A REVIEW ON SCOPES, METHODS AND RATIONALE OF INTEGRATIVE APPROACH IN SIDDHA MEDICINE WITH BIOMEDICINE

In India, according to WHO 2018 statistics, there were 63% of death occurred due to Non-communicable diseases (NCDs), in which Cardiovascular diseases were leading cause of death 27%, followed by Cancer 9%, Chronic respiratory disease 11%, Diabetes 3% and other NCDs 13%. This indicates that NCDs needs to become a priority in controlling and preventing. Therefore, the only effective intervention may be at controlling and preventing NCDs disease is Integrative Medicine. Integrative Medicine is a medical practice synthesizing Traditional medicine and Biomedicine preventive measures and treatment interventions. Autonomy of patients may end in no benefit out of their ignorance to select between the treatment options available in a country like India where Seven Recognized medical systems are available as a platter. Siddha system of medicine is one of the traditional medicines of India, practiced in the southern part of the country. This study aims at providing Health care system under one roof, in order to save public money, time and health as an existing model as co-location in Tamil Nadu. This can be achieved through assessing feasible areas of integration in the Siddha system of medicine with biomedicine. So the study deals with the utilization of Siddha system of medicine, scientific validation of Siddha medicines, Siddha medicine research undertaken by biomedical practitioners and some government policies supporting mainstreaming of Siddha.


Definition
of integrative medicine (IM) is healingoriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence and makes use of all appropriate therapies [1]. Based on the review and close reading of medical peer-reviewed journals and government health statistics, Null et al. [2] show that the number of people having In-hospital, adverse drug reactions (ADR) to prescribed medicine in the US is 2.2 million per year. The most stunning statistic, however, is that the total number of deaths caused by conventional biomedicine is 783,936 per year, far higher than the number of deaths attributable to heart disease in 2001 that was 699,697 and cancer that was 553,251. In India, neither do we have any statistics of damages caused by medicine, nor a procedure to record damages due to medical errors and iatrogenic effects. The increase in the prevalence of non-communicable diseases, drug resistance and pharmaceutical complications; growing dissatisfaction with the outcomes of certain biomedical treatments; and the gaps provide conventional health care to several segments of the population, have directed much attention to traditional, complementary and alternative medical (TCAM) systems [3]. This has led global population to conceive the idea of integration of Biomedicine with Traditional Medicine as it may mutually benefit both the medical systems in the form of filling up the gaps.
Indian traditional medicine is prevalent around the globe and integration exists scatterdly with modern medicine for different health needs [4]. Siddha system of medicine is one of the traditional medicines of India, practiced in the southern part of the country. It is a primordial system of medicine that existed in the world. Siddhars are the spiritual scientists; they are well versed in Metallurgy, Geology and Phytochemistry. They have used all kinds of herbs, metals, minerals and animal products vastly. In spite of their popularity, the rational design, proper standardization, and careful monitoring of traditional Indian formulations, along with tough scientific evidence, are essential for their promotion [4]. In our time, there are lots of research are undertaken to bring out the scientific validation of Siddha medicine and they are published in national and international peer-reviewed journals. In AYUSH research portal around 1153 Siddha research articles, some of the research articles for various diseases are listed below (table 1).

Utilization of siddha system of medicines
In a study Shalini Rudra et al. explore the out-of-pocket expenditure on AYUSH treatment. The result shows that, the average expenditure on AYUSH medicines is Rs 270 in rural and Rs 378 in urban areas and is lower than average expenditure on non-AYUSH (allopathic) medicine [37]. This study focuses on AYUSH and lacks individual System wise which is warranted. To explore the integrative medicine, it is vital to understand the feasibility, efficacy and acceptability of Siddha interventions among the public. Some of the studies in Siddha OPDS around Tamil Nadu are listed below ( Phytochemical analysis of methanolic extract of seeds of Mucuna pruriens by gas chromatography-mass spectrometry; the analysis reveals the presence of 5 major compounds namely, pentadecanoic acid, 14methyl-, methyl ester, dodecanoic acid, 9,12-octadecadienoic acid (z,z)-, methyl ester, 9,12-octadecadienoic acid and 2-myristynoylglycinamide which are therapeutically potential [50].
These examples show how the benefits of Siddha medicines could be brought into the mainstream health care where they are balanced to play an increasingly important role.

Government health policies for mainstreaming of siddha
Several policies which may help to integrate Siddha medicine for health care system are listed below, . This is not only to treat diseases, but also to prevent diseases [56]. As a result, there is a reduction in morbidity and mortality of dengue fever. The antiviral activity of nilavembu kudineer was estimated by Jaspreet jain et al. [57], dengue and chikungunya virus through in vitro evaluation shows, NVK provides protection against CHIKV and DENV-2 during active infection and also help to prevent virus infection in the cells.

Amma magapeeru sanjeev kit
For the first time, drugs of Siddha systems have been incorporated into the kits of ante-natal cases throughout the state of Tamilnadu. Health and Family Welfare Department Demand No.19 Policy Note 2016-17 stated that Amma maperu sanjeevi, at Rs. 10 crore scheme, which will have a bouquet of 11 siddha medicines for pregnant women and newborn." A kit contains Madhulai Manappagu, Karuveppilai Podi, Nellikkai Legiyam, Elathy tablet, Annabedhi tablet, Ulundhu thailam and Pinda Thailam (both for external application), Paavana Panchakula thailam, sathavari legium, kunthiriga thailam, Urai mathirai. These medicines will reduce nausea, vomiting, balancing iron deficiency, reducing false pain, improve immunity in infants. This helps the health systems to take care of many of women and children as a first line of care through the Siddha medicine [58].

