IntroductionÂ
Ayurveda, which literally translated means “the science or knowledge of life” is the traditional medical system of India. Its origin dates back an estimated 5-10,000 years, and it is widely considered to be the oldest form of health care in the world. It is understood by most scholars that, as knowledge of Ayurveda spread out from India, it influenced the ancient Chinese system of medicine, Unani medicine, and the humoral medicine practiced by Hippocrates in Greece. For this reason, Ayurveda is often referred to as the “Mother of all healing.”
The knowledge of Ayurveda has its written origins in the Vedas, the sacred texts of India, believed to be the oldest writings in the world. Written in Sanskrit, the Vedas cover a vast number of subjects from grammar to health care. The Vedas were written approximately 2500BC or earlier. Current knowledge about Ayurveda is mostly drawn from relatively later writings, primarily the Caraka Samhita (approximately 1500BC), the Ashtang Hrdyam (approximately 500 AD), and the Sushrut Samhita (300 – 400AD). These three classics describe the basic principles and theories from which Ayurveda has evolved. They also contain vast clinical information on the management of a multitude of diseases. Later writings and research expand on this early clinical information.
Ayurveda is based on the premise that disease is the natural result of living out of harmony with our environment.
Natural is an important word because Ayurveda understands that symptoms of disease are the body’s normal way of communicating disharmony. With this understanding of disease, Ayurveda’s approach to healing becomes obvious: to reestablish harmony between self and environment. Once reestablished, the need for the body to communicate disharmony diminishes, symptoms dissipate, and healing is said to have occurred.
Ayurveda understands each person and the disease the person is manifesting as a unique entity. It could be said that no two people are alike, and no two diseases are alike. Therefore, Ayurveda does not approach the cure of a disease as much as it approaches the cure of a person. This approach vastly differs from allopathic medicine. Where allopathic medicine looks for a drug that will cure a statistically significant number of people for a specific condition, such as rheumatoid arthritis, Ayurvedic medicine looks for a treatment that will cure an individual person of their unique presentation of the disease. Since no disease affects two people in exactly the same way, no two cures are exactly the same.Â
Principles
For the Ayurvedic practitioner, it is necessary to understand the nature of the patient, the nature of the disease, and the nature of the remedy. Only then will a physician be able to provide the greatest care. The qualities of Nature are said to be either heavy or light, cold or hot, stable or mobile, sharp or dull, moist or dry, subtle or gross, dense or flowing, soft or hard, smooth or rough and cloudy or clear. A person, a disease or a remedy is understood to have a unique combination of these qualities. It is the goal of the Ayurvedic practitioner to understand as many of the qualities as they can about their patient and their patient’s condition.
A person may be heavy or light, move quickly or slowly, feel more warm or cool, have a sharp or dull mind, have moist or dry skin. These are examples of understanding the nature of a person. Similarly, a disease like arthritis may be defined as producing sharp or dull pain, migrating (mobile) or localized to one or more joints (stable), producing vasodilatation around the joint (warm), or vascular constriction (cool). By understanding the presentation of a disease through its qualities, the uniqueness of a disease is understood.
Herbal remedies are also understood in terms of their qualities. Substances that are nourishing are described as being heavy, such as licorice. Substances that are depleting are light, such as red clover. Some herbs create warmth in the body, such as ginger, and others cool the body, such as goldenseal. The fundamental principle of treatment in Ayurveda is to treat the disease with the qualities opposite to its nature. Cold diseases are treated with warm remedies, heavy diseases are treated with light remedies, and so on.
Ayurveda describes the human being as being composed of five elements, three doshas (biological energies), seven dhatus (tissues), and numerous srotas (channels). The five elements are ether, air, fire, water, and earth. These five elements, which also make up all of Nature, are not meant to be taken literally. They are ideas described as elements. They are the ideas of space, motion, heat, flow, and solidity respectively. They have the qualities as noted above. The three doshas, the biological forces that govern the functions of the body, are composed of these elements.
