Start-ups Embrace Ayurveda Boom

WHEN ANIRUDDHA JOSHI, an engineering student, took his father to a doctor who specialises in pulse-based diagnosis technique — Nadi Parikshan — he was amazed to see the wealth of information the practitioner of this age-old system of medicine could extract just by placing his fingers on the patient’s wrist. The technique intrigued him so much that when he began his PhD at IIT Bombay, his focus was on developing the first-ever accurate pulse recording sensor. Today, Pune-based start-up Atreya Innovations sells a digital device called Nadi Tarangini, a patented AI-based instrument based on pulse (nadi) diagnostic system according to ayurvedic principles. It gives a pulse report of 22 ayurvedic parameters along with diet and lifestyle corrective plan within minutes. It even tracks the level of thoughts and stress!

Joshi says his company’s main objective is to develop the world’s most personal and portable health monitor based on ayurveda and data science, helping people globally get back to a healthy and balanced lifestyle. “Our sales team is selling at a rate of one or two devices a day. We have sold our devices to over 1,000 ayurveda clinics, more than 35 ayurveda colleges, four spas and nine yoga studios, touching the lives of over 4.5 lakh patients.”

Joshi is part of a growing tribe of tech entrepreneurs trying to reshape the future of age-old Indian systems of medicine. Start-ups in AYUSH (acronym for ayurveda, yoga and naturopathy, unani, siddha, sowa-rigpa and homoeopathy) are blending technology and traditional knowledge to offer a variety of solutions, products and services, ranging from digital clinical decision management and support systems to electronic health records software to digital ayurveda database, e-commerce platforms and online consultation.

Ayurveda is the predominant traditional system of medicine in India. Unani (also known as tibb, an Arabic word) is a medical system with comprehensive solutions for various states of the human body, providing preventive, promotive, curative and rehabilitative healthcare. Siddha is individualistic in nature, and diagnosis of diseases are done through examination of tongue, colour of body, speech (voice), eye, touch, stool, urine, nadi (pulse) and status of digestion of individual patients. Yoga comes from the Sanskrit word “yuj”, which means “to unite or integrate”. It is primarily a way of life, first propounded by Maharshi Patanjali in systematic form Yogsutra. Naturopathy has cost-effective non-pharmacological therapies involving the use of natural materials for healthcare and healthy living. Homoeopathy is based on the principle of Law of Similars, which means a drug that could produce certain symptoms in healthy individuals could also cure similar disease symptoms, in accordance with natural laws of similars perceived by ancient physicians. Sowa-rigpa, commonly known as Amchi medicine, is the traditional medicine of the Himalayan regions. Its fundamentals are based on Panch Maha Bhuta, Tri Dosh, Sapt Dhatu and other ayurvedic fundamentals.

The Ministry of AYUSH categorises India’s AYUSH market by revenue share — nutraceuticals (42.3%), pharmaceuticals (30%), herbal plants (13.8%) and others, including cosmeceuticals, plant derivatives and plant extracts. The only way to understand the huge share of ayurveda in the AYUSH economy is to look at the number of licensed manufacturers offering products in the segment and the number of beds offering ayurveda services. According to official data, of the 8,705 licensed AYUSH manufacturing units in the country, 7,463 cater to ayurveda. The rest include unani (599), homoeopathy (384) and siddha (259). In terms of bed strength, too, of the 61,549 AYUSH beds across institutions in India, 45,268 offer ayurveda treatment and care.

AYUSH in general and ayurveda in particular are fast adopting technology and using digital tools to introduce not just better medicines and medical practices, but superior herbal ingredients, health supplements and nutraceuticals as well.

