STATUS OF INDIAN MEDICINE AND FOLK HEALING With a focus on integration of AYUSH medical systems in health care delivery Part II
Shailaja Chandra
Former Secretary, Government of India Ministry of Health & Family Welfare Department of AYUSH and Former Chief Secretary, Government of Delhi
Under the aegis of Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) Ministry of Health & Family Welfare Government of India FEBRUARY 2013
Front cover: Collage of medical manuscripts in Sanskrit, Tamil and Arabic Back cover: Holy basil (Ocimum sanctum)
Intellectual property rights of this report rest with Department of AYUSH, Ministry of Health & Family Welfare, Government of India and Shailaja Chandra, former Secretary, Government of India and former Chief Secretary, Delhi
Printed at: India Offset Press A-1, Mayapuri Industrial Area, Phase-I New Delhi – 110 064 (India)
ii  Status of Indian Medicine and Folk Healing
Contents Acknowledgements
vii
Officers, Experts and Stakeholders Consulted
xi
Abbreviations and Acronyms
xxi
Executive Summary
xxvii
Summary of Major Findings and Recommendations
xxxv
Chapter 1: Status of Integration
3 – 63
Health Seeking Behaviour and Medical Pluralism
3
Congruence of Traditional and Modern Medicine
14
Status of Adjuvant Use of Ayurveda and Unani Medicine
22
Contemporary Ayurveda and Ethical Marketing of Ayurvedic Drugs
40
Annexures:
Annexure-I: Roadmap for Mainstreaming of AYUSH under NRHM - Joint letter of Secretary, Department of Health and Secretary, Department of AYUSH to all States
53
Annexure-II: Joint Letter of Secretary, Health and Secretary, AYUSH to States
56
Annexure-III: Minutes of the Meeting on Approach to Part II of the Status Report held on 9th December 2011at 2.30 pm in the CCRUM Conference Hall, Janakpuri, New Delhi
58
Annexure-IV: Questionnaire to Investigate the extent of Adjuvant AYUSH Therapy with Patient Responses
61
Annexure-V: List of Experts/Faculty/Practitioners who commented on Survey outcomes on the Adjuvant use of AYUSH
62
Annexure-VI: List of leading Pharmaceutical Companies engaged in manufacturing Ayurvedic Medicines
63
Chapter 2: AYUSH in Selected States - Findings from Field Visits
67 – 140
Odisha
67
Uttar Pradesh
75
Andhra Pradesh
91
Himachal Pradesh
102
Jammu & Kashmir
111
States Consulted (Bihar, Uttarakhand, West Bengal)
118
Contents iii
Annexures:
Annexure-I: List of Officers who attended the meeting chaired by the Commissioner-cum-Secretary, Health and Family Welfare, Government of Odisha at the request of the PI
121
Annexure-II: List of Faculty members the PI met at AK Tibbiya College, AMU, Aligarh
122
Annexure-III: Treatment of choice in Ayurveda and Unani for Common Disease Conditions
123
Annexure-IV: Letter of the PI to Principal Secretary, Andhra Pradesh
128
Annexure-V: List of Faculty and Staff PI met at the Rajiv Gandhi Government PG Ayurvedic College and Hospital, Paprola
130
Annexure-VI: Letter sent to the Health Secretaries of West Bengal, Uttarakhand, Bihar and Madhya Pradesh
131
Annexure-VII: Questionnaire sent to the Health Secretaries of States
132
Annexure-VIII: Anubandh for AYUSH doctors in Uttarakhand
135
Chapter 3: Postgraduate Education in Ayurveda – Filling the Gaps
143 – 149
Chapter 4: Building Credibility for Panchakarma
153 – 160
Chapter 5: A Study of Selected State Pharmacies
163 – 175
Annexures:
Annexure-I: Grant in Aid released to States/UTs under the Centrally Sponsored Scheme for Quality Control of ASU&H drugs from 2000-01 to 2011-12 (in Rs. lakhs)
173
Annexure-II: Questionnaire for Preparing Status Report on Government Ayurvedic Pharmacies
174
Chapter 6: Regulatory Framework for ASU Drugs
179 – 201
Annexures:
Annexure-I: Letter of Secretary, UP to all the CMOs regarding harassment faced by the ISM practitioners in the State
194
Annexure-II: Court order on the issue of Inter-disciplinary Cross-practice in UP
195
Annexure-III: Ministry of Health & Family Welfare’s notification regarding practice of Gynaecology & Obstetrics and Diagnostic Ultrasonography by ISM Graduates
197
Annexure-IV: Himachal Government’s circular allowing ISM practitioners to use modern medicine
198
Annexure-V: Directorate of ISM, J&K Circular regarding “Prescription of Allopathic Medicine by AYUSH Doctors”
199
Annexure-VI: Proposal of J&K Department of ISM to notify the use of essential allopathic medicine by AYUSH doctors
200
iv Status of Indian Medicine and Folk Healing
Chapter 7: Guru-Shishya Parampara – A Critique of the Rashtriya Ayurveda Vidyapeeth
205 – 222
Annexures:
Annexure-IA: Recommendations of the Review Committee of Department of ISM, Government of India which had reviewed the performance of RAV
213
Annexure-IB: Recommendations of the International Management Institute, New Delhi on the future growth options for Rashtriya Ayurveda Vidyapeetha (RAV), New Delhi
215
Annexure-II: Details of Gurus and Shishyas associated with RAV since the time of inception
217
Annexure-III: Covering letter of the PI with Questionnaire issued to MRAV/CRAV alumni/Shishyas
218
Annexure-IV: List of Gurus and Shishyas who responded/ did not respond
220
Chapter 8: National Institute of Indian Medical Heritage (NIIMH) – A Historical Overview and Major Contributions
225 – 231
Annexure:
Annexure-I: Research Activities Reported in NIIMH Bulletin/Journal, 1963-2009 Chapter 9: Folk Healing Practices of the North East
230 235 – 265
Annexures:
Annexure-I: Letter of the PI to the Director of North East Institute of Folk Healing
263
Annexure-II: Questionnaire on the Practice of Traditional Medicine and Folk Healing in the North Eastern States
265
Chapter 10: Ayurvedic Veterinary Products – Status and Future Prospects
269 – 273
Chapter 11: Initiatives with a Difference
277 – 279
Chapter 12: Transformation Needed
283 – 286
Contents v
Acknowledgements When Part I of this report was written I had acknowledged the contribution of scores of people who had helped me in big ways and small. What follows are a few repetitions but many more additions. Under the Presidentship of the Honourable Minister for Health and Family Welfare, Shri Ghulam Nabi Azad as the President of CCRUM I continued to receive whole-hearted support from the Department of AYUSH and the Research Councils particularly from Unani Medicine and Ayurvedic Sciences. Headed by the Union Secretary (AYUSH), Shri Anil Kumar the Department’s officers gave me access to data and information without which it would not have been possible to have delved down to the root of so many subjects. The Secretary was always accessible whenever I requested to meet him and shared his thoughts with candour. I am grateful to stalwarts like Prof. Valiathan, Prof. Ranjit Roy Chaudhury, Prof. RH Singh who gave me the benefit of their valuable advice which has been acknowledged in the report. I must also mention the part played by Dr. SP Aggarwal, the former Director General Health Services, Ministry of Health & Family Welfare who grounded his remarks in down-to-earth wisdom on what was possible and practical. Shri Bala Prasad (then the only Joint Secretary in the Department), put me in touch with the right persons which facilitated my work greatly. In particular Dr. DC Katoch was one person who provided information by return e-mail within minutes. Of greatest value were the