Vata dosha is a biological force which governs all motion in the body. Composed of ether and air, it is light, dry, mobile, and cool. People with a predominance of this energy in their bodies tend to exhibit these characteristics. They tend to be thin, have dry skin, feel cold easily, and move and speak quickly. They also tend to have a greater amount of cold emotion, such as anxiety and fear. Vata dosha imbalance can affect any system of the body and cause an increase in those qualities. For instance, the respiratory system becomes dry as seen in dry asthma and non-productive coughs. The digestive system becomes dry and constipated, an abnormality of motion. Dryness may precipitate stone formation in the kidneys or gall bladder, and an increase in the motile quality of vata in the nervous system is understood to cause hyper-excitability. The cold nature of vata can become severely disturbed and cause Raynaud’s Phenomenon. Wasting conditions are viewed as an increase in the light quality of vata. Therefore, anywhere in the body where there is an increase in the qualities of vata, there will be physiological disturbance.
Pitta dosha is a force which governs all digestion in the body. Composed primarily of fire, it is hot, light, sharp, and exhibits flow. It contains a little water, and thus it is neither very moist nor dry. People with a predominance of pitta in their bodies exhibit these qualities. They feel warm and are less affected by cold weather. They have a rosy complexion, are moderate and reasonably steady in their weight, have a mesomorphic body build, and can have a sharp and intense personality. This personality tends to be challenged by a greater amount of heated emotion such as anger, resentment, and jealousy. As pitta governs digestion, the digestive system tends to be strong. There is little trouble digesting food. Bowel movements occur frequently, 2-3X per day. Pitta dosha imbalance can affect any system in the body but is predisposed to affect systems that are said to contain a lot of fire. When pitta affects a system, usually greater heat builds at that location. The liver, small intestine, blood, skin, and eyes are systems in which pitta exerts a great influence. Hepatitis, hyperacidity, acne and conjunctivitis are examples of heated pitta conditions in these regions of the body. Pitta disturbance can affect any system. Infections anywhere in the body producing heat and fever are understood as pitta disturbances.
Kapha dosha is a biological force which governs growth in the body. Composed of water and earth, it is heavy, moist, stable, soft, and dull. People with a predominance of kapha in their bodies tend to carry more weight, have thicker, denser bones and skin, and have a more traditional endomorphic body build. They also tend to have moist supple skin and full, thick hair. This person’s personality tends toward being relaxed and not easily disturbed. They talk and move slowly. They can be challenged by heavy feelings, such as lethargy and rigidity. When kapha increases in the body, there is a greater production of mucous which, like kapha, is heavy, thick, and moist. There may also be swelling and weight gain. While kapha can affect any system of the body, the stomach and lungs are the most susceptible. It is here that we see several common signs of kapha disturbance–nausea, limited appetite, and mucous formation. Conditions such as obesity, some cancers, chronic bronchitis, lung congestion, and fluid retention syndromes have a kapha disturbance as a component of the pathophysiology.
While the doshas are seen as the causative agents of disease, dhatus, upadhatus, and srotas are understood to be the site of the disease. Dhatus are tissues, upadhatus are additional tissues, and srotas are channel systems. There are seven tissues; plasma, blood, muscle, fat, bone, marrow, and reproductive tissue. Unlike Western medicine, which understands each tissue to be separate, Ayurveda understands each to be dependent upon the tissues preceding it for its nourishment and health. Hence, a problem which develops in one tissue, if not corrected, will eventually have systemic consequences. Pathology in Ayurveda can be partially understood in terms of what dosha is affecting what dhatu. When vata enters a dhatu, that dhatu becomes lighter, drier, and hyper-mobile. When pitta enters, it becomes heated, and when kapha enters, it becomes heavier, moister, and more stable. In a muscle, vata disturbance causes wasting and atrophy, pitta disturbance causes infection and inflammation, and kapha disturbance causes excessive growth.
Srotas are channel systems similar to the organ systems of the human body. The major srotas are somewhat equivalent to the respiratory system, digestive system, reproductive system, cardiovascular system, urinary system, and water metabolism system. These are additional sites of disease where doshas may become aggravated.
During the metabolic processes of the body, Ayurveda recognizes that metabolic waste is produced and must be properly eliminated to maintain optimal health. Waste materials are called malas. Obstruction to their removal is another causative factor in disease.