According to the Ministry of AYUSH’s Decade of Transformative Growth report, AYUSH manufacturing industry grew six times — from ₹21,697 crore ($2.85 billion) in FY15 to ₹1,37,800 crore ($18.1 billion) in FY22. Adding another ₹1,67,700 crore worth of market of AYUSH services, the report puts India’s AYUSH market at ₹3,59,900 crore ($43.4 billion) — a 2.8% global market share, up from 0.5% in 2016. The ministry’s AYUSH landscape covers therapeutic segment as well as wellness, FMCG, herbal extracts and other possible businesses that have an AYUSH link to arrive at this market size estimate. What makes the ministry’s claim interesting is the fact that technology adoption and efforts to provide science-based evidence for the effectiveness of traditional therapies and practices are beginning to transform the entire AYUSH ecosystem. “We are working closely with the Ministry of Health for mainstreaming of AYUSH. We have different schemes for industry facilitation; we do global positioning of AYUSH and are creating an ecosystem that will transform India’s traditional medicine sector. We already have over 900 AYUSH start-ups,” says Vaidya Rajesh Kotecha, secretary, Ministry of AYUSH.

What is so interesting about new-age AYUSH firms? How are they transforming the sector, and how are traditional players responding? Also, is the growth real? Can AYUSH systems actually make a global impact? And, is the government playing a critical role in driving these changes?

Redefining Practices

In 2017, NirogStreet, a Delhi-based start-up set up a year ago with the objective of making ayurveda the first call of treatment for people, organised a conference in the Constitution Club, New Delhi. It brought together about 250 ayurvedic doctors, academicians, companies and stakeholders, including the public. “When I started NirogStreet in April 2016, I was clear about what I was not going to do. I did not want to build an online consultation booking website or an online sales outlet. But I was not clear what I have to do to help one billion-plus lives make ayurveda their preferred choice of treatment. The response to the conference from ayurvedic doctors was my ‘aha’ moment. I knew that to make ayurveda trustworthy, I should create a community platform for practitioners,” recalls founder Ram N. Kumar. The company’s first product was an app and later a website to connect doctors, for peer-to-peer learning and deliver better healthcare to patients. It was exclusively meant for BAMS (Bachelor of Ayurvedic Medicine and Surgery) graduates. “We built a simple community where doctors would learn from peers, share experiences, case studies, and in the process, make treatments more effective for patients,” explains Kumar. Today, NirogStreet has over 50,000 verified ayurvedic doctors who are active on the platform. Of the 4,50,000 registered BAMS graduates in the country, some 1,50,000 have downloaded the app and are connected to the platform. While the community platform is entirely free, NirogStreet has onboarded about 50 reputed ayurveda companies from whom these doctors can order the products they prescribe. With its own warehouses in place, the company takes care of product quality and delivery. “We are building a 100% supply side ecosystem for ayurveda and AYUSH. We have 6,000 SKUs on the platform. In FY23 our audited revenue was close to `37 crore. It should be close to `100 crore in FY24. This year we are going to do `300 crore worth of transactions through the platform,” says Kumar.

The RP-Sanjiv Goenka Group recently launched two new products under its fast-growing wellness category — De-Stress & Chill Gummies and De-Stress & Focus Tablets. While De-Stress & Chill Gummies has been formulated using saffron, ashwagandha, and lavender (gummies calm the mind, improve mood, and reduce anxiety), De-Stress & Focus tablets contain doses of enXtra, KSM-66 ashwagandha, and blueberry to boost concentration and sharpen memory.

Across the country, tech-enabled offerings catering to the AYUSH sector are being tried out by dozens of firms. For instance, Kerala-based PramAna AyurTech Solutions is developing deep-tech solutions to enhance clinical evidence-building capabilities of ayurveda hospitals and physicians. It is known as the first AI-based, point-of-care digital assistant built on ayurveda intelligence for hospitals and physicians.