Varmam (Physical manipulation)
In biomedicine, the treatment for musculoskeletal disorders are local injections of steroids, Nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, antidepressants, muscle relaxants are either ineffective or provide short-lasting benefits [59]. With this hitch the medical industry is in need of effective, long lasting benefits in musculoskeletal disorders. Siddha varmam therapy originated from the southern part of Tamilnadu, is now practiced in South Asian countries like India, Srilanka and Malaysia. Varmam specifies the therapeutic manipulation of certain points in which the life energy is found pooled. Handling on these points with a particular force for the definite time will release the life energy from these points and fetch relief to the affected individual by regulating the flow of life energy which is blocked due to attack on particular Varmam points or due to other causes [22]. It offers a conservative management approach to pain, Neuro-musculoskeletal disorders, metabolic disorders, sensory defects, gastrointestinal, respiratory diseases, endocrine disorders, pediatric diseases like autism and trauma [9,22,24,30].  [60].

Karanool sigichai (Chemical cauterization)
Karanool sigichai is a unique para surgical treatment carried out for the management of fistula-in-ano. It is a method of chemical cauterization of fistula. Achyranthus salt, Dalmia extensa salt etc. are smeared on a surgical thread which is used to cut the tract. The major advantages of this procedure are, it will preserve the function of continence and prevents the recurrence of the condition and also cost effective [61,62]. This will open up a new scope of Siddha parasurgical procedure in Anal fistula.

Attai vidal (Leech therapy)
In the Act of June 28, 2004, the Food and Drug administration (FDA) cleared for the first time the commercial marketing of medicinal leeches for medicinal purposes and determined that leeches are medical devices. In Siddha text leech therapy, especially indicated for edema, headache, abdominal pain caused by dysentery, whooping cough in children, inflammatory joint diseases, eye diseases. Bio-constituents in leech saliva have vasodilator, anesthetic, anti-inflammatory activity and also inhibits the blood coagulation [63]. Leech therapy is used clinically for various diseases they are Osteoarthritis, Epicondylitis, varicose veins, and hematoma. It is also evident leech was used in dreadful condition, menigococcal purpura. As an integrative approach now leech is used in bone reconstruction surgery.

Yoga
The term 'Yogam' means 'union'. Siddhars have defined yogam as an art which controls the mind by preventing it from distracting through sense and sense organs and fuse it with the divinity. The eight steps or stages of yogam areIyamam (Learning discipline), Niyamam (Purity of action), Asanam (posture), Pranayamam (controlling one's breath), Prathyaharam (Controlling 5 senses), Dharanai (the practice of concentration), Dhyanam and Samadhi. Third step or stage of yogam is asanam, means posture or pose, it is also called as yogasanam. The perfect and scientific art of controlling one's breathing is called Pranayamam. It is also called as 'vasi' and 'vasiyogam [64]. Yoga can be integrated with various diseases such as Musculoskeletal disorders, Bronchial asthma [65], hypertension [66], depression, insomnia etc [13,19]. It can also be used as an adjuvant therapy for many non-communicable diseases.

DISCUSSION
The concept of 'integrative' medicine has come up several times earlier and is not new. This, however is not a call for Siddha alone, but it is all about the direction of change. World Health Organization (WHO) has announced desirable doctor-population ratio as 1:1,000.
In India as per current population, it gives a doctor (modern medicine) and a population ratio of 0 The Indian government also supports to promote the traditional medicine in India. The budget al. location for the Dept of AYUSH has increased gradually over the years. In the 12th Five Year Plan of India (2012-2017), the total allocation for AYUSH was INR. 10,044 crore, which was 235% more than the actual expenditure of 11th Plan [66]. Till date, AYUSH facilities have been co-located in 506 District Hospitals, 374 sub district Hospitals, 2871 CHCs, 8995 PHCs, and 5716 other healthcare centers. The Magnitude of AYUSH infrastructure in the country has reached 7,99,879 registered practitioners, said by the AYUSH minister on 19 July 2019 [67,68].
Although we have proof of scientific validation, the utilization of Siddha medicines for various diseases, the data for Siddha Intervention as Add-on, limitations for Siddha intervention (Dislodgement of renal calculi of bigger size), areas where Siddha can compliment such as usage of Mathan thylam in diabetic ulcer without disturbing the contemporary treatment module, drug-drug interactions, drug food interactions and food based health benefits have to be documented. The discovery of complete integrative approach guidelines of Siddha medicine with biomedicine is the only approach to resolve this crisis. Both Siddha and biomedicine experts in a particular field should assemble and prepare the guideline to safeguard the public.

CONCLUSION
Hence, there has been a huge utilization of Siddha medicine and also proof of scientific validation of Siddha medicine its usage in both communicable and non-communicable diseases, Integrating Siddha medicine with biomedicine is essential to offer better health facilities to public. Integration of Siddha with the existing health care system, not only helps in preventive and promotive health also focuses more in complementing Biomedicine by offering profound Siddha Varmam, Yoga therapy. Integrative approach is the only way to achieve the dream of health in an efficacious and cost effective manner.