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Ayurveda

Ayurveda (or Ayurvedic medicine) is an ancient medical system used primarily in India, Sri Lanka, and Nepal.  Up to 80% of India's population engages in Ayurveda, an integrative system of foods (spices & herbs), yoga, meditation, and massage.  It was used as long ago as 5000 years in the Indus Valley civilization then developed during the Vedic period 3000 years ago.  Its principle elements were developed 2000 years ago.  Many of the concepts of that era have persisted today in the medical system, leading to many Western scientists and physicians concluding it is a pseudoscience.  

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The Ayurvedic medical system is by nature a holistic system that holds physical existence, mental existence, and personality are a unit with each element having influence on the other elements.  The term ayurveda comes from the sanskrit word meaning "life-knowledge" and many of its concepts are rooted in Hinduism, Sāṅkhya and Vaiśeṣika philosophies, as well as with Buddhism and Jainism. with the classical Ayurvedic text, the Sushruta Samhita, claiming the God of Ayurveda Dhanvantari reincarnated himself as king of Varanasi, and taught Ayurveda to physicians including Sushruta. The system emphasizes humoral balance, and suppressing natural urges is considered unhealthy and claimed to lead to illness.

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Like the Hindu philosophy, Ayurveda has many lists of things that are important to the principles of practice. For instance, Ayurveda treatises describe three elemental substances, the humours (Sanskrit doṣas), wind (Sanskrit vāta), bile (pitta) and phlegm (kapha), and state that equality (Skt. sāmyatva) of the doṣas results in health, while inequality (viṣamatva) results in disease. Ayurveda treatises divide medicine into eight canonical components- 

  • Kāyacikitsā: general medicine, medicine of the body

  • Kaumāra-bhṛtya: the treatment of children, paediatrics

  • Śalyatantra: surgical techniques and the extraction of foreign objects

  • Śālākyatantra: treatment of ailments affecting ears, eyes, nose, mouth, etc. ("ENT")

  • Bhūtavidyā: pacification of possessing spirits, and the people whose minds are affected by such possession

  • Agadatantra: toxicology

  • Rasāyanatantra: rejuvenation and tonics for increasing lifespan, intellect and strength

  • Vājīkaraṇatantra: aphrodisiacs and treatments for increasing the volume and viability of semen and sexual pleasure.

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Ayurveda names seven basic tissues (dhatu), which are plasma (rasa), blood (rakta), muscles (māmsa), fat (meda), bone (asthi), marrow (majja), and semen (shukra). Like the medicine of classical antiquity, Ayurveda has historically divided bodily substances into five classical elements (Sanskrit [maha]panchabhuta, viz. earth, water, fire, air and ether.   There are also twenty gunas (qualities or characteristics) which are considered to be inherent in all substances. These are organized in ten pairs: heavy/light, cold/hot, unctuous/dry, dull/sharp, stable/mobile, soft/hard, non-slimy/slimy, smooth/coarse, minute/gross, and viscous/liquid.

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Ayurveda also names three elemental substances, the doshas (called Vata, Pitta and Kapha as seen in the center of the diagram below), and states that a balance of the doshas results in health, while imbalance results in disease. One Ayurvedic view is that the doshas are balanced when they are equal to each other, while another view is that each human possesses a unique combination of the doshas which define this person's temperament and characteristics. In either case, it says that each person should modulate their behavior or environment to increase or decrease the doshas and maintain their natural state.  

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Vata Dosha

Those who practice Ayurveda believe this is the most powerful of all three doshas. It controls very basic body functions, like how cells divide. It also controls your mind, breathing, blood flow, heart function, and ability to get rid of waste through your intestines. Things that can disrupt it include eating again too soon after a meal, fear, grief, and staying up too late.  With a dominant vata dosha as your main life force, you have a tendency to develop asthma, cardiac disease, anxiety disorders, dermatologic problems, and rheumatoid arthritis. 

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Pitta Dosha

This energy controls your digestion, metabolism (how well you break down foods), and certain hormones that are linked to your appetite.

Things that can disrupt it are eating sour or spicy foods and spending too much time in the sun.

If this is your predominate dosha, you’re more likely to develop conditions like Crohn’s disease, cardiovascular disease, and infections.  

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Kapha Dosha

This life force controls muscle growth, body strength and stability, weight, and your immune system.

You can disrupt it by sleeping during the day, eating too many sweet foods, and eating or drinking things that contain too much salt or water.

If it’s your main life energy, you may develop asthma and other breathing disorders, cancer, diabetes, nausea after eating, and obesity.

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DIAGNOSIS

Ayurveda has eight ways to diagnose illness, called Nadi (pulse), Mootra (urine), Mala (stool), Jihva (tongue), Shabda (speech), Sparsha (touch), Druk (vision), and Aakruti (appearance).  Ayurvedic practitioners approach diagnosis by using the five senses. For example, hearing is used to observe the condition of breathing and speech. The study of the lethal points or marman marma is of special importance. Some of the techniques used to make diagnosis including "deep pulse" are quite foreign to western physicians. 

The Ayurvedic practitioner considers the whole human being, believing that people have within them the required energy to bring the body back to a healthy, or balanced, state.