Ayur Sattva Technovation in Ahmedabad, meanwhile, creates software products and applications for physicians, and to improve the management of ayurvedic hospitals, naturopathy centres, and resorts. Bareilly-based Kapeefit Health is a digital ayurvedic doctor consultation platform, online pharmacy and electronic health record system dashboard developer. Kochi’s Ekavaidya Knowledge Services has developed Dravya app, a digital database on ingredients and products of ayurveda for authentic information. Kalash Medtech in Bengaluru is developing an apparatus and method for an automated ayurvedic therapeutic device for Kayasheka (pizzicchil) treatment. Pune-based Keshayurved Hair & Skin Care is already offering hair and skincare solutions and specialised ayurvedic treatment using latest technology and software-based report system for diagnosis. Nadipulse Prognostics in Kanpur is yet another start-up that aims to harness the wisdom of Nadi Parikshan (pulse diagnosis) through wristband technology. The wristband can help diagnose physical and mental conditions, and provide holistic healing solutions with dietary, lifestyle and yoga.

Product Focus

India’s AYUSH manufacturing industry has grown eight fold during 2014-24, says Kotecha. The study commissioned by the ministry projected a six-fold growth in seven years, which has become eight-fold in 10 years. “The size of the industry, according to latest estimates, is $48-50 billion, of which $24 billion is manufacturing alone,” he adds. The growth has been fuelled by factors, including a renewed interest in traditional remedies post-Covid. “Exports of chyawanprash and ashwagandha have gone up 700% and 400%, respectively,” says Kotecha.

The most prominent example of innovative approach in product development and marketing of AYUSH products in the last decade has been the growth of Patanjali Ayurved. Riding on the popularity of yoga guru Baba Ramdev, the company has been expanding its product portfolio at breakneck speed in recent years. In spite of controversies and litigations surrounding the claims made by the company, Patanjali continues to be one of the leading AYUSH firms in the organised sector, the ministry’s study points out. Other top firms by revenue from AYUSH-related products include Dabur, GSK, Marico and Hindustan Unilever (HUL). While product innovations, brand acquisitions and brand extensions are part of routine business activities of established majors, start-ups, too, are innovating in production and marketing of AYUSH products.

Hyderabad-based Ixoreal Biomed sells ashwagandha, a medicinal plant extract branded as KSM-66 Ashwagandha, a full-spectrum extract. The company uses a unique proprietary extraction process, based on Green Chemistry principles, sans alcohol or any other chemical solvent. In less than a decade, KSM-66 has become the world’s best-selling ashwagandha ingredient, with export to 48 countries and a global market share of 65%. According to Ixoreal, KSM-66 has been evaluated in 24 Gold Standard clinical trials to prove the effectiveness of ashwagandha. The company has complete control over root selection, cultivation, harvesting and processing of products.

“We ran a process for an induction of a global marquee private equity firm a couple of years ago and based on our business size, profitability, growth and market leading position, we got offers well upwards of $1.5 billion valuation,” says Kartikeya Baldwa, CEO, Ixoreal. “However, we chose not to pursue those offers since we found some lack of strategic alignment with the firms. Currently we are not in discussion with any investor and would like to keep it that way… But I do believe that the existing numbers of our business would give us a valuation of at least $2.2 billion,” says Baldwa.

As in the case of several other consumer-oriented industries and products, companies using digital marketing tools are also gaining traction. Bengaluru-based Adret Retail, which owns Kapiva brand of products, is one such example. The company considers itself India’s first modern holistic ayurvedic brand delivering innovative solutions to millennials. Kapiva is one among many digital platforms that have come up with ways of selling their natural products that can be broadly classified under AYUSH.

Yoga And Others

“Today the world is seeing a new yoga economy emerging” — When Prime Minister Narendra Modi stated this during his address to mark the International Day of Yoga on June 21, 2024, in Srinagar, it wasn’t just a pep talk.

One and a half years ago, in December 2022, Nita Nair, a researcher associated with Tata Memorial Centre (TMC), Mumbai, presented a landmark breast cancer study that looked at the effect of yoga on breast cancer patients at San Antonio Breast Cancer Symposium, one of the most prestigious conferences in the world held annually in the U.S. Results of the randomised clinical trial by TMC showed yoga resulted in a 15% relative improvement in disease-free survivors and 14% in overall survivors.

A decade after the United Nations recognised June 21 as International Day of Yoga, India’s ancient physical, mental and spiritual practices are gaining global popularity with each passing year. The country’s efforts to promote yoga are attracting wellness and mental peace-seeking foreign nationals to yoga centres, fuelling the local economy.