official letters of introduction sent to the State Governments which enabled me to observe and record the ground realities. The Director-General of CCRUM Professor Shakir Jamil continued to extend the support of the whole institution and enabled me to hold two joint meetings of the two Research Councils for Unani and Ayurvedic medicine where numerous experts, faculty members and practitioners of both systems gave me the benefit of their advice. Dr. KM Siddiqui, Deputy Director in CCRUM did the behind the scenes work for the meetings and also drew up and time-tuned the travel itineraries for my visits to different States. Without this, it would have been difficult to have synchronised meetings with so many people at so many places. He also provided me the services of a statistician Shri Zameer Ahmad who assisted me in assembling the statistical portions of the report. Dr. Ramesh Babu Devalla, the Director General of CCRAS continued to extend invaluable support, chiefly by finding the right person at each juncture who could give the technical support that I needed. Because of this I was able to get useful base papers prepared by Dr. N Srikanth, Dr. Sarada Ota and Dr. Pradeep Dua - all from CCRAS who helped me to assemble the facts for three chapters. The role of several officers from the National Institutes under the Department of AYUSH must also be placed on record. Among these I recall Dr. V V Prasad, Director, Rashtriya Ayurved Vidyapeeth because of his brevity with words but capacity to deliver on promises.
Acknowledgements  vii
Dr. Ajay Kumar Sharma, the Director of the National Institute of Ayurveda was good enough to assign four faculty members to help me to get a study on selected State pharmacies done, when I was about to abandon the idea. Shri Otem Dai, the Director of the North-Eastern Institute of Folk Medicine went out of his way to help me to prepare the chapter on folk medicine in the North-East with enthusiasm. He assigned a resourceful Senior Research Officer Shri Hemen Hazarika to coordinate the work. The work was organized despite many parts of the North-East being affected by torrential rain and floods and the Internet system remaining out of commission for several weeks at a stretch. Before the work relating to the interface of AYUSH and NRHM was undertaken, I had requested Dr. Ritu Priya, Professor, Center of Social Medicine & Community Health, Jawaharlal Nehru University (JNU), former Advisor, Public Health Planning (NHSRC) to help unravel her own report on 18 States. Dr. Priya gave me the benefit of briefing me through her experience and introduced me to Dr. Shweta also an Ayurvedic doctor who walked me through the report with enthusiasm. A very special mention needs to be made of the Principal Secretaries in charge of AYUSH Shri K Ratna Kishore in Andhra Pradesh, Shri J P Sharma in U.P., Shri Ashok Shekhar in Rajasthan, Shri Ali Raja Rizvi in Himachal Pradesh, Smt Anu Garg in Odisha and Shri M K Dwivedi in Jammu and Kashmir, all of whom went out of their way to make my visits to their States as meaningful as possible. In Andhra Pradesh Dr. Srivasuki held charge as the Commissioner AYUSH and accompanied me during most of my visits to the facilities in Hyderabad. The State Directors of Ayurveda/Unani/ ISM who gave me immense support in different ways include Dr. KR Kohli from Maharashtra, Dr. Raksha Goswami, Director Ayurveda and Dr. Shoeb Qasmi, Director (Unani)-both from Uttar Pradesh, Dr. PS Draik from Himachal Pradesh and Dr. Kabir Dar from Jammu & Kashmir. All of them wanted to see the project succeed in the interest of the systems and used their personal contacts and initiative to pack in as much as possible, including gracious hospitality . Several other State officials from the departments of Ayurveda and Unani medicine looked after me and their resourcefulness must be acknowledged. Among these I will always remember Dr. Narendra Hota, the State Research Officer for AYUSH in Odisha, Dr. Ramanna, Regional Deputy Director, AYUSH in Andhra Pradesh along with Dr. Satya Prasad, the Principal of BRKR Ayurvedic College, Hyderabad for arranging the visits with enthusiasm and imagination. I also recall with warmth the tremendous support given by Dr. A.A. Hashmi, Deputy Director Unani in Uttar Pradesh. Dr. Nuzhat Manzoor and Dr. Shabeer Ahmed Gaffari from J&K accompanied me to innumerable health facilities with meticulous planning. Although the programme included several scheduled meetings and the distances to be covered to different districts were long, they took care of every detail so that I could spend limited time fruitfully. Likewise, Dr. Om Raj Sharma, Research Officer of CCRAS at Mandi accompanied me during my entire visit to Himachal Pradesh and his personal contacts and friendly approach provided me with rare insights. Thanks must be given to numerous people who helped me at the back end without whose help this report could never have been completed. To start with, I am grateful to Dr. Sathyanarayana Dornala who coordinated the amalgamation of the chapters using his dexterity with computer
viii  Status of Indian Medicine and Folk Healing
applications and knowledge of people, places and happenings to make useful suggestions. That most of the work could be done on e-mail across the country and also across continents and oceans (when I was overseas) reflects his quick understanding. I was assisted throughout by a young BAMS graduate Dr. Anubha Yadav who despite her youth and relative inexperience made up through her quick comprehension, willingness to learn despite being buffeted with constant instructions. That she could measure up to the most exacting standards which I laid down and also maintain enormous documentation systematically, speaks volumes for her potential. She is a gem of a girl. Behind the scenes, Shri Dilawar Singh, Administrative Officer at CCRUM, his assistant Shri Arya, Accountant maintained all my accounts and rid me of so many tedious but essential responsibilities. Shri Humayun, the ever-helpful PA to the DG asssisted me in innumerable ways, always smiling and never putting off anything he could accomplish even to the next minute! A rare virtue. I also acknowledge the support of Shri Ajay Nirwal who looks after the office of the Chairman of the Delhi Public Library - a position I hold in an honorary capacity. In the end, I depended on Shri Mehr-e-Alam Khan, Consultant (Portal) at CCRUM, who enabled me to turn sheaves of unruly paper into an organized report despite his several pressing commitments. If editorial mistakes remain, I am at fault. I hope the report will be found useful and will be disseminated to the State Governments along with copies of Part-I of the Report. The findings and recommendations given in the Report are my own and do not reflect the views of the Department of AYUSH. This has been an exciting learning experience for me and one that I will always treasure. My grateful thanks to all those who made it possible. Shailaja Chandra Principal Investigator and Former Secretary, Government of India & Former Chief Secretary, Delhi
Acknowledgements  ix
Officers, Experts and Stakeholders Consulted Department of AYUSH, Ministry of Health & Family Welfare, Government of India 1. 2. 3. 4.
