1. What do we lack ????????????????? Dr Remya Krishnan MD (Ay) PhD, Associate Professor , Ayurveda 2. Ayurveda differs from Modern Medicine in the process of medical decision making . EBM in Modern Medicine refers to the concept that clinical decisions are formally supported by data based evidence derived from RCT. EBM in Ayurveda refers to the process of medical decision making formally supported by basic research evidence in science 3. Ayurveda is a settled science the theorems ( definite) and laws of which are proven and established by cause- mechanism- effect relationship . Modern Medicine is an unsettled science the theories ( indefinite) and observations are temporarily proven and approved by probability based statistics. 4. Though the basic science of Ayurveda insists to practice Science Based Evidence (SBE), Ayurveda doctors until today have not recognised and incorporated its necessity and relevance in their practice. 5. Substandard health care practices Excessive cost from irrational use of medicinal drug resources . Unsettled complexities and confusions in clinical practice Absence of global acceptance of the science as Medical system 6. Scientific method in Ayurveda is not hypothesis formation and data collection, classification and analysis for accepting or rejecting a particular diagnosis or treatment . Scientific method in Ayurveda is the judicious appraisal of science and science based techniques for conclusive decision making 7. The science of Ayurveda incorportes quantitative tools and highly accurate basement knowledge even when multiple factors act individually or together to affect the disease risk, progression or in response to treatment . The knowledge and tools constitute the scientific substratum of Ayurveda . 8. Modern Medicine is still in infancy of understanding and utilising the complexities and subtleness in diagnosis , management and prevention of any disease despite of technological advancement. The scientific basement and tools of Ayurveda on pertinent application would enable a scientist physician to solve the complexities in every named and unnamed diseases 9. No teaching and learning of Evidence based practice of Ayurveda . Physicians can never practice EBM if they are unfamiliar with science because in Ayurveda the intended and crucial primary evidences are embedded in science 10. The physicians who possess specialised skills in certain procedures and techniques continue the same in each and every case they get without appraisal of situation by evidence based guidelines in science. For eg kshara sutra experts and Panchakarma skilled physicians would recommend these to all patients of them irrespective of whether it is intended or not . 11. Acceptance of RCT double blind study reports of drug and procedures as approved evidence for medical decision making in place of Science Based Evidence (SBE ) of primary validity is leading to serendipity results 12. Physicians adopting variable practice styles based on tradition, convention, personal experiences , recollection etc and thus hardly know how to employ science in practice. 13. Opinions of greatness imposed personalities in the background of tradition, business etc . They create a wide misled impact in national and international platforms. 14. Patient welfare is many times the last concern that drives most of the clinical decisions. Economic incentives and financial issues ( dispensing and prescribing by common unit) exert stimulatory influences . Ignorance of what is intended forces the physician to practice business and not science 15. A physician of Ayurveda hardly knows the accurate mode of examination and case eliciting with relevant background questions when patients describe their signs and symptoms . At present , there is no standardised science based working diagnostic plan to work out accurate diagnosis for Ayurvedic physicians 16. Dr. Rajkumar and Dr.Remya Krishnan had developed a working diagnostic and treatment plan derived from science by employing science based parameters called Evidence Triad Approach (ETA) The physicians can reach the most scientifically optimised decisions by pertinent application of Science Based Evidence in three levels of increasing order of superiority namely the silver, golden and the diamond evidence by applying ETA. 17. ETA incorporates all the required scientific decision making components in a well structured format for confirmation of diagnosis and management decisions in all the cases that are encountered with 18. A patient presenting with dry cough The clinician decided even before starting to elicit the history that the patient is having vatik kasa by hearing dry cough . According to the physician the status is kasa owing to pranavaha srotodushti and is Vata predominant 19. The clinican failed to elicit the intrinsic and extrinsic factors which initiate the disease which would have clearly informed the adhisthana and samutthana vishesha of kasa in the patient . The patient was having all subjective and objective features of allergic cough (more dry cough early morning and middle of night exacerbated by certain specific agents )which is probably vishaja kasa . 20. Vishaja kasa requires immediate attention to the triggering cause gara visha in rakta vaha srotas leading to dry cough and not vitiated Vata in Pranavaha srotas . Treatment for Vata/ Vata kaphaja kasa targeted to Pranavaha srotas will NEVER produce cure of the disease . 21. The physician went wrong not because the patient (clinical status) got diverged from the textbook but rather the physician had got diverged from science . Most of the physicians fail to recognise the underlying initiators of pathogenesis and thus make their initial diagnosis wrong 22. When the initial diagnosis itself is wrong, then every subsequent calculatiuons are wrong . Though the patients provide accurate information, the physicians are unable to make use of them in correct mode in medical decision making 23. Experience can never make the situation changed. The more experienced the physician is, the more experienced his errors will be and he becomes stubborn to accept errors and continuously practice the error . Pertinent experience based on science is only valid experience. 24. Clinical practice guidelines based on Basic research evidences already exist in Ayurveda.Intense training is required for the physicians to employ them accurately in practice and research. Guidelines are to be conveyed by applying the scientifically standardised tools of EBA 25. These science based evidence based guidelines will serve to define and describe explicitly why and how the particular diagnostic and treatment decisions in particular situation are only scientifically accurate for the situation in specific. Guidelines are based on inbuilt basic research evidences and hence are primarily evidence based . 26. SBEBA provides a finished set of tools and techniques to practice Evidence Based Ayurveda. SBEBA is thus an enormously significant contibution that is changing the current irrational way of practice of Ayurveda. SBEBA advocates to replace reliance upon the gray haired tradition based healers with systemic learning, appraisal and application of indepth science of Ayurveda in accordance to variable state and stage . 27. THANKYOU