According to Ayurveda, each person has a constitution that was determined at conception. This constitution is the inherent balance of these three doshas. The constitution determines a person’s basic body type and personality. While other factors influence the formation of both the body and personality, the constitution provides the predisposition in much the same way as a person’s genetics. It is a common misconception that Ayurveda groups people according to three types. In actuality, there are infinite combinations and permutations of these three basic energies in each person. Therefore, we see that each person is understood to be unique. The Ayurvedic practitioner’s first objective is to understand the nature or constitution of the patient. This tells the practitioner who they are treating.
Next the practitioner attempts to understand the disease or the nature of the imbalance. Ayurvedic pathology is understood according to the doshic imbalance and the imbalance of qualities within the body. The practitioner assesses the state of the doshas, dhatus, upadhatus, srotas, and malas of the body. The overall strength of the body is an important factor in future treatment and is assessed as well. The term ojas is applied to the strength of the body, although more accurately it is that which gives the body the ability to endure stress.
While pathology is important to understanding the nature of the disease, equally important is etiology. Etiology is understood according to how the patient’s lifestyle, habits, and environment caused the doshas to become disturbed. A lifestyle which emphasizes a fast pace, changes of job or relationship, travel, fast foods, and dry, light foods–such as a vegetarian diet–is likely to cause an aggravation to vata dosha. A lifestyle which is intense, competitive, highly focused, and which emphasizes spicy hot foods is likely to aggravate pitta. Kapha is aggravated by a sedentary lifestyle and a diet of heavy, moist foods, such as milk, yogurt, and meat.
Forms of Therapy
Understanding the nature of the person and the nature of the disease, the practitioner can now design a treatment program to guide the patient back into balance. This program utilizes what is commonly called five sense therapies as its foundation, along with specialized treatments for the mind and bodily purification and rejuvenation.
Using the sense of taste, the practitioner is able to prescribe a diet consisting of the opposite qualities of the disease or imbalance. This diet is very specific and describes the exact foods in each category a patient may consume. This includes specific meats, dairy, nuts, vegetables, etc. In addition, the practitioner recommends herbs that work along similar principles. In addition to the effects that herbs have on the energies and qualities of the body, Ayurveda recognizes that some herbs also possess the capability to have strong effects on specific organs and symptoms. This fact is taken into consideration in the design of the formulations.
Using the sense of vision, color therapies are utilized. Colors are understood to possess the same qualities as all of Nature and, again, colors are prescribed that have the opposite qualities of the disease. Colors can have strong special effects on specific diseases, and this is recognized and considered in designing a treatment.
The ears provide a vehicle for treatment using sound therapies. Ayurveda has traditionally utilized sound energies called mantras for healing. Different sounds affect the doshas in different ways. These sound energies are understood to stimulate specific organs and endocrine glands, possibly affecting hormonal production.
Aroma therapy provides treatment through the sense of smell. The qualities of a smell have different effects upon the doshas. For example, sweet-smelling fragrances increase kapha but bring balance to vata and pitta.
Through the skin, the application of specific oils and massage are utilized. Different strokes and pressures affect the doshas in different ways. The patient may be told to apply massage to themselves, or the massage may be applied by the practitioner.
For the treatment of the mind, Ayurveda merges with its sister science from India: yoga. By using yoga and meditation, the patient is encouraged to adopt a lifestyle emphasizing peace of mind and connection to God. The resultant stress reduction is an understood component of the healing process.
Ayurveda also emphases the importance of keeping the body clean and pure. Toxins, both external and intrinsic to the body, interfere with the flow of waste material out of the cells resulting in impaired function. To remove these toxins, Ayurveda employs a technique known as Panchakarma, meaning “the five actions.” This is a program performed for 7-28 days at a specialized center. Panchakarma utilizes a restricted diet, massage therapies, additional medicated oil therapies, medicated steam therapies, and elimination therapies such as enemas, purgation, and nasal/sinus cleansing with special oils snorted into the nasal passages. This last treatment is called nasya. Historically, and in some parts of the world currently, two additional therapies are utilized. They are therapeutic vomiting and blood letting with leeches. In addition to these physical modalities, the patient retreats from the world and enjoys time for meditation and reflection.
