the National Programme for Prevention of Cancer, Diabetes, and Cardiovascular Disease; Yoga–Ayurveda lifestyle clinics; AYUSH tribal health and mobile units; and the school health program with AYUSH lifestyle. The services of the AYUSH community in a global health care crisis like the COVID-19 pandemic were noteworthy. Preliminary studies have been conducted on consumer behavior toward Ayurvedic products and services. A study5 with structured interviews of 500 respondents from a remote area of the Joginder Nagar region of Himachal Pradesh showed that 64. 8% out of 500 respondents preferred Ayurveda medicines over other systems, and 77% were regular consumers of Ayurveda products for conditions such as the common cold and allergies. It also reported that consumers used without a doctor’s prescription and were consumed with allopathic medications. Similar reports have been made from the Gujarat6 and Kerala7 regions. India ranks among the top 10 global wellness tourism markets and is one of the fastest-growing global destinations for medical and wellness tourism in the world. The market size of global wellness tourism in India is expected to reach 20–25 billion by 2025–26, and Ayurveda is the major contributor. 8 Ayurveda Pharma Industry Ayurveda Pharma industry growth has been phenomenal in the last decade. The global Ayurveda industry was USD 3. 4 billion in 2015 and is projected to reach USD 9. 7 billion in 2022, growing at a compound annual growth rate (CAGR) of 16. 2% from year 2015 to 2022. The Indian Ayurveda market size was USD 3 billion in 2016 and is projected to grow by 16% by 2021. 9 India’s trade in Ayurveda products in 2008–2009 was USD 120 million and rose to USD 150. 96 million in 2017–2018, and imports were USD 10. 24 million, registering a trade surplus of USD 130. 48 million in 2017–2018. 10 7500 manufacturers across 10 states participated in the Ayurveda tech startup NirogStreet survey. The Ayurveda product market in India, as per the Nirog Street survey, is projected to reach USD 16. 27 billion, or Rs 1. 2 lakh crore, by financial year 2028 from USD 7 billion, or Rs 57, 450 crore, in financial year 2024. Overall growth of Ayurveda products and services is expected to grow at a CAGR of 15% from 2023 to 2028. A report on the Ayush sector by the Forum on Indian Traditional Medicine under the Research and Information System for Developing Countries states that the market size of the Ayush industry was US 2. 85 billion in 2014-15 and increased to US 18. 1 billion in 2020. 11 Ayurveda pharma companies report that only 10–15 products, or 1%–2% of manufacturing by volume, are exported as Ayurveda products. And accordingly, only 1%–2% of the products are registered drugs and sold through pharmacies in foreign countries. Export of most products is as health supplements or food supplements in markets like the US and UK. 10 Ayurveda industry growth is due to drug development, quality assurance, and government programs. PCIM and H, World Health Organization’s (WHO’s) Certification of Pharmaceutical Products (CoPP), the AYUSH Premium mark from the Quality Council of India, Ayush Oushadhi Gunvatta Evam Uttpadan Samvardhan Yojana, Central Sector Scheme on Conservation, Development and Sustainable Management of Medicinal Plants, Quality Control of AYUSH Drugs, etc. The National Pharmacovigilance Programme for Ayurveda, Siddha, Unani, and Homoeopathy drugs was introduced to monitor safety, adverse reactions, and quality issues. 12 The Bureau of Indian Standards (BIS), the national standards organization in charge of creating Indian Standards, has created a special section for Ayush standardization. BIS has published 91 standards that span a wide range of topics, including Panchakarma equipment, Ayurvedic and Yoga terminology, and individual herbs. This will address challenges related to the efficacy of products, safety, and quality control. 13 Standardization of classical drugs and development of modern dosage forms have been initiated. Development of nano-herbals, extract-based standardized formulations, Ayush patent and proprietary medicines, etc. , has contributed to the growth. Guidelines for GMP, heavy metal screening, standard manufacturing procedures, and marker-based standardization have been strengthened. Modern analytical technologies such as High-Performance Thin-Layer Chromatography (HPTLC), High-Performance Thin-Layer Chromatography (HPLC), DNA barcoding, and nano-formulations are increasingly used. 14 Drug discovery and phytopharmaceutical development are actively pursued. The Drug Controller General of India approved guidelines for Ayurvedic phytopharmaceuticals, allowing plant-based extracts to be developed using modern pharmaceutical science. 