Shri Anil Kumar Secretary Shri Bala Prasad Joint Secretary Dr. Dinesh Katoch Joint Advisor (Ayurveda) Dr. Manoj Nesari Joint Advisor (Ayurveda)
ASU Research Councils Central Council for Research in Unani Medicine: Headquarters, New Delhi: 1. Prof. Syed Shakir Jamil Director General 2. Dr. Khalid M Siddiqui Deputy Director 3. Mr. Mehr-e-Alam Khan Consultant & formerly Research Officer (Publication) 4. Dr. Abdul Raheem Assistant Director (Unani) RRIUM, Bhadrak (Odisha): 1. Dr. L Samiullah
Deputy Director (Unani)
2.
Dr. Subhan Allah Khan
Assistant Director (Bio-chemistry)
CRIUM, Lucknow: 1. Dr. Maqbool Ahmed Assistant Director (Unani) RRIUM, Aligarh: 1. Dr. Latafat Ali Khan Deputy Director (Unani)
CRIUM, Hyderabad: 1.
Dr. Ataullah Sharief
Director Incharge
2.
Dr. MA Waheed
Deputy Director
3.
Dr. Mushtaq Ahmad
Ex-Director
4.
Dr. MA Wajid
Assistant Director
5.
Dr. S Mazhur-ul-Haq
Assistant Director (Pathology)
6.
Dr. Alokananda Chakraborty Assistant Director (Physiology)
RRIUM, Srinagar (J&K): 1. Dr. Arsheed Iqbal Research Officer (Unani) Central Council for Research in Ayurvedic Sciences: Headquarters, New Delhi: 1.
Dr. Ramesh Babu Devalla
Director General
2.
Dr. N Srikanth
Assistant Director (Ayurveda)
3.
Dr. Sarada Ota
Research Officer (Ayurveda)
4.
Dr. Pradeep Dua
Research Officer (Ayurveda)
CRI(Ayurveda), Lucknow: 1.
Dr. Ramji Singh
Assistant Director (Ayurveda)
ARRI, Mandi: 1.
Dr. SK Sharma
Assistant Director (Ayurveda)
Officers, Experts and Stakeholders Consulted  xi
2.
Dr. Om Raj Sharma
Research Officer (Ayurveda)
ARRI, Jammu: 1.
Dr. Krishna Kumari
Assistant Director (Ayurveda)
National Research Institute of Ayurvedic Drug Development (NRIADD), Odisha: 1. 2.
Dr. Banamali Das Research Officer (Ayurveda), Scientist-II Dr. MV Acharya Assistant Director
National Institute of Indian Medical Heritage (NIIMH), Hyderabad: 1. 2. 3. 4. 5. 6.
Dr. Ala Narayana Director Dr. K Bharathi Research Officer (Ayurveda) Dr. GP Prasad Research Officer (Ayurveda) Dr. V Sridevi Research Officer (Ayurveda) Dr. B Venkateshwarlu Research Officer (Ayurveda) Dr. T Saket Ram Research Officer (Ayurveda)
AYUSH National Institutes 1. 2. 3.
Prof. V V Prasad Director Rashtriya Ayurveda Vidyapeeth, New Delhi Prof. Ajay Kumar Sharma Director National Institute of Ayurveda (NIA) Jaipur Dr. K Shankar Rao* Associate Professor & HOD Department of Rasa Shashtra & Bhaisajya Kalpana National Institute of Ayurveda (NIA) Jaipur
xii  Status of Indian Medicine and Folk Healing
4.
Dr. V Nageswar Rao* Associate Professor Department of Rasa Shashtra & Bhaisajya Kalpana National Institute of Ayurveda (NIA) Jaipur 5. Dr. Parimi Suresh* Assistant Professor Department of Rasa Shashtra & Bhaisajya Kalpana National Institute of Ayurveda (NIA) Jaipur 6. Dr. Sanjay Kumar* Lecturer Department of Rasa Shashtra & Bhaisajya Kalpana National Institute of Ayurveda (NIA) Jaipur 7. Dr. Otem Dai* Director North East Institute of Folk Medicine (NEIFM), Pasighat 10. Shri Hemen Hazarika* Senior Research Fellow North East Institute of Folk Medicine (NEIFM), Pasighat 11. Shri K Jeyaprakash* Senior Research Fellow North East Institute of Folk Medicine (NEIFM), Pasighat State Health Ministers, Chief Secretaries, Principal Secretaries, Commissioners, Directors and Others Odisha: 1. Smt Anu Garg Commissioner-cum-Secretary Department of Health and Family Welfare 2. Dr. BK Mishra Special Secretary Department of Health and Family Welfare 3. Shri Pramod Meherda Managing Director NRHM, Odisha
4. 5.