While each therapy is understood to be important, Ayurveda emphasizes lifestyle analysis and change as the most significant aspect of the healing process. The practitioner helps a patient understand how lifestyle has contributed to the origin of the present condition and offers support as the patient attempts to create a new lifestyle in greater harmony with their constitution.
After evaluating the patient, the Ayurvedic practitioner designs a program utilizing the therapies noted above. These therapies may be instituted over a period of time and are generally not prescribed all at once, as they may prove to be overwhelming for a patient to implement successfully.
Demographics
There are no formal studies on how many patients utilize Ayurvedic medicine and principles in their lives. Since Ayurveda is a relatively new science in the West, the percentage is probably low. Worldwide, the traditional medicine of Ayurveda is still used primarily by the poor in India who are unable to afford Western medicine.
Indications and Reasons for Referral
Ayurveda is a complete medical science which should be considered whenever allopathic medicine is unable to produce the desired results. As Ayurveda includes protocols for the care of every system of the body, it can play a role in the management of any case. It is being used most effectively in the United States on patients with chronic and sub-acute disease. It is not generally recommended for acute diseases. Ayurvedic lifestyle therapies may also be utilized effectively to enhance wellness and prevent disease.
Research Base
Research in Ayurveda has centered around the pharmacological use of Indian herbs. In the botanical and Ayurvedic medicine journals, literature detailing herb constituents, actions, indications, and contraindications is abundant. Successful treatments of a multitude of diseases using herbs from India are well documented. Clinical evidence suggests that there are few harmful side effects from Ayurvedic treatment, and this is supported by 5000 years of anecdotal evidence.
Drug-like Information and Safety
The actions of most herbs and the cross-reactions of herbs and drugs have not been studied in great detail. History suggests few harmful interactions, and most herbs are safe in the hands of a qualified practitioner. Practitioners are educated regarding which herbs and procedures are to be avoided by pregnant and lactating woman. Botanical research journals contain the latest information on the actions, effects, and side effects of many herbs. The Indian Materia Medica by Nadkarni is the principle book summarizing research on herbs used in Ayurveda.
Visiting a Professional
A patient who visits an Ayurvedic practitioner should expect to receive an evaluation consisting of: a minimum of a history of the chief complaint, past medical history, a review of systems, and a review of any medications–such as herbs and vitamins the patient may be taking. Observations are made of the shape of the face, size of the neck, size and depth of the eyes, color, quantity and quality of hair, thickness of the skin and width of the bones. Detailed examination procedures include the pulse and the tongue. Examination of the abdomen and the taking of vital signs completes the evaluation. After the examination, which usually lasts about one hour or longer, the practitioner spends time educating the patient about their findings. During this report of findings, the practitioner educates the patient about Ayurveda and their imbalances. In Ayurveda it is said that it is more important what the patient knows than what the doctor knows. A patient should leave with a clear understanding of their path back to health. Follow-up visits are scheduled to support patients as they make progress and confront challenges. Follow-up visits include ongoing counseling and education. Additional therapies are integrated into the program slowly, over time, as the patient strives to create a lifestyle of harmony through the five senses.
Credentialing and Training
Currently, there are only a few places in the United States where practitioners receive thorough training. Programs vary from one to two years in duration and often include part-time classroom education and independent study. In California graduates of the California College of Ayurveda receive certification as a “Clinical Ayurvedic Specialist” and use the initials C.A.S. This is the only institution in the United States offering complete clinical training for the practitioner. Other training programs vary in duration and focus. At most schools, the focus is on the philosophical and fundamental principles of Ayurveda. There are also home study programs offered through the American Institute of Vedic Studies and by specific teachers. These programs focus on the philosophical and fundamental principles as well.
What to Look for in a Provider
When looking for a practitioner of Ayurveda, evaluate the extent of their education. Check to see if anyone or any organization has certified their competency. If possible, research the organization that certified them. Always try to meet with the practitioner and discuss the cases they have managed, and their results. Ask how they manage cases and what criteria they use to assess progress. The California College of Ayurveda maintains a list of graduate practitioners throughout the United States.