Government Initiatives

Thanks to his annual international yoga day addresses, the Prime Minister remains the most high-profile ambassador of AYUSH. In fact, in the first 100 monthly Mann Ki Baat addresses by PM Modi, AYUSH was mentioned in 37 episodes. Several start-ups referred to in those episodes have used the recognition to add to their brand-building exercises.

That’s not all. Budgetary allocation for the Ministry of AYUSH has increased from ₹1,272 crore in FY15 to ₹3,712 crore in FY25. The government has also made a conscious effort to bring AYUSH into the mainstream public health delivery system. “We have 12,500 AYUSH health and wellness centres (ayushman arogya mandir). Additionally, AYUSH doctors have been co-located in almost 35,000 National Health Mission facilities across India. There is an AYUSH centre in all district hospitals. In tertiary care centres, we have collaborations with several institutes. Multiple areas of research are ongoing and we have posted more than 42,000 AYUSH research publications in our portal,” says Kotecha.

The Centre has also notified a special visa category (AYUSH visa). The number of applicants in the category will be known in coming months.

Challenges Ahead

In spite of the claims of high demand for AYUSH products in the export market, trade numbers do not show any exceptional jump in recent years. One of the key categories of exports broadly described as medicaments of the ayurvedic system (which includes chyawanprash) dipped to $12.5 million in FY24 from $14.09 million in the previous year. The value of exports was the lowest in the last five years in this specific category. Similarly, the HS Code, which covers herbal products, food supplements etc, saw exports dip to $162 million in FY24 from a five-year high of $178 million in FY23. One of the hurdles exporters of AYUSH products face in developed markets is labelling requirement. Label it as an ayurveda product confined to the specifications in India’s pharmacopoeia, and it gets treated as a medicine which requires a different set of stringent approval process in that particular country. Labelling it as food supplements may not pass muster if it is categorised differently.

Controversies surrounding misleading claims and side effects of AYUSH products offer challenges in the domestic market as well. While the fact remains that unscrupulous elements within the industry are the ones that resort to unethical practices, erosion of trust is very quick in a digitally connected world. Scarcity of quality raw materials, rising costs, competition from bigger players etc are seeing traditional players in the segment either lying low, or preferring over-the-counter (OTC) products over therapeutic ones.

What The Future Holds

Several developments, nationally and internationally, may brighten the prospects of AYUSH products and services. For instance, in more than 30 countries that have approved ayurveda as a traditional system of medicine, the government is working on how their regulatory systems can recognise Indian standards. The World Health Organization (WHO) is developing an International Pharmacopoeia on Herbals — a collection of recommended procedures for analysis and specifications for active pharmaceutical ingredients (APIs), excipients and finished pharmaceutical products. This will see several plants of medicinal value from India, South East Asia etc included in it. Once ready, it will be recognised by other member countries of WHO as well.

Another business facilitation measure with possible far-reaching impact is the work carried out by a recently created AYUSH vertical in the Bureau of Indian Standards (BIS). Over 100 Indian standards for AYUSH products and services, including the ones for yoga mat, accessories and panchakarma procedures have been notified. As the next step, BIS has proposed to the International Organisation for Standardisation (ISO) to have a sectional panel on AYUSH. It is pending for voting. Once that happens, the Indian standards of AYUSH products will get ISO standards, allowing an easy entry to 150-plus ISO member countries.

On the domestic front, the Food Safety and Standards Authority of India (FSSAI) has created an Ayurveda Ahar category. It has been notified and regulations are in the final stage. Once it is launched, all non-therapeutic categories of AYUSH products will get an authentic certification of approval. There will be an approved recipe for classical products, and innovations will be categorised differently. Such a stamp of approval is expected to make AYUSH products more credible within the country and in foreign markets. It’s a long way still.

India’s share in the global traditional market is miniscule. Combined efforts of stakeholders, including the government, should create an impact, if not today, some time in future.