15 Companies and research institutions are filing patents for standardized extracts, rasayana formulation, and herbal cosmetics. 16 These measures address major criticisms of Ayurveda regarding the quality and safety of Ayurveda medicines. This effort bridges classical knowledge with modern drug development pathways. Digital and Technological Integration In order to combat biopiracy and preserve the integrity of its traditional knowledge, the Ministry of Ayush worked with the CSIR to create the Traditional Knowledge Digital Library in 2001. The Ministry of Ayush developed Ayush Grid (AG), a digital health platform, in 2018. It functions in tandem with India’s national digital health infrastructure, the Ayushman Bharat Digital Mission. The National Ayush Morbidity and Standardized Terminologies Electronic portal, which attempts to provide a standard language and codes for Ayush systems, is one of the AG’s major accomplishments. The creation of the WHO worldwide terminologies and morbidity codes for Ayurveda, Siddha, and Unani has benefited greatly from this portal. 17 COVID-19 accelerated digital adoption in Ayurveda. The AYUSH Sanjivani App collected data from more than 1 crore citizens about immunity-boosting measures and outcomes. 18 Telemedicine consultations and e-pharmacy services expanded access to remote populations. Artificial intelligence tools are being explored for classical text mining, disease-pattern prediction, and drug discovery. 19 Global Status of Ayurveda Ayurveda is now legally recognized in more than 30 countries as a traditional medicine system. WHO global report 2019 acknowledges the use of Ayurveda in 90 member states and is due to affordability in the current times of soaring healthcare costs. 20 In spite of varying legal status of Ayurveda, increasing demand is driving greater recognition by various countries. Ayurveda education and service are provided in many countries, including certificate, diploma, and degree-level programs. More numbers of Ayurveda consultants from India are visiting foreign countries regularly for Ayurveda education and healthcare services. The exponential increase of foreign patients visiting India for Ayurveda healthcare services made Ayurveda the main contributor in medical and wellness tourism in India. The establishment of the WHO Global Center for Traditional Medicine (GCTM) in Jamnagar in 2022 will help enhance the quality, safety, and integration of traditional medicines into national health systems. GCTM seeks to assist countries in utilizing traditional medicine to attain universal health coverage. The International Classification of Diseases-11 was updated to include Ayurveda, allowing dual coding and improving data collection and evidence-based medicine for traditional medicine in 2025. This helps in the inclusion of Ayurveda in national healthcare strategies, promoting holistic and inclusive healthcare worldwide, and brings uniformity in data collection and research. Global recognition of Ayurveda is being propagated through various governmental programs and activities. Central Sector Scheme for Promotion of International Cooperation in AYUSH, PCIM and H, Ayush Export Promotion Council, etc. The Ministry of AYUSH by 2025, 21 signed 50 country-to-country MoUs for cooperation in the field of Ayurveda and AYUSH with foreign nations, research/academic collaboration, setting up of Ayush Academic Chairs in foreign universities, and establishment of 39 Ayush Information Cells in 35 foreign nations. WHO-GMP (COPP) has been given to 31 Ayurvedic drug manufacturers to facilitate the export of Ayurveda drugs. Way Forward Ayurveda does have major challenges in rising to claim its right place in the global health sector. Ayurveda is bound to face newer challenges globally as the regulatory requirements and standards keep evolving. Ayurveda, like any science, needs reforms, growth, and upgrades and to evolve to the current requirements in all components such as education, marketing, industry, and community service. Lack of data, shortage of skilled manpower, research, shortage of quality raw materials, variable quality standards of manufacturing units and services, product standards for etc. , are the issues to be Government and governmental educational industry, Ayurveda practitioners, policy and stakeholders to and in not in to address the challenges and However, the last decade has seen a paradigm in by various and accordingly, Ayurveda has seen growth. have strong Ayurveda growth in all of the will to be the of traditional medicines and of interest There are no of