So instead of focusing on a treatment or medicine to heal the illness, the Ayurvedic practitioner concentrates on the techniques that will strengthen the healthy elements inherent in every body, which will in turn help the individual to recover. This tenet is called svabhavoparamavada, and it refers to the Ayurvedic ideal of helping the body call upon its own energy to heal. Treatments and medicines are a vital part of this process, but act only to support the body's self-reparation, rather than cause it.  Practitioners of ayurvedic medicine believe the body has seven "chakras", which some claim are 'spiritual centers', and which are held to be located along the spine.  Imbalances in chakras contribute to disease.  

TREATMENT

Herbs and Herbal Formulas

This ancient practice is key to Ayurvedic medicine, which teaches that the action and effectiveness of each herb is determined by its ras (taste), virya (active potency), and vipak (post-digestive effect). Thus the Ayurvedic administration of herbs is considered a precise science, requiring deep knowledge of plants and their effect on human physiology, biochemistry, and psychology. Ayurveda does not support the theory that herbs are benign and have no side effects.Thus, Ayurvedic herbs should only be prescribed by qualified practitioners.

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Panchakarma

This multi-step detoxification regimen is thought to remove ama(a toxin). The regimen includes massage, steam treatment, vamana (induced vomiting), virechana (use of prescribed herbal and oil-based laxatives) and basti(medicated enema), blood letting, and nasya (a nasal treatment). These treatments are followed by a strict dietary and herbal regimen, a rejuvenating therapy, and recommendations for daily routines. Note: this invasive procedure requires the supervision of a trained Ayurvedic practitioner; contraindications and side effects should be closely monitored.

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Diet and Nutrition

Ayurvedic diet and nutrition practices are vital to healthy living, and are important components of treatment, recovery, and disease management. Dietary practices are tailored to each individual's constitution, with six primary "tastes" forming the basis for practitioners' recommendations:

  • Sweet: promotes strength and nourishes all tissues

  • Sour: stimulates digestive power

  • Salty: maintains water electrolyte balance

  • Pungent: improves digestion and absorption

  • Bitter: stimulates all other tastes

  • Astringent: helps in absorption

The ayurvedic diet emphasizes having foods with every meal that embody all of these tastes and also food that is colorful.  The more colors, the better, therefore Indian meals frequently consist of very brightly colored foods in different dishes.

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Ayurvedic Massage

These treatments are performed by trained therapists who work under the supervision of trained Ayurvedic practitioners. Oils are selected and prepared according to the practitioner's specific diagnosis.

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Shirodhara

This special technique involves dripping medicated oil on the forehead, or "third eye region." The type of medicated oil used, the number and length of treatments, and the duration of the overall therapy must be determined by an Ayurvedic practitioner, and performed by a trained massage therapist under proper supervision.

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Ayurvedic Training, Practitioners, Licensures

In the USA, Ayurvedic practitioners are not licensed by the states or federal government.  It is considered an "alternative" medical therapy.  There are a few licensed schools in the US for training, but most training in the US is via apprenticeship and self-taught learning.  Therefore the quality and reproducibility of the practitioners in the US is not guaranteed since there are no requirements for anyone claiming to be an Ayurvedic practitioner. 

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Safety of Ayurvedic Medicine

There are some concerns about the safety of Ayurvedic Medicine.  1. Using this medical system may cause patients to miss more serious diagnosis, and delay the treatment of serious conditions.   2. The herbs and herbal formulas used in Ayurvedic Medicine may interact in unpredictable ways with Western medicines.  Most have not been studied in terms of interactions or safety or efficacy.  3. Ayurvedic herbal medicines may contain toxic levels of heavy metals.  Like Traditional Chinese medicine (TCM), Ayurvedic herbs are grown in uncontrolled environments that may have heavy metals.  A 2008 study of these herbs found 22% contained toxins in significant amounts including lead and mercury, leading to lead encephalopathy Curr (Drug Saf. 2008 Jan;3(1):54-9). 

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Western Medicine and Science Views of Ayurveda

Doctors and scientists in the West consider Ayurveda to be a niche medicine largely limited to participants from India, Sri Lanka, or Nepal.  The science to support its use, especially herbal remedies is often considered to be very weak, and therefore many consider it a religious pseudoscience.  But this view focuses primarily on the herbal formulas, not taking into account Ayruveda is a system that involves far more than herbs.

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Scientific Reviews

Despite thousands of years of use, Ayurvedic medicine has very little literature support, and there are only a few reviews with enough clinical trials to make any scientifically based decisions.  Ayurveda is as much a belief system as a science, and its practitioners do not publish sufficient papers to warrant a generalized acceptance of its use.  

  • Rheumatol Int. 2015 Feb;35(2):211-32.  Rumalaya and Shunti-Guduchi seem to be safe and effective drugs for treatment of OA-patients

  • Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008288.  There was insufficient evidence to recommend Ayurvedic medicine for the treatment of diabetes mellitus

  • Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006867  There is insufficient evidence to recommend Ayurveda for the treatment of schizophrenia as there is only one small pilot study. 

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