Dr. Upendra Kumar Sahu Director of Health Services Shri Padmalochan Behera Director Indian Medicine & Homeopathy Joint Secretary Department of Health and Family Welfare 6. Dr. PK Das Director of Medical Education & Training Uttar Pradesh: 1. Shri JP Sharma Principal Secretary Medical Education & AYUSH 2. Sh. SK Saxena Special Secretary Medical Education 3. Shri Sanjay Agarwal* Principal Secretary (NRHM) 4. Dr. Saudan Singh Director General Medical Education 5. Dr. Mohammad Sikander Hyat Siddiqui* Director (Unani) 6. Dr. RR Choudhary Director (Ayurveda) 7. Dr. Raksha Goswami Ex-Director (Ayurveda) 8. Dr. M Shoeb Qasmi Ex-Director of Unani Services 9. Dr. AA Hashmi Deputy Director (Unani Services) Andhra Pradesh: 1. Shri KR Kishore Principal Secretary Health & Family Welfare 2. Dr. KP Srivasuki IFS Commissioner ( AYUSH) 3. Dr. KV Ramanna Regional Deputy Director of Ayurveda 4. Dr. K Vishnu Prasad Director (Medical Education)
Himachal Pradesh: 1.
Shri Ali Raja Rizvi
Principal Secretary (Health & Ayurveda)
2. 3. 4.
Shri PS Draik Director (Ayurveda) Shri Rameshwar Sharma Additional Director (Ayurveda) Dr. RakeshPandit Ex-OSD, Directorate Ayurveda
Jammu & Kashmir: 1.
Shri Sham Lal Sharma
Health Minister
2.
Shri Madhav Lal
Chief Secretary
3.
Shri MK Dwivedi
Secretary of Government of Jammu & Kashmir
Health & Medical Education Department
4.
Shri Syed Iftikhar
Special Secretary
Health & Medical Education Department
5.
Dr. Yashpal Sharma
Mission Director
NRHM
6.
Dr. Saleem-ur-Rehman
Director Health Services
Kashmir
7.
Dr. Abdul Kabir Dar
Director, Indian Systems of Medicine & Homoeopathy
8.
Mr. KA Quasba
Joint Director
Agriculture
9.
Mr. Pran Dullo
Joint Director
Floriculture
10. Dr. KS Manhas
Dy. Director
ISM, Jammu
Officers, Experts and Stakeholders Consulted  xiii
11. Dr. Abdul Lateef
Assistant Director
ISM Unani
12. Dr. Rakesh Kumar Raina
Assistant Director (Ayurveda)
ISM
Bihar 1. Shri Vyasji* Principal Secretary Department of Health and Family Welfare 2. Shri Amarjeet Sinha* Ex-Principal Secretary Department of Health and Family Welfare Uttarakhand: 1. Dr. Ranbeer Singh* Principal Secretary 2. Dr. Pooja Bhardwaj* Director General (AYUSH) West Bengal: 1. Shri Sanjay Mitra* Principal Secretary Madhya Pradesh: 1. Shri Tanvir Krishnan* Principal Secretary 2. Shri Sudesh Kumar* Ex-Principal Secretary Maharashtra: 1. Dr. KR Kohli* Director (Ayurveda) Rajasthan: 1. Shri Ashok Shekhar* Principal Secretary (AYUSH) 2. Dr. Ujwal Rathore* Director (Ayurveda) Karnataka: 1. Shri GN Sreekantiah* Director (AYUSH)
xiv  Status of Indian Medicine and Folk Healing
Arunachal Pradesh: 1. Shri K Tayeng* Secretary Department of Health & Family Welfare Assam: 1. Shri JC Goswami* Commissioner & Secretary Department of Health & Family Welfare 2. Shri AB Mohammad Younis* Commissioner Department of Health & Family Welfare Manipur: 1. Shri K Moses Chalai* Commissioner Health & Family Welfare Meghalaya: 1. Shri DP Wahlang* Commissioner-cum-Secretary(Health) Department of Health & Family Welfare 2. Dr. A Das* Director of Health Services Nagaland: 1. Shri Menukhol John* Commissioner & Secretary (Family Welfare) Department of Health & Family Welfare 2. Shri T Limsong* Secretary (Family Welfare) Department of Health & Family Welfare Government of Nagaland North Eastern Council, Shillong: 1. Shri PS Thangkhiew* Planning Advisor North Eastern Council Government of Shillong Sikkim: 1. Shri K Bhandari* Secretary Department of Health & Family Welfare
Tripura: 2. Shri SK Roy* Principal Secretary Department of Health & Family Welfare Academics and Experts consulted 1. 2. 3. 4. 5. 6. 7.
Prof. MS Valiathan National Research Professor Manipal University, Manipal Prof. Ranjit Roy Chaudhury National Professor of Pharmacology (National Academy of Medical Science) And Advisor Health Government of National Capital Territory of Delhi Prof. Ram Harsh Singh Life time Distinguished Professor Faculty of Ayurveda Banaras Hindu University Dr. LS Chauhan Director National Centre for Disease Control Ministry of Health and Family Welfare Government of India Prof. Bhushan Patwardhan Professor Interdisciplinary School of Health Sciences University of Pune, Pune Mr. Darshan Shankar Chairman Foundation for Re-vitalization of Local Health Tradition (FRLHT) Bengaluru Dr. Ritu Priya Professor Center of Social Medicine & Community Health Jawaharlal Nehru University (JNU) Former Advisor Public Health Planning National Health Systems Resource Center (NHSRC), Delhi
8.
Dr. Rama Jaysundar Additional Professor Department of NMR All India Institute of Medical Sciences, New Delhi 9. Dr. SR Narahari MBBS, DVD; MD (Dermatology) Director, Institute of Applied Dermatology Kasaragod, Kerala 10. Dr. Madhulika Banerjee Associate Professor Department of Political Sciences Delhi University 11. Dr. Kishor Patwardhan Assistant Professor Department of KriyaSharir Faculty of Ayurveda Institute of Medical Sciences Banaras Hindu University 12. Dr. Shweta AS Ex-Consultant (AYUSH) Public Health Planning National Health Systems Resource Center (NHSRC), Delhi ASU Pharmaceutical Sector 1.
Dr. DBA Narayana
Chairman
Indian Pharmacopoeia Commissions Crude Dry & Herbal Product Committee
2.
Dr. Philipe Haydon
CEO
The Himalaya Drug Company
3.
Ms. Julie Buragohain
Head-Corporate Legal
The Himalaya Drug Company
4.
