The parallel system: traditional, complementary and integrative therapies in neurorehabilitation in India

Abstract

Background: Disorders of the nervous system are now the leading cause of disability-adjusted life-years (DALYs) worldwide, accounting for 443 million DALYs and affecting 3.40 billion people, 43.1% of the world’s population. In India, non-communicable neurological disorders’ share of total DALYs doubled between 1990 and 2019, from 4.0% to 8.2%, with stroke alone accounting for 37.9% of neurological DALYs. Against this burden stands a second, parallel health system: 755,780 registered Ayush practitioners, 3,885 Ayush hospitals, and 12,500 Ayush Health and Wellness Centers, with public awareness of 94%–96% and national usage exceeding 50%. Most Indian patients with neurological disability use both systems, and almost none are managed by a clinician who knows what the other system is doing.

Objective: To appraise the current evidence for traditional, complementary, and integrative (TCI) therapies in neurorehabilitation in India, to separate what is demonstrated from what is asserted, and to propose a funded mechanism for integration anchored in the World Health Organization’s (WHOs) ratified frameworks.

Methods: Narrative review with a structured search of PubMed, the Cochrane Library, and Europe PubMed central (PMC) from September 2026, supplemented by WHO policy documents, Ministry of Ayush reports, and Clinical Trials Registry-India records. Therapies were grouped as movement-based (yoga, tai chi, Baduanjin, dance, and Kalarippayattu), whole-system pharmacological (Ayurveda, Siddha, and Unani), single-agent phytotherapeutic (Withania somnifera, Bacopa monnieri, Mucuna pruriens, and Centella asiatica), needle- and pressure-based (acupuncture, acupressure, and marma), and manual/procedural (Panchakarma, Abhyanga, Shirodhara, and Kalari massage). Evidence was graded by design hierarchy, with particular attention to sham-controlled comparisons.

Results and Discussion: The evidence is uneven, and that unevenness is itself the main finding. Yoga has Class I evidence in epilepsy for reducing felt stigma, with significantly higher odds of >50% seizure reduction (OR 4.11, 95% CI 1.34–14.69) and of complete remission (OR 7.4, 95% CI 1.75–55.89) in a 160-patient shamyoga- controlled Indian trial. Yoga in Parkinson’s disease improves motor scores (UPDRS-III mean difference –5.64, 95% CI –8.57 to –2.70), balance, mood, and quality of life in meta-analysis and is non-inferior to stretching and resistance exercise, with an added psychological benefit. Mucuna pruriens met all non-inferiority efficacy and safety endpoints against dispersible levodopa/benserazide in advanced Parkinson’s disease, with fewer dyskinesias. Conversely, yoga for stroke rehabilitation rests on two trials and 72 participants at very low GRADE certainty; acupuncture’s apparent benefit in stroke disappears against sham; and the first randomized controlled trial of Ayurvedic rehabilitation in ischaemic stroke, AyuRvedic TrEatment in the Rehabilitation of Ischemic STrOke patients in India (a randomized controlled trial) (RESTORE) (140 patients across four Indian comprehensive stroke centers), found Ayurveda not superior to physiotherapy, with the unadjusted Fugl-Meyer upper-extremity score favoring physiotherapy. Safety is not a footnote: lead was detected in 65% of 252 Ayurvedic samples in one public health investigation, and C. asiatica alters valproate and phenytoin pharmacokinetics.

Conclusion: The question is no longer whether Indian patients will use traditional and complementary therapies during neurological recovery; they already do, at scale, usually without telling their neurologist. The question is whether Indian neurology will regulate, measure, and integrate that use or continue to ignore it. Integration is feasible and necessary, but only on the terms the evidence itself sets: yoga and structured movement therapies as adjuncts within the rehabilitation prescription now, single-agent phytotherapeutics under pharmacovigilance, and whole-system Ayurvedic rehabilitation inside registered trials until a positive one exists.