Dr. JLN Sastry
Head Healthcare Research
Dabur Research and Development Centre, Ghaziabad
Officers, Experts and Stakeholders Consulted  xv
5.
Brigadier VAM Hussain
Ex-Managing Director
IMPCL
6.
Dr. Amit Agarwal
M/s Natural Remedies Ltd. Group of Industries
Bengaluru
Heads of Educational Institutions Faculty Members, Research Officers and Medical Officers Odisha 1. Dr. BB Behera Deputy Director Homoeopathy Department of Indian Medicine & Homeopathy 2. Dr. Gaurav Giri Drugs Inspector (Ayurveda) Department of Indian Medicine & Homoeopathy 3. Shri RN Sethy Establishment Officer Department of Indian Medicine & Homoeopathy 4. Shri Adait Kumar Pradhan State Programme Manager National Rural Health Mission 5. Dr. Rama Krushna Mishra Inspector Ayurveda Cuttak Circle, Odisha 6. Dr. Surendra Kumar Mishra I/C Inspector of Ayurvedic Eastern Circle Bhubaneshwar 7. Prof. (Dr.) Kamadev Das Principal Gopalbandhu Ayurveda Mahavidyalaya Puri, Odisha 8. Dr. LK Nanda Former Principal Dr. ACHMC&HC Bhubaneshwar
xvi  Status of Indian Medicine and Folk Healing
9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.
Dr. NP Naik Deputy Superintendent Government Ayurvedic Hospital Bhubaneswar Dr. Narendra Hota State Research Officer Directorate of AYUSH State Government Dr. RN Acharya Scientific Officer Drug Testing Laboratory (ISM) Bhubaneshwar Dr. Kamal Khan In-charge Government Unani Dispensary District Bhadrak, Odisha Dr. Satyabrata Mohapatra Ayurvedic Medical Officer Odisha Dr. Subrat Mohanty Ayurvedic Medical Officer Odisha Dr. Md. Okar Shamce Unani Medical Officer Government Unani Dispensary Cuttak Dr. Safiqur Rehman Medical Officer (Unani) Dobal, District Bhadrak, Odisha Dr. Ashok Kumar Sitha In-charge PHC, Satasankh, Odisha Dr. RN Mishra In-charge Medical Officer CHC, Dharamshala, Jajpur, Odisha Dr. JJ Mishra Gynaecologist CHC, Badachana, Odisha Dr. Manoranjan Mohapatra Consultant AYUSH Odisha Dr. Soumya Devi AYUSH Doctor
22. 23.
PHC, Satasankh Odisha Dr. Anita Behera AYUSH Doctor CHC, Dharamshala, Jajpur, Odisha Dr. Rehanuddin Khan AYUSH Doctor (Unani) City Hospital, Cuttak
Uttar Pradesh 1. Prof. Saood Ali Khan Principal and Chief Medical Superintendent AK Tibbiya College 2. Prof. Shagufta Aleem Dean Faculty of Unani Medicine AK Tibbiya College, AMU, Aligarh 3. Prof. Mukhtar Husain Hakim Department of Moalijat AK Tibbiya College, AMU, Aligarh 4. Prof. Abdul Mannan Department of Moalijat AK Tibbiya College, AMU, Aligarh 5. Prof. MMH Siddiqui Department of Elaj Bit Tadbir (Regimental Therapy) AK Tibbiya College, AMU, Aligarh 6. Dr. Misbahuddin Siddiqui Associate Professor Department of Moalijat AK Tibbiya College, AMU, Aligarh 7. Dr. Younus Siddiqui Associate Professor Department of Moalijat AK Tibbiya College, AMU, Aligarh 8. Dr. Sanjeev Rastogi Associate Professor Department of Panchakarma State Ayurvedic College& Hospital University of Lucknow, Uttar Pradesh 9. Dr. Tafseer Ali Assistant Professor and Deputy Medical Superintendent AK Tibbiya College & Hospital, AMU Aligarh
10. 11. 12. 13.
Prof. M Wasi Akhtar Department of Moalijat AK Tibbiya College, AMU, Aligarh Dr. YC Sharma Lecturer (Medicine) State Ayurvedic College Lucknow, Uttar Pradesh Dr. Arvind Srivastava Lecturer State Ayurvedic College, Uttar Pradesh Dr. Mohd Belal Guest Faculty Department of Amaraze Jild AK Tibbiya College, AMU, Aligarh
Andhra Pradesh 1.
Dr. N Satya Prasad
Principal
Dr. BRKR Government Ayurvedic College
Hyderabad
2.
Dr. Syed Arifuddin
Principal
Government Nizamia Tibbi College
Hyderabad
3.
Dr. Mir Yousuf Ali
Professor & HOD
Department of Ilmul Advia
Government Nizamia Tibbi College
Hyderabad
Himachal Pradesh 1.
Dr. SK Sharma
Sr. Medical Superintendent
Regional Ayurvedic Hospital
State Government of Shimla
2.
Prof. Sanjeev Sharma
Medical Superintendent
Rajiv Gandhi Government PG Ayurvedic College (RGGPGAC&H)
Himachal Pradesh
3.
Prof. YK Sharma
Head
Department of Kayachikitsa
Officers, Experts and Stakeholders Consulted  xvii
4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
Rajiv Gandhi Government PG Ayurvedic College (RGGPGAC&H) Himachal Pradesh Prof. Eena Sharma Head Striroga avam Prasuti Tantra Rajiv Gandhi Government PG Ayurvedic College (RGGPGAC&H) Himachal Pradesh Dr. Ramesh Arya Head & Professor Department of Shalya RGGPGAC&H Himachal Pradesh Dr. Sanjeev Awasthi Reader & Head Department of Shalakya RGGPGAC&H, Himachal Pradesh Dr. Baldev Awasthi District Ayurvedic Officer Kullu Dr. Vidyasagar Gupta District Ayurvedic Officer Mandi Dr. Bhagat Ram Sharma District Ayurvedic Officer Kangra Dr. Hemraj Sharma District Ayurvedic Officer Solan Dr. Uttam Chand Chandel District Ayurvedic Officer Bilaspur Dr. Subhash Rana In-charge ISM Herbal Garden Jogindernagar, Himachal Pradesh Dr. Sushil Nag Ayurvedic Medical Officer, Casualty RGGPGAC&H Himachal Pradesh Dr. Thakur Singh Bhatt Ayurvedic Medical Officer, Casualty RGGPGAC&H Himachal Pradesh
xviii  Status of Indian Medicine and Folk Healing
15. 16.
Dr. Virender Kaul Ayurvedic Medical Officer, Casualty RGGPGAC&H Himachal Pradesh Dr. Vikram Rana Ayurvedic Medical Officer, Casualty RGGPGAC&H Himachal Pradesh
Jammu & Kashmir 1. Dr. Mohammad Iqbal Principal KTC, Srinagar 2. Dr. Khurshid Ahmad Bhakshi Principal IAMS, Srinagar 3. Dr. Mohammad Iqbal Medical Superintendent Jawahar Lal Nehru Memorial Hospital Rainawari, Srinagar 4. Dr. Mohammad Maqbool Medical Superintendent District Hospital, Pulwama 5. Smt Geeta Garg Professor Jammu Institute of Ayurveda Research Jammu & Kashmir 6. Dr. Mohammad Ayuoob Ganie District Medical Officer District Hospital, Pulwama 7. Dr. Syed Ashaq Hussain District Medical Officer Srinagar 8. Dr. Syed Ashiq Hussain ADMO, Srinagar 9. Dr. Saif-ul-Abrar In-charge, AYUSH Unit Jawahar Lal Nehru Memorial Hospital Rainawari, Srinagar 10. Dr. Mushtaq Ahmad Parry In-charge, AYUSH Unit Government Medical College & Hospital Srinagar 11. Dr. Bilal Ahmad Wani Unani Doctor In-charge PHC, Gulmarg
12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
Dr. Asif Khan Block Medical Officer and In-charge CHC, Tanmarg Dr. Shabeer Ahmed Gaffari Medical Officer Directorate of ISM, J&K Dr. Nuzhat Manzoor Technical Officer J&K State Medicinal Plant Board Dr. AS Shawl Sr. Scientist (Ex-HOD) Indian Institute of Integrative Medicine (IIIM), Jammu Dr. Nazir Ahmed Ahanger Unani Doctor Government Unani Hospital Shaltang, Srinagar Dr. Irfan Bandey Unani Doctor Government Unani Hospital Shaltang, Srinagar Dr. Musaddaq Ahmed Unani Doctor Government Unani Hospital Shaltang, Srinagar Dr. Roohi Tabbasum Ayurvedic Doctor Government Unani Hospital Shaltang, Srinagar Dr. Shaheen Mir Ayurvedic Doctor Government Unani Hospital Shaltang, Srinagar Dr. Bilal Ahmed Ayurvedic Doctor Government Unani Hospital Shaltang, Srinagar Dr. Taseer Unani Doctor Jawahar Lal Nehru Memorial Hospital Rainawari, Srinagar Dr. Shahnawaz Unani Doctor Jawahar Lal Nehru Memorial Hospital Rainawari, Srinagar
24. 25. 26.
Dr. Mushtaq Ahmad Aga Unani Doctor Government Medical College & Hospital Srinagar Dr. Irfana Latief Unani Doctor Government Medical College & Hospital Srinagar Dr. Arshad Hussain Thoker Unani Doctor District Hospital, Pulwama
Delhi 1. Prof. Raisur Rahman Department of Moalejat Ayurvedic & Unani Tibbia College & Hospital Karol Bagh, New Delhi 2. Dr. HC Gupta Associate Professor Department of Kayachikitsa Ayurvedic & Unani Tibbia College & Hospital Karol Bagh, New Delhi 3. Dr. Praveen Choudhary Associate Professor Department of Shalya Ayurvedic & Unani Tibbia College & Hospital Karol Bagh, New Delhi 4. Dr. Prabhakar Rao Chief Medical Officer Employees State Insurance Corporation (ESIC Dispensary) Nand Nagri, New Delhi 5. Dr. Sathyanarayana Dornala Panchakarma Specialist Swami Vivekanand Ayurvedic Panchakarma Hospital Dilshad Garden East Delhi Municipal Corporation 6. Dr. Mamta Ralhan Senior Medical Officer Municipal Corporation of Delhi Rajouri Garden New Delhi
Officers, Experts and Stakeholders Consulted  xix
Private Practitioners 1. 2.
Dr. G Geetha Krishnan Senior Consultant Ayurveda Co-ordinator Integrative Medicine Department of Integrative Medicine Medanta the Medicity, Gurgaon Dr. Gopal Dutt Sharma Principal Vaidya Yagya Dutt Sharma Ayurved Mahavidyalaya Khurja, Uttar Pradesh 3. Hakim MS Usmani Formerly Senior Faculty Ayurvedic &Unani Tibbia College & Hospital Karol Bagh, New Delhi 4. Hakim AJ Khan Formerly Senior Faculty Ayurvedic & Unani Tibbia College & Hospital Karol Bagh, New Delhi 5. Hakim Anwar Ahmad Formerly Senior Faculty Ayurvedic & Unani Tibbia College & Hospital Karol Bagh, New Delhi 6. Dr. Tom Paul Angamali, Ernakulum 7. Dr. Rakesh Kapoor Traditional Healer Himachal Pradesh 8. Dr. Ashwini Sharma Ayurvedic Practitioner Himachal Pradesh 9. Dr. Manik Soni Ayurvedic Practitioner Himachal Pradesh 10. Dr. Mohammad Haroon Unani Practitioner Uttarakhand
11. 12. 13. 14. 15. 16. 17.
Dr. M Sadique Unani Practitioner District Bhadrak Odisha Dr. Niyametullah Siddique Unani Practitioner District Bhadrak Odisha Dr. Mazharuddin Private Practitioner Nimasahi, Cuttak Vaidya Kripa Ram Traditional Healer Arki Village, Himachal Pradesh Vaidya Ram Kumar Bindal Ayurvedic Practitioner Solan Hakim Zafar Khan Unani Practitioner Sambal District, Uttar Pradesh Shri Sabir Ali Ansari Bone Setter (Unani) Uttar Pradesh
Others 1. 2.
Ms. Reecha Das 5th year B.A.L.L.B The West Bengal National University of Jurisdical Science Kolkata Dr. Claudia Lang* Postdoctural Researcher of Cultural Anthropology Institute of Social and Cultural Anthropology Ludwig-Maximilians-University Munich Germany
Technical Staff: 1. Shri Zameer Ahmad Investigator, CRIUM Lucknow
Note: * Those with whom the PI corresponded through mail or phone.
xx  Status of Indian Medicine and Folk Healing
Abbreviations and Acronyms ADHD
Attention Disorder
ADMA
Deficit
Hyperactive
BAMS
Bachelor of Ayurvedic Medicine & Surgery
Ayurvedic Drug Manufacturers' Association
BD
Bis Die (two times in a day)
BHU
Benaras Hindu University
ADMO
Assistant District Medical Officer
BMO
Block Medical Officer
AIDS
Acquired Immuno Syndrome
BPH
Benign Prostatic Hypertrophy
BPL
Below Poverty Line
AIIA
All India Institute of Ayurveda
BUMS
AIIMS
All India Institute of Medical Sciences
Bachelor of Unani Medicine & Surgery
CABG
Coronary Artery Bypass Graft
AIIPMR
All India Institute of Physical Medicine and Rehabilitation
CAM
Complementary and Alternative Medicine
AIW
Artificial Insemination Workers
CCIM
AMO
Ayush Medical Officer
Central Council Medicine
AMU
Aligarh Muslim University
CCMB
ANM
Auxiliary Nurse Midwife
Centre for Cellular Molecular Biology
AP
Andhra Pradesh
CCRAS
APD
Acid Peptic Disease
Central Council for Research in Ayurvedic Sciences
APL
Above Poverty line
CCRUM
APM
Ayurvedic Proprietary Medicine
Central Council for Research in Unani Medicine
ARRI
Ayurveda Institute
CD
Compact Disc
CEO
Chief Executive Officer
CGHS
Central Scheme
Deficiency
Regional
Research
of
Government
Indian and
Health
ART
Anti Retroviral Therapy
ASC
Altered State of Consciousness
ASHA
Accredited Social Health Activist
CH
Community Health
ASIIA
A Science Initiative in Ayurveda
CHC
Community Health Centre
ASU*
Ayurveda, Siddha, Unani
CMC
Christian Medical College
ASUDCC
Ayurveda, Siddha & Unani Drugs Consultative Committee
CME
Continuing Medical Education
CMO
Chief Medical Officer
ASUDTAB Ayurveda, Siddha & Unani Drugs Technical Advisory Board
CRAV
Certificate of Rashtriya Ayurveda Vidyapeeth
ATT
Anti-tuberculosis Treatment
CRIUM
AVP
Ayurvedic Veterinary Products/ Ayurvedic Veterinary Practice
Central Research Institute of Unani Medicine
CRM
Common Review Mission
AVS
Arya Vaidya Sala
CSIR
AYUSH*
Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy
Council of Scientific & Industrial Research
CSRP
Centre for Scientific Research in Panchakarma
Abbreviations and Acronyms  xxi
FMRI
Functional Magnetic Resonance Imaging
Clinical Trials Registry of India
FPG
Fasting Plasma Glucose
CV
Curriculum Vitae
FRLHT
D&C Act
Drugs & Cosmetics Act
Foundation for Revitalization of Local Health Traditions
DAO
District Ayurveda Officer
FSSAI
DCA
Drugs & Cosmetics Act
Food Safety & Authority of India
DCAR
Drugs & Cosmetics Act Rules
GAU
Gujarat Ayurved University
DCGI
Drugs Controller General of India
GB
Governing Body
GCP
Good Clinical Practices
DDA
Delhi Development Authority
GDP
Gross Domestic Product
DG
Director General
GHPL
Good Health Plan Ltd.
DGHS
Director-General Services
GIT
Gastro-Intestinal Tract
GMP
Good Manufacturing Practices
CSS
Centrally Sponsored Scheme
CT
Computerized Tomography
CTRI
of
Health
Standards
DH
District Hospital
GOI
Government of India
DHS
Directorate of Health Services
GP
General Practitioner
DIL
Dabur India Limited
HCCA
DIMH
Department of Indian Medicine & Homoeopathy
Homoeopathic Central Council Act
HDC
Himalaya Drug Company
DM
Diabetes Mellitus
HIV
Human Immunodeficiency Virus
DMET
Director of Medical Education & Training
HOD
Head of Department
HP
Himachal Pradesh
DMRA
Drugs and Magic Remedies Act
HPTLC
DNB
Diplomate of National Board
High Performance Thin Layer Chromatography
DOTS
Directly Observed Treatment – Shortcourse chemotherapy
HS
Hora Somni (at bed time)
IAD
Institute of Applied Dermatology
DPR
Detailed Project Report
I-AIM
DS
Double Strength
Institute of Ayurveda Integrative Medicine
DTL
Drug Testing Laboratory
IAS
Indian Administrative Service
DUB
Dysfunctional Uterine Bleeding
IBS
Irritable Bowel Syndrome
EAG
Empowered Action Group
ICCMR
ECG
Electro Cardiography
EEG
Electroencephalography
International Congress on Complementary Medicine Research
EFC
Expenditure Finance Committee
ICMR
ELISA
Enzyme Linked Immunosorbent Assay
Indian Council Research
ICU
Intensive Care Unit
ENT
Ear, Nose, Throat
IDEA
ESIC
Employees State Corporation
Initiative on Diabetes Education and Awareness
IEC
FMCG
Fast Moving Consumer Goods
Information, Education Communication
xxii Status of Indian Medicine and Folk Healing
Insurance
of
and
Medical
and
J-AIM
Journal of Ayurveda Integrative medicine
Indian Forest Service
JAMA
Indira Gandhi National Open University
Journal of American Medical Association
J&K
Jammu & Kashmir
IHD
Ischaemic Heart Disease
JNU
Jawaharlal Nehru University
IIHM
Indian Institute of History of Medicine
KHADC
Khasi Hills Autonomous District Council
IIHMR
Indian Institute of Management Research
KIMS
Kalinga Institute Sciences
IIIM
Indian Institute of Integrative Medicine
LCMS
Liquid Chromatography Mass Spectrometry
IIPS
International Institute Population Sciences
LHT
Local Health Traditions
MBBS
Bachelor of Medicine Bachelor of Surgery
IEEE
Institute of Electrical Electronic Engineers
IFS IGNOU
and
Health
of
of
and
Medical
and
IISc
Indian Institute of Science
IIT
Indian Institute of Technology
MCI
Medical Council of India
IJAR
International Journal of Ayurveda Research
MD
Doctor of Medicine
MDT
Multi Drug Therapy
IJCP
International Journal of Clinical Practice
MIS
Management System
IM
Integrative Medicine
MLA
Member of Legislative Assembly
IMA
Indian Medical Association
MLC
Member of Legislative Council
IMCC
Indian Council
MMP
Modern Medicine Practice
MO
Medical Officer
IMI
International Institute
MoHFW
Ministry of Health & Family Welfare
IMNCI
Integrated Management of Neonatal and Childhood Illness
MR
Medical Representative
IMPCL
Indian Medicines Pharmaceutical Corporation Ltd.
MRAV
Member of Rashtriya Ayurveda Vidyapeeth
IMS
Institute of Medical Sciences
MSR
Minimum Requirements
INCAA
Indian National Confederation and Academy of Anthoropologists
NAAC
National Assessment Accreditation Council
IPCA
Indian Pharmaceutical Combine Association
NABH
National Accreditation Board for Hospitals & Health Care Providers
IPD
In Patient Department
NBE
National Board of Examinations
IPHS
Indian Public Health Standards
NBRC
National Brain Research Centre
ISM&H*
Indian Systems of Medicine & Homoeopathy
NCAER
National Council of Applied Economic Research
IT
Information Technology
Medicine
Central
Management
Information
Standard and
Abbreviations and Acronyms  xxiii
National Centre for Complementary and Alternative Medicine
OD
Omne die (once a day)
OHA
Oral Hypoglycemic Agents
OPD
Out Patient Department
NCD
Non-Communicable Diseases
OSD
Officer on Special Duty
NCE
New Chemical Entities
OTC
Over the Counter
NCHRH
National Council for Human Resources in Health
PA
Personal Assistant
NCT
National Capital Territory
PNDT Act
Pre Natal Diagnostic Techniques Act
NE
North East
PCIM
NEIFM
North East Institute of Folk Medicine
Pharmacopoeia Commission for Indian Medicine
PCOD
Poly Cystic Ovarian Disease
NFHS
National Family Health Survey
PCT
Participating Countries Treaty
NGO
Non-Government Organization
PEPC
NHSRC
National Health Research Centre
Performance Expectations Patient Counselling
PEPSU
NIA
National Institute of Ayurveda
Patiala and East Punjab States Union
NIDDM
Non Insulin Dependent Diabetes Mellitus
PG
Post Graduation
PGI
Post Graduate Institute
NIH
National Institutes of Health
PHC
Primary Health Centre
NIHFW
National Institute of Health and Family Welfare
PhD
Doctor of Philosophy
NIIMH
National Institute Medical Heritage
PHFI
Public Health Foundation of India
PHSC
Public Health Sub Centre
NLEM
National List Medicines
PI
Principal Investigator
PIL
Public Interest Litigation
NMBG
Nehru Memorial Garden
PIP
Project Implementation Plan
PLIM
NMITLI
New Millennium Indian Technology Leadership Initiative
Pharmacopoeial Laboratory for Indian Medicine
PME
Pre-mature Ejaculation
NMPB
National Medicinal Plants Board
PPG
Post Prandial Glucose
NMR
Nuclear Magnetic Resonance
PPM
Patent & Proprietary Medicine
NRHM
National Rural Health Mission
PRI
Panchayati Raj Institutions
NRI
Non Resident Indian
PSA
Principal Scientific Adviser
NRIADD
National Research Institute of Ayurvedic Drug Development
PSC
Public Service Commission
PSU
Public Sector Undertaking
NSAIDS
Non Steroidal Anti Inflammatory Drugs
QCI
Quality Control of India
RAV
Rashtriya Ayurveda Vidyapeeth
NSG
National Security Guards
RCH
Reproductive & Child Health
NSSO
National Sample Organization
R&D
Research and Development
NCCAM
NUD
Systems
of
of
Non Ulcer Dyspepsia
xxiv  Status of Indian Medicine and Folk Healing
Indian Essential
Botanical
Survey
&
RGGPGAC Rajiv Gandhi Government Post Graduate Ayurveda College
TDS
Ter die sumendus (three times a day)
TID
Ter in die (three times a day)
TM
Traditional Medicine
Regional Research Institute of Unani Medicine
UAE
United Arab Emirates
UGC
University Grants Commission
SAB
Skill Attendant at Birth
UNAIDS
SC
Sub Centre
United Nations Programme on AIDS
SMPB
State Medicinal Plants Board
UP
Uttar Pradesh
SOP
Standard Operating Procedures/ Practices
US
United States
USA
United States of America
SPECT
Single Photon Emission Computerized Tomography
USG
Ultra Sonography
UT
Union Territory
SPM
State Programme Manager
UTI
Urinary Tract Infection
SRF
Senior Research Fellow
VAP
Veterinary Ayurvedic Products
STD
Sexually Transmitted Diseases
VATS
Video-Assisted Thoracic Surgery
VD
Veterinary Doctor
VHC
Village Health Committee
VLI
Veterinary Livestock Inspectors
VLW
Village Level Workers
WHO
World Health Organization
RMP
Rural Medical Practitioners
RO
Research Officer
ROTP
Re-Orientation Programme
RRIUM
Training
TAMPCOL Tamil Nadu Medicinal Plant Farms and Herbal Medicines Corporation Ltd. TB
Tuberculosis
TBS
Traditional Bone Setter
TCM
Traditional Complementary Medicine/Traditional Chinese Medicine
* Explanatory Note on the alternate use of ASU, AU, AYUSH and ISM&H in Parts I and II of the Report. •
In Part I the term ASU was used because that report dealt with specific aspects of the Ayurvedic, Siddha and Unani systems of medicine in relation to research, education, practice and drug manufacture. The acronym ASU referred to the three systems and was also used to distinguish them from Homoeopathy, Naturopathy and Yoga.
•
In Part II there is practically no mention of the Siddha system. This is because the PI has based most of the findings upon observations and interviews held in States where the Siddha system is not being practised. Hence when referring to the medical systems, the term AU has been used.
•
The acronym AYUSH has been used mainly in the context of integration of health delivery envisaged by NRHM. The term AYUSH has therefore been used in a generic sense as used in Government parlance and refers to its role in service delivery.
•
The term ISM has been used occasionally in keeping with this nomenclature which continues to be used in States like Jammu & Kashmir.
Abbreviations and